Dáil Éireann Debate, Wednesday - 14 May 2014
10. Deputy Bernard J. Durkan asked the Minister for Health the degree to which he is satisfied regarding the availability of an adequate supply of doctors, nurses and consultants throughout the health services; if any particular trends have been identified which might indicate the needs for corrective measures to ensure adequate provision in respect of all health staff in the future; and if he will make a statement on the matter. [21205/14]
Amharc ar fhreagraThis question relates to the need to ascertain the extent to which adequate numbers of health professionals are available to meet the requirements throughout the health service, from general practitioners to consultants to nursing staff.
I thank Deputy Durkan for his question. Although the HSE has the capacity to recruit where it is necessary to do so in order to ensure patient safety and to support service delivery, there is evidence that there are, at present, difficulties in recruiting certain front-line staff including consultants, NCHDs and specialist nurses. I am currently progressing measures to ensure we will have an adequate supply of highly skilled consultants, doctors and nurses into the future. There has been a significant increase in the number of whole-time equivalent consultant posts since the establishment of the HSE. The number increased by 723 from 1,947 in January 2005 to 2,670 in December 2013. However, some specialties are experiencing international shortage, and these have been traditionally difficult to fill, regardless of the salary scale. There are also some hospitals to which it has historically been difficult to attract applicants, in particular smaller hospitals in rural areas. The establishment of hospital groups will help to address this issue, as this will allow doctors to be appointed as group resources.
The ability of the public service to attract and retain high quality front-line staff shapes the extent to which the HSE can maintain and develop the range of health services required. I set up a group under the chairmanship of Professor Brian MacCraith last July to carry out a strategic review of medical training and career structures. The group will make recommendations aimed at improving the retention of medical graduates in the public health system and at planning for future service needs. It provided an interim report in December 2013 focusing on training. In April 2014 the group submitted its second report to me and this dealt with medical career structures and pathways following completion of specialist training. The final report of the group will deal with workforce planning, and this is due to be submitted by the end of June 2014. The work of the group is fundamental to ensuring we have attractive propositions for consultants and doctors in training - NCHDs as they are called - in the years ahead.
Additional nursing support is being made available throughout the system. Measures include the increase in nursing hours available under the Haddington Road agreement and the appointment of almost 500 nurses and midwives under the graduate scheme, with more than 200 others currently in the recruitment process. This innovative model combines a contract of employment, which includes clinical rotation, with a fully funded interdependent education programme. I have just approved the establishment of a task force to develop a framework that will determine the staffing and skill mix requirements for the nursing workforce in a range of major specialties. I am very pleased that the chief nursing officer will be involved and she will be supported by the appointment of three additional assistant nursing officers. These will determine the staffing and skill mix requirements for the workforce in major specialties. The focus will be on the development of staffing and skill mix ranges which will take account of a number of influencing factors. The task force will be chaired by the chief nursing officer.
Where front-line staffing shortages exist, the HSE makes alternative arrangements to ensure service provision, including recourse to agency and locum cover. However, it is preferable that sufficient numbers of doctors, nurses and NCHDs are recruited to permanent posts to support the most efficient and effective delivery of services.
The reason I am allowing this time is because we started ten minutes late.
I thank the Ceann Comhairle. I thank the Minister for his comprehensive reply. I further inquire whether he is satisfied regarding the adequacy of the supply of professionals such as doctors, nurses and consultants becoming available, whether they in turn have options, whether they choose to emigrate or remain in the service in this country and the extent to which it is possible to encourage the latter.
Professor Brian MacCraith's report will address the issues with reference to NCHDs in particular. I do not believe the issue of the salary rate in this country is what bothers them, although this will always be part of it. They believe they do not have a clear career path. It can take up to 12 years or more to become a specialist in this country whereas it takes six years in other countries. They feel somewhat devalued and disrespected by the system. All these things must change or these people will continue to leave. They are highly mobile, they are the brightest and best and they are voting with their feet. They leave this country to go to the finest institutions across the world and they rise to the top of those institutions. I had the pleasure of meeting many of them when I visited America for Saint Patrick's Day. They are in the Mayo Clinic, the Cleveland Clinic, Boston hospital, Boston Children's Hospital and Massachusetts General Hospital, for example. We want to keep our people at home, and while we want them to go abroad to widen their experience and their horizons, we also want them to come back to us. If this is to be possible, we need to offer them a career path that is also respectful of them in which they are treated with respect. Sadly, this is not the case at the moment. This report addresses that issue and many other issues. There will always be difficulties and issues associated with the recruitment of both doctors and nurses to particular parts of the country which are regarded as remote or unattractive. However, the hospital groups should help to address this situation.
