The public health service in Ireland operates in a global market for medical specialists which is experiencing a world-wide shortage. Nonetheless, the number of consultants working in the public health service continues to grow year on year. It increased by 125 whole time equivalents (WTE), or just over 4 per cent, in the year to the end of May 2019. In the five years to the end of May 2019 the number of consultants has increased by 533 - over 20 per cent - and now stands at 3,121 WTE's.
While it would be preferable if all vacant posts could be occupied on a permanent basis, the majority of vacant posts not filled on a permanent basis are filled by alternative arrangements; fixed-term, locum or other agency arrangements, to support service delivery. It is recognised that many areas in our health system currently lack sufficient capacity to meet the ever-increasing demand for services and the needs of patients, resulting in unacceptably long waiting times for hospital appointments and procedures. Reducing waiting time for patients for operations and procedures is a key priority for Government. Last year saw a considerable improvement in the number of patients waiting for procedures. As a result of increased activity and the ongoing collaboration between the HSE and the National Treatment Purchase Fund (NTPF), the number of patients waiting for an inpatient or day case procedure fell to 70,204 in December 2018. This was from a peak of 86,100 in July 2017, and represents a reduction of over 18% in the overall number of patients waiting for a procedure. The number of patients waiting in excess of 3 months fell by more than 17,700, or 31% in the same period from July 2017 to the end of December 2018.
Budget 2019 announced that the Government had further increased investment in tackling waiting lists, with funding to the National Treatment Purchase Fund increasing from €55 million in 2018 to €75 million in 2019. The joint Department of Health, HSE, and NTPF Scheduled Care Access Plan 2019 was published in March. Under the plan, the HSE, in line with the National Service Plan, will deliver 1.155 million elective inpatient and day case discharges at a value of €1.4 billion in 2019.
Recruitment and retention of consultants has been examined by the Public Sector Pay Commission. The Commission found that evidence of recruitment campaigns with very low levels of applications was indicative of on-going difficulties regarding the recruitment of consultants. The Commission acknowledged that the difference in pay between the pre-existing and new entrant consultants is greater than that for other categories of public servants. It proposed that the parties to the Public Service Stability Agreement jointly consider what further measures could be taken, over time, to address the pay differential.
The Government accepted the Report of the Commission and recognises that there are significant recruitment and retention challenges in relation to consultant posts. The proposal of the Commission does need to be addressed. The next step is to engage with the representative organisations of medical consultants.