Cost to HSE of recruiting 371 staff a month ‘not sustainable’

Current levels of recruitment in the health service - running at 371 staff per month - are not sustainable when combined with the ongoing cost of pay deals and other health service pressures such as pharmaceuticals, a new Government spending review has found.

The review also says that HSE estimates on expenditure on agency staff have been "consistently out of line" with actual spending ranging from €52 million to €154 million above the projected level from 2015 to 2017.

It says it appears that assumptions underpinning agency pay profiles are “not realistic or achievable”.

The review suggests that staffing levels for doctors and nurses is back beyond the levels in place in 2009 when calculated per 1,000 of population.

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The review says the number of personnel employed in the HSE across all grades increased by 14,213 whole time equivalents (WTE) or 15 per cent between the beginning of 2014 and the end of 2017.

It says there has also been a substantial increase in recruitment in the early part of this year with 1,482 staff taken on or a monthly average of 371.

However it says that the health budget for 2018 only provided for an additional 1,800 staff to be hired -- or around 150 WTEs per month.

“If this recruitment rate continues for the remainder of 2018 and 2019, it is expected that this would add €235million to the pay bill in 2018 and €250million in 2019. This would result in an increase in direct pay spend of €485million by end 2019. Going forward, this monthly recruitment level does not appear sustainable when combined with the cost of pay deals and other health service pressures such as pharmaceuticals.”

The spending review says that the 2018 health budget allocated an additional €494million for current expenditure. It warns that if recruitment continues at between 150 WTEs to 371 WTEs per month, it will cost an estimated additional €359 million to €396 million this year .

“This would mean that 73 per cent to 80 per cent of the total current health budget would be spent on pay. This is beyond the pay bill budget and would only leave €98million to €135million of the additional budget (current expenditure) available to fund all other cost pressures in 2018.

The review says from 2015 to 2017 the largest number of the additional staff taken on were recruited into acute services with 3,868 personnel taken on.

“ While the greatest number of additional staff were directed toward acutes, in terms of percentage growth in the staff numbers the service area which experienced the greatest percentage growth is health and wellbeing with a 13 per cent increase in staffing over the 2 year period. The areas with the lowest percentage growth in staff were primary care and mental health with 4 percent each. It suggests this is contrary to official health policy.

The review says that compared to other OECD countries Ireland has a relatively low number of doctors per 1,000 population.

“It can be seen that Ireland’s international position did not change over the period 2009 to 2015 despite a number of policy changes in the area of recruitment. In 2015, the number of doctors per 1,000 population in Ireland has now moved past 2009 levels.”

“Contrary to findings on doctors per capita, Ireland has a considerable number of nurses per capita compared to other OECD countries. Ireland is in the higher quadrant of OECD countries when comparing the number of nurses per 1,000 population. When looking at the change in the same metric over time it can be seen that the number of nurses per 1,000 population in 2015 is almost back at the same level experienced in 2009. Given that recent increases in staff numbers have been beyond growth in demographics, it is expected that this rate will now have moved beyond 2009 levels.”

The review maintains the ratio of nurses to doctors in Ireland -- at 3.8 -- is high compared to other countries.