‘Great resignation’ and pandemic burnout putting ambulance service at risk - HSE documents

Recruitment efforts being surpassed by demand as healthcare workers seek jobs with better work-life balance, leaving a ‘resource gap’

Ambulances at St. Vincent's University Hospital in Dublin, Ireland, on Wednesday, Jan. 27, 2021. Ireland should brace for “rough” weeks ahead in its fight to contain one of the globe's worst virus outbreaks, Health Minister Stephen Donnelly warned. Photographer: Patrick Bolger/Bloomberg

The ambulance service is being confronted by a “great resignation” and post-pandemic burnout among healthcare workers, according to internal HSE documents.

A presentation on the workforce plan for the National Ambulance Service (NAS) covering the period to 2026 warns that recruitment efforts are being surpassed by demand, with a “critical and immediate need to increase workforce capacity”.

With pressure increasing on services as the number of emergency calls grows, the document shows that the NAS is also facing new challenges.

It outlines that while people are living longer and the population is growing, it is “with a higher incidence of chronic disease”, meaning older people experience a “reactive provision of care” often requiring frequent hospital admissions. “This creates the need for the NAS to deliver alternative care pathways that support people within their homes and communities.”


It finds that “addressing key challenges around workforce demand and the recruitment and retention of staff will be vital to the ability of the NAS to continue to support Sláintecare initiatives” and hit targets outlined in the HSE’s National Service Plan.

However, it is struggling to recruit new staff and hold on to those it has — with modelling showing a “resource gap” growing in the years to come.

The staff turnover rate for the service was “steadily decreasing year on year” from March 2017 to March 2021.

However it finds “there was a significant increase from March 2021 to March 2022″, when the turnover rate grew from 4.2 per cent to 4.6 per cent.

Some 83 workers left the ambulance service in 2021, up from 68 in 2017. The plan shows that in 2017-2018, new starters equivalent to 13.6 per cent of the workforce started, but in the year to March 2022, that figure was 7.2 per cent.

With demand estimated to grow by 107 per cent over the 10-year period from 2017 to 2027 and recruitment to the NAS being “surpassed by demand” for the organisation’s services, the document concludes: “This poses a serious risk to the ability of the NAS to deliver urgent and emergency care services.”

It finds that a total increase of 2,160 whole-time equivalents is needed from 2022-2026, and argues that additions to the workforce “will need to be front-loaded in 2023 to facilitate sustained growth up to 2027″ and “mitigate immediate risks” in capacity.

The workforce is expected to decline by almost 860 over the period due to turnover and retirements.

“The NAS has an urgent need to recruit additional staff,” the document finds, adding that recruitment efforts are being surpassed by service demand. It warns that the number of new starters relative to the size of the current workforce has fallen over the last five years. “This likely reflects the ‘great resignation’ of healthcare workers towards careers which offer them greater flexibility and work-life balance,” it states.

The report squarely blames the pandemic for exacerbating these employment and retention challenges, saying it “precipitated a shift in priorities”, with people pursuing better working conditions and more flexible terms. “In addition, staff burnout and turnover instigated by the Covid-19 pandemic has led to ‘the great resignation’ of healthcare workers.”

Sinn Féin health spokesman David Cullinane said the level of burnout among paramedics is “extremely high”.

“We have a dire shortage of capacity and this has been known for years. This is putting an intolerable strain on existing staff, with high levels of overtime week in, week out.”

Figures released to Mr Cullinane show the average overtime bill in the NAS is €1.5 million per month over the last 18 months.

The HSE explained that there is “no ready supply” of paramedics in Ireland or internationally, and NAS mostly educates its own workforce with a three-year degree-level programme. There are more than 200 students at different stages of the programme.

Jack Horgan-Jones

Jack Horgan-Jones

Jack Horgan-Jones is a political reporter with The Irish Times