Health chief admits ‘failure’ to deal with exit of graduate medics from Ireland

Robert Watt says ‘step change’ is needed to double number of medical and nursing graduates

Ireland’s top civil servant in charge of health has admitted a “failure” to plan for a worsening shortage of doctors as existing recruitment targets cannot keep pace with the changing population.

Robert Watt, secretary general of the Department of Health, said a “step change” was needed to double the number of medical and nursing graduates while a separate offensive needed to be launched to make sure they stayed here once qualified.

It was “not acceptable”, he said, that Ireland was chasing medical staff from overseas having trained up “a lot” of graduates in Ireland who then chose to emigrate.

“A lot of young graduates go away, but they do come back... but there is an issue about retention clearly,” he said.


“The reality is – to be perfectly frank, to admit this – I think there has been in the past a failure to properly plan in terms of workforce. Absolutely... we need to do better.”

Mr Watt suggested a “radical” expansion of existing medical schools, a complete overhaul of the existing regime for training up doctors and nurses or completely new medical schools as possibilities in dealing with the deepening shortfall.

Speaking before an Oireachtas joint committee on health on Wednesday, Mr Watt said last year saw the largest ever increase to the health service workforce – up by 5,000-6,000 staff – while this year another 4,000 were expected to be recruited.

But he said: “I accept it is not enough... We need to double the number of undergraduates each year, in terms of medicine, coming into the system.”

He added nursing colleges also needed to almost double numbers to keep up with the demands of a growing and ageing population.

“I agree it is not acceptable that we are going internationally to bring people in,” Mr Watt said. “We need to train more of our own people to work in the health system.”

Meanwhile, it has emerged the Health Service Executive (HSE) expects to spend €2 billion on the response to the Covid-19 pandemic in 2022, twice the sum planned for this year.

HSE chief executive Paul Reid will outline the expected spending at the Dáil’s Public Accounts Committee (PAC) on Thursday where he will also tell TDs that talks are under way to secure more funding for the health service this year.

The demand-led nature of costs during the pandemic – including more vaccinations and testing than expected, particularly during Omicron surges – are likely to be put forward as reasons for the higher than expected spending on Covid this year.

It comes as €1.7 billion was set aside in the budget for potential spending on Covid-19 in 2023, a sum significantly higher than the indicative provision of €1 billion in the Summer Economic Statement.

At the committee meeting on Wednesday, Róisín Shortall, co-leader of the Social Democrats and a former minister of state for primary care, told Mr Watt she found it “very hard to comprehend” that the State spends €23 billion on the health service every year and it is “incapable of recruiting people because there is little or no forward planning in relation to the workforce”.

“It beggars belief, given the level of unmet need in this country, that the biggest problem [the HSE has] is it can’t get the staff,” she said.

Describing it as “madness”, she said Ireland was going to “huge expense training hospital doctors to leave this country, then we are scrambling around trying to get foreign doctors in here”.

“This is madness. Why is there not a clear robust workforce plan, for this year, for next five to 10 years, the next 20 or 30 years? All the projections are available in terms of our population growth,” she said.

“Why is that not being done, and who is responsible for not doing it? It is the most fundamental thing you would have in a major organisation with that sort of massive budget. I just can’t get my head around it.”

The Dublin North West TD said she had spoken to Simon Harris about it and that the Minister for Higher Education was “happy to extend places in third level if [he] gets figures from the Department [of Health] or the HSE”.

“I don’t think a plan exists, there is no evidence of it,” she said, telling Mr Watt that she did not “take any confidence that you are on top of it”.

Meanwhile, junior doctors were leaving Ireland “in their droves”, she added.

Paul Reid, in what may be his last appearance before the Oireachtas committee as outgoing chief executive of the HSE, insisted there was a three-five year “forward planning function” for new recruits into the health system.

But he added that “for us to stand still on any given year, we have to recruit 10,000 people” and the HSE was working to “get the mix right and better”.

Brian Hutton

Brian Hutton is a freelance journalist and Irish Times contributor

Cormac McQuinn

Cormac McQuinn

Cormac McQuinn is a Political Correspondent at The Irish Times