Health service struggling to recruit temporary staff as doctors can ‘pick and choose’

More than €60 million spent last year on ‘non-framework’ agencies for recruiting doctors and healthcare assistants, HSE audit documents show

Hospitals and community healthcare organisations (CHOs) across the country spent more than €60 million last year on unapproved agencies to recruit temporary doctors and healthcare assistants, Health Service Executive internal audit documents show.

In some parts of the country, spending on “non-framework” suppliers exceeded that on suppliers included in a framework for the provision of short-term, temporary and locum staff.

Hospitals and CHOs argued they had to use suppliers outside the framework because those within it were unable to provide the required staff.

The use of non-framework suppliers may result in value for money not being achieved by the HSE, the internal audit reports warn. It can also result in contractual obligations such as vetting or medical clearance that are applied to framework suppliers not being applied to non-framework companies.


In 2017, the HSE introduced a new framework agreement for the recruitment of agency staff. Under the agreement, only agencies on the framework contract can be used to provide locum staff: “There is no authorisation for any HSE staff member to use any agency outside of the agencies formally contracted for a particular staff category in the relevant lot area.”

According to an audit report on agency spend on healthcare assistants, obtained under freedom of information, only 60 per cent of the €79.7 million spend on agency staff across the nine CHO areas was with suppliers listed on the framework. In CHO “area 9″, covering north Dublin, 85 per cent of spending was on non-framework suppliers.

In hospital groups, 89 per cent of the €79.5 million spent was on framework suppliers of healthcare assistants.

Meanwhile, only 55 per cent of the €37 million spent by CHOs last year on recruiting agency doctors went on framework suppliers. Some 89 per cent of €62.5 million spent by hospitals on agency doctors was on framework suppliers.

The HSE told its auditors that the international marketplace for sourcing junior doctors and consultants was “very difficult, and the doctors in question can pick and choose where they wish to work and know their own value”.

The report points to framework suppliers being unable to supply the necessary resources, leading to “widespread usage” of non-framework suppliers.

Two hospital groups – Children’s Health Ireland and RCSI Hospitals – failed to supply details to HSE internal audit that could be reviewed.

In a separate report, HSE internal auditors assessed the accuracy of patient trolley-counting in six hospitals and found records in four of them were accurate. At Cork University Hospital, six patients who were on trolleys in the wards had not been listed in the daily figures when they should have been. An incorrect entry about patients awaiting beds at Tallaght University Hospital was ascribed to a data entry error.

Paul Cullen

Paul Cullen

Paul Cullen is Health Editor of The Irish Times