HealthAnalysis

Hard to see how HSE cost-saving measures will add up to better healthcare

A recruitment freeze and plans to drastically reduce reliance on agency staff go not seem to go hand in hand

The hours being worked by medical professionals have become unsafe due to the current recruitment ban, a recent Oireachtas committee meeting was told. Photograph: iStock
The hours being worked by medical professionals have become unsafe due to the current recruitment ban, a recent Oireachtas committee meeting was told. Photograph: iStock
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Jack White
Tue Jun 04 2024 - 06:05

A recent Oireachtas committee meeting heard how some doctors are struggling to keep their eyes open in hospitals.

The hours being worked, which have never struck a great balance for younger medical professionals, in particular, within the HSE, have become unsafe due to the current recruitment ban, the committee heard.

That was the argument made by representatives of the Irish Medical Organisation (IMO) who described the embargo that has been in place since October due to financial constraints as “inconceivable” at a time when more staff are needed.

Frontline health professionals filling the gap have borne the brunt of the ban, which is leading to increased exhaustion.

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The effects on service provision and the associated dangers for patients, particularly in emergency departments, are well documented.

Last year, when the recruitment embargo took effect, the HSE spent the highest amount ever on agency staff, an eye-watering sum that reflected the system’s reliance on outside workers to keep going.

Spending on agency staff has been significantly increasing over the past decade, from €212.9 million in 2013 to a record €647.3 million in 2023.

[ HSE spends €4.2bn on outside agency staff since 2013 ]

The HSE said agency staff are used in the context of global health staff shortages that are affecting the ability to maintain safe and effective services.

The number of agency staff needed and paid for is indicative of a significant shortfall of resources on the ground. Why, then, has the HSE implemented a recruitment freeze over the past eight months and why are there simultaneous plans to drastically reduce its reliance on agency staff?

The two do not seem to go hand in hand and, if the IMO’s concerns are anything to go by, this combination of measures could be detrimental to service provision, particularly in the winter months.

The HSE was allocated a record €23.5 billion in Budget 2024 but its chief executive, Bernard Gloster, warned this was inadequate and the health service simply does not have enough funding for what it is doing.

The projected overspending of more than €1.5 billion for 2023 had sent budget negotiations into a spiral last autumn, prompting the HSE to try to rein in spending this year.

Part of the cost-saving measures include plans to save €250 million by reducing agency hours by a third.

A further €80 million will be saved through the conversion of agency staff to direct employees, though the number of staff is not specified.

Improving staff productivity will be essential to maintain current service levels while reducing the level of agency hours used, the HSE’s National Service Plan for 2024 states.

“This means that we need to improve the efficiency and effectiveness of our care and other processes so that we can safely provide more care for patients via the same or less staffing hours. This must be done without reducing quality for patients or overburdening our staff,” it adds.

But if staff are struggling to keep their eyes open, there may not be much left to give.