New rules to limit health service spend will impact key recruitment and patient safety, IMO says

NEW RULES TO control overspend in the health service will impact patient safety because it will impose a ‘de facto recruitment freeze’, the Irish Medical Organisation (IMO) has said. 

The IMO, which represents doctors, said that the Department of Health’s new sanction process to control spend over their budgets comes with a “prohibitive hurdle” that will halt hospitals replacing existing positions or employing new staff. 

The IMO states this plan has already commenced and means that any health region running more than 2% over its pay budget looking to replace or recruit staff must first consider whether the work can be delivered differently or met using staff and resources already available.

Professor Matthew Sadlier, President of the IMO, said the measure was “Draconian” and it poses a “clear and significant risk to patient safety”.

“Not only does the measure in isolation place unrealistic and prohibitive barriers on doctor recruitment, but it comes against the backdrop of a department setting wholly inappropriate budgets and in a health system that does not have nearly enough doctors to meet ever-growing demand.

“To meet the needs of our population we need 6,050 consultants – we currently have 4,945 whole-time equivalents and, of those, 20% are not filled on a permanent basis with over 325 posts unfilled. Consultants are covering long-term vacancies right across the system which is unsustainable.

“Waiting lists will continue to grow until we have a sustainable and funded workforce, which means patients will be denied timely care,” he said. 

Sadlier said that it was “wholly unacceptable” that, when a consultant leaves or retires, time would be wasted making an “unnecessary” case for their replacement.

“We need rapid turnover of doctors throughout the system to ensure patients are not adversely affected by natural attrition. The timelines from business case to approval to appointment are already too long,” he added. 

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Risk assessment

Sadlier said it was unclear if a risk assessment for the introduction of this measure had been carried out by the Department of Health or HSE. 

He added that the measure was likely to represent a clear breach of employment rights, in that doctors who have applied and interviewed for, then accepted a role, would now have no guarantee it would be funded. He noted that the IMO is already in the process of representing members who have been impacted in this way.

Sadlier said the government needed to start being honest with the public about the real provision of health services.

“With this measure, the reality is there will be no new services and no expansion of capacity, with the current level of services under threat. It is obvious that the Government’s aim is to reduce the number of people delivering care, not increase them,” he explained. 

The IMO is seeking immediate engagement with both the Department of Health and the HSE on this matter.

Labour Health spokeswoman Marie Sherlock TD has said the minister for health and minister for public expenditure have now “lost the run of themselves” in their desperate and reckless bid to contain the HSE deficit.

“There are serious questions to be asked about the competence of those making these reckless decisions about how our health service is run.

“The decision to force all recruitment decisions through the Department of Health tears apart the notion that the HSE runs the health service.

“But more crucially, it divorces the link between patient safety and clinical decision-making about safe staffing with the appropriate local and regional HSE managers who are tasked with running the health service.

“This is both reckless and downright dangerous at a time when hospitals are already relying to an alarming extent on surge capacity and dealing with very high increases in demand,” she said.

Statements have been requested from the HSE and Department of Health.