Dáil Éireann debate -
Thursday, 29 Feb 2024

Earlier this week, I raised with the Taoiseach and, I think, the Minister the issue of some healthcare professionals and allied professionals who are receiving letters about their annual leave prospects informing them these will be constrained because of the recruitment embargo. As the Minister knows, I am not a supporter of this embargo. How long will it last, what are the current ceilings for recruitment of staff for 2024 and how will they impact on service provision for this year?

I am acutely aware of the localised pressures that the pause is causing. I was in Sligo University Hospital on Friday last where I spoke with emergency department teams and various clinical teams across the hospital. They highlighted to me, as others have, that the pause is causing real pressures on the front line. I fully acknowledge that.

The issue we have is that the HSE hired between 2,000 and 2,500 more staff last year than it was funded to do. It has either hired or is in the process of hiring between 2,000 and 2,500 staff and it has no money to pay their salaries. It should not have done that. The HSE was funded to hire in excess of 6,000 staff in another record year of recruitment. In fact, over the lifetime of this Government, the HSE has hired well over 26,000 extra staff, believe it or not, which is a 22% increase. There has been a vast increase in staff. As we have discussed previously, there are nearly 8,500 more nurses and midwives, 4,000 more health and social care professionals and nearly 3,000 more doctors and dentists. The HSE continued to hire into unfunded posts and, regrettably, we had to use a very blunt instrument, a pause, to say it just had to stop hiring thousands of staff when it had no money to pay their salaries. Obviously, the State will pay their salaries but the HSE is not funded to do so.

We are now taking a more nuanced approach to this. In spite of record recruitment, there are front-line services that are really coming under pressure. Limited exemptions have been put in place in some areas, including in emergency care, ICU, maternity care and some community nursing areas. As the Deputy is aware, we are fully honouring the hiring of graduate nurses and doctors. I will say more in my next response.

This is the first time the Minister, or anyone in Government, has accepted that this pause, or what many would call an embargo, is, as he puts it, causing real pressures in hospitals. Every time we have raised this until now, we have received a completely different response, which is to say there is nothing to see here and it is not having an impact. I raised these precise issues in recent months. Indeed, when the freeze was first put in place, I contacted hospital managers and chief officers across the State to get a better understanding from them. They told me the pressures this was putting on them and the tough decisions they are making, including in my local hospital in Waterford, about keeping wards open. One the one hand, they are being told to rein in agency spend, while on the other they cannot replace or hire staff. What the Minister said on the budget parameters for this year does not make sense given that we know the health service was not properly funded. The Minister said there was increased demand. That demand has to be met. We cannot turn away patients. That is the reason hospitals and healthcare organisations are recruiting staff. We need them to treat patients. We are now in a situation where it will be possible to recruit only one third of the staff we were able to recruit annually in each of past three years. That will have an impact on patient care.

I would love to be in a position where the HSE could simply go out and hire whatever staff it believed was appropriate and we could simply write a blank cheque, which is what we would have to do. I know the Deputy is not suggesting we do that. We cannot do that. We cannot run any public service in that manner. I am aware that there are pressures but it is also incumbent upon me and others to challenge the HSE to a certain extent. As some in the HSE, who have seen this over many years, have put it to me, there is a culture of additionality in the HSE. In other words, there is a view that this or that can only be done with more staff as opposed to an acknowledgement that there is more staff than ever before. In fact, there are thousands more staff in the HSE that it was even funded to hire. How can it be that staff cannot be redeployed or the thousands of extra staff cannot be used to deal with some of these pressures? I appreciate the pressures. We are looking at the situation and at ways of dealing with it to protect front-line services. At the same time, we need to challenge service providers by saying they have more staff than they have ever had before and they need to deploy them as well as possible.

I do not see it is a case of either-or. We should always challenge the healthcare system. We should always challenge those at the top in the system to achieve greater productivity and to ensure we are getting value for money and efficiencies. That should go without saying.

My understanding is - the Minister often boasts about it and I accept it is an achievement - that the net increase in staff in each of the past three years was, on average, approximately 6,000, give or take. This year it will be much less than that. All I am asking is what we should have done. The cost of this would be about €200 million. In the context of the health budget, it is not a huge amount of money but it would make a big difference by allowing the health system to recruit at least the numbers we were recruiting in previous years. If we do not do that, we are training all of these graduates and where do they go? If they cannot be recruited into the public system - we are only recruiting one third of what we were able to recruit in the last number of years - what the Minister is saying to them is they should hop on a plane and go elsewhere or go and work in the private sector. There will come a time when we will need those staff. This is a foolish strategy that will not work. I accept that we need to put controls in place but not to the extent that we are only hiring a fraction of staff this year that we were hiring in previous years.

I imagine that when we get to the end of this year recruitment will be more than half what it was in previous years. The Deputy is correct that we have hired about 6,000 staff per year for the last three years. That has been very unusual. When we look back at previous years, a normal year in the previous five years would have meant hiring between 2,000 and 3,000 additional staff. This year, we have about 2,300 or 2,400 new staff through new development funding, so the number is still growing, and there will be additionality on top of that as well. We will probably end up with in and around 3,000 additional staff. Compared with what we will call a normal year, a pre-Covid year, we are expanding the service by about 3,000 staff, which would be seen as a pretty healthy expansion. We have just become used to these three record years of recruitment. I would love to have had funding for 6,000 staff. That would have been great but we have to work within the budgets we have.

I ask the Minister for Health if he will ensure a local recruitment campaign is carried out for the National Ambulance Service in south Tipperary and if the NAS will commit to improving recruitment processes, providing a recruitment officer to attend job recruitment seminars and visit local schools and developing an advertising campaign to recruit ambulance personal for south Tipperary.

I thank the Deputy for raising this matter. I know he will join me in acknowledging the extraordinary commitment of the National Ambulance Service workers in delivering care for his constituents in south Tipperary and across the country. We are investing significantly in the National Ambulance Service. This year, investment will be approximately €227 million, which amounts to a €58 million increase in the lifetime of this Government.

Staffing has also increased by nearly 40% increase in the past eight years and just in the past few months, there has been another important increase.

To address the specific question about local workforce needs, the National Ambulance Service runs local targeted local advertising campaigns. In south Tipperary this has involved advertising through local radio and targeted recruitment advertising on social media platforms. The service has created a recruitment and retention working group for new recruitment campaigns for students and qualified paramedics, focusing on areas including south Tipperary.

I recently met Mr. Robert Morton, the director of the National Ambulance Service, to discuss future service development and identify further opportunities for increasing training capacity and recruitment. The National Ambulance Service college currently has 410 students at various stages of training, with 110 having commenced in the past few weeks, in January. It is great to see a pipeline of future paramedics and advanced paramedics. As the Deputy may be aware, the ambulance service is also working with several third level institutions to provide degree level courses. One such institution already does so. The service will certainly continue to expand its workforce and recruit, including as per the Deputy's question, in south Tipperary.

The national recruitment campaign has not led to significant improvements in staffing levels in south Tipperary. I also compliment the very hard work and dedicated service all the ambulance services provide across the country. What is difficult is that there are no efforts to recruit locally. The Minister said there was a recruitment campaign but the 45 km rule means that paramedics will be assigned to a base within 45 km of their home unless a recruitment drive happens locally. That is the problem.

There are huge difficulties in south Tipperary with regard to the staffing levels of our paramedic service. There are currently eight staff vacancies in the south Tipperary paramedic service, which is an awful lot in that area. Two of them are temporary but the remaining six are long-term vacancies which have not been filled. The difficulty is that there is no effort to recruit locally. There are recruitment campaigns but they have not been effective. The south Tipperary ambulance service covers Tipperary town, Cashel, Clonmel and paramedic bases. Other areas in the south east and around the country have a full complement of staff because they benefit from national recruitment drives. However, an urgent recruitment drive is required in south Tipperary to ensure the area has services and to fill the urgent vacancies. The Minister mentioned social media. The recruitment drives have been have not been effective. We need an officer to visit schools, colleges, employment seminars and so on.

South Tipperary can certainly be looked at in terms of expansion. The National Ambulance Service works from bases in Cashel, Clonmel and Tipperary. The service in south Tipperary has a total allocated workforce of 46 and is recruiting locally for some vacancies. For example, it has been advertising on Spin Southwest and on Beat 102-103. It has had targeted local advertising campaigns through social media.

The Deputy's reference to the 45 km rule is relevant and there is no question that in some parts it could limit the number of people who can apply for these jobs. On the reverse side, it has been very successful in retaining staff. The latest note I have, which we put together when preparing for the Deputy's question this morning, indicates that the National Ambulance Service now has the highest level of retention of any part of the HSE. The service believes the 45 km rule has been an important part of that.

The main issue is local recruitment, which the National Ambulance Service has not undertaken seriously in south Tipperary for a number of years. The only recruitment is what south Tipperary ambulance personnel have done themselves but they have limited local resources and the staff are under constraints due to the number of vacancies.

The National Ambulance Service needs to be in schools and at job recruitment seminars as standard. That is simply not happening. We know that the 45 km rule has benefits but it is impacting in this case because people who live in Waterford or Limerick when they are recruited will obviously stay where they are because it suits them. There needs to be niche area recruitment by the National Ambulance Service in south Tipperary because it is not happening. The Minister mentioned Spin Southwest and Beat 102-103. While those stations cover the south-east, they are not local. We have Tipp FM and Tipp Midwest radio stations and local newspapers. We need to be more focused on south Tipperary. Beat 102-103 covers the whole south east and is listened to in Tipperary but not by the people we want to recruit to this service because it is for a younger age group. We need to be more focused on south Tipperary to allow the good personnel to continue their excellent work.

I will bring the Deputy's suggestions on engaging with schools and so on back to the National Ambulance Service and ask it to redouble its efforts in terms of local recruitment. I acknowledge that in spite of the fact the National Ambulance Service has these vacant posts, the ambulance service in south Tipperary has been doing very well. We can look at two of the main indicators that are important for patients in terms of response times, namely, purple calls, which cover life-threatening incidents in cardiac and respiratory, and red calls, which cover all other life-threatening emergencies. In 2023, the percentage of responses recorded within 19 minutes increased on the previous year from 65% to 70% for purple calls and from 37% to 41% for red calls. It is worth acknowledging the services are doing better. I will take the Deputy's suggestions back to see what further can be done to hire into those posts.