The folly of the recruitment embargo

Runaway budgets do need to be curtailed, but freezing the appointment of new staff is not the answer

So Budget season has come and gone. It was most notable for the politicians and bean counters telling us that as a health service, we are living way beyond our means, as the infamous quote almost goes. This has resulted in a recruitment freeze across the entirety of the HSE with some very limited exceptions, such as new consultants, doctors in training, and graduate nurses and midwives. It includes administrative and managerial posts, but also members of the health service’s workforce that it is utterly dependent on, such as all doctors not in training, home help services, and agency nursing staff.

The most disappointing part of this is that in the last year or so there was a feeling, at least in the community, that investment was finally coming through. Where I am based locally as a GP, there has been new community-based specialty services introduced in diabetes, respiratory, and geriatric medicine. Emergency department staff are working with the ambulance service directly to go out to people’s homes to reduce admissions where they are not necessary. There are more streamlined online referral processes and we now have excellent direct access to imaging which has helped us decide who actually needs referral to specialty services. Towns across the country from Bantry to Ballyshannon have welcomed shiny new primary care centres and community hospitals. It’s very unlike me to toot the HSE’s horn, but all of these mean that we are no longer as reliant on hospital-based services and may be able to reduce admissions when they are not needed. Our hospital colleagues have also been doing trojan work with outpatient clinics, diagnostics and endoscopy procedures being run over weekends in a bid to cut waiting lists.

But, of course, all this investment obviously costs money – there have been huge increases in staffing and resources required to fund all this. We all know that HSE budgets are enormous, tens of billions of euro every year for a country of only five million people. It’s simplistic to say that that a health service can be run like a budget airline but we all know there are efficiencies to be found. It’s simplistic to just call for reductions in management and administration staff because when they function properly they are as vital to running a good service as any consultant or nurse. But we all know that there are too many people sitting in offices not getting enough done. We all know that the health service is spending money in the wrong places, such as pouring huge sums into the profits of private imaging centres and hospitals for diagnostics and waiting list initiatives rather than further investing in public health services directly.

Runaway budgets do need to be curtailed, but cutting recruitment is not the answer. Cutting recruitment of NCHDs not in training will disproportionately affect our smaller peripheral hospitals across the countries which are completely reliant on these staff. Cutting agency nursing will lead to greater pressure upon and burnout of our existing nurses who will continue to vote with their feet and go overseas for better working conditions. Cutting allied healthcare teams, such as physio and occupational therapy and home help services, will lead to more failed discharges and more people back on trolleys in emergency departments.

Budgetary decisions are not made in a vacuum. With coming elections that the current Government are widely expected to lose, it’s no wonder that they’re attempting to out-populist the populists. I’m fortunate enough to not need another non-means tested energy grant or tax cuts of a couple of euro here or there this year – what I do need is my patients being able to receive the care that they require  both in hospital and in the community. I need to know when I have no choice but to refer to the emergency department, that they will get safe, appropriately staffed care and there will be community services for them when they come home.

When we are hearing the news stories in January about yet another seemingly unprecedented and unexpected trolley crisis, I will have no time for the politicians on the airwaves saying that something must be done because all of this was completely and utterly predictable.