What now for NCHDs?

This time last year NCHDs were at the precipice. In July 2022, IMO NCHDs voted “overwhelmingly” for industrial action. Unsafe and illegal working hours; failure by the employers to pay NCHDs for all hours worked; unsustainable costs associated with training; and not receiving full entitlements to annual leave and study leave were the main reasons for the comprehensive result. Following the vote, the IMO commenced talks with the Department of Health and HSE to resolve these issues.

Negotiations were not easy. But there were already signs the Government was taking NCHD concerns seriously before an agreement was reached. A national taskforce on the NCHD workforce was established in September 2022 to put in place sustainable workforce planning strategies and policies to address and improve issues facing the group.

Eventually, in December 2022, a deal was struck. Among its terms was that a new “transparent” system for monitoring European Working Time Directive compliance would be agreed. New rostering rules were brought into force and the IMO secured agreement to work towards a new NCHD contract.

In April of this year, the interim recommendations of the national taskforce were published. Recommendations on induction and onboarding, infrastructure, medical workforce, work-life balance, and governance were put forward for immediate implementation. Even though there were still issues of concern (in a recent interview with the Medical Independent, IMO NCHD Chair Dr Rachel McNamara admitted implementation of the agreement was “fragmented”), at least there were signs of progress.

However, any progress has been shattered with the revelation that the recruitment of NCHDs will be paused under the new HSE recruitment embargo.

The IMO is warning that it will take “all necessary action” to protect the rights of the doctors and their patients.

The Organisation has met with the HSE and clearly outlined the negative effects of this policy, which it says is in breach of NCHD contractual rights.

Speaking after the meeting, Dr McNamara said: “At our meeting we advised the HSE of the chaos a recruitment freeze would cause for the health services. We also strongly rejected the position of the HSE that the NCHD agreement reached in 2022 could now be implemented in the context of a recruitment freeze.”

“When the IMO brokered an agreement with the HSE last year, to avoid strike action by NCHDs over illegal and unsafe working hours, the HSE acknowledged that in order to achieve compliance with its obligations under the Organisation of Working Time Act, an additional 800 posts were required for targeted intervention on working hours. No targeted recruitment took place in 2023 and the additional NCHD posts that were hired were to keep services going.”

It is not surprising that NCHDs feel so betrayed by this move. And it is nearly impossible to see how their working lives can be improved in line with last year’s agreement while the group is subjected to a recruitment embargo.

The HSE is in a perilous financial position, with the most recent estimates predicting a deficit of between €1.4 and €1.5 billion by the end of the year. But frontline healthcare professionals should be protected to the greatest extent possible from measures to address the funding gap.

The health service is still feeling the effects from the decade of austerity. The recruitment embargo will only worsen the problem of crowded emergency departments and long waiting lists that plague our hospitals. And it will make it extremely difficult, both now and into the future, for NCHDs to believe health management is in any way serious about addressing their concerns.