Driving improvements in wellbeing, workforce, and accountability 

Prof Gozie Offiah discusses key actions required by the new Government to support a sustainable medical workforce

The new Government faces a range of issues affecting doctors and patients that require action. Long waiting lists, staffing shortages, and issues with healthcare funding and investment, continue to burden a system still under strain following Covid-19. Progress in numerous policy areas, held up during the pandemic, now need to move forward with some urgency.

At MPS, we have a particular perspective on the reforms needed. We represent the professional interests of over 16,000 healthcare professionals in Ireland, we often support them during their darkest times, and we have a good view of the support they need for their mental wellbeing.

Clinical negligence claims

We see the impact that excruciatingly slow clinical negligence claims processes have on doctors’ mental wellbeing. Many doctors who have experienced a claim tell us it resulted in anxiety and depression. Some quit medicine, which is the last thing we need.

A protracted claims process also means lawyers are involved extensively and over a longer period and our data shows this is racking up legal costs that are among the highest of all the countries where MPS operates. This affects the cost of indemnity which doctors require to protect themselves against claims.

The implementation of pre-action protocols – a set of guidelines laid out through legislation, which explain the conduct and steps a court expects parties to take before claims can commence – would begin to address this issue and we hope to see swift progress.

Investigation timelines

Another area of focus should be improving processes such as Medical Council investigations and coroners’ inquests.

Doctors expect to be accountable for the healthcare they provide. However, they also have a right to expect that it is done in a way that is fair, proportionate, efficient, and sensitively handled. Sadly, we see first-hand when supporting doctors through various processes that this is not always the case.

We recently surveyed members who had been subject to a Medical Council investigation. Ninety-three per cent reported that the experience caused stress and anxiety and 73 per cent said it impacted on their health and wellbeing. The length of processes was a significant factor which distressed doctors. Notably, 88 per cent of survey respondents said the investigation took longer than expected and nearly three-quarters (74 per cent) said the process being completed more quickly would have made it less stressful.

We recognise that the majority of the work to improve timelines and embed compassion and support into the process lays at the door of the Medical Council and we have been pleased to see some progress on this. However, some improvements are dependent on Government action. As an urgent priority, the Government should rapidly implement the powers outlined in the Regulated Professions Act 2020 so that the Medical Council can triage cases not requiring further action, closing spurious cases swiftly, and instead focus on cases which potentially pose a risk to patient safety.

We also know that members increasingly report being involved with coronial investigations and inquests. Reforms to the coronial service would greatly assist in bringing the process back to the fundamental purpose of an inquest; investigating who died, where, when, and the cause of death.

When it comes to coroner inquiries, the Government should also work with An Garda Síochána to ensure that coroners hold the responsibility of approaching witnesses, including doctors, to attend court. This would remove the distressing experience of having the Garda as a first point of contact, which can make inquests appear as criminal investigations against witnesses.

We urge the next Government to formulate a retention plan for both experienced medics and those who are newly qualified

Wellbeing

Modern medicine allows doctors to do more to improve their patients’ lives than ever before. However, mounting evidence shows that doctors feel stressed, burnt out, and unable to cope in ever greater numbers.

We see how poor mental wellbeing affects doctors personally and how it can impact on patient care and staff retention. Mental wellbeing is therefore the third area which we believe requires attention from the new Government.

There must be a shift to implement proactive, independent wellbeing support. Support for doctors and specialists is available from a variety of organisations; however, these services are often overburdened. We call on the Government to work with the HSE and private hospital organisations to ensure that specialised support is being facilitated. Peer support, counselling services, debriefing from stressful and traumatic incidents, and wellbeing support, must all be provided as standard, operating confidentially so that doctors can access help without repercussions from employers.

The Government should also secure funding for existing mental health and wellbeing services such as the Practitioner Health Matters Programme. There are many excellent resources available, however the services often rely on donations. By safeguarding these services, healthcare professionals will always be able to access confidential and independent help.

Workforce

Finally, the Government must take steps to ensure the medical workforce is properly resourced and sustainable for the future. This is key to the delivery of timely and effective care to patients.

Actions should include increasing both medical school places and hospital doctor posts, retaining those already in the workforce or about to enter it, and supporting those who come to Ireland from overseas.

The National Taskforce on the NCHD Workforce made a series of recommendations in its interim report (April 2023) and final report (February 2024). Among these, it urged the Government to commit to a workforce plan to increase consultant posts to 6,000 and NCHDs in training to between 5,800-6,000 by 2030. We urge the new Government to commit to these recommendations in order to meet the growing demand for doctors.

It is crucial that both newly qualified and experienced doctors are retained in the workforce. Around 700 doctors per year are choosing to move abroad after completing their intern year, which constitutes around 80 per cent of the annual cohort of interns qualifying in Ireland. Doctors at all levels of experience choose to move and work abroad for a host of reasons, however, this choice should not be a made due to burnout, poor mental health, or lack of staffing and resources. We urge the next Government to formulate a retention plan for both experienced medics and those who are newly qualified.

International medical graduates are a vital part of the workforce. In 2022, more than 70 per cent of newly registered doctors in Ireland trained overseas. It is crucial that doctors entering the workforce receive an adequate and appropriate induction to ensure they feel welcomed, valued, and supported as they transition to clinical practice.

Rapid progress in each of these four areas would ultimately help to improve patient care. Doctors who are engaged, well supported, and experience proportionate and timely accountability, find it much easier to be compassionate, provide safer patient care, and will thrive in their careers for longer.

We look forward to working with the new Government on these and a range of other critical issues affecting our members.