Working conditions in healthcare reflect a wider attitude to workers 

Overall respect for the role work plays in people’s lives is lacking and needs to be addressed

Recently, I was asked to do a short media segment on a health topic. I spent an hour or so preparing notes for the presenter and emailed them to the researcher early on the morning of the planned interview. A couple of hours before the interview, the gig was shelved. “Welcome to the gig economy,” a friend who plays music for a living, said wryly.

Gigs, where you agree to be available and prepare in advance for work that doesn’t materialise, freelance assignments that aren’t paid for months, the ‘app’ economy of precarious employment, failure to tackle excessive hours, and student nurses working shifts without payment are all part of a spectrum of tolerance for poor treatment of workers.

The EU has driven significant protections, valuing the contribution of workers to society. We have legislation providing enhanced protection for workers and the Workplace Relations Commission to regulate their application. An example of a positive change has been employment laws to address the exploitative practice of zero-hour contracts, which became increasingly common at the start of this century. Despite these steps forward, creative erosion and blithe disregard of workers’ rights continues. In the Supreme Court several weeks ago, the standing of delivery drivers as employees was put on a more secure footing with a landmark judgment. This will bring change to that sector hopefully. But like zero-hour contracts, as one avenue of exploitation is closed off, another may open.

A wider position on the contribution of work to the shared life we lead and the social obligations that workers should receive in return is due. That discussion should have occurred following the contribution of frontline workers during the Covid-19 pandemic, with farmers still producing food, delivery drivers getting it to the shops, and people serving other people in public-facing jobs. Although many in our population were not allowed to go out to work, an equally large proportion didn’t have any choice but to do so. Being able to work is a privilege that some don’t enjoy. However, working in poor conditions is a long way from a privilege.

With the IMO Annual Conference last month, there was media focus on the considerable hours worked by doctors in training. The discussion was muted, with the tone of ‘same old’ story. The fact that doctors continue to work more than 60 hours each week in a role of significant responsibility was highlighted by the Medical Workforce Intelligence Report published by the Medical Council. A stark fact, which leads to a certain shrugging of the shoulders when the hours worked are published each year, is that although there have been improvements over the last three decades, the rate of improvement has been abysmal. Rosters of shifts continue to be wildly outside compliance with the European Working Time Directive.

Large corporations and employers – including in healthcare – continue to wriggle out from under the burden of their social obligations. These obligations include receiving a roster in advance, being paid on time, access to time off, and the capacity to balance work commitments with a satisfying home life.

There is also an ever-expanding pay disparity between the most junior and senior levels of workers. In 2017, Oxfam documented in a report that eight men own the same wealth as the 3.6 billion people who make up the poorest half of humanity. Ireland now has more millionaires than ever before. In large corporations the ratio of CEO pay to average worker pay is 200:1.

Why are doctors’ hours a perennial topic of conversation? Why do we accept the dreadful working and care environment of an emergency department besieged with trolleys? For the same reason as a ‘contract’ worker gets their shift cancelled at short notice, a paramedic can’t finish an hour early after attending a traumatic incident, and a trainee solicitor is in the office until midnight – overall respect for work and hours of people’s lives is lacking. They are not seen as being individuals with very human needs. Yet a CEO has no role without them.

Due to enhanced EU and national protection of worker’s rights, we run the risk of being lulled into believing that everything is okay. But it is not okay to work over 60 hours a week, in the same way that it’s not acceptable to foster a culture of precarious, low-paid employment. In terms of social justice, political action eventually follows persistent protest. Following years of requests for student nurses to be paid, and the publication of the McHugh Report, the Minister for Health agreed in 2023 to subsistence, accommodation, and placement payments.

Respect for any one person’s time and skill is a small ask, given the enormous value that working people bring to all of us.