Assessing the HSE’s recruitment woes

As the HSE develops a new recruitment programme, an internal review of the 2022 service plan highlights the major workforce challenges facing the Executive. David Lynch reports.

Ireland’s acute hospitals may require over 15,000 extra staff by 2035 to care for a growing population, according to projections from the Economic and Social Research Institute (ESRI). 

The research, which was funded by the HSE, concluded that “the largest increases in workforce are projected for health and social care professionals who are particularly required by older people in hospital”. 

But the Executive has more immediate recruitment concerns, with the HSE National Service Plan 2022 (NSP 2022) outlining a target to recruit an additional 5,500-10,000 whole-time equivalent (WTE) staff this year. 

This, along with recruitment required to implement Sláintecare reforms, has resulted in a rethink in the Executive’s strategy. 

New programme 

The HSE is developing a new recruitment strategic programme, it has informed the Medical Independent (MI). 

At the April meeting of the HSE people and culture committee, the National Director of Human Resources Ms Anne Marie Hoey told committee members that a new strategy was being prepared. According to minutes, she informed the meeting that “as part of the rollout of Sláintecare, the HSE is receiving funding for the delivery of services in 2022 and beyond”. 

“To augment work underway in relation to recruitment, the HSE is developing a robust resourcing strategy to meet the current and future needs of the organisation.” 

In response to questions from committee members, Ms Hoey said that “this development will enhance work with the education sector, regulatory and statutory bodies to support the resourcing strategy for health”. The committee asked for a follow-up paper on the strategy for retention of staff and innovative ways to attract new employees. 

Asked about progress made since April, a HSE spokesperson said the new programme will be “a strategic programme under the umbrella of National HR, but collaboration across all functions, services and external stakeholders will be crucial to its success”. 

“The role of the recruitment reform and resourcing programme is to implement the new model of recruitment across all areas in the HSE, together with building the necessary digital infrastructure,” the HSE’s spokesperson told MI. 

Competitive 

The spokesperson noted the HSE was “operating in a very competitive global recruitment market”. The new programme was being developed because of the anticipated “implementation requirements of Sláintecare, together with the impact of an ageing population”. 

“The aim of this programme is to ensure we maximise retention across the organisation, together with building the appropriate workforce pipelines to meet the future needs of the organisation.” 

The competitive global market is a matter the HSE has made clear to Minister for Health Stephen Donnelly in recent months. 

As reported last month in MI, a first quarter review of the NSP 2022 sent to the Minister on 1 June sounded the alarm that recruitment targets will be difficult to achieve. 

A copy of the review and cover letter from HSE board Chair Mr Ciarán Devane was seen by this newspaper following a Freedom of Information request. Asked about the Minister’s response to the review, a Department of Health spokesperson said the Minister acknowledged the NSP 2022 review as submitted by the HSE. 

“He has asked the HSE board to maintain focus on recruitment for the remainder of the year in order to ensure maximum progress on the delivery of the funded reforms as set out in the NSP 2022,” said the Department’s spokesperson. 

‘Aggressively strive’ 

The review concluded that the HSE was “confident that at a minimum” its recruitment policies would “result in an additional 5,500 new WTEs by year end”. This 5,500 is the “minimum resourcing target” set out in the NSP 2022, but the HSE’s review added it would “aggressively strive towards the stretch target” of 10,500 additional WTEs. 

But this striving will be against some serious downwind, according to the review, which noted the “significant market supply challenges/unpredictable workforce supply”. 

These include the Covid-19 pandemic, which “will continue to bring uncertainty and complexity to the planning and delivery of services in 2022”. 

This impact is not just felt in services, but also in the individual decisions taken by the 

tens of thousands of HSE employees, leading to possible increased staff turnover. 

“As the global economy opens up post-Covid, the turnover can be expected to increase in 2022,” according to the review. “Some graduates from the last two years may choose to travel, coupled with increased retirements, from those who delayed their retirement or increased their hours to assist the health services in its response to Covid.” 

In order to address standard ‘staff churn’ due to retirements, resignations and promotions, “this will equate to circa 9,500 appointments to maintain existing staffing levels”. 

“However, the HSE has committed to an ambitious recruitment target beyond this to meet the commitments in the National Service Plan,” the review noted in its conclusion. 

In recognition of the increased global competition, together with the ambitious recruitment targets, the review stated that the HSE was supplementing “robust recruitment strategies to maximise the national market with comprehensive international recruitment across the clinical grades such as nursing, HSCPs [health and social care professionals], medical and dental”. 

Consultants 

The review mentioned there were “particular professions where the recruitment challenge is greatest” and this challenge can be exacerbated in attracting professionals to “dense urban areas and some remote rural locations”. 

The ongoing recruitment and retention crisis for medical consultants has long been raised by the IMO and IHCA. A particular difficulty in attracting consultants to hospitals outside the major cities has been noted by observers. Talks on a new Sláintecare consultant contract are continuing between the Department, HSE, IMO and IHCA. 

In the review, the HSE said that overall staffing levels year-to-date were “+161 WTE (9.9 per cent) above the minimum resourcing target” (as of 31 March 2022). 

The increase in 2022 stood at +1,778 WTE (+1.3 per cent), which was above the quarter one recruitment target of 1,617. Employment levels at the end of March 2022 showed there were 134,101 WTEs (equating to 153,282 personnel) in the HSE. 

In his cover letter to the Minister, Mr Devane wrote that the review recognised the additional challenges of the impact of the recent Government decision on reversal of the Haddington Road Agreement (HRA), as well as the “impact and service implications of the response to people arriving in Ireland from Ukraine”. 

Indeed, as reported last month in MI, the HSE review placed a particular focus on the restoration of pre-austerity era working hours, which the review noted had a “significant impact” on recruitment targets. In April, the Government announced it approved the Report of the Independent Hours Body, which recommended that all civil and public service employees would no longer have to work extra hours that were detailed in the HRA signed in 2013. 

The HSE review said that the HRA hours reversal “is equivalent to the loss of a minimum of circa 3,800 WTEs across the HSE… Not all WTEs will be replaced or indeed be replaceable, however there will be a requirement to replace WTEs in critical patient services as a matter of priority to maintain safe patient care. As a consequence, it also brings further complications to our efforts at resourcing and financial planning for 2022.” 

While the HRA working hours reversal impacted HSE staff across the board, initially there was a health exception. The Independent Hours Body excluded hospital consultants because of the ongoing negotiations regarding a new Sláintecare contract. 

In April, the Government went along with this recommendation, however that decision has since been reversed. 

According to an internal HSE memo seen by this newspaper, dated 22 June and written by Ms Hoey, “the Department [of Health] has recently confirmed the reduction in HRA hours for consultants, which are now to be included in the reversal of the HRA”. 

Contacted by this newspaper, the Department’s spokesperson confirmed that consultants were now “encompassed in the reversal of Haddington Road Agreement hours”. 

Asked for more information regarding this decision, the Department told MI that “engagements are currently underway with representative bodies on the Sláintecare consultant contract and accordingly, further public comment about this matter would not be appropriate at this point in time”.