'Fragility' of future medical care warning as 17 hospitals face staffing crisis

Mercy University Hospital in Cork City.

Some 17 hospitals, including Tralee, Clonmel, and the Mercy in Cork, are facing a recruitment crisis with over 1,000 additional doctors needed in the next decade.

A new HSE analysis warns of “the fragility” of future medical care for patients relying on these hospitals with over 100 vacant posts at the moment.

There is “a consultant recruitment crisis across every specialty” in these 17 hospitals, known collectively as the Model 3 network, the analysis shows.

One concern highlighted is that 7% of doctors at these hospitals are not on the specialist division of the Medical Council of Ireland register and 24% are in temporary locum posts.

At Tipperary University Hospital, Clonmel some 26% of consultants are not specialists, and 9% at University Hospital Kerry, but this is at 0% in the Mercy Hospital.

The review looked at hiring patterns over 18 months also.

They found that of 104 posts approved for these 17 hospitals in 2021 only 38% were filled permanently after 18 months. A further 41% were filled only on a non-permanent basis.

Hospital management criticised the recruitment process, saying it is “long and complex, with multiple stakeholders”.

Across this group of hospitals, NCHDs (non-consultant hospital doctors) or doctors in training make up 24% of the doctor’s workforce compared to 12% across larger hospitals.

“This variance is significant and should be regarded as a risk to the sustainability of the workforce at Model 3 hospitals,” the report warns.

However, there is variation depending on location. At the Mercy Hospital in Cork City, 12% of the doctors are NCHDs, but at the South Tipperary University Hospital in Clonmel, this stands at 33%.

In addition, these doctors told the report team the lack of senior consultants has a negative impact on their training.

One said: “Formal teaching was reduced due to a lack of filled permanent consultant posts and a lack of NCHDs, leading to increased clinical workload.” The report, launched at the HSE National Doctors Training and Planning annual National Medical Workforce Conference, also found a higher proportion of doctors at these smaller hospitals are nearing retirement.

Some 33% of doctors at these sites are over 56 compared to 23% in larger hospitals.

Urban-rural split

The report again identifies an urban-rural split with nearly half the consultants in University Hospital Kerry aged over 56 but the age profile of Mercy Hospital staff is in line with a larger hospital.

At Our Lady’s Hospital in Navan, 13% of the doctors are over 66, and 10% at Cavan Monaghan hospitals.

“A service delivery crisis is inevitable unless Model 3 hospital posts are made more attractive,” warned Professor Brian Kinirons, medical director with National Doctors Training and Planning.

He said he was impressed by the ambition of these hospitals to deliver high-quality care, but many challenges remain.

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HSE chief clinical officer Dr Colm Henry said while larger hospitals offer complex care, the “greater proportion of healthcare” is in these hospitals and community services.

He described the challenges as “stark”.

“If we do not undertake measures to improve the recruitment of consultants for Model 3 hospitals, it will undoubtedly impact negatively on our ability to deliver safe and effective patient care in the medium term,” he also warned.

The report makes a series of recommendations including for workforce planning and re-assessment of on-call rotas to make the posts more attractive.