Regional health hubs relying on non-approved agency workers

In 2022, some €64m was spent by the HSE on staff from agencies not included in a 2017 framework agreement.

Regional health hubs’ reliance on non-approved agency healthcare workers could see patients treated by staff without adequate medical clearance or who have failed to undergo mandatory vetting, two new reports find.

Just under a quarter of the HSE’s €259m spend on agency doctors and healthcare assistants in 2022 came from non-approved sources, an issue posing a potentially systemic risk according to the two separate HSE internal audit reports.

The health service spent €99.5m on locum doctors and €159.3m on healthcare assistants last year surplus to its spend on contract staff, a recurring problem for the HSE given agency staff are more expensive to retain than those employed by the State.

Internal audits

Internal audits conducted on the infrastructure behind the HSE’s spend on non-approved agencies — those not included in a 2017 national framework agreement for the control of the deployment of temporary agency staff across the sector — concluded that such use of non-approved suppliers “may result in value for money not being achieved by the HSE”.

The two audits, conducted in July and September 2023, concluded that the use of such non-framework agencies could lead to issues such as contractual obligations placed on framework providers not being met by their non-approved counterparts.

Such issues include a potential lack of medical clearance and the possibility of non-vetted agency staff being used for the treatment of patients, the reports said.

Some €64m, or 24.7%, of the overall expenditure was spent on staff from agencies not included in the 2017 framework agreement for the management of the use of agency staff.

That figure is concentrated in the local community healthcare organisations (CHOs) as opposed to the hospitals, with 41%, or €48.2m, of the overall spend in the regional health networks used for the retention of non-approved staff, compared with just 11% of the same spend in the hospitals.

In terms of the CHOs, 94% of locum doctors provided in CHO2 — Galway, Roscommon, and Mayo — came from outside the approved framework.

The region with the largest proportional spend on non-approved locum healthcare assistants was Dublin primary care, CHO9, where 85%, or €1.8m, of agency spend in 2022 went on non-approved providers.

Ireland’s hospital groups were far more in compliance with the framework agreements in place, with just €15.8m of the overall €142m spent on agency doctors and healthcare assistants coming from non-approved suppliers.

However, two of those groups, Children’s Health Ireland and the Royal College of Surgeons, failed to supply financial details for the HSE’s internal audit to review.

Some of the reasons given for the reliance on non-approved staff included: 

• A lack of qualified consultants being available from approved sources with regard to intellectual disabilities; 
• Difficulty in filling child and adolescent mental health services postings via traditional HSE recruitment structures; 
• Agencies in the framework being unable to provide healthcare assistants for residential services.

Five recommendations were made via the audits, all of which were given a high priority rating and three of which were deemed to be of potentially systemic importance to the HSE.

The final reports recommended that the HSE’s procurement and human resources functions should review the results of the reports, and that “measures should be put in place” to “deal with” the risks identified as part of a new procurement framework.