Recruitment and Retention of
Health Care Providers in
Remote Rural areas
Status report for IRELAND
Name of author
Wesley Henderson
25th September 2012
Contents
1.
Introduction
3
2.
Geography
3
3.
Population
5
4.
Demographic Trends
6
5.
Rural Deprivation
11
6.
The Organization of the Health Care Services
13
7.
Urban Area
18
8.
Education
21
9.
Health Care Professionals
23
10. Summary of Findings
26
11. References
28
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1. INTRODUCTION
The Northern Peripheries Programme (NPP) aims to help peripheral and remote communities on the
margins on Europe to develop economic, social and environmental potential.
This report provides baseline information in relation to the Recruitment and Retention project for a
defined catchment area within the island of Ireland. It includes details of geography, demography,
social economics and other environmental factors relating to health care provision. An overview of
health care across the catchment areas is given in terms of organisation, education and any key
aspects associated with recruitment and retention of staff.
This report is submitted in line with the NPP programme objectives.
2. GEOGRAPHY
Ireland is an island to the north west of continental Europe and is the third largest island in Europe,
approximately 84,000 square kilometres. Although it is an island, it has two government jurisdictions
that separate the Republic of Ireland (ROI) from Northern Ireland. The capital city of the ROI is
Dublin and the capital city of Northern Ireland is Belfast.
In relation to climate the dominant influence is the Atlantic Ocean. Consequently, Ireland does not
suffer from the extremes of temperature experienced by many other countries at similar latitude.
The warm North Atlantic drift has a marked influence on sea temperatures. This maritime influence
is strongest near the Atlantic coasts and decreases with distance inland. Winters tend to be cool and
windy, while summers,, when the depression track is further north and depressions less deep, are
mostly mild and less windy.
The defined area for the Recruit and retain project in ROI covers all of the western side of Ireland(see
figure 1) stemming from County Donegal down to and including County Cork.
Figure 1: Map of Ireland - Defined Catchment Area in Republic of Ireland
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Source: Northern Periphery Programme Website www.northernperiphery.eu
The catchment area also covers all of the Northern Ireland with the exception of Greater Belfast
(see figure 2).
Figure 2: Map of Northern Ireland - Defined Catchment Area
Source: Northern Periphery Programme Website www.northernperiphery.eu
ROAD NETWORKS
The Republic of Ireland historically having a less-developed network than that of Northern
Ireland, only used to consist of a few short sections of motorways. With significant European
Union funding, the majority of national roads in the Republic of Ireland continue to be upgraded.
Since the 1990s, as part of the National Development plan, improvements on most major routes
and construction on motorways and dual-carriageways have gone underway. A number of road
improvement schemes are still to be undertaken in some areas including western Galway and
County Donegal. Some are still in the planning stages while the undertaking of several schemes is
currently suspended, as referenced by the National Roads Authority.
Northern Ireland boasts a well-developed network of primary, secondary and local routes
however, the rate of development has been slower than that of the Republic of Ireland in recent
years. A number of notable bypasses and upgrades to dual-carriageways have recently been
completed or are due to begin. An example of this would the scheme for improvements to the
road connecting Omagh and Enniskillen to improve access to the new regional hospital in
Enniskillen. Many of the schemes aim to widen existing roads, for example several roads leading
into Londonderry, while several aim to create bypasses of smaller towns and villages. Many more
dual-carriageways are also planned to be added to the network, most notably leading to
Londonderry.
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3. POPULATION
The population of the island of Ireland is approximately 6 million with 1.8 million resident in
Northern Ireland. Within the defined catchment area of Northern Ireland, outside the greater
Belfast area, the population is 1.46 million. Within the Republic of Ireland the population of the
defined area is 1.55 million which includes the cities of Limerick, Cork and Galway. These three
cities have a combined population of c.244,000 according to Central Office Statistics (2006). The
components of the population figures are set out in table 1 below.
TABLE 1: Population within NPP Catchment Areas of Northern Ireland and Republic of Ireland
Source: Compiled from Central statistics Office (CSO) and Northern Ireland Research & Statistics Agency (NIRSA)
Relative Population Density between urban and rural areas
In terms of population density within the catchment rural areas, this varies within the Republic of
Ireland between 21.2 persons/square km in County Leitrum to 54.01 persons/square km in
County Cork.
In relation to the Northern Ireland catchment area it is important to state that the distinction
between rural and urban is not clear-cut. According to a “Report of the Inter-Departmental
Urban-Rural Definition Group in February 2005” rural areas have been characterised by a
dispersed population, agricultural or other intensive land use and distance from major urban
centres.
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4. DEMOGRAPHIC TRENDS
4.1 MIGRATION LAST FIVE YEARS.
Emigration among Irish has increased sharply from 27,000 to 40,200 over the 12
months to April 2011 while emigration among non-Irish persons fell for the second year
in a row. Overall emigration is estimated to have reached 76,400 in the year to April
2012, an increase of 16.9 per cent. The following figure 3 sets out population trends
from 1987 to 2011 which encapsulates natural increases through deaths and births as
well as a comparison to net migration over the years.
Figure 3 Migration Trends in Republic of Ireland
Source: Central Statistics Office, Ireland
The above table shows that the natural increase in the population continues to be
strong, however, the effect of emigration on net migration has offset the trend. The
result is a relatively small increase in the overall population in the Republic of Ireland.
Within the Northern Ireland catchment area, a report “Migration Statistics Northern
Ireland 2009” issued from the NI statistics and research Agency indicated a downward
trend in international migration to Northern Ireland. 23,500 people were recorded to
have come to live in Northern Ireland and 21,400 people left Northern Ireland to live
elsewhere, a net migration figure of 2,100 added to the population. More recently,
estimates from NIRSA in 2011 have indicated that emigration has higher than
immigration.
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4.2 AGE DISTRIBUTION OF POPULATION
Northern Ireland has the fastest growing population in the UK. Currently there are
approximately 1.8m people in the province, a figure which is expected to rise to 1.937m
by 2022 (see figure 4). From a health and social care perspective, possibly the most
significant aspect of this increase is the rising number of older people.
Figure 4: Population Projections
Source: Northern Ireland Research & Statistics Agency
According to NIRSA projections, up to 2022 the number of people aged 65 years and
over is estimated to increase to 348,000. This is 18% of the total population compared
with 15% now. The area of highest growth is in the west of the province whilst the area
projected to have the highest number in this age bracket is the South Eastern locality. In
Northern Ireland life expectancy increased between 1998-2000 and 2008-2010 from
74.5 years to 77 years for men and from 79.6 years to 81.4 years for women. There is
projected to be twice as many people aged 65 and over in 2047 as there were in 2011.
In relation to the younger population the number of children in Northern Ireland is
projected to increase by 4% over the period to 2025. In the Republic of Ireland, it is
anticipated there will be an increase by 2026 in the younger population by more than
13% within the west of Ireland which is the catchment area of NPP. This will contribute
towards a 28.8% increase of younger persons (0-14 years) within the state. However, as
indicated earlier, migrations trends will impact on the overall projected population
growth with an annual population increase of 1.5 per in the west.
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4.3 LIFE EXPECTANCY / NEONATAL MORTALITY
The mortality assumptions at national level within the Republic of Ireland envisage a
decrease in mortality rates consistent with increases in birth rates. As with the Northern
Ireland catchment area, the number of people in R.O.I aged over 65 years is expected to
rise across all regions. The very old population (80 years and over) is expected to double
by 2026.
4.4 EMPLOYMENT STATUS LAST FIVE YEARS
In relation to employment, statistics produced by the CSO for the Republic of Ireland has
demonstrated an increase in unemployment levels. Table 2 sets out the labour force
status between 2006 and 2011.
Table 2: Persons aged 15 and over by economic status 2006 - 2011
Source: Central Statistics Office – Highlights from Census 2011
Although there was an increase of 5.8% in the labour force I.e those eligible for
employment, there has also been an increase of 8.7% of the population not in the
labour force. Factors impacting on this are an increase in the number of students,
retirement and persons looking after the home.
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The number of people unemployed based on their declared economic status in April
2012 has increased by 136.7% as shown in figure 5 with the overall unemployment rate
for the state at 19%.
Figure 5: Unemployed Persons 1981 – 2011 in Republic of Ireland
Source: Central Statistics Office Ireland
Noteably statistics within the 2011 census have shown unemployment blackspots which
include Cork, Limerick and Donegal within the NPP catchment area.
Within Northern Ireland a similar pattern has emerged with a higher unemployment
trend as shown in Figure 6:
Figure 6: Seasonally Adjusted Claimant Count Rates
Source: Monthly Labour Market Report (July 2012)
The above table shows the employment benefit claimant count in Northern Ireland was
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higher than the UK average and there is a continual increase in unemployment.
The report also highlights there were levels of unemployment claims in County Derry
than anywhere else in the region as shown below in Figure 7.
Figure 7: Claim Count Rates per District Council Area
Source: Monthly Labour Market Report (July 2012)
It is notable from the above table that Derry, Limavady and Strabane are in the north
western region of Northern Ireland and Derry city is quite a large urban area. As a
reminder to the reader, Belfast is not within the catchment area of NPP.
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5. RURAL DEPRIVATION
Northern Ireland have measures of deprivation compromising indicators of income,
employment, health deprivation & disability, social environment, housing, education
and geographical access to services. These indicators are combined in a multiple
deprivation measure (MDM) to help the reader compare areas and provide a means of
ranking. The higher the MDM score the more deprived the area.
Within the four Trust catchment areas some patterns have emerged and Table 3 shows a
compilation of the most deprived areas across the four Northern Ireland health Trusts.
Table 3: Multiple Deprivation Measures (MDM) Scores for Northern Ireland Catchment Area
Source: Northern Ireland Statistics and Research Agency
A number of Derry and Strabane areas have featured as most having higher MDM
deprivation scores in comparison to other areas not presented in this table. There are
over 580 wards where MDM scores have been applied. It should also be mentioned
Belfast areas were scored as part of the study but have been excluded from the above
table.
In the ROI deprivation indices use data available from census information. Three
dimensions used are demographic profile, social class composition and labour market
situation. From the 2006 studies this showed areas of Count Donegal, North West Mayo
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and western Galway as being extremely disadvantaged.
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6. THE ORGANIZATION OF THE HEALTH CARE SERVICES
Health service provision is conducted differently in Northern Ireland than in the
Republic of Ireland.
6.1 SERVICE DELIVERY IN NORTHERN IRELAND
This section outlines the roles, responsibilities and relationships between the Northern
Ireland Department and health and social care (HSC) bodies. Figure 8 below shows the
structure of the health and social care system.
Figure 8: Organisation of Health Care across Northern Ireland
Source: Public Health Agency
In terms of service commissioning and provision, the Department discharges this duty
primarily by delegating the exercise of its statutory functions to the Health and Social
Care Board (HSCB) and the Public Health Agency (PHA) and to a number of other HSC
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bodies created to exercise specific functions on its behalf.
The HSCB has a range of functions that can be summarised under commissioning,
Performance management & service improvement and Resource management.
The PHA’s primary functions can be summarised under improvement in health and
social well-being, Health protection and Service development . In exercise of these
functions, the PHA also has a general responsibility for promoting improved partnership
between the HSC sector and local government, other public sector organisations and
the voluntary and community sectors to bring about improvements in public health and
social well-being and for anticipating the new opportunities offered.
Health and Social Care Trusts
HSC Trusts, are the main providers of health and social care services to the public, as
commissioned by the HSCB. There are now six HSC Trusts operating in Northern Ireland:
•
Belfast Health and Social Care Trust
•
South Eastern Health and Social Care Trust (covering local council areas of
Newtownards, Down, North Down and Lisburn);
•
Northern Health and Social Care Trust (covering local council areas of Coleraine,
Moyle, Larne, Antrim, Carrickfergus, Newtownabbey, Ballymoney, Ballymena,
Magherafelt and Cookstown);
•
Southern Health and Social Care Trust (covering local council areas of Dungannon,
Armagh, Craigavon, Banbridge and Newry and Mourne);
•
Western Health and Social Care Trust (covering local council areas of Derry, Limavady,
Strabane, Omagh, and Fermanagh)
•
Northern Ireland Ambulance Service Trust (covering all of Northern Ireland)
The six HSC Trusts are established to provide goods and services for the purposes of
health and social care.
The BSO, which is established as the Regional Business Services Organisation contributes
to health and social care in Northern Ireland by taking responsibility for the provision of
a range of business support and specialist professional services to other health and
social care bodies.
These include: administrative support, advice and assistance; financial services; human
resource, personnel and corporate services; training; estates; information technology
and information management; procurement of goods and services; legal services;
internal audit and fraud prevention.
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The PCC is a regional body supported by five local offices operating within the same
geographical areas covered by the five HSC Trusts and LCGs. The overarching objective
of the PCC is to provide a powerful, independent voice for patients, clients, carers, and
communities on health and social care issues.
The RQIA was established is an independent health and social care regulatory body,
whose functions include keeping the Department informed about the provision,
availability and quality of health and social care services; promoting improvement in the
quality of health and social care services and Reviewing and reporting on clinical and
social care governance in the HSC.
Special Agencies are established to provide specific functions on behalf of the
Department. These include Northern Ireland Blood Transfusion Service (NIBTS) ,
Northern Ireland Medical and Dental Training Agency (NIMDTA), Northern Ireland
Guardian ad Litem Agency (NIGALA) and Non Departmental Public Bodies (NDPBs).
Health and Social Care Board and Family Practitioner Services
The HSCB has a key role to play in managing contracts with family practitioners, not only
in terms of pay and performance monitoring but also in terms of quality improvement,
adherence to standards and delivery of departmental policy. The HSCB is accountable to
the Department for the proper management of FPS budgets. There are 107 GP training
practices in Northern Ireland of which 86 are within the catchment area.
Hospitals / Specialized service in Northern Ireland
In Northern Ireland there are a network of nine acute hospitals where more specialised
inpatient care is provided supported by seven local hospitals, with additional local
hospitals in other locations, as appropriate. The nine acute hospitals are the Royal
Hospitals, Belfast City, Ulster, Antrim, Causeway, Altnagelvin, Daisy Hill, Craigavon and
the new South West Hospital.
The following regional map of Northern Ireland (figure 9) shows where the various
hospitals are located.
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Figure 9 – Map of Northern Ireland Hospitals Network
Source: Health Estates Investment Group DHSSPS
Change in Healthcare Provision in Northern Ireland
A report Transforming Your Care issued by the DHSSPS for Northern Ireland sets out
changes that will shape the way health care is delivered in the future.
Through a comprehensive engagement with the public, Transforming Your Care found
that the vast majority of people would prefer services delivered closer to home.
Therefore, in the future HSC model, more of the services that currently require a
hospital visit will be available locally. The report also points out the current model is not
fit for purpose. The example is given of the ongoing failure to deliver acceptable A&E
waiting times.
In summary, for planned care the report indicates there will be need to be
improvements through shorter lengths of stay for inpatients, more patients receiving
treatment in day case or outpatient settings, the required access to diagnostics and
bringing access times into acceptable limits. These and other service transformations
will be in the context of moving over time to a hospital system made up of five to seven
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major acute hospital networks across Northern Ireland.
6.2 SERVICE DELIVERY IN REPUBLIC OF IRELAND
The model of service delivered by the Health Service Executive in Republic of Ireland
(ROI) is based on all services, community and hospital, being linked to local populations.
Services are organised into four regions within a national framework. The regions are
subdivided into 17 areas with acute and community services delivered to a defined
population. More complex care is divided through national models e.g cancer services.
It is important to state, in line with major announced changes through a Health Service
Bill 2012, that a single tier health service is envisaged which will eventually dissolve the
HSE and replace this with a system that responds to needs of patients rather than
financial means.
Hospitals in Republic of Ireland
Within the HSE in R.O.I, a wide range of emergency, diagnosis, treatment and
rehabilitation services are provided in across 50 public hospitals as set out in Appendix
1.
In some of these hospitals world class national specialist services include heart, lung and
liver transplants, bone marrow transplants, spinal injuries, paediatric cardiac services
and medical genetics.
Primary Care Services in HSE
In the HSE Primary Care services provide a single point of contact to the health system
for the person. These professionals include GP and Practice Nurse, Community Nursing
Service – Public Health Nurse, Community Registered Nurse, Occupational Therapist,
Physiotherapists and home helps.
The Primary Care Team members also link with other community-based disciplines to
ensure all health and social needs are provided for. Disciplines include speech
therapists, mental health professionals, podiatrists, social work, dentists and ophthalmic
services.
Within the HSE, in June 2012 there were 408 Primary Care Teams in operation each
serving a population of approximately 8,000 to 12,000.
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7. URBAN AREA
It has been decided to provide urban comparators separately for Northern Ireland and
the Republic of Ireland on the basis population projections are not on the same
timeframes and projected figures are not available for all individual areas.
Northern Ireland Urban Comparator
The term “Greater Belfast Area” is used to refer to Castlereagh, Carrickfergus, Lisburn,
Newtownabbey and North Down. The population density i.e. persons per square
kilometre in Greater Belfast is approximately 4,989.2, Belfast alone having
approximately 2,451.6. Northern Ireland has a population of 1,810,900 with Belfast
having a population of approximately 337,000 (see figure 10). Belfast is host to several
hospitals. Situated a few minutes from Belfast city centre is Belfast Royal Victoria
Hospital which treats over 80,000 people as inpatients and 350,000 people as
outpatients every year. The additional hospitals on this site are the Royal Jubilee
Maternity Service, Royal Belfast Hospital for Sick Children and the Royal Dental Hospital.
The Belfast City Hospital is a 900 bed modern university teaching hospital. Musgrave
Hospital is a non-acute which provides a range of regional specialist healthcare services.
The Mater Infirmorum Hospital is an acute hospital delivering services to the North
Belfast and the surrounding areas.
The city also boasts two main universities. Queen’s University Belfast is one of the UK’s
top Redbricks featuring highly on the league table of UK universities every year. Belfast’s
second university is the University of Ulster which maintains 5 sites across Northern
Ireland: Coleraine, Portrush, Jordanstown, the Magee campus in Londonderry and a
campus in Belfast itself. Other further education institutes include the Belfast
Metropolitan College which offers both vocational education and academic
qualifications.
Approx. Distances from Belfast –







Londonderry – 70 miles
Dublin – 105 miles, Population - 527, 612 (2011 CSO)
Cork – 266 miles, Population – 119, 230 (2011 CSO)
Galway – 233 miles, Population – 75,529 (2011 CSO)
London – 461 miles
Edinburgh – 177 miles
Cardiff – 381 miles
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Figure 10: Population Comparisons in Northern Ireland
Trust Area
NHSCT
SEHSCT
SHSCT
WHSCT
BELFAST
Trust Area
NHSCT
SEHSCT
SHSCT
WHSCT
BELFAST
Population
% Change
2008
2011
453824
463520
2.14
341085
348008
2.03
348657
363994
4.40
296909
302532
1.89
334528
337039
0.75
Population
% Change
2008
2022
453824
491681
8.34
341085
366695
7.51
348657
415988
19.31
296909
318999
7.44
334528
343196
2.59
Source: Northern Ireland Statistics and Research Agency
Republic of Ireland Urban Comparator
The capital and most populous city of Ireland, Dublin has an area of 114.99 km2 with a
population density of approximately 4.588/ km2. By 2012 Dublin city is projected to
increase in population by over 20% from 2011 which is a greater level of increase than
the west and mid-west regions (see figure 11). There are a large number of hospitals in
the city, about 7 or 8 providing acute care. Amongst these are St. James’s Hospital, the
largest university hospital in Dublin, it’s academic partner being University of Dublin
Similarly, St. Vincent’s Hospital is partnered with University College Dublin. Also in
Dublin is the Beaumont Hospital, a large teaching hospital. Dublin is a popular choice for
both Irish and international student to pursue higher education, as it is host to three
renowned universities and a vast amount of other higher education institutes. The
University of Dublin is the oldest university in Ireland, dating back to the 16th Century
and is partnered with the famous Trinity College. The National University of Dublin is the
largest in Ireland with approximately 22,000 students in attendance. The highly
renowned Royal College of Surgeons is part of this institution. Other institutions include
Dublin City University and the Dublin institute of Technology, the largest non-university
third level educational institute in Dublin. As statistical projections for each of the
counties in the Republic of Ireland catchment area are not available, the census
information and projections are not directly comparable to the Northern Ireland figures.
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Approx. Distances from Dublin






Belfast – 105 miles
Galway – 130 miles
Donegal – 159 miles
Cork – 162 miles
London – 360 miles
Cardiff – 270 miles
Edinburgh – 279 miles
Figure 11: Population Comparisons in Republic of Ireland
Area
Dublin
Population
2006
% Change
2011
1183000
1302000
10.06
Mid-West
359000
389000
8.36
West
411000
454000
10.46
Area
Dublin
Population
2011
% Change
2021
1302000
1563000
20.05
Mid-West
389000
437000
12.34
West
454000
529000
16.52
Source: Central Statistics Office Ireland
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8. EDUCATION
Medical Education
There are a small number of education centres across Ireland for medical
undergraduates namely:
 Belfast (Queens University),
 Dublin 3 universities at Trinity, University College Dublin (UCD) and Royal Colleague
of Surgeons Institute (RCSI).
 Cork University
 Galway University
 Limerick University (for entry at post graduate level only)
Within Northern Ireland there is a service level agreement with Queens University for
the placement of undergraduates at hospitals to train and gain exposure to health care.
Students are undergraduates for five years and upon graduation enter foundation level
for two years as they develop their junior doctor status. Within the foundation period
doctors apply to work at hospitals in timeframes across various specialties and after two
years look to develop core training skills. For junior doctors aiming to further progress
their careers, they tend to work in major acute hospitals at cities like Belfast and Dublin
where they gain increased exposure on more specialised services. This enables junior
doctors to gain the necessary expertise to be considered as future consultants.
Some of the challenges cited in facilitating or attracting medical undergraduate training
include occupational health clearance, suitable accommodation, capacity of staff
supervision and throughput from the catchment population. The ability for rural
hospitals on attracting medical staff back to hospital allegedly is enhanced from
previous work placements or training in such facilities.
Nursing and Midwifery Education
In Northern Ireland there are two universities that provide nursing education; University if Ulster
and Queens University. Some nursing education is also provided through Open University. It is a
three year programme with an initial community focus on placements with exposure later in the
programme to hospitals. Upon graduation there is a requirement to register with the Nursing &
Midwifery Council (NMC) in Northern Ireland. Placements are coordinated at Trust level
through practice facilitation teams and hospitals must be clinically approved to supervise
students.
In recent times Government funding for Universities has been decreasing in an effort to
drive efficiency. As a consequence, entrance criterion has increased making it more
difficult for applicants to obtain nursing student places at university. There is a fear that
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in the future there may be a shortfall in qualified nurses.
Other challenges faced in nursing student placements, noted by universities, is the
ability to gain placements in community due to supervision and nature of work. Also the
congregation of acute centres with consolidation of services can also reduce the number
of opportunities for student placements.
In Northern Ireland the Royal College of Nursing (RCN), a professional organisation for
nurses, also offer training through programmes and events for nurses, health care
assistants and student nurses. These are mainly delivered in Belfast or in some
instances at workplaces.
In Republic of Ireland the equivalent to NMC is An Bord Altranais and nurses are
required to register with the respective organisation to enable them work across
juridictions.
Continuing Education
Most health care professionals in clinical roles are trained at University level. Trusts in
Northern Ireland offer developmental training through their management development
departments as well mandatory training to ensure individuals are equipped for their professions. RCN also offer support for degrees or postgraduate courses. In the Republic of
Ireland continuing education follows a similar pattern.
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9. HEALTH CARE PROFESSIONALS
Northern Ireland Staffing Levels
The following table 4 sets out the number of staff employed across the NPP catchment
of Northern Ireland. The Greater Belfast area health care staffing areas have been
excluded from this analysis. In total there were over 41,800 staff employed within the
four Trusts and 1138 Northern Ireland Ambulance Service staff.
Table 4: Staff Employed in Northern Ireland (excluding Belfast) - 31st March 2012
Notes:
Figures exclude bank staff, staff on career breaks, Board members, and staff with a whole-time
equivalent of 0.03 or less. NI Ambulance Service Trust staff are excluded from the Trust Total.
Source: Human Resource Management System, DHSSPS.
In terms of proportion, Nursing and Midwifery are 25% of the workforce, administrative
& clerical are over 16% with other staff groups forming lower proportions.
Turnover rates for Northern Ireland Health Care Staff
Figures on turnover have only been drawn from 2010/2011 information where it was
concluded that while nursing staff had the highest volume of leavers at 897 (for the
year April 2010 to March 2011), this represented the second lowest leaving rate at 4.3%.
The joining rate, however, decreased to 2.3%.
Support Services staff had the highest leaving rate at 7.1% of staff in post, representing
483 staff.
Levels of movement between HSC organisations were highest amongst Professional &
Technical staff at 1.6%. The majority of this was among Allied Health Professions and
Psychology staff.
Republic of Ireland Staffing Levels
Figures are not readily available for the western counties of ROI catchment area,
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however the total number of staff in the HSE was recorded as 104,392 (see table 5)
which was a reduction of 3.3% compared to the end of 2010.
Table 5: Employment Monitoring Summary in HSE
Source: HSE Employment Report to CEO
With the exception of medical/dental positions all staff categories were below the 2010
levels. The impact of a voluntary early retirement scheme and voluntary redundancy
scheme was seen in 2011 in the exit of 2006 staff across the HSE.
At the end of 2011 staff turnover amounted to approximately 7000 whole time
equivalents (WTE) as opposed to 370 WTE new positions commenced during the year.
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Recruitment and Retention of Healthcare Professionals – Overview on Challenges
Through initial discussions with service managers and human resource senior managers,
there are challenges across certain categories of staff, particularly in the western areas.
Such challenges appear in medical groups, mental health, child and adolescent mental
Health Services (CAMHS) in ROI, critical care in ROI, childrens nursing and some
community functions.
The HSE for the past five years has been going through a significant reform process as a
result of which staff are redeployed throughout the system to meet current and future
needs of clients. To some extent this is also happening in Northern Ireland especially in
line with regional strategies like “shared services” where some administrative and
clerical functions are being centralised across the province.
As stated, the HSE have been challenged in filling some specialised posts most notably in
the area of Neo Natal, Theatre and Critical Care. However, it is understood there has
been a global shortfall in recruits in meeting criteria for these positions. The HSE is also
adopting an approach of internal development in conjunction with universities and
educational sector. Other challenges are the attraction of qualified audiologists and
work is under way between HSE and a UK university to sponsor a number of students to
obtain the qualification.
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10. SUMMARY OF FINDINGS
A number of key challenges have been identified throughout the compilation of this
status report and it is important to present these to the reader as a baseline for further
investigation or action.
i)
The Northern Periphery Programme catchments areas in Ireland fall across two
principle government jurisdictions. In terms of consistency of gathering information
on demographics, workforce turnover etc… this has been challenging e.g separate
census sources.
ii)
In terms of populations statistics there is a projected increase in the older population
across the catchment areas which will result in more pressure upon health care
provision. The younger population is also expected to rise in the west of Ireland,
however migration trends will offset this rise to a gradual increase in overall
population.
iii) Deprivation measures have highlighted a few areas which are more disadvantaged than
others which are Donegal, west coast of Galway and also the western side of Northern
Ireland.
iv) Unemployment has increased in both jurisdictions with particular blackspots
highlighted in count areas of Londonderry, Donegal, Cork and Limerick.
v)
Tough austerity measures have been implemented in the Republic of Ireland which has
sliced health care budgets and inhibited the ability for health care agencies to recruit
staff on a like for like basis. This places increased pressure on those service heads to
concentrate efforts on staff retention to avoid potential service gaps if key staff leave
organisations.
vi) Change is taking place across the organisation of Health care both north and south of
the border which may have an impact upon the “recruit and retain” project. In
Northern Ireland a “Transforming Your Care” strategy has been developed to provide
as much health care closer to home rather than in hospital facilities which may work
towards a reduction in the number of acute hospitals. In the Republic Ireland, a Health
Service Bill 2012 is being implemented to reduce structural tiers and aim to provide
health care more in line with patient needs. There has been emphasis in ROI in
establishing more primary care teams.
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vii) Nursing student placements are under pressure with reduced government funding to
universities, strategies towards re-design & consolidation of hospital services and the
ability of community health care to absorb student placements. This may lead to a
future shortfall in qualified nursing staff.
viii) Challenges in attracting medical staff to rural hospitals may be attributed to a lack of
previous work experience or placement of the individuals in those facilities.
ix) Through interview with key HR directors it has been discovered that some specialised
positions have been difficult to fill in the Health Service Executive e.g Neo Natal,
Theatres or Critical Care.
x)
Regarding workforce statistics, overall there have been relatively few positions created
in the HSE compared to staff turnover. Redeployment mechanisms are put in place to
try and meet current and future needs. In Northern Ireland the allied health
professions and technical staff have the highest levels of movement between HSC
organisations.
xi) Urban area comparisons have shown that population in the rural areas of Northern
Ireland will increase at a greater pace than in the urban Belfast area.
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11. REFERENCES
The Irish Meteorological Service Online (www.net.ie/climate-ireland)
Northern Ireland Statistics and Research Agency (www.nisra.gov.uk)
Cooperation and Working Together partnership (www.cawt.com)
Central Statistics Office for Ireland (www.cso.ie)
Report of the Inter-Departmental Urban-Rural Definition Group – Department of Finance
and Personnel (Feb 2005)
Labour Market Monthly Report, Department of Trade and Investment for Northern
Ireland www.detini.gov.uk/labour-market-report
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