Joint Committee on Health & Children
11th June 2013
Opening Statement
by
Mr Barry O’Brien
National Director, Human Resources
Health Service Executive
Good afternoon Chairman and members of the Committee.
Thank you for the invitation to attend the Committee meeting.
I am joined by a number of my colleagues:

Dr Ciaran Browne, National Lead, Acute Services

Prof. Eilis McGovern, Director of Medical Education and Training

Mr. Andrew Condon, General Manager, Human Resources
Introduction
Non Consultant Doctors play a very important and fundamental role in the provision of services in our
hospitals. The current NCHD workforce comprises approximately 4,910 NCHDs, including 570 Interns,
1,812 Senior House Officers (SHOs), 1,620 Registrars and 908 Specialist / Senior Registrars.
Of the 4,910, 80% hold structured training posts; while 20% of NCHDs hold service posts. In recent years
the HSE has increased the proportion of NCHDs in formal training schemes from less than 40% to
approximately 80%, increased the number of Specialist Registrar posts by 60% and this year, will further
increase intern posts from 570 to 639.
HSE recruits a small proportion of NCHDs
There are two types of NCHD posts – training posts and service posts. 81% of NCHDs are recruited by
postgraduate training bodies for placement in training posts in hospitals or health agencies. The HSE
recruits approximately 15% of NCHDs – all of whom are recruited to service posts. HSE-funded agencies
recruit the remaining 4% of NCHDs to service posts.
Particular Hospitals and specialties have experienced difficulties filling NCHD posts over the past number
of years. Addressing this issue has been a priority for the health service and has included a number of
recruitment programmes internationally.
This has meant that over the past three years, the vast majority of NCHD posts – 98% - are filled
normally. Where staffing issues exist, there remain sufficient agency staff to meet service needs. This
means that the hospital system has operated with a small ongoing vacancy level in recent years.
In this context, a challenge facing the health service is that higher payments to agency staff have
incentivised NCHDs to leave normal employment and work for agencies with the expectation that they will
be hired back by hospitals. This is particularly relevant in Emergency Medicine and Psychiatry.
NCHDs are recruited twice a year – in January and July – to accommodate training rotations. A number of
recruitment processes are underway in preparation for July 2013:
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
Postgraduate training bodies are filling posts on training schemes;

the HSE Centralised Applications process – which simply directs applications to hospitals

local recruitment by HSE hospitals and agencies – where candidates are selected, interviewed and
a decision made to fill posts;

external recruitment in South Africa – focusing on Emergency Medicine;

An agreed process with the College of Physicians & Surgeons of Pakistan to rotate their trainees
into Irish hospitals as part of their training scheme in Pakistan before they return to training posts in
Pakistan.
Particular concerns identified in relation to recruitment for July 2013 include changes in the quality
of applicants to some sites in terms of training or experience, the ongoing requirement for Registrar level
doctors in Emergency Medicine and Anaesthesia who are in short supply internationally and the
consequences of ongoing adjustment of training schemes to ensure participants have a reasonable
chance of competing successfully for consultant posts. This means that some schemes are reducing the
number of training posts – albeit the proportion of training posts continues to increase.
3. Specific actions to ensure posts are filled

College of Physicians and Surgeons of Pakistan – the HSE MET Unit and ISD have worked to
together with the College to place trainees in a structured training programme in Ireland for two years.
The interview process indicated – which was conducted in conjunction with the relevant postgraduate
medical training bodies – that applicants were of a high standard. This initiative is likely to yield up to
30 doctors in 2013 but has potential for greater numbers and additional specialties in 2014 and
beyond - and will be of significant benefit to Emergency Medicine – a specialty that has been
consistently at risk of vacancies over recent years.

South Africa – earlier this year the HSE engaged 2 recruitment companies to begin the process of
sourcing additional doctors from South Africa. This was initially focused on access through the
Supervised Division but revised access rules for general registration based on South African intern
equivalency from 2006 required a change in approach. Initial reports from the recruitment companies
indicate potential availability of 10-20 candidates primarily in Emergency Medicine with limited
numbers across other specialties. Depending on specialty match the HSE will assign these doctors to
work in hospitals with traditional recruitment challenges (e.g. Drogheda, Letterkenny).

Medical Council - Since February, the HSE has provided four administrative staff to the Medical
Council to support the efficient and timely registration of doctors prior to the July rotation.

Ongoing local and national recruitment - the normal NCHD recruitment process is currently taking
place in parallel to the measures above following advertising by the National Recruitment Service
nationally and internationally. Delays in confirming fill rates for training scheme posts and timeframes
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for interviews create difficulty in accurately reporting on vacancies. Current data indicates that
approximately 200 posts remain to be filled for the July rotation. These constitute 4% of all NCHD
posts. Vacancies are concentrated in three specialties – Anaesthesia, General Medicine and
Emergency Medicine, at Registrar level. Alongside the measures described above, hospitals
experiencing particular challenges have been authorised to advertise – nationally and internationally
in addition to broader HSE advertising. Hospitals are also evaluating revised NCHD rotas and – in
exceptional circumstances, the use of agency staff. This latter option is clearly a last resort given the
financial implications. Vacancies are generally located in small-medium size hospitals which have
limited consultant numbers and do not have the volume or complexity of activity to support training
posts.

Taking account of trends in filling posts over the last number of weeks and noting that the system
operates with an ongoing vacancy level, it is anticipated that the vacancies will reduce on a day by
day basis in the period up to 8th July.

Retention of Irish medical graduates - the HSE is a partner in an NCHD Graduate Retention initiative
established in 2012. As part of this initiative appropriate support services for trainee doctors are being
identified and trainee doctor representatives, who will represent the concerns of trainee doctors at a
senior level with the hospital management structure, are being appointed.

Key concerns in terms of retention are long working hours and pay for hours worked. In this context
the HSE has established a National Implementation Group to progress compliance with the
requirements of the European Working Time Directive and facilitate introduction of electronic time
recording and rostering systems. The Minister for Health has indicated to the European Commission
that it is committed to full implementation of the EWTD for NCHDs by end 2014;

Each hospital / agency has prepared an action plan which identifies the steps to be taken to
implement the National Standards, other actions that will reduce NCHD hours and related timescales
and accountability with a particular focus on two key targets:
1. A maximum working week of 68 hours;
2. A maximum period on-site on-call of 24 hours.
The National Group has just completed a process of site visits to each acute hospital and will be
reporting on the extent to which NCHDs are compliant with the 68 hour target in coming weeks.

Under the Public Service Sustainability Agreement – which the IMO is recommending that its
members accept – the IMO and the HSE have agreed, under the heading ‘Retention of Graduates of
Irish Medical Schools’ to:
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“review the current Public Health & Community Medicine, NCHD and Consultant career
structure with the aim of further developing the career and training pathways from Intern to
Consultant / Specialist level. This will take account of service needs, training and service
posts, the health reform programme, the urgent requirement to reduce NCHD working hours
and developments in relation to EU legislation. The overall objective is the retention of
graduates of Irish Medical Schools within the public health system and the attraction back to
Ireland of such graduates - where they have left previously. The Management side and the
IMO will begin the process by June 2013.”

Also under the Public Service Sustainability Agreement, the IMO, INMO and SIPUT have confirmed
their full cooperation with the commencement of task reallocation from doctors to nurses, in specified
areas, as follows:
1. phlebotomy,
2. cannulation,
3. first dose medication,
4. delegated discharge.
and have committed to further negotiations on other changes to healthcare delivery in order to
achieve EWTD compliance:

While there is agreement on the principle underpinning the savings that may be realised from task
reallocation, there is debate regarding the quantum of savings that can be achieved. Taking that into
account the parties have agreed that an intensive evaluation process take place on a number of acute
sites (Beaumont, Tullamore, Mater) to identify realisable cash savings. This process is underway
currently.
This concludes my opening statement and together with my colleagues we will take your questions.
Thank you.
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