Public hospital staffing to increase substantially by 2035

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Workforce requirements for all public hospitals in Ireland were set to increase substantially over the coming years and across all current HGs and proposed RHA configurations, according to the ESRI.

 In a report “Projections of workforce requirements for public acute hospitals in Ireland, 2019–2035,” the ESRI said projected workforce requirements were primarily driven by the underlying projected demand for hospital care, itself a function of a projected growing and ageing population.

The report said an additional 1,695 Consultant WTEs would be required to cater for projected service demands and to reduce the ratio of NCHDs in training:consultants to 1.1:1 and the ratio of NCHDs non-training:consultants to 0.4:1, from current levels.

The application of this skill-mix distribution would also have implications for the projected WTE requirements for training and non-training NCHDs. Under this scenario, projected average annual growth in training NCHD requirements would increase by 2.6 per cent, to 1,629 WTEs, while projected average annual requirements for non-training NCHDs would fall by 2.3 per cent or 767 fewer posts than in 2019.

The ESRI said that using current hospital activity levels as a basis for projecting hospital workforce, however, would ignore large backlogs for care that had developed in recent times. “These backlogs have arisen from a chronic under-investment in capacity and workforce over a number of years, and have been exacerbated more recently by the impact of the COVID-19 pandemic and the cyberattack on HSE information systems.

“Findings from this report suggest that while additional workforce will be required to deliver the necessary additional activity to address waiting lists, most of this extra activity will be non-recurring (i.e. temporary) and required to clear backlogs that have arisen. Once these backlogs have been cleared, the additional recurring activity (and associated workforce) to maintain target waiting times is relatively modest.

“The projections provided in this report assume that this additional care is to be delivered through expansion of public hospital capacity. However, should capacity continue to be purchased from the private hospital system, the projected public workforce requirements would be lower. Additionally, it was outside the scope of the analysis to consider specialty requirements of those waiting and how that might affect the ability of hospitals to deal with backlogs. If backlogs are concentrated in certain specialities, they make take longer to clear as targeted recruitment may be required. As acknowledged in this report, however, addressing waiting-list issues will require a multi-faceted approach as, in reality, backlogs for care are also related to factors such as bed shortages and a lack of theatre space and not just staffing requirements.”

The report said a key element of Sláintecare related to shifting the focus of care delivery from a hospital-centric model to one with greater access to care delivery in the community, which might have knock-on effects for additional acute workforce requirements. As modelled, an enhancement of community care services could help offset a material amount of projected additional workforce requirements, although this represented a relatively small offsetting effect relative to the projected impact of population ageing on workforce requirements. “However, our assumptions are subject to uncertainty. Greater access to community care can be expected to increase demand for these services and their workforce, national and international evidence on the substitutability of community and acute care is mixed. This makes it challenging to model the likely impact of enhanced community care services on acute hospital demand and workforce.”

The ESRI said the main waiting-list assumption in the report assumed that the backlog of cases on the waiting list was gradually reduced over a 10-year period, after which waiting times would be maintained at 12 weeks going forward by planning for additional service demand. It also assumed an OPD conversion rate, or the number of first time OPD attendances ‘converting’ to day or in-patient cases, of 33.3 per cent. An alternative assumption was that the backlog reduction took place over 7 years with a lower OPD conversion rate of 20 per cent.