Ireland will need an additional 6,236 Consultants over the next eighteen years to deliver the Consultant Delivered Health Service, which is a key element of the Government’s programme of strategic structural reform of the health sector, according to a report providing independent information to the Oireachtas.
In addition to the new Consultants, the report proposes a significant decrease in the number of non-training NCHDs and an increase in the number of NCHDs in-training to facilitate training sufficient Consultants to fill projected vacancies, including retirements and the increased number of new Consultants required.
This implies that expected demand for NCHDs and Consultants would cost approximately €2.2782 billion more in 2042 than in 2024.
The analysis indicates that between 2024 and 2030, to take account of the training to non-training NCHD and NCHD to Consultant ratios, transitioning to the stated targets would necessitate provision of an extra 1,196 WTE NCHDs (2,687 Training, a decrease of 1,489 Non-Training) and an extra 3,322 WTE Consultants.
The Parliamentary Budget Office “Cost and Workforce Projections of Non Consultant Hospital Doctors and Consultants in a Consultant-Delivered Health Service,” is concerned about the continuing high ratio of NCHDs to Consultants in the Irish health service, which has been seen as driven largely by service rather than training needs.
The report is also concerned at:
- The need to ensure that future Consultant vacancies at least cover likely exits by Consultants from the health service, particularly through retirement.
- The availability of training places to aspiring specialists.
- The large number of non-training NCHDs.
“Consultants on the cusp of (or actually taking) retirement from the public health service are being more or less matched by approved vacancies, particularly in recent years. However, it is notable that 23% of vacancies outstanding at the end of 2023 had remained unfilled for 18 months or more,” said the report.
It pointed out that while there had been a gradual increase in WTE Consultant numbers in the Irish public health service, this increase did not meet the targets set by the National Taskforce on the NCHD Workforce.
The report says Ireland is unusual among its international peers in terms of its relative lack of Consultants working in the health service.
The Report said the National Taskforce on the NCHD Workforce had recommended an increase in Consultant posts by 2030, implying a ratio of 110 Consultants per 100,000 inhabitants.
It also says Ireland is an outlier among its OECD peers in terms of its excessive reliance on non-training, non-consultant hospital doctors in the public health system. Such reliance is inconsistent with the overarching policy aim of establishing a Consultant-delivered health service.
The authors said that in recent years there had been several reports and working groups which had supported the need to decrease the ratio of non-consultant to Consultant doctors in the country. These reports had also specifically identified the need to increase the number of Consultants within the Irish public health service and to decrease the use of non-training NCHDs.
The Hanly report noted that increases in NCHDs in Irish hospitals were attributable to largely ad hoc service reasons, with little regard for training or projected workforce needs and was concerned at the NCHD/Consultant ratio of 2.27 NCHDs for every Consultant, but as of March 2024 this had only been reduced to 2.02 NCHDs for every Consultant.
The 2014 MacCraith Report reiterated the views of the Hanly Report regarding the need to reverse the ratios favouring NCHDs over Consultants. The MacCraith Report noted that while there had been an increase in the number of Consultants observed in the period since the publication of the Hanly Report, an increase in NCHDs had also been observed. The increase in NCHDs was, in the view of MacCraith, attributable to service needs, and exceeded the number of training posts on offer.
The report said Ireland’s level of reliance on NCHDs was also an outlier compared to its OECD peers. Ireland, for example had almost twice as many NCHDs per 1,000 of its population as the Netherlands, but in contrast, Ireland’s most recently reported proportion of Consultants was below that of all of their European OECD counterparts. Ireland is an outlier among its European OECD counterparts in terms of its proportion of non-training NCHDs (or equivalents), but has a relatively low proportion of Consultants among this cohort. At the same time, the report said it should be noted that in terms of purchasing power, Consultants working in Ireland earned more than most of their OECD counterparts This was an important factor for consideration in light of the Government’s aspiration towards a Consultant-delivered health service.
The Report said the recruitment of doctors from outside of Ireland was significant by international standards and may be in breach of the country’s World Health Organisation (WHO) obligations
It is noted that 12,824 registered doctors in Ireland in 2023 obtained their first medical qualification outside the country. This represented just over 43% of all doctors registered in Ireland for that year.
It said it was inescapable that the stock of overseas educated doctors had been on a continuous upward trajectory in the last decade or so, more than doubling between 2012 and 2023.
“The most recent figures (mainly 2021) indicated that Ireland ranked fourth among its fellow OECD member countries in terms of its proportion of overseas-educated doctors. It should also be noted that Ireland was the highest-ranked EU Member State on this list.”
Report provides independent and impartial information, analysis and advice to the Oireachtas
The Parliamentary Budget Office (PBO) provides independent and impartial information, analysis and advice to the Houses of the Oireachtas.
It makes it clear that the analysis in the paper was carried out without endorsement or criticism of ongoing policy developments in respect of workforce planning in the wider health service in Ireland.
“It is not the intention of the PBO to critique past or present Governmental and/or policy initiatives via this paper. Nor is it the intention of the PBO to endorse, criticise or warn against any particular level of staffing or spending. The PBO has not analysed demand for private medical services, or the cost of same.”
