The very obvious difficulties the health service has in recruiting and retaining qualified staff lie at the heart of talks about to get under way between the Department of Public Expenditure, unions representing doctors and nurses, and the public service pay commission.
However, the significance of the discussions starting today runs far beyond health.
The support of nurses is seen in Government as critical in getting the proposed new national pay agreement over the line, following the decision of the Irish National Teachers Organisation members to reject the deal last month.
With its 40,000 members, the Irish Nurses and Midwives Organisation (INMO) is now in a pivotal position to decide the fate of the agreement, and may be in a position to extract a price commensurate with its strategic influence.
The INMO has put off a decision on whether to recommend the agreement to its members until a meeting of its executive council at the end of this month, but says it wants to see real progress on issues of concern by then.
The health service unions want the Government to show flexibility in dealing with the recruitment and retention issue, identified by Minister for Health Simon Harris as his main priority.
The challenge facing the Government is to design a set of incentives to make working in the health service more attractive, without setting a costly precedent that would have to be applied in other sectors. Aside from the political considerations, though, there are very good reasons for addressing the daunting staffing issues that affect the Health Service Executive. Currently, up to 400 consultant posts lie unfilled, while some recruitment campaigns for consultants have attracted no qualified applicants. More than 50 new junior doctors say they intend to leave after training.
“HSE hospitals are not an employer of choice for many doctors, not when rival systems in the US, the UK, Canada and New Zealand are offering better pay and working conditions,” says a spokeswoman for the Irish Medical Organisation.
The INMO estimates that 1,000 of the 1,600 newly trained nurses have left the State to work in health services elsewhere.
The price of these staffing problems is increased pressure on other staff, massive bills for agency staff, repeated and often fruitless recruitment campaigns in far-flung parts of the world, and continuing bad press about the health service.
“If anyone thinks they can solve these problems of recruitment and retention without addressing pay, they are mistaken,” says Liam Doran, outgoing general secretary of the INMO. “Ultimately, the only solution that will work long-term is to employ Irish-trained nurses in the Irish health service.”
The union wants to see nurses and midwives starting on the same pay as other health professionals such as physiotherapists or dietitians – currently, the gap is €5,000-€6,000 a year, rising to €7,000 after 15 years.
Under an agreement reached between the HSE and the INMO earlier this year, 1,000 new posts are to be created by the end of the year.
However, the union is unhappy with the implementation of this plan, and it wants this addressed in the latest talks.
Even if that agreement is fully implemented, there will still be 2,000 fewer nurses working in the health services at the end of 2017 than a decade ago, Doran points out. Brexit will ensure the pressure stays on, with British health bodies recruiting in Ireland “like never before”, he predicts.
The shortage of nurses seems particularly acute in areas such as theatre and intensive care, but the INMO is insistent that any incentives agreed be applied across the board rather than targeted at areas of greatest need.
This has obvious implications for costs, and knock-on effects in other parts of the public sector.
The outflow of doctors from the system is as much due to lack of resources and proper organisation as pay, so it is possible that the current talks could provide non-pay solutions to the problems afflicting hospitals, such as theatre closures, a lack of protected theatre time, and organisational backup.
Top of the agenda of the Irish Medical Organisation will be an end to the pay differential between older staff and those appointed since a pay cut was imposed in 2012.
Although this cut has since been partially reversed, the organisation says it can still take newer staff up to a decade to achieve parity.
The measure, put forward for understandable reasons during the economic downturn, has probably outlived its usefulness.
It has certainly attracted the ire of the profession and is constantly cited by emigrating doctors as one of the main reasons why they decided to leave.