4th September 2018

Minister Donohoe welcomes publication of the Report on recruitment and retention issues in the health sector

The Minister for Finance and Public Expenditure & Reform, Paschal Donohoe T.D., today (Tuesday) welcomed the publication of the Report of the Public Service Pay Commission on recruitment and retention issues in certain health sector grades.

The Public Service Pay Commission was tasked under the Public Service Stability Agreement 2018-2020 to conduct a comprehensive examination of underlying difficulties in recruitment and retention of staff in the public service. The Commission adopted a modular approach to its work and the report published today reflects a comprehensive examination of recruitment and retention issues in relation to the grades of Medical Consultants, Non Consultant Hospital Doctors and Nurses and Midwives in the health service. Further considerations and work by the Commission on recruitment and retention issues will address other grades and sectors of the public service.

Commenting on the release of the Report, the Minister said: “I welcome the Report from the Public Service Pay Commission, which was considered by Government earlier today. There are many viewpoints on the issues confronting our health services. That is why the independent evidence-based analysis of recruitment and retention provided by the Commission in this Report is so important.

I know this proved to be a complex and challenging endeavour for the Chairman, the members of the Commission, and the Secretariat. I would like, in particular, to thank the Chair and the members of the Commission for the commitment and expertise which they brought to the task.

“I understand there is a commitment between public service employers and staff representatives to meet within four weeks of to discuss issues around implementation of the Report. It is important that this agreed process is adhered to and that space is afforded to the parties to reflect on the detail in this Report and engage in that process.”

The Commission will be making all of its submissions and inputs and the Report publicly available on its website, www.paycommission.gov.ie.

ENDS

Notes to Editor

Main Findings:
• The main findings of the report are that:
o There is no generalised recruitment and retention problem in respect of nursing and midwifery but some difficulties exist in meeting workforce requirements in specific areas;
o Promotion opportunities and training impact Non-Consultant Hospital Doctors (NCHD) turnover;
o There is a general difficulty in recruiting consultants with certain locations and specialities experiencing more significant problems.

On a general level the Commission noted the following:
“The Commission is not persuaded, based on the evidence available, that current pay arrangements are, in themselves, a significant impediment to recruitment. Indeed the Commission remains of the view, expressed in its first Report, that remuneration is not the main issue impacting on the recruitment and retention where difficulties exist”

“It is apparent to the Commission that where some recruitment and retention difficulties have been identified the causes of such difficulties are multifactorial”.

“Current pay rates do not appear to be unduly affecting the number of nurses, midwives and doctors applying to work abroad”.

“In practice increasing pay may or may not be the most effective option for an employer that wishes to attract more staff”.

In relation to average salaries the Commission found that:
 The average earning for all HSE Staff Nurses and Midwives (excluding all promotional grades) in 2017 was approximately €51,000 including allowances overtime and other payments.
 The average earnings for NCHDs in 2017 was in excess of €74,000 including overtime and other payments.
 The average earnings for Consultants in 2017 was almost €180,000 including overtime and other payments.

Specific findings and recommendations were made in respect of each of the three groups examined.

1. Nurses and Midwives’ Findings
“Since 2013 numbers have increased steadily by an average 2.2% per year (752 WTE), but at 2017 year-end remained 5.7% (2,229 WTE) below the 2007 peak”.
“CAO data supplied to the Commission confirms that, as a percentage, demand for nurse and midwife courses has remained around 9% of total CAO applications from 2007 to 2018.”
“In 2018 there were 5,494 first preference applications for 1,830 nursing and midwifery undergraduate places (3.06 first preference choices for every available place).”
“This is a strong indication that a career in nursing and midwifery continues to be attractive to school leavers.”
“Internationally qualified nurses and midwives are another key supply source for recruitment into the public health service.”
“There are substantial year-on-year increases for EU and non-EU qualified nurse NMBI (Nursing and Midwifery Board of Ireland) registrations between 2014 and 2016. The combined level of internationally qualified nurses and midwives registering in 2016 was 1,552 higher than in 2013”.
“In 2017 the turnover rate (excluding students was 6.8%, 0.3% lower than the 2016 rate. Excluding retirement, the 2017 rate was 5%, 0.2% lower than 2016”.
“The Commission “consider that the national levels of nursing and midwifery turnover rates do not indicate a generalised retention crisis, but that the retention challenge is of an order which would justify some additional measures to reduce voluntary staff departures as far as possible.”
“The available evidence suggests that none of the turnover rates reported are significantly out of line with those experienced in private sector employment generally.”
In relation to Certificates of Professional Status applications required for practice abroad:
“The number of CCPS issued was highest in 2007 at 2,180. In 2017 the comparable figure was 1,343 or 38.4% lower”.
“The number of nurses who received CCPS was highest in 2013 at 1,596, relative to this peak, the number in 2017 was 1,096 or 3.9% less than 2007.” The reduction of 500 nurses requesting a CCPS between 2013 and 2017 is a reduction of 31.3%.
“Evidence examined by the Commission indicates continuing difficulties in retaining nurses and midwives in specific areas”.

2. Non Consultant Hospital Doctors’ Findings
“There has been strong and consistent growth in NCHD numbers.”
“The number of NCHDs has increased by almost 30% during the period 2007 to 2017.”
“It is clear to the Commission that there has been a consistently strong level of supply of doctors over the past decade.”
“The growth in NCHD numbers over the last three years is largely as a result of increased recruitment to achieve European Working Time Directive (EWTD) compliance.
“Ireland produces the most medical graduates per capita in the OECD.”
“Data received in relation to numbers applying and accepting places on medicine courses indicates that a career in the medical profession continues to be highly desirable.”
“Overall, the number of graduates as reported by the Higher Education Authority (HEA) from relevant medical courses has shown strong and consistent growth from 542 in 2009/2010 to 1,252 in 2015/2016, an increase of 230%.”
“A useful indicator of total supply is the number of doctors maintaining their registration on the Medical Council Register. The number of doctors on the Register has been rising each year and data supplied by the Medical Council shows that in the period 2011 to 2017 the number of doctor registrations increased by over 20% to 22,649.”
“The evidence from the Commission’s analysis and various other studies signal that training and promotion opportunities are the key influencer of migration and turnover in this group”

3. Consultants’ Findings
“Consultants were not subject to the Moratorium on Recruitment and Promotions in the public service (2009-2014) and the number of consultants employed has steadily increased over the last decade.”
There has been “an increase in consultant numbers of 33% from 2007 to 2017.”
“The difference between serving numbers and the establishment number has declined from a surplus of 41 in 2007 to a deficit of 169 in 2017.” This suggests some difficulties in filling approved positions through recruitment.
“In 2017 consultant turnover rates based on HSE data were 7.8% (or 6.6% excluding retirements), this is a reduction of 1.1% compared to the 2016 turnover rate”
“By comparison with other sectors, this rate of turnover is low”.
“The 2017 Solas National Skills bulletin reports turnover figures based on QNHS survey data. It reports that in 2016, the Health Associate Professionals rate was 10.3%, the rate for Teaching and other educational professionals was 8.3% and the national average was 14.2%”.
“The Commission concludes that there is a general difficulty in recruiting consultants with more significant problems in certain specialities and geographic locations.”

4. Main Recommendations:
 Location Allowances currently paid to nurses in 13 service areas in the health service should be increased by 20% and extended to cover maternity services.
 Specialist Qualification Allowance currently paid to nurses and midwives who acquire post graduate qualifications in their relevant disciplines should be increased by 20%.
 Staff nurses and midwives should be eligible to attain the grade of Senior Staff Nurse/Midwife after 17 rather than the current 20 years post qualification experience.
 The Commission believes the prioritisation of the four key issues in the Seventh Assessment of NCHD Posts will have the potential to deliver improvements in the employment training environment and family lives of NCHDs. These priority areas are:
1. Protected training time
2. Refund of fees
3. Transfer of tasks
4. The position of ‘service grade doctors’ who do not occupy training posts

5. Other
• It is important to remember that the Government has already committed significant resources to the pay of all public servants under the terms of the PSSA over three years.
• The Agreement runs to December 2020 and has a cost over that period of €887 million
• The benefits to different income groups are progressive range from 7.4 per cent to 6.2 per cent over three years.
• The Agreement includes restoration of pay cuts and the conversion of the existing FEMPI Pension Related Deduction (PRD) into a permanent Additional Superannuation Contribution while providing modest increases in the threshold at which it applies.
• At the end of this Agreement pay cuts will be restored to all public servants earning up to €70,000 which is equal to almost 90 per cent of public servants
• There is also separate engagement underway with ICTU on addressing new entrant pay scale issues which is directly relevant to almost 1/3 of nurses.

6. Health Expenditure and Staffing Trends
 From 1997 to 2017, total Government expenditure on healthcare rose from €3.6bn to €15.6bn
 From 2014 to 2018 spend increased dramatically as health spending increased by an average of €560m annually from the post-crisis trough.
 In total expenditure on health has increased by €2.35bn or 17.7% since 2013.
 Since 2014 there has been a 13% increase in recruitment levels in the HSE. At end 2017 there were 110,795 WTEs employed by the HSE.