Number of unfilled consultant posts increases to 728, 45% more than previously believed – new data analysis
- More than a fifth of all consultant posts are now vacant or unfilled on permanent basis;
- 612,000 people — 12% of the population of Ireland — are now waiting for an outpatient appointment with a consultant;
- More than a quarter of a million have been waiting longer than a year for an outpatient appointment, Irish Hospital Consultants Association data analysis reveals;
- Patients in all parts of the country impacted by significant consultant deficits with the South/South West and Western regions with the highest number of unfilled posts;
- IHCA says worsening wait times can be traced back to a 2012 decision to cut pay of hospital consultants appointed thereafter, calls for immediate reversal.
New data from the HSE's National Doctors Training and Planning unit confirms that over a fifth of all permanent consultant posts, 728 in total, are now vacant or filled on a temporary, locum, or agency basis.
It comes as 612,000 people — 12% of the population of Ireland — are now waiting for an outpatient appointment with a consultant. Over quarter of a million, 255,000, have been waiting longer than a year, five times the 2014 number. A further 75,000 people are awaiting inpatient/day-case treatment.
The new HSE figures, analysed by the Irish Hospital Consultants Association (IHCA), confirm that as of 4 November 2020, of the 728 posts, 554 are at hospital level with 174 at community level (see below). A total of 237 permanent consultant posts are vacant, with two of unknown status and likely vacant. A further 406 permanent consultant posts are filled by temporary and locum consultants, with an additional 83 posts filled on an agency basis. It was previously believed approximately 500 consultant posts were vacant or unfilled on a permanent basis.
The specialties with the largest percentage of permanent consultant posts that are either vacant or filled on a temporary/locum or agency basis are:
Psychiatry — 32%, 153 posts
Emergency Medicine — 29%, 33 posts
Intensive Care Medicine — 27%, 9 posts
Medicine — 22%, 176 posts
Paediatrics — 21%, 49 posts
Pathology — 20%, 60 posts
Radiology — 19%, 60 posts
Surgery — 17%, 93 posts
Of the 83 approved consultant posts filled by agency staff, more than half (46) of these are in psychiatry. Around 1 in 5 posts currently vacant in pathology (23%), psychiatry (23%), and radiology (17%) have been vacant for longer than three years.
The 728 vacant and permanently unfilled consultant posts are at hospital group and community levels with patients across all regions of the country impacted.
Hospital Groups breakdown:
|Hospital Group||Counties||Number of Consultant Vacancies or Permanently Unfilled Posts||No Waiting for Outpatient and Inpatient/Day Case Care (Oct 2020, NTPF)|
|Ireland East Hospital Group||Dublin, Westmeath, Kilkenny, Wexford, Meath||88||135,847|
|RCSI Hospitals Group||Dublin, Louth, Cavan, Monaghan||77||67,632|
|Dublin Midlands Hospital Group||Dublin, Offaly, Kildare||85||111,146|
|University of Limerick Hospitals Group||Limerick, Clare, North Tipperary||52||61,435|
|South/South West Hospital Group||Cork, Waterford, Kerry, South Tipperary, Kilkenny||117||138,748|
|Saolta University Health Care Group||Galway, Sligo, Donegal, Mayo, Roscommon||104||122,480|
|Children’s Hospital Group||Dublin||31||50,389|
Community Healthcare Organisations (CHO) breakdown:
|Community Healthcare Organisation (CHO)||Counties/Areas||Number of Consultant Vacancies or Permanently Unfilled Posts|
|CHO 1||Donegal, Sligo/Leitrim/West Cavan, and Cavan/Monaghan||14|
|CHO 2||Galway, Roscommon, Mayo||16|
|CHO 3||Limerick and North Tipperary/East Limerick||8|
|CHO 4||Kerry, North Cork, North Lee, South Lee and West Cork||28|
|CHO 5||South Tipperary, Carlow/Kilkenny, Waterford and Wexford||22|
|CHO 6||Wicklow, Dun Laoghaire and Dublin South East||22|
|CHO 7||Kildare/West Wicklow, Dublin West, Dublin South City, and Dublin South West||18|
|CHO 8||Laois/Offaly, Longford/Westmeath, Louth, and Meath||17|
|CHO 9||Dublin North, Dublin North Central, and Dublin North West||29|
The South/South West Hospital Group (117) and Saolta University Health Care Group (104) have the highest number of consultant posts vacant or filled on a temporary, locum or agency basis and among the largest waiting lists. However, the University Limerick Hospitals Group has the highest percentage of its posts vacant or unfilled permanently – at 29% (52 consultant posts).
Ending the waiting lists
At 1.49, Ireland has the lowest number of medical specialists per 1,000 population in Europe, 41% below the EU average of 2.53. A HSE report published earlier this year found that Ireland has the lowest number of consultants in practically all specialties, and confirmed the number of consultants in hospital-based specialties will have to increase by more than half (53%) to address current shortfalls and meet increased patient demand to 2028.
The IHCA says that one of the primary causes of the HSE’s worsening waiting list problem is consultant pay disparity. To help fill the 728 vacant posts as quickly as possible, the Association is calling on the Minister for Health and the Minister for Public Expenditure and Reform to end the 2012 pay inequity that was imposed unilaterally on consultants who took up HSE contracts after that date.
IHCA President Professor Alan Irvine commented:
“This data confirms that Ireland’s ability to provide quality, timely care to patients is worsening. Put simply, over 600,000 people require specialist medical treatment but our system is not providing the permanent specialist expertise to care for them.
“A major part of this problem is a direct result of this country’s ongoing consultant recruitment and retention crisis, which is continuing throughout the worst disease pandemic in a century.
“Reduced availability of specialist care means longer stays in hospital beds, which are already in critically short supply. We have welcomed the additional investment in hospital beds but without the permanent specialists to care for these patients, waiting times will get longer and longer as the evidence shows.
“Short-term measures to temporarily fill gaps is both expensive and unreliable. Medical agency costs have doubled. In addition to the large number of permanent consultant post that cannot be filled, the HSE’s employment of 117 doctors who are not on the Medical Council Specialist Register, has contributed to a four-fold increase in medical indemnity claims.
“Whatever theoretical saving was envisaged in the 2012 cut, it has actually generated a massive, ongoing loss to the taxpayer equivalent to hundreds of millions of euro per year. Irish patients are not getting hospital and mental health services that they need; they are simply being added to an ever-increasing waiting list.
“To end both this wasteful expenditure and the consultant shortage, especially in the context of the current public health emergency, we call on the Minister for Health and Minister for Public Expenditure and Reform to urgently prioritise this issue and end the 2012 consultant pay disparity immediately.”
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