TÁNAISTE MICHEÁL MARTIN has said it is “inevitable” that the health service will have to move to a seven-day roster.
The Tánaiste was asked about the proposal by The Journal at Bloom in the Phoenix Park today: “I believe it is inevitable. It comes with challenges on the HR front. But you know, in terms of those figures, they were revealing in and of themselves. And we would have all been aware of that anecdotally, in terms of the degree of activity that happens over the weekend.
“It’s not sustainable into the future given the population growth, we have to use our assets to the fullest extent possible. That means using our hospitals to the fullest extent possible and discharging people when they’re ready for discharge, and treating people over the seven day period.”
This comes after HSE chief executive Bernard Gloster said last week that he is seeking to introduce a “permanent” new seven-day working roster for hospital staff.
The HSE said it wants to avoid a “substantial impact” of overcrowding on hospitals.
Many healthcare staff, such as nurses, work on a roster covering a seven-day week already. However, some other hospital staff work on a Monday to Friday basis.
The Taoiseach, who also paid a visit to Bloom in the Phoenix Park today, said a seven-day roster is something the government will be discussing with the healthcare unions.
“We are heading into negotiations on the next round of public pay increases, and of course, that’s the kind of thing that we’re going to want to discuss with the healthcare unions,” he said.
The Taoiseach said it is important to acknowledge that people who work in the health service do work weekends and work nights.
“Sometimes they get a bit offended when people imply that they don’t,” he said. However, the current roster involves more of a “on-call system” in the evenings and weekend.
“We do have a 24/7 health service, but there’s not enough of that happening in the evenings and weekends. So that’s a shift that needs to happen.”
Varadkar said there is 20,000 more staff in the health service than three years ago, stating that there is a need to make sure that some of that additional resources goes into more evening work and weekend work.
“But we also need to be realistic and respectful to healthcare workers. Nobody wants to work weekends for the rest of their life. Nobody wants to work most evenings for the rest of their life,” he said.
Ireland is also in competition with the Middle East, Britain, the US, Canada and Australia, when it comes to recruitment.
“We need to bear that in mind too. Our pay is very competitive in Ireland, our health care workers are paid very well compared to the rest of the developed world. But the terms and conditions aren’t always great.
“And people feel under a lot of pressure, have a lot more patients to care for than they would have in different systems. And we will lose healthcare staff if we don’t work with them on how we reform terms and conditions, so that we get a better health service and also they get a better quality of work life.”
The Business Post reported on 24 May that Gloster told the Oireachtas Health Committee that he was to writing to all hospital staff to request they volunteer for a seven-day working roster to reduce overcrowding to reduce overcrowding in Emergency Departmnents for the June bank holiday weekend.
It reported that the aim is to allow hospitals to discharge patients over the weekends at the same rate as they are during the regular working week. It reported that the absensce of sufficient senior decision makers, such as consultants, means that patient discharges can be delayed over the weekends, adding to overcrowding.
The Business Post reported that Gloster is planning to seek the introduction of the permanent seven-day working rosters for hospital staff in the new public sector pay talks which are expected to begin in the summer.
However, consultants said earlier this month that they already work rosters that cover the full seven-day week.
In a statement on 8 May, Professor Matthew Sadlier, the Irish Medical Organisation’s chairperson of the Consultant Committee, said doctors, including consultants, are already providing seven-day services through on-call rosters to deal with urgent patient need.
“With over 900 vacant or temporary filled consultant posts, we simply do not have enough consultants to provide routine services over five days, let alone seven days,” Saldier said.
Similar to the comments made by Sadlier about consultants providing weekend on-call services, Extra.ie reported that trade union Siptu’s sector organiser John McCamley said radiographers provided a seven-day service in every location.
The IMO warned in a statement today that HSE plans to introduce seven-day working rosters in the health system will not make any meaningful difference if the underlying crises of capacity and doctor recruitment and retention are not urgently addressed.
“Moving services over seven days with the same level of capacity and staffing is not going to make a significant difference,” Sadlier said today.
“We have become focused on patient discharges rather than patient outcomes.
“Doctors must remain free to make the best clinical decisions for patients and not be concerned with notional discharge targets.”
Reacting to the IMO’s comments today, Gloster told RTÉ’s News at One that he would be “a bit disappointed to say that deploying the health service to work beyond an on-call system on the days of the weekend wouldn’t make any difference”.
“I actually believe it’d make a fundamental difference. Even with current resources, the distribution across the week can be better,” he said.
“Our hospital and healthcare system does not function at the weekend at the same rate as it does during the week. The level of discharges in our hospitals and the level of admissions during the week is fundamentally different,” the HSE chief added.
The Irish Nurses and Midwives Organisation (INMO) on Wednesday called on the HSE to take “immediate corrective measures” to deal with hospital overcrowding after it revealed that 11,856 people were without hospital beds in May.
The figures showed the worst level of hospital overcrowding since the INMO began counting trolleys, and beat the previous peak recorded this January.
University Hospital Limerick had 1,857 patients on trolleys, followed by Cork University Hospital with 1,310 patients and University Hospital Galway with 896 patients.
Sligo University Hospital had the 4th highest number of patients on trolleys with 751, followed by Tallaght University Hospital with 704 patients.
Nurses are working in a system that has normalised over 500 people a day on trolleys. They have had little to no reprieve from overcrowding.
— Irish Nurses & Midwives Organisation (@INMO_IRL) May 31, 2023
This type of overcrowding must be immediately addressed by Government and the HSE. pic.twitter.com/ECqkjmh19f
Gloster also last week wrote to healthcare staff pleading with them to volunteer for weekend work ahead of the June bank holiday.
“We appreciate this is a significant request, but evidence informs us that if we do not start to provide a wider range of services over the weekend periods, we will see substantial impact in our hospitals with onward implications for the rest of the healthcare system which extend beyond the bank holiday weekend period,” the letter said.
Gloster told the News at One today that there has been a “varied” response from staff who have been requested to work over the bank holiday weekend.
“I think it’s important to say that the call wasn’t for everyone in the entire health service to turn up this weekend. The call was for the purpose of achieving additional purposeful activity and by that meaning that decisions could be made in hospitals and those decisions could be enabled, be that at diagnostic level or a discharge level,” Gloster said.
He expained that typically coming into a bank holiday weekend, hospital admissions might go down about 20%, but discharges go down about 66%.
“Those two variables don’t add up. So the ask was for additional supports this weekend to try and reduce that”
Gloster said the HSE is also looking into GPs providing out-of-hospital diagnostics.
“We’ve had [this] during the week and now looking to see can we build a model for those for weekends. So this isn’t just about the June bank holiday weekend, this is going to be successive over the next couple of weeks and months,” he said.
“I think what’s important is to say that it marks my intention to bring formal proposals to the representative organisations of all of our grades that our future recruitment would allow us the capacity to roster and deploy on a five over seven basis as opposed to five over five.”
With reporting by Christina Finn
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