Implications for health system reform, workforce recovery and rebuilding in the context of the Great Recession and COVID-19: a case study of workforce trends in Ireland 2008–2021

Abstract

Background Workforce is a fundamental health systems building block, with unprecedented measures taken to meet extra demand and facilitate surge capacity during the COVID-19 pandemic, following a prolonged period of austerity. This case study examines trends in Ireland’s publicly funded health service workforce, from the global financial crisis, through the Recovery period and into the COVID-19 pandemic, to understand resource allocation across community and acute settings. Specifically, this paper aims to uncover whether skill-mix and staff capacity are aligned with policy intent and the broader reform agenda to achieve universal access to integrated healthcare, in part, by shifting free care into primary and community settings. Methods Secondary analysis of anonymised aggregated national human resources data was conducted over a period of almost 14 years, from December 31st 2008 to August 31st 2021. Comparative analysis was conducted, by professional cadre, across three keys periods: ‘Recession period’ December 31st 2008–December 31st 2014; ‘Recovery period’ December 31st 2014–December 31st 2019; and the ‘COVID-19 period’ December 31st 2019–August 31st 2021. Results During the Recession period there was an overall decrease of 8.1% (n = 9333) between December 31st 2008 and December 31st 2014, while the Recovery period saw the overall staff levels rebound and increase by 15.2% (n = 16,789) between December 31st 2014 and December 31st 2019. These figures continued to grow, at an accelerated rate during the most recent COVID-19 period, increasing by a further 8.9% (n = 10,716) in under 2 years. However, a notable shift occurred in 2013, when the number of staff in acute services surpassed those employed in community services (n = 50,038 and 49,857, respectively). This gap accelerated during the Recovery and COVID-19 phase. By August 2021, there were 13,645 more whole-time equivalents in acute settings compared to community, a complete reverse of the 2008 situation. This was consistent across all cadres. Workforce absence trends indicate short-term spikes resulting from shocks while COVID-19 redeployment disproportionately impacted negatively on primary care and community services. Conclusions This paper clearly demonstrates the prioritisation of staff recruitment within acute services—increasing needed capacity, without the same commitment to support government policy to shift care into primary and community settings. Concerted action including the permanent redistribution of personnel is required to ensure progressive and sustainable responses are learned from recent shocks.

Responsive and Resilient Healthcare? Moments of Resilience in post- hospitalisation services for COVID-19

“…We found that at each case study site, the needs of patients following a hospital admission with COVID-19 created conditions that required strategies to build resilience into healthcare systems (21,31). In response to witnessing the impact of COVID-19 in the acute phase, and demand in the community for speci c services for patients experiencing on-going issues, at each case study resource management was required as staff took action to redesign and restructure sociotechnical resources available to them to establish follow-up provision for patients (30).…”

Work-related experiences of consultant psychiatrists during the COVID-19 response: qualitative analysis

“…guidance surrounding infection control), all need to be seen within the context of the historical deprioritisation of community mental health services in Ireland. 10 , 11 Although this study did not directly seek to compare the experiences of those working in community sectors with those in hospital sectors, it is interesting to note a number of recent studies showing how some healthcare workers in hospital-based settings during the COVID-19 response reported experiencing improvements in their working environment. This seeming paradox can be explained to a large extent by surge capacity measures initiated, such as improved staffing, sick leave cover as well as improvements in infection control measures.…”

“…23 At a broader level, it could be argued that the syndemic nature of COVID-19 as experienced by the most economically precarious and marginalised, as well as the burnout crisis among consultant psychiatrists, are both driven by what Rose et al 24 describe as a hollowing out of community mental health services as a result of more than a decade of austerity-driven policy in the provisioning of healthcare and social protection in Ireland and elsewhere. 10 Therefore it is crucial that an understanding of the syndemic nature of health crises like COVID-19 is at the forefront of current debates regarding how to enhance the resilience of healthcare systems. 25 Such an understanding would compel addressing the structural antecedents of distress among healthcare workers in both community and acute settings, such as improved working conditions and better delineation of responsibilities between clinicians and senior management.…”

Enumeration of the Public Health Workforce in New York State: Workforce Changes in the Wake of COVID-19

“…While the principal causes of workforce shortages differ by region, country, state, and locality, many of the core sources, identified across existing literature, reflect findings from this study, including low salaries, gaps in training and education, lack of long-term career growth opportunities, and long recruitment timelines [ 3 ]. Several European countries, including France, Germany, the Republic of Moldova, Italy, and England report difficulties recruiting students into public health due to low salaries [ 19 ]. In England, a lack of specific training and professional development pathways create a barrier to entering the public health field as a long-term career trajectory.…”