The impact of austerity on the health workforce and the achievement of human resources for health policies in Ireland (2008–2014)

Abstract

BackgroundThe global economic crisis saw recessionary conditions in most EU countries. Ireland’s severe recession produced pro-cyclical health spending cuts. Yet, human resources for health (HRH) are the most critical of inputs into a health system and an important economic driver. The aim of this article is to evaluate how the Irish health system coped with austerity in relation to HRH and whether austerity allowed and/or facilitated the implementation of HRH policy.MethodsThe authors employed a quantitative longitudinal trend analysis over the period 2008 to 2014 with Health Service Executive (HSE) staff database as the principal source. For the purpose of this study, heath service employment is defined as directly employed whole-time equivalent public service staffing in the HSE and other government agencies. The authors also examined the heath sector pay bill and sought to establish linkages between the main staff database and pay expenditure, as given in the HSE Annual Accounts and Financial Statements (AFS), and key HRH policies.ResultsThe actual cut in total whole-time equivalent (WTE) of directly employed health services human resources over the period 2008 to 2014 was 8027 WTE, a reduction of 7.2% but substantially less than government claims. There was a degree of relative protection for frontline staffing decreasing by 2.9% between 2008 and 2014 and far less than the 18.5% reduction in other staff. Staff exempted from the general moratorium also increased by a combined 12.6%. Counter to stated policy, the decline in staffing of non-acute care was over double than in acute care. Further, the reduction in directly employed staff was to a great extent matched by a marked increase in agency spending.ConclusionsThe cuts forced substantial HRH reductions and yet there was some success in pursuing policy goals, such as increasing the frontline workforce while reducing support staff and protection of some cadres. Nevertheless, other policies failed such as moving staff away from acute settings and the claimed financial savings were substantially offset by overtime payments and the need to hire more expensive agency workers. There was also substantial demotivation of staff as a consequence of the changes.

Doctor, how can we help you? Qualitative interview study to identify key interventions to target burnout in hospital doctors

“…The overwhelming emphasis on issues of staffing, cover and leave in our study is in line with other studies and not surprising, given the current doctor shortage and growing patient population in Ireland 34 38. The shortage of doctors is a global phenomenon predicted to reach crisis levels by 2030 39–42. Burnout has been associated with increased physician attrition,43 and as more burnt-out physicians reduce their hours, migrate and seek early retirement, those who stay are left under greater strain.…”

“…This suggests that the current situation in some hospitals could be improved through optimisation of existing management and HR practices. This finding adds further nuance to a related finding in a 2016 study of key stressors for hospital doctors in Ireland where the top three stressors for consultants were related to a lack of long-term planning, quick fix management decisions with respect to resourcing among other things and staff shortages 39…”

Burnout in consultants in child and adolescent mental health services (CAMHS) in Ireland: a cross-sectional study

“…Current consultant psychiatry numbers (per 100 000) in Ireland are less than half the EU average, and a vicious cycle is perpetuated between under-resourcing, poor work conditions, high work stress, long waiting lists and unacceptable patient risk. Retention of existing staff and recruitment of new staff are a top priority, yet difficult to attain, with both Irish trained and non-EU trained doctors considering leaving 35. In our study, as with other studies, new entrants to consultant posts are already showing signs of high BO, with many newly trained doctors now choosing to emigrate.…”

Impact of economic recessions on healthcare workers and their crises’ responses: study protocol for a systematic review of the qualitative and quantitative evidence for the development of an evidence-based conceptual framework

“…As other workers during an economic recession, healthcare workers are affected by a combination of job insecurity, decreased purchasing power and reduced labour market opportunities 9. It has also been suggested that these effects are often amplified by the reduction of welfare support and salary cuts by the restrictive policies governments typically apply to the largest spending sectors (including commonly health) in the attempt to balance budgets and reduce deficits 8 10…”

“…The known effects of economic contractions and austerity policies on health workers include salary cuts and job losses, compounding migration intentions,11 12 decreased motivation,10 unwanted organisational changes13 and an increase in the tendency to engage in concurring profit-generating activities,14 often at the expense of the quality of service. Scholars have started to explore the area of the effect of Europe’s most recent financial crisis on human resources for health (HRH) policies,15 and health workers’ responses to the changing economic circumstances,10 11 16 but to the best of our knowledge, no specific review has been conducted on this subject.…”