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Monday 11 December 2023 Dublin: 9°C
Don Moloney
Health in Ireland

'I’ve never seen morale so broken': What one change do healthcare workers want to improve the system?

We asked health workers and others familiar with the sector what they want to see happen to improve healthcare in Ireland.

IRELAND’S HEALTHCARE SYSTEM is frequently hit with criticism and suggestions for how it can be improved. 

Change is currently underway in the form of Sláintecare – the programme aimed at eliminating Ireland’s two-tier health system. 

But progress on the overhaul has been slow. In the meantime, patients and staff continue with the system in place.

We asked a number of healthcare workers and others familiar with the sector: What one thing would you like to see happen to improve healthcare in Ireland? 

Here’s what they said.  

Dr Catherine Motherway – head of the Intensive Care Unit at University Hospital Limerick 

“I would like policymakers to listen to frontline staff and if they commission reports, to act upon them.

“If they commission a report from a group of experts, they should act upon them and publish them and if they can’t act upon them, say why not.”

Tony Gregg – paramedic and branch secretary for the National Ambulance Service Representative Organisation

“The one thing from a paramedic point of view to improve services would be a more fluid system of admission through the Emergency Department.

“Ambulances are held up unnecessarily at A&Es due to the crowded situation that exists at the moment. We need to get into A&Es to drop people in quicker and do the job we need to do quicker.”

Tadhg Daly – CEO of Nursing Homes Ireland 

“I think the big thing really is development of primary care services. For me, care in the community is huge. Access to therapies like OT [occupational therapy], physio and public health nursing for people in the community and nursing homes is critical.

“We’re working with the HSE on mobile medical X-rays. If you take an older person in a nursing home – 89, 90 years of age – it makes no sense for that person to be sitting in an ambulance or transport going into a hospital for an X-ray. So bring the service out to people.

“I think there’s a role there for nursing homes in that. Nursing homes have the physical infrastructure for example.

If you’re in West Cork or North Donegal and you’ve a nursing home there based in Gortahork or Castletownbere, why would you be building a primary care centre beside it?

“Why not actually bolt on services to the nursing home and get people to come into the nursing home for their monthly check-up or their wound care or whatever. Utilisation of existing resources and the whole of primary care services is critical.”

Dr John Cannon – non-consultant hospital doctor and chair of Irish Medical Organisation’s NCHD committee 

“The government needs to start listening to the staff of the health service, particularly its young doctors. We want to stay in Ireland, we’re giving them every opportunity to change things, we’re telling them what will stop us from emigrating.

But the government seems unwilling to listen to young doctors, who are the GPs and consultants of tomorrow.

“It’s a great shame, because most of us want to stay in Ireland, but the government through neglect, equivocation and disinterest is slamming the door on us and perpetuating the recruitment and retention crisis for another twenty years.

“Essentially the government is calling the bluff of young doctors. They’re gambling that we will tolerate the untenable and austere conditions because we have a vocation and calling to be doctors.

“They’re gambling we will work unsafe hours because we won’t leave the hospital until every patient has been seen and their needs attended to. They’re gambling that a tired doctor won’t make a serious or life-threatening mistake because of exhaustion.

“They’re gambling we won’t emigrate because of our love of Ireland and our family ties.
And where has that strategy got them?

I’ve never seen morale so broken. This generation of doctors is ready to pack its bags unless the government decides to stop equivocating and act. But no one is listening.

Dr Illona Duffy – Monaghan GP  

“Improved access for everybody to general practice in Ireland. We now know that there’s so many people out there with no GP.

“The HSE has always wanted to ignore this as a problem until it came to Covid when they needed to [address it].

“They asked the IMO [Irish Medical Organisation] and the ICGP [Irish College of General Practitioners] to ask members to take on these patients in a temporary capacity.

“This allowed them to get social welfare services so they wouldn’t go into work with Covid and so that they could get tests done. It proved so important, but it also proved that the HSE knows that there are loads of people with no GP.”

Lourdes Sanchez – family carer for her son Conor

“At the moment for us, the main issue is to get respite. I’ve been fighting for that since August [2021] because we used to get six nights of respite per month. Then when Covid started, that was suspended completely. It hasn’t been reinstated. 

The premise of respite is seen as nice to have and it’s not that at all. Respite is not a nice to have, respite is a necessity for families.

“In my case, my husband has MS [multiple sclerosis] and he cannot look after our son. I can barely look after him. And even though we have home support, it’s exhausting because we have Connor 24/7.

“For us, that little bit of respite gives us the opportunity to recharge and to have something to look forward to. 

“We never go out as a family, we never go on holidays, we never have some time away so it’s not a ‘nice to have’, it’s a necessity. They fail to recognise that respite is a necessity. 

“There are many [issues], it’s not the only one. But right now it’s my main objective to get that respite reinstated.” 

Dr Mohsin Kamal – paediatric doctor  

“The one thing I want to change in the Irish health system is fair chances of medical training on merit for everyone, irrespective of their ethnicity.

“I want Ireland to give equal opportunities to everyone and if someone has already gained experience in the system, then the system needs to utilise that experience to provide the highest level of care.

“If Ireland starts giving BST [Basic Specialist Training] exemption on the basis of experience and membership exams to overseas doctors, then within five years our health system will have enough doctors to run the system efficiently.” 

Ciarán Freeman – third year nursing student in NUIG and chairperson of the Irish Nurses and Midwives student section  

“With one year left until I qualify, I want to see Ireland try its best to keep [nurses] here when we graduate. One change we want to see is the government to take leadership in following up on promises to improve our conditions.

Currently, and for the last number of years, Irish nurses and midwives have been working in incredibly challenging conditions, and as their students we’ve been by their side throughout it all.

“Irish third level students pay the highest fees in the EU, and yet no nursing student in Ireland currently receives adequate allowances to even cover their transport to placements. When this is how we are valued as students by the HSE, we know it will be no better when we qualify. 

“The future of the HSE depends on significant improvements in our conditions. Most of us want to stay – so don’t keep forcing us to leave.”

Dr Damien Lowry, chartered member of the Psychological Society of Ireland

“Improve the staff-facing supports that currently exist in the format of occupational health, particularly in terms of resourcing this domain with psychological personnel.

“Recent research [currently under peer review], led by psychologists at the Mater Hospital, on healthcare workers across five, prominent, Dublin-based, adult hospitals (Mater, James’s, Beaumont, Tallaght and Vincent’s) revealed markedly elevated levels of psychological distress amongst survey respondents.

“It’s also well known that healthcare workers have experienced higher levels of mental health distress long before the Covid pandemic. 

Our staff is our greatest resource and patient care is likely to be enhanced by a healthy workforce.

Eimear Kyle – third year in TCD undergraduate medicine and spokesperson for the Association of Medical Students Ireland

“The overarching feeling of many Irish medical graduates knowing no alternative but to emigrate in search of better pay and working conditions is undeniable.

“It could be derived from the relative inaccessibility to medical education to begin with.

“Many students believe that expensive preparation courses for the HPAT and GAMSAT [admission tests] are required not just to succeed, but to merely level out the playing field to begin with.

“The specialist Graduate Entry Medicine loan from Bank of Ireland is being discontinued this July.

This will likely further the culture of financial inequality within medical education, with a decrease in levels of diversity within Irish medicine and the closing of doors for people who are greatly suited and would contribute to the field.

“The overwhelming message here is that only well-off families have the ability to support their children through a medical degree.

“The issue of repaying such a large debt needs to be addressed. No doubt, such debts result in emigration to countries that boast higher pay scales. It is this attitude and culture that will only exacerbate the current shortage of medical doctors in this country.”

This work is co-funded by Journal Media and a grant programme from the European Parliament. Any opinions or conclusions expressed in this work are the author’s own. The European Parliament has no involvement in nor responsibility for the editorial content published by the project. For more information, see here

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