Martin Daly: Doctor Exodus, Safe Staffing and Broken Hospital IT

Thank you to the witnesses for attending here today. This is an extremely important topic, and I suppose what keeps coming back in all of the presentations are levels of staffing, capacity, and infrastructure and resources. So I'd like to just again reflect, the amount of young Irish doctors who leave these shores and go to other jurisdictions, most especially Australia, for a number of years, many of them come back, some don't, but one recurring theme when you talk to them is about the culture in Australia, in the hospital settings that they're working, the healthcare settings they're working. For example, my own son went to Australia, he said, well, what's the difference between Ireland and Australia? And he said, he was working in an emergency room, and he said, access to senior decision makers, access to, and that may be SHOs, registrars, or consultants, adequate staffing within departments, and a culture where they're encouraged to contact more senior decision makers when they're in trouble. Could I ask maybe the IMO to respond to that? So we're now seeing about 60% of interns leave the Irish system after intern year, which is growing and increasing, and many now are staying away for longer periods. They're also leaving various stages of the training scheme, so cumulatively, this is having a huge effect where doctors are not coming back into the system. I think the safe staffing and the really long working hours are the key drivers. The amount of stress, like our NCHC colleagues, and I'll ask Rachel to speak a little on this, actually feel a moral hazard going into work. They feel unsafe, they are concerned about the negative incidents and the adverse events that will happen, and very often they're in charge, as you know, Deputy, of huge numbers of patients across the hospital system without adequate staffing. So Rachel will speak a little further on this. I'd just like to ask an additional question to that, and maybe you can address that. Are we relying on a model where we actually spend, the Irish state spends considerable amounts of money educating young medical graduates for export, and that we actually have to import doctors from other jurisdictions in order to carry out the day-to-day service of our health service? Well, I'm not sure I would agree that we train them for export. We certainly train them to be doctors. We don't enable them to practice effectively when they become doctors. Our system is reliant on a large number of doctors who we have to bring in from other jurisdictions, and we're not retaining and recruiting the people we spend, the taxpayer spends a lot of money training here. That's true, our system is reliant on a large number of international graduates, and we're very grateful for them to come and work here and make Ireland their home. However, the mix of, most of those graduates are in the NCHD category, and we just simply don't have enough consultants. The Hanley report from over a decade ago suggests we should have double the number of consultants and half the number of NCHDs, yet we still flood the system with NCHDs without investing in consultants. Yes, thank you, Deputy Daly. I'd like to kind of pick up on your point around safe staffing in particular. So I remember vividly sitting on a ward, crying about 15, 16 hours into a 24 hour shift because I was so tired, so deliriously tired that I was afraid that my next decision was going to end up killing someone. And that is the reality for doctors sitting in hospitals up and down the country. Model twos, model threes have been staffed by a single individual overnight. And it's a situation that cannot be allowed to continue. And that is the key issue. That is the key safety issue. And when we look at all of the incidents of high profile litigation and horrific outcomes for patients and for families, I don't think there's been a single one where safe staffing hasn't been a key driver of that. And a single point of failure of one clinician operating, might be out of hours, might be in an emergency department that's under particular pressure. That is the key issue facing or causing the exodus, causing people to not just leave the country but leave the profession entirely, get so far in a training scheme. Lots of investment, lots of time for that individual and the state. And it's not tenable that they would continue in that role. Could I, I'm on a tight lock. No, but I appreciate the answer and I appreciate your own personal experience which is something that is a recurrent personal experience from when I listened to young doctors. One of the big issues for young doctors in the system and nurses and allied health professionals is the lack of digitalization in our health service. Under the European digital, European Union digital decade and the EU Commission's digital compass 2030, we're supposed to be fully digitalized patient records. Ireland is not simply in the middle of the table at last. It is an outlier. It is so far behind. Only five of our 47 hospitals, public hospitals, hold a functioning electronic record system. Five out of 47. This is in a country where we're a leader in social media, IT, and in many of our other government services, such as revenue, of course, collecting money, and other departments, we're leaders within the European, we lie mid-division. But in healthcare, the Department of Health and the HSE have allowed a situation to develop where we are an outlier, simply off the charts in terms of digitalization. I'm on a tight frame, but how would proper electronic record, functioning record systems make to doctors and nurses and allied professionals in our healthcare setting? I think that there is a huge problem. The systems are antiquated, they're antiquated. There are multiple systems to log onto before you can even see a patient record. I think one of the key issues, though, is that the patient record needs to be from the community right into the hospital, and we are decades behind. Like, doctors and all our other colleagues, we read about AI, we hear the HSE lecturing on AI. We are so far away from knowing what AI, we can't even get functioning computers in the hospitals. I think both of my colleagues would speak on this to their own experience. Yeah. If I can, Deputy Daly, just briefly come back to you. I mean, the issue with doctors leaving the country, and I disagree with the concept that we're training doctors for export. We are a small country, we don't, we've won university in the top 100 in the world, so doctors do need to leave the country to get experience. The issue is doctors coming back, it's not the issue of doctors leaving, okay? And the fear now is that we always had a large number of interns going to Australia, we had a large number coming back, and the fear is that that number coming back is getting smaller and smaller, and that is the main problem there. We need to be more creative, we need to look at Australia, we need to look at reciprocal training arrangements, we need to look at encouraging doctors from other countries to come here while our doctors go there to get mutual experience, but that lack of creativity in kind of central HR and the HSE is just mind-boggling, right? And the second thing on digitalization, like we did a project recently where we looked at the records in St. Brendan's Hospital from like 100 years ago. They were completely the same as they are now. Like you could have walked into an Irish hospital in the late 19th century, and your medical information has been recorded in exactly the same format as it is today. It is absolutely crazy. And there is no political leadership to actually press a button. Whatever system is introduced will not be perfect, but at least it'll be something. So something needs to happen. We have a situation where we've highly trained doctors, nurses, allied health professions, admin staff, running around the hospital with paper records after receiving electronic referrals from GPs in the community. And we also know- Electronic referrals, which have to then be printed out in order to be filed. We also know that the new children's hospital has a different operating software system than St. James' Hospital on the same site with no interoperability. And that is a fact. So thank you for your answers. I appreciate it. And just if I could add a final point. Chronic underinvestment. We're still not at a 1% healthcare spend on digital. And the strategy sets out that we need to be spending two to 4% at a minimum. And that's to stay steady, not to catch up. We're dealing with hundreds of systems on a daily basis and they don't speak to each other. Thanks very much.