Changing demographics mean that nearly 13,000 additional nurses and midwives costing almost €1 billion annually would be required in hospitals by 2041 if current levels of care were to be maintained, according to figures published by the Parliamentary Budget Office (PBO).
The PBO estimates that even if the number of training places was doubled over the next 17 years and the majority of newly-qualified nurses and midwives stayed within the Health Service Executive, there would be an average recruitment shortfall of about 2,000 a year leading to a continued reliance on hiring staff who have qualified overseas.
That, the office says in a detailed document prepared for members of the Oireachtas, “may well amount to reneging on Ireland’s obligations under the WHO Global Code of Practice on the International Recruitment of Health Personnel”.
The PBO’s projections draw on figures provided by the Central Statistics Office, the Nursing and Midwifery Board, the Irish Nurses and Midwives Organisation (INMO), the Organisation for Economic Co-operation and Development and the Department of Public Expenditure and Reform.
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It models a number of scenarios in relation to staffing levels in nursing and midwifery between now and 2041, based on maintaining the current ratio of nurses and midwives working for the HSE per 100,000 members of population, which it puts at 868, adjusting that figure to take account of Ireland’s changing demographics, primarily its ageing population, and increasing the number of nurses and midwives to 1,000 per 100,000 over time.
The basic assumption involves an increase in population from 5.15 million in 2023 to 6.05 million in 2041.
It finds that while maintaining the 868 per 100,000 figure would involve the need to recruit an additional 7,800 whole-time equivalents (WTEs) at an extra cost €592 million (at 2023 values), seeking to maintain current levels of service while taking account of the population’s likely dependency on medical services, would involve increasing the number per 100,000 to 953 resulting in an expansion of the number of WTEs from about 45,000 at present to 57,660 at a total cost of €4.39 billion per year, an annual increase of €964 million.
Achieving that larger number of staff, it suggests, will be made more challenging by turnover, which ran at 9.9 per cent in 2022, up from 6.4 per cent just two years earlier, and the limited numbers of nursing graduates coming into the system.
The model envisages a 7.9 per cent turnover rate and suggests that even doubling the current number of graduates going into the system over time would leave a cumulative shortfall of just over 40,000.
The report finds that HSE spending on agency nurses and midwives, though much smaller than spending on staff, has increased at a faster pace, from €55 million in 2012 to €130 million in 2022.
It suggests the average cost of a nurse/midwife in the system, taking into account all grades, including tutors and managers, is just over €76,000 but puts the average salary of a hospital nurse/midwife in Irish hospitals at €49,400 compared with €42,300 in the UK, €50,000 in Spain, €65,100 in Australia and €78,300 in the United States.
Nurses and midwives, it suggests, make up about a third of the HSE’s entire staff.
A spokesperson for the INMO said that if the number of nurses and midwives required was to be achieved, “there must be a laser-like focus on recruitment and retention measures”.
“We know there is a chronic and unsustainable over-dependence on nurses and midwives who have trained in other countries.
“Creating additional training places and the environment that makes future graduates want to remain in Ireland will go a long way to ensuring we are maintaining our obligations to recruit nurses and midwives ethically.”
The Department of Health was approached for comment.
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