The Health Service Executive (HSE) has spent €4.2 billion on outside agency staff since 2013, new figures show.
Last year’s spend was the highest on record at €647.3 million despite the HSE’s target spend for the year having been set at €293.9 million.
The figures come amid plans by the executive to drastically reduce the reliance on agency staff this year, while a recruitment embargo implemented in October remains in place in a bid to cut costs.
The data, released under the Freedom of Information Act, shows the HSE overspent on outside agency staff by more than €1.2 billion over the past eight years.
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Though its targets for spending in this area are not available from 2013 to 2015, the HSE spent €3.4 billion from 2016 through 2023 on outside staff despite having a budget of €2.2 billion for this purpose over the same period.
The costs outlined are for statutory services only and do not include voluntary hospitals such as Beaumont Hospital, Tallaght University Hospital and Mercy University Hospital in Cork.
In 2023 agency staff hired for support services including health and social care professionals accounted for the highest costs at €234.3 million; followed by nursing staff (€146.2 million); medical and dental staff (€135.7 million); and management and administration staff (€86.3 million). The spend on agency management and admin staff rose sharply from €10.4 million in 2013 to €100.9 million in 2022, before decreasing last year.
As a whole, agency staff costs have more than tripled since 2013 when €212.9 million was spent.
“At a time of a recruitment freeze, which is being classed as a cost-saving measure, the fact that over €4 billion has been spent on agency staff, including the services of management consultancy firms, is shocking,” said Phil Ní Sheaghdha, general secretary of the Irish Nurses and Midwives Organisation (INMO).
She said agencies were making millions at the cost of poor workforce planning and bespoke retention measures which should be put in place by the HSE and individual hospital groups.
“The excessive spend on agency staff shows that we are nowhere close to recruiting and retaining the amount of nurses we need in the public health service.
“We know... that when you have the correct number of nurses, the reliance on agency drastically drops,” she said.
A HSE spokeswoman said agency expenditure was under constant review, and the reduction and control of agency costs continued to be a “particular focus”.
The HSE National Service Plan for 2024 aims to cut the hours of agency staff used by about one-third. Costs will also be cut by €80 million through the conversion of agency staff to HSE employees.
The spokeswoman said finding available staff continued to be a challenge. “This is not unique to Ireland, but rather a global health workforce challenge. Recruitment and retention of clinical, nursing and other key staff is a constant challenge and impacts adversely on the ability to maintain safe and effective services.
“Therefore, as part of the HSE’s overarching resourcing approach whereby direct employment does not meet the needs of service delivery requirements, agency staff are utilised,” she said.
The spokeswoman said agency staff covered both short and long sick leave absences, maternity leave, as well as vacancies waiting to be filled.
“There are also additional resourcing requirements with the replacement of lost hours in critical services areas following the reversal of the Haddington Road Agreement,” she said.
The HSE spokeswoman added that, at times, the executive had been unable to fill vacancies “even via agency” which were also experiencing difficulty in recruiting due to a lack of availability as well as accommodation availability and costs.
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