Left on hold: the healthcare staff who answered Ireland’s call

From mid-March, Irish doctors and nurses living and working in Australia, New Zealand and other far-flung places returned home to help with the biggest health crisis the State has ever experienced. The photos of young medics arriving in Dublin Airport provided much-needed comfort at a time when the numbers of cases and deaths were rising rapidly every day.

The sobering two-part RTÉ Prime Time Investigates special this week demonstrated the severity of the crisis experienced by our healthcare workers. By capturing what life was like for staff and patients in the busy Covid ward at St James's Hospital, Dublin, the fly-on-the-wall documentary cut through the statistics to show the human strain that went into bringing the coronavirus under control. It captured the pressure our health system was under in April and May - even as it was bolstered by many who had returned from overseas.

But now, as the crisis appears to be under control in this country and with the third phase of easing the lockdown under way since Monday - in effect marking the wholesale reopening of Irish society and business - poor staffing levels in hospitals and in the GP service have been thrown into sharp relief.

"It's the same as it ever was," says one hospital doctor with 20 years' experience in the Irish system. "There was so much optimism about so many medics coming back to help control Covid-19, but now that the first wave has been brought under control, you're seeing hospitals understaffed and those that are there - doctors and nurses - are overworked again.

"There had been a lot of hope that the crisis would result in a completely new approach to staffing - and, of course, that costs money - but they were pipe dreams. Right now, you've got graduates coming into an environment where there are no positions for them, doctors who've returned from places like Australia are struggling to get any sort of guarantees about where they will be working and for how long, and existing staff overwhelmed with a workload and rosters that would be considered utterly unsustainable in a country with a first-class health system."

While Be on Call for Ireland provided heart-warming images, some of those who answered the call have had a tough time of it since coming back. Latest HSE figures show that the 73,000 figure was largely composed of people from outside the healthcare professions who felt their skills could be used in the fight against Covid. Some 14,100 were healthcare personnel from various strands of the sector, with a significant proportion already working in healthcare in Ireland and another large group comprising retired doctors and nurses.

In a statement to Review, the HSE said: "As of July 2, 194 doctors, nurses and health and social care appointees have been deployed from the Be on Call for Ireland initiative to HSE services in both community, acute and public health departments. An additional 715 candidates have full recruitment clearances in place and are 'job ready' as per service need. 940 candidates are in the clearance process.

"The Be on Call for Ireland recruitment initiative was part of an overall recruitment effort made by the HSE. During the Covid-19 period, over 4,100 jobs were filled by the national recruitment during this period. Substantial recruitment also took place at local level in community and acute settings."

However, many of those who returned to Ireland were given short-term contracts - often of no more than three months - and have now been told they are no longer needed. According to Paddy Hillery of the Irish Medical Organisation, many had given up jobs and prospects overseas "to make sure their families and countrymen would be protected" underwent two weeks' unpaid quarantine on their return from abroad. Some were left out of pocket, having to pay rent and being ineligible for pandemic unemployment payments, he says.

"To say to these doctors, 'Thank you for coming back, but we don't need you right now, we'll call you again if we do' is unacceptable," Hillery adds. "There is a sense of betrayal. Staff have put themselves on the front line treating people with Covid, putting themselves and their families at risk."

It is an especially bitter blow when one considers that the proportion of medical staff infected by Covid-19 in Ireland is among the highest in the world - front-line health workers account for almost a third of the 25,000-plus people who contracted the virus to date. Seven health staff have died from the disease.

Review has been contacted by a number of healthcare personnel who returned from abroad thanks to Be on Call and have struggled to find gainful employment since the crisis was brought under control. "I don't want to go public on it," says one, a nurse, who returned from the UK, "because I'd be afraid that that would scupper my chances of work, but the shifts have dried up over the past couple of weeks. I feel a bit stupid now, because I had been under the impression that jobs would be there for those who came back."

On March 19, the then health minister Simon Harris told RTÉ radio that money was not an issue; the key was to get doctors and nurses to return to Ireland to fight the virus. "The only restraint," he said, "is the availability of people, not finances. In many cases, we'll be offering people full-time, permanent jobs - in other cases, contracts of at least three months' duration."

For psychiatric nurse Áine Gleeson, answering Ireland's call did not turn out the way she had expected. On June 2, in response to a March 17 tweet from Harris launching "a massive recruitment drive for the health service", she tweeted: "Yet to receive even one available shift in the Donegal area since arriving home from Australia 11 weeks ago since this announcement. Now unemployed and unable to qualify for the Covid payment #shambles".

Gleeson later recounted her experiences on Highland Radio, although attempts by Review to contact her this week were unsuccessful.

Marianne Hennigan had a much better experience. She was working as a hospital doctor in Perth, Australia and was inspired to leave everything and return home to help when Be on Call was launched. She was one of several Irish medics who flew home with assistance from the initiative - her flights and quarantine accommodation in Dublin were paid for by donors to the scheme, which was wound up in May.

"We're Irish and we trained in Ireland and I think we wanted to give back," she says. "It was just a case of being able to get home. Flights were being cancelled and those that were going were costing thousands."

She got a placing in the emergency ward at a busy Dublin hospital, and quickly found herself in the thick of the work. It was rewarding, but onerous. After the comparative calmness of daily work in Australia, she says it was a tough adjustment. "Staffing levels are much lower than they are in Australia," she says. "So you can end up working really long hours in Ireland. That's never been addressed."

One of the reasons she emigrated in the first place was a sense of burnout from her time as a junior doctor. "It was exhausting. You'd work 70-hour week for months on end. About half of my colleagues - young interns - flew out [to Australia and New Zealand] that year."

Hennigan says that on returning to Dublin in May, she was enthused to see so many additional healthcare workers on the wards. "It was manageable, but as those extra people started to leave in the last few weeks, we started to see a rise in the number of people being left on trolleys, and with huge waiting times before anyone could see them."

She is now set to embark on a GP programme to become a much-needed general practice doctor. It's a much-needed role given that the IMO has estimated that the country will be short of 2,000 GPs by 2025.

For Anthony O'Connor, a consultant at Tallaght Hospital, the adversity of the past few months represented a golden opportunity to sort out staffing once and for all. "We had all this talent back in the country. We have new doctors coming on stream - many of them would be on planes all over the world [had the pandemic not hit]. Here was a chance to put an end to very long hours and burnout and to help us be ready for a second wave of this virus," he says.

"When it [the pandemic] all kicked off, they were saying - quite rightly - let's get everybody on board and then halfway though they started worrying about the cost. There are a few nurses that got completely left in the lurch and there were no shifts for them at all."

O'Connor is anxious about how the health system will cope with the fallout from the coronavirus. "What worries me is what we're heading into," he says. "There are huge backlogs [for non-Covid-related surgeries and so on that had to be postponed] so we're going to need people more than ever, but instead we're letting people off and telling them they're not needed any more. What if there's a second wave and we put out the call again? They won't come back a second time."

It's a sentiment shared by Eoin Kelleher, anaesthesia trainee, and author and illustrator of the book Journey Through the Body. "I know people that gave up good hospital jobs and the lives they had made for themselves in places like Australia, and came back here to do their bit and now they face job uncertainty here," he says. "It was a huge upheaval for them."

Kelleher says there has been no shortage of platitudes, but little meaningful attempt to improve staffing levels. "It's all well and good to clap for healthcare staff," he quips, "but where are the jobs?"

An Irish doctor who returned from New Zealand just last month says the differences between the two countries is stark. "It was commonplace to work a 38-hour week in New Zealand," she says. "Everything was rostered properly. You could make plans. It was the same for nurses. I remember you'd have a nurse saying they had a really busy day if they had to look after five patients - here, it could be 12 or 13.

"It's down to how money is spent," she adds. "Of course, it's going to cost more to have a larger volume of staff, but surely the care provided is better when you don't have staff suffering from burnout and your workload is more manageable?"

She is keen to highlight a phenomenon where a glut of trainee doctors will be available for internship this year, but may struggle to get work - and may be unable to travel for employment due to restrictions on overseas travel. "But if the system remains as it is - where it can feel really hard to be a doctor, to help people - many will simply leave when they get the opportunity."

A doctor who tweets as @IrishHealthInsider paints a stark picture. "It can be exhausting/soul destroying," he tells Review. "I think what many don't realise is that doctors leave for better conditions and training opportunities rather than pay. Most people I know who leave, especially those who don't return, do so because they want their lives back.

"They want to be training rather than patching holes in some dreadful small hospital with terrible standards.

"Essentially, our staffing levels during the day are usually adequate - not enough to get people out on time or take all their holidays - but most services function. At night, and over weekends, it's skeleton staff - often dangerous to patients and, of course, very stressful for the doctors.

"With Covid, the on-call skeleton staff expanded - pretty much doubled - as well as some services moving to seven days a week rotas so they were always around for their patient. This was the success of hiring more doctors - it felt safe; safer than ever despite a pandemic."

His prognosis for the immediate future is bleak. "Even without a second surge, I don't know how our current staffing levels will be able to catch-up on the backlog of clinics, diagnostics, procedures, etc - not to mention people who, through no fault of their own, stayed at home with something they should have presented to hospital with [such as a transient stroke], then go on to present later on much sicker. We'll try to [manage the situation] because in fairness to many of the medics in this country, they work themselves to the bone to keep things barely afloat."