When the Department of Health moved out of Hawkins House into its shiny new home on Baggot Street, did anyone bother to bring the dusty old pile of reports on medical workforce planning? The Hanly report, the MacCraith report and so on - they made for good reading, but the failure to implement their recommendations has meant that Ireland's hospitals remain woefully understaffed.
The Irish health service's ability to recruit and retain staff was already at crisis point before the onslaught of a global pandemic. Medical representative bodies have been decrying the shortage of staff for years, yet doctors and nurses continued to emigrate in their droves. This brain drain of Irish-trained medics and nurses, a perennial issue, intensified in the years after the 2008 recession, driven by swingeing cuts in pay and a recruitment freeze. Medical schools and nursing colleges were in effect training graduates for export. In 2016, six out of 10 newly qualified doctors indicated they planned to leave once their intern year was finished.
Consider that our number of hospital beds per 1,000 of the population is considerably below the average for the OECD group of developed countries. Our occupancy rates, at about 95pc, are among the highest in Europe. An occupancy limit of 85pc is recommended internationally to ensure patient safety and allow for surges in activity. Yet these beds are served by ever-dwindling numbers of medical staff. According to the Irish Nurses and Midwives Organisation, last year there were 1,157 fewer nurses and midwives working in the HSE than in 2007, despite increased activity in the system. Ireland also has the lowest number of consultant specialists in the EU; the European average is 2.45 per 1,000 of the population, but Ireland has just 1.44.
In January, there were 540 unfilled permanent consultant posts across the acute hospital system - roughly one in five of the available posts. Suitable candidates are simply not applying. A major factor is pay inequity. A 30pc cut imposed on newly-appointed consultants in October 2012 (which is yet to be reversed) meant that doctors who had trained in Ireland or internationally could not justify working in a system where their colleagues would be earning up to €50,000 more for the same work. Factor in onerous rosters, cancelled procedures and a lack of protected time for academic research and it's not hard to see why many medics booked a one-way flight to the US, Australia or Canada. According to a report from the Medical Council last year, 700 specialists left Ireland between 2015 and 2017. Many doctors feel they will get better training and experience elsewhere, and progress up the ladder quicker and more smoothly. As well as an infinitely better work-life balance, they are also seeking the holy grail: the satisfaction of knowing they can provide optimal patient care in a safe environment.
Aggressive and highly incentivised recruitment campaigns in recent years have arguably been abject failures.
The 'Bring Them Home' campaign that began in 2015 and aimed to attract hundreds of nurses back to Ireland by enticing them with generous relocation costs was quietly stood down within a couple of years, having tempted only a fraction of the numbers needed.
This has led to a costly over-reliance on expensive agency staff, which has further contributed to a draining of the HSE's considerable budget. Ireland's dependence on internationallytrained doctors has also steadily increased - from 13.4pc of all doctors working in Ireland in 2000 to 42pc in 2017.
A similar reliance on overseas nursing staff has been ingrained, with almost two-thirds of newly registered nurses and midwives last year having trained outside Ireland.
Medical representative bodies have been banging this drum for years, but the situation has added urgency in the context of Covid-19. The Irish Medical Organisation has warned that our health services face an unprecedented staffing crisis in the coming months as worldwide demand for doctors soars. They say Ireland will continue to struggle to attract and retain the doctors and consultants it will need as a result of the underpaying new recruits and poor morale among existing staff.
Many deficits were laid bare during the current outbreak. For example, Ireland has a historic paucity of public health specialists, given that they are not afforded consultant status here. In recent months, several highly skilled experts in this critical area have taken jobs overseas.
The staggering response to the Be on Call for Ireland initiative shows that doctors, nurses and other healthcare professionals want to work in Irish hospitals. But the sticking-plaster solutions put in place to address capacity and staffing issues as the crisis escalated are being summarily ripped off, with many returning junior doctors and nursing staff told there are no permanent roles for them.
Sláintecare may well be the first cohesive document that promises to produce a health service that is fit for purpose. A 10-year cross-party plan, it was broadly welcomed by the medical profession.
Under the plan and the associated Health System Capacity Review, the public system would require an additional 2,600 hospital beds and almost 600 extra consultants. Bear in mind the plan was drawn up in the absence of a global pandemic and the unfathomable challenges it presents to the health service.
But as we often hear, challenges bring about opportunity. The big question is: using Sláintecare as a roadmap, can the health service be rebuilt in light of Covid-19 to produce a system that is adequately resourced and staffed, one that Irish medical and nursing graduates are eager to work in and will be adequately rewarded for their service? The fear is that Sláintecare and its recommendations will simply gather dust, like so many reports before it.