On holidays this week, I bumped into a retired nurse. As we chatted , she told me how sad she felt about losing her two children to Australia. One a doctor, the other a physio, they have made their lives in Perth.
Both left Ireland well before the pandemic, and the long period of no travel made the separation worse initially – but also demonstrated to her grown-up children that a good life could be made elsewhere, without the disruption of trips back to Clare.
Technology has eased the disconnect, but her daughter has now had two children, and the desire to hold grandchildren close is powerful.
“All that effort to get them through the Leaving, get the points, get through college – all a waste of time for our family,” she said ruefully.
Ireland educates healthcare professionals for export. We have done so for decades. Our graduates gain further experience and qualifications in this country, but increasingly leave at later stages of their career – at exactly the time when they have much to contribute to patient care and the development of services, a time that generally coincides with planning a family and buying a house.
The pressures of finding affordable housing and childcare here have been widely reported. Young, educated graduates are making lifestyle and career decisions based on a belief that they deserve better home and working conditions.
In June, doctors who are members of the Irish Medical Organisation (IMO) voted for industrial action to address long-standing problems relating to unsafe rosters, inability to take leave, pay and training supports.
This week we saw the HSE apologise for its failure to pay doctors in several hospitals. The message of casual disrespect this sends to professionals in their 20s and 30s is disastrous. It’s a fundamental fact that our society recognises the value of work through payment. This has long been a source of dissatisfaction among nurses – the public rank them highly for trust and dedication, but they are not paid enough.
Irish people may view doctors as privileged. In terms of educational opportunities, it’s true that healthcare staff are privileged. What is less appreciated is the struggle of two parents – a nurse and a farmer, say – to get those opportunities for their children: the sacrifices made in the hope that their grown offspring will do better, be part of wider family life and give back to our country; who will care for us as we get older.
The difficulties our healthcare services face in recruitment are many. The system is paralysed with inaction. Some actions require difficult decisions to be made, and that is not within the current culture.
Last month, many hospitals were forced to continue services with only 75pc of staffing levels as younger doctors left for training places abroad. Elderly people sitting on a chair for hours in A&E, children running out of time in their development due to lack of disability assessment and supports – these needs urgent action.
Similar to the zealous focus that was directed at Covid, I feel daily metrics on health could be reported. Public health and the services required to care for people are a national matter of relevance to each person affected by lack of these services in terms of their quality of life and their expectations for the future. Similar updates exist on waiting lists and numbers of patients on trolleys, but the information could be presented in more detail and with more context.
Lots of organisations use risk registers to mitigate and address service deficits. Not sharing this information with taxpayers and voters is disingenuous and leads to a lack of trust.
Ireland has chased big-tech investment and development. We also have an extremely tech-literate population. Those same technology resources are there for us to focus on health. Daily metrics and risk-reporting would not create panic, they would share the burden of accountability and openness and build respect and trust.
The public need to know the extent of the healthcare recruitment crisis. They need to know why health professionals choose to leave, not just for a few years to gain experience elsewhere, but for good.
They also need to know there are solid plans to reverse the trend. Providing this information to the public is honest and respectful and helps everyone to understand why we are where we are right now.
Every medical student wants to do their best to look after their patients. By achieving this, they also protect themselves and ensure safe services for their families. When the balance tips, it gets too challenging to fulfil your job and your hopes.
The price is emigration of our healthcare graduates to countries where they feel valued and respected, but it’s a price paid by all.
Suzanne Crowe is a consultant in pediatric intensive care at Crumlin Hospital and president of the Medical Council