National Taskforce on NCHD Workforce - Improving the Training Environment

The National Taskforce on NCHD Workforce aims to enhance the training experience, well-being, and work-life balance for Non-Consultant Hospital Doctors (NCHDs) in Ireland. The taskforce focuses on four key areas: addressing on-site working structures, fostering a culture of education and training, organizing postgraduate training regionally, and informing medical workforce planning. It also considers factors like educational support, gender equality, retention, and career progression. The growth in the NCHD workforce and clinical activity complexities are highlighted, emphasizing the need for sustainable improvements in NCHD training programs.

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• NCHD Workforce
• Training Environment
• Healthcare
• Medical Education
• Ireland

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1. National Taskforce on NCHD Workforce National Taskforce on NCHD Workforce Forum of Postgraduate Training Bodies Meeting 31st May 2023

2. Taskforce: Terms of Reference Taskforce: Terms of Reference . Purpose: Put in place sustainable improvements for NCHD experience, training, wellbeing and work-life balance in order to support present and future retention of NCHDs in Ireland* Four priority areas to be addressed: 1. Develop strategies to address NCHD on-site working structures and supports. 2. Establish a plan to enhance and foster a culture of education and training at clinical site level. 3. Make recommendations regarding the regional organisation of postgraduate training. 4. Inform medical workforce planning The Taskforce will consider the following: - Educational supports for the training needs of NCHDs. - Alignment to future healthcare model, i.e. move to RHA structure. - Gender, equality, and diversity issues. - Attrition / retention of interns and graduates of postgraduate training programmes. - Opportunities for career progression available in Ireland for all NCHDs. *The current IR engagement and any future IR engagement will proceed in accordance with established IR practice Why A Taskforce ? 2 An Roinn Sl inte | Department of Health .

3. Non-Consultant Hospital Doctors Employed in the Public Health Service, 2011 to 2020* Growth in NCHD Workforce Growth in NCHD Workforce Year NCHDs (WTEs)* 1990 2020/21 2011 5,079 2012 5,070 34% 2013 5,086 Consultants 3547 Trainees 4849 2014 5,483 Consultants 1120 NCHDs 2130 2015 5,894 32% 2016 6,135 44% 66% Service NCHDs 2593 2017 6,417 Total NCHDs 7442 2018 6,635 24% 2019 6,856 2020 7,470 Ratio 2:1 Ratio 2:1 % Change 2011 - 47.1 2020 *Source: Health in Ireland Key Trends 2021 (Statistics and Analytics Services, DoH)

4. Clinical Activity & Complexity Clinical Activity & Complexity Total Acute Hospital Discharges (Inpatient and Daycase) and ED Attendances, 1997-2021 2,000,000 1,800,000 1,600,000 No. of discharges/attendances 1,400,000 1,200,000 1,000,000 800,000 600,000 Source: In-patient & Day Case Activity data: Hospital In- Patient Enquiry (HIPE). Emergency Department: Health Service Executive. 400,000 200,000 0 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 Total (In-Patients and Day Cases) Discharges ED Attendences

5. 2013 2004 2021 1990s 2003 2014 2016 2006 2007 Senior Registrars c100% overseas pre- consultancy Post Higgins Report Formal Training Programmes Hanly Report Forum Framework for Postgraduate Medical Education 2021-30 Health Act Fottrell + Buttimer Reports Medical Practitioners Act NDTP Medical Workforce Intelligence Report Forum of IPGMTB METR NDTP Strategic Plan 2016-20 MacCraith Report Structured Training Programmes Curriculum / Assessments Legal Regulation Centralised with rotations on clinical sites no formal agreements - Lack of Resources

6. Intern Group Current location of non-Ireland CSCSTs (2016) 24 Status 2015-2017 intern cohorts in any of the 2016 to 2021 records Progression of 2016-2017 CSCST Cohorts in 2021 UK: Removing barriers to IMGs accessing the labour market 2019 Medicine included on the UK Shortage Occupation List removes RLMT requirements 2021 Health and Care Worker Visa Uncapping the UK Foundation Programme

7. The Model of Training Future The Model of Training Future Requires Clear Service Models & Workforce Configuration Requires Clear Service Models & Workforce Configuration Evolving Service Models? Ambulatory / Community Care Urban & Rural Generalism vs Specialism Evolving Workforce? Inter-professional Expanding clinician workforce Diversity & Work Practices Clinical Educators Clinical Researchers Training Sites? Trained Trainers with time Leadership Medical Technology

8. Taskforce Vision: Deliver high quality E&T for all NCHDs in an accountable, respectful, and supportive working environment that facilitates appropriate work-life balance Training Bodies Medical Council NDTP Accountable Engagement / Quality Assurance Clinical Sites Governance NCHD Supports Facilities & Infrastructure Future Workforce and working roles Changing Work-Life Balance / Working Conditions

9. NCHD Taskforce Members NCHD Taskforce Members Prof. Anthony O Regan (Chair) Consultant Physician, Chief Academic Office, Saolta University Health Care Group Ms Anne Marie Hoey National Director, HSE National HR Dr Norella Broderick SR Psychiatry, Community Care (rep) Dr Niamh Humphries Senior Lecturer, RCSI Graduate School of Healthcare Management Dr Jennifer Carron Cardiology SpR, Mater Misericordiae University Hospital Dublin Mr Leo Kearns Chief Executive Officer, Medical Council of Ireland Consultant Physician, Waterford University Hospital; NDTP Group Clinical Director for Medical Education and Training Prof. John Cooke Ms Rachel Kenna Assistant Secretary, Department of Health, Strategic Workforce Planning Consultant Anaesthetist Galway University Hospital, Medical Director, HSE National Doctors Training and Planning Prof. Colette Cowan CEO, UL Hospitals Group Prof. Brian Kinirons Prof. Mary Day National Director, HSE Acute Operations Ms Fiona Lynch Medical Manpower Manager, Mercy University Hospital Consultant Physician and Intern Tutor, South Tipperary General Hospital Dr Christina Donnellan Dr Tamlynn Muller Registrar, Mercy University Hospital Cork Consultant General Surgeon, Wexford General Hospital; Chair, Forum Irish Postgraduate Medical Training Bodies Dr Brian Doyle SPR Anaesthesia St Vincent s UH Mr Kenneth Mealy Consultant Paediatrician, Rotunda Hospital, and National Lead NCHD Dr Jennifer Finnegan Dr Knut Moe ICGP, General Practice, Primary Care Dr Laura Finnegan SHO Urology Mercy University Hospital Dr Amir Niazi National Clinical Adviser and Group Lead for Mental Health, HSE Dr Hannah Forde Consultant Physician, Beaumont Hospital Ms Leah O Toole Assistant National Director, HSE National Doctors Training and Planning Dr Maire Rochford Ob-Gyn SpR, National Maternity Hospital Ms Breda Rafter Principal Officer, Department of Health, Strategic Workforce Planning Dr Colm Henry Chief Clinical Officer, HSE Prof Kevin O Malley Consultant Surgeon, Chief Clinical Director, IEHG Mr Martin McCormack Secretary Forum of Postgraduate Training Bodies Dr Sean Casey NCHD Lead NDTP (Paediatrics)

10. Workstream 1 Work-life Balance Workstream 2 Workstream 3 Governance for Education and Training NCHD Working Life NCHD Onsite Training Support & Resources Objectives: NCHD Supports Workforce Planning and Configuration Objectives: Objectives: Objectives: Objective: a. Establish annual targets for Consultant and NCHD posts. Working Supports Work-Life Balance Strengthen structures for training and education opportunities for all NCHDs on clinical sites Establish optimum governance structure to support clinical education and training for the Non Consultant Hospital Doctor Workforce a. a. a. Induction / Onboarding b. Ensure appropriate induction is in place for all NCHDs c. Medical manpower d. Well being initiatives e. Family friendly supports f. Reducing red tape (Increments, payroll..) a. The working week b. Flexible working/training c. Protected training time d. Rotating b. Gradually reduce the reliance of NTSDs (non-training scheme NCHDs) by; b. Progress the use of simulation training and other tools to enhance NCHD education and training on site Placing meaningful controls on the expansion of the NTSD; 1. 1. Clinical educator Pilot 2. Administration Increasing the conversion rate from NTSDs to training NCHDs by lifting the barriers; 2. Define and ensure generic training and on-site facilities are of an appropriate standard for all NCHDs ( e.g locker, kitchen with fridge, showering and changing facilities etc) c. Increasing training opportunities 3. Increasing the number of practising Consultants. 4. Reimagine roles of the medical workforce under this new structure of service delivery. c. d. Use new structure and configuration of workforce for service delivery to inform postgraduate training into the future.

11. Deliver high quality E&T for all NCHDs in an accountable, respectful, and supportive working environment that facilitates appropriate work-life balance

12. Workload & Conditions Traditional Infrastructure Vs Emerging Workforce Support Culture Work-life Balance & Sustainability

13. Accountable Governance HSE & Clinical Sites MMP Capacity & Experience Capacity Modelling & Training Payroll & Repetition NER & Central Payroll Support Induction & On-boarding Protected & Enhanced Rosters & Cover eRosters & Emergency Cover Occupational Health NCHD HSE Occupational Health

14. Accountable Governance HSE & Clinical Sites MMP Capacity & Experience Capacity Modelling & Training Payroll & Repetition NER & Central Payroll Support Induction & On-boarding Protected & Enhanced Rosters & Cover eRosters & Emergency Cover Occupational Health NCHD HSE Occupational Health Respect & welcome - emerging workforce ????? Consultant Support & Mentorship Highlight and develop Doctor Time Efficiency & Patient Safety Task Allocation & Monitoring Culture Protected Time (also culture) Priority for Clinical Sites Working hours & the working week IR agreement & Culture Less than full time working / Training PGTBs Targets & Supports Regional Training life balance PGTBs

15. Accountable Governance HSE & Clinical Sites MMP Capacity & Experience Capacity Modelling & Training Payroll & Repetition NER & Central Payroll Support Induction & On-boarding Protected & Enhanced Rosters & Cover eRosters & Emergency Cover Occupational Health NCHD HSE Occupational Health Respect & welcome - emerging workforce ????? Consultant Support & Mentorship Highlight and develop Doctor Time Efficiency & Patient Safety Task Allocation & Monitoring Culture Protected Time (also culture) Priority for Clinical Sites Working hours & the working week IR agreement & Culture Less than full time working / Training PGTBs Targets & Supports Regional Training life balance PGTBs Working Conditions Strategic Capital Investment Infrastructure Learning Environment (Hub & Spoke) Integrated Resources ICT Supports Strategic Planning

16. Accountable Governance HSE & Clinical Sites MMP Capacity & Experience Capacity Modelling & Training Payroll & Repetition NER & Central Payroll Induction & On-boarding Protected & Enhanced Support Rosters & Cover eRosters & Emergency Cover Occupational Health NCHD HSE Occupational Health Respect & welcome - emerging workforce ????? Consultant Support & Mentorship Highlight and develop Doctor Time Efficiency & Patient Safety Task Allocation & Monitoring Culture Protected Time Priority for Clinical Sites Working hours & the working week IR agreement & Culture Less than full time working / Training PGTBs Targets & Supports Regional Training life balance PGTBs Working Conditions Strategic Capital Investment Infrastructure Learning Environment (Hub & Spoke) Integrated Resources ICT Supports Strategic Planning Consultant & NCHD Target Agreed pipeline RPL Workforce Planning Non NCHD Workforce Staff Grade / PA / Advanced Practice

17. July 10th Minister Update March 30th Oct 7th Taskforce Est Dec 20th Minister Update Oct 30th Final Report Minister Interim Report Phase 3 Phase 2 Phase 4 Phase 1 Workforce Configuration ICT Education & Training Resources LTFT training Gender Equality & Diversity Issues Task-allocation & Efficiency Mentoring Health & wellbeing The working week NCHD Working Standards NCHD MMP Support Roles Accessible Liaison Officer Training Enhanced use of NERS First Day Induction (protected time) Enhanced Induction (Non-Irish trained) Consultant / NCHD Targets Review of Non-NCHD workforce HSE NCHD Occupational Health Hub Accountable Governance on Sites Draft Report Consultation Consultation

18. Taskforce Vision: Deliver high quality E&T for all NCHDs in an accountable, respectful, and supportive working environment that facilitates appropriate work-life balance Training Bodies Medical Council Implementation Steering Group Project Manager NDTP Accountable Engagement Clinical Sites NCHD HSE Professionalise Medical Educational Role NDTP Pilot Administrative Support Occupational Health Hub Workforce Consultant & Trainee Targets (Ratio 1: 1.3) MMP Protected Induction (Enhanced for IMGTI) Working Facilities Capital Fund & Gap Analysis Access & Training Capacity Modelling RPL Training Facilities & Support (Educational space & tools e.g. Clinical Sim) NCHD Working Efficiency Non NCHD Workforce PA Review Regionalisation Culture / Work-Life Balance / Wellbeing Initiatives