Minister Carroll MacNeill outlines baseline for on-site consultant rostering
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From: Department of Health
- Published on: 1 April 2025
- Last updated on: 12 April 2025
Minister for Health Jennifer Carroll MacNeill has today (1 April 2025) brought a Memo to Government on reducing Emergency Department overcrowding by delivering urgent care services over seven days and ensuring that all staff, including consultants, are rostered over seven days and in the evenings.
Minister Carroll MacNeill stated:
"The impact on patients and their families from the very high level of hospital congestion experienced in early February post the St Brigid’s day bank holiday was too great to remain unresolved.
"I requested the HSE to provide an analysis of the consultants rostered over the St Brigid’s weekend and to increase the number of senior decision makers rostered onsite for the St Patrick’s weekend, to ensure adequate cover was in place.
"The increased on-site senior decision maker presence over the St Patrick’s bank holiday weekend was a major factor in the significant 70% reduction of trolley numbers when compared to St Brigid’s weekend.
"I would like to thank healthcare staff for their effort and commitment at all times, especially now as we move to making this increased onsite weekend presence of senior decision makers the new baseline."
Preliminary analysis of HSE roster data shows that:
- approximately 80% of consultants are rostered during the day, Monday- Friday, with most weekend cover being provided by an on-call service
- 12% of consultants are rostered to work in the evenings
- 11% of consultants are rostered on a Saturday and 6% on a Sunday
Ahead of the St Patrick’s Day weekend, consultant rosters for the bank holiday weekend were submitted nationally for review from all sites. These were assessed and where it was identified that the consultant cover was not sufficient, sites were asked to re-do rosters to ensure adequate cover.
This resulted in improved transparency of local rostering arrangements and sets a much clearer expectation of the need for on-site rostering over any historic on call arrangements.
The Minister’s request for deeper analysis of hospital consultant rostering in all acute hospitals, has resulted in the development of a new rostering dashboard. This enables us to see the rostering arrangements for very hospital, every specialism and every consultant in the country. This new visibility now enables more efficient and effective rostering of senior decision makers in the evenings, on weekends and public holidays.
- More information available in figures 1 and 2.*
Minister Carroll MacNeill stated:
"The Public Only Consultant Contract providing for rostered work from 8am-10pm Monday to Friday, and 8am-6pm on Saturdays, however the majority of consultants are still only rostered during the day Monday-Friday.
"Our attention must now be focused on realising the benefits of the Public Only Consultant Contract by maximising the use of the hours in the contract to increase access to services in the evenings and at weekends.
"This is essential for our emergency departments, our waiting times and our broader use of existing hospital infrastructure. We will approach these in a sustained and sequential way over the next six and twelve months to achieve the best possible use of all our healthcare assets – most importantly our excellent health care staff on whom our patients depend."
HSE management are working to ensure that changes to consultant rosters are implemented in a sustainable manner and that the improved performance over the St Patrick’s weekend is built upon.
Notes
Government has invested heavily in new consultant posts with the number of consultants increasing by 43% since December 2019. There are now 4,640 WTE consultants employed by the HSE.
To support the provision of 7/7 services, the Public Only Consultant Contract, introduced in March 2023 provides for evening, extended out of hours and Saturday rostering. A core objective of this contract is to enhance senior decision-making presence on-site.
As of the 24 February 2025, 2,859 consultants have signed the Public Only Consultant Contract, representing approximately 62%* of consultants working in the public health service. *Calculated by using 2,859 public only consultant contracts signed divided by 4,640 WTE (total consultant WTE as of February 2025).
In addition to the key actions identified in Annex 1, the HSE Senior Management Team have an intensified focus on engagement on the totality of Urgent and Emergency Care Services at national, regional and local levels.
This information is subject to validation by the HSE.
Data from Figure 1 shows that all consultants are currently being rostered:
- it shows that approximately 80% of consultants are rostered during the day, Monday- Friday, with most weekend cover being provided by an on-call service
- 12% of consultants are rostered to work in the evenings
- 11% of consultants are rostered on a Saturday and 6% on a Sunday
This information is subject to validation by the HSE.
Data from figure 2 shows that despite the Public Only Consultant Contract providing for rostered work from 8am-10pm Monday to Friday, and 8am-6pm on Saturdays, the majority of consultants are still only working during the day Monday-Friday.
The two graphs above show us that even though 62% of the consultants are on the POCC, this has not translated to a shift in working patterns.
Annex 1: UEC Operational Plan 2024 - Key Actions
Vaccine: Preventable illness
Promote uptake of Influenza, Measles and COVID-19 vaccinations to improve compliance for all target groups including Healthcare Workers.
Specialist care in the community
Community Specialist Teams (CSTs) for Chronic Disease Management to deliver 19,000 patient contacts each month.
CSTs for Older Persons will deliver 11,750 patient contacts each month.
GP out of hours
Work with GP Out of Hours Services to maintain/increase GP OOH contacts and reduce the level of GP OOH referrals to EDs.
NAS care pathways
Maximise usage of existing NAS alternative care pathways.
Local injury units
Injury Units to provide a 7-day service, 8am to 8pm including Bank Holidays.
Patient streaming at ED
High levels of streaming in the emergency department, for example: to Medical Assessment Units, GEMs Units, Injury Units, ICPOP assessment and other appropriate services.
Senior decision makers in ED
Roster amendments for Senior Decision Makers developed on a 7/7 basis and implemented to meet the predictable increased weekend and public holiday demand.
Consultant rounding in ED
Consultant daily rounding of admitted patients each morning in EDs and in surge beds to expedite decisions and treatment.
Demand and capacity management
Each hospital/community service to have a centralised operational hub that provides visibility of all available bed capacity in hospitals, community and private facilities
Clinical and oversight, operational
Senior clinical and operational decision makers rosters to be developed on a 7/7 basis and implemented to meet the predictable increased weekend and public holiday demand.
Cohorting
All sites will have plans in place to support the transition to hospital wide cohorting of patients to specialty or dedicated wards, commencing with the cohorting of Older Adults (≥ 75 years) to specialist geriatric wards by year end.
Extended hours
Roster amendments and additional services should be developed on a 6/7 basis in the interim, ultimately working to a 7/7 basis and implemented to meet the predictable increased weekend and public holiday demand.
Senior clinical review
All admitted patients on wards to have senior clinical review every morning to expedite decisions and treatment.
Length of stay
Hospitals will implement protocols for inpatients with Length of Stay over 14 days transitioning to over 7 days.
Patient flow
All clinically appropriate patients in Model 3 and Model 4s to transfer to alternative care settings including Model 2s, Rehabilitation Beds and Transitional Care Beds (TCBs).
Discharge plan for every patient
All inpatients to have a comprehensive plan for discharge, developed in conjunction with community services. A predicted date of discharge is to be assigned at time of admission.
Discharge processes
Operational processes will be in place to support the discharge of patients prior to midday on a 7/7 basis, and to deliver a consistent level of discharges each day.
Managing delayed transfers of care
In anticipation of their final care plan being fulfilled, all available options are to be put to suitable patients who are experiencing a DTOC if they have already been approved for NHSS long term care. Patient choice to be prioritised, however in line with the discharge policy, patients will be safely transferred on the third offer provided to them.