Open letter expressing recruitment and retention concerns in NAS

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An Open Letter to Mr Bernard Gloster, Chief Executive Officer, Health Service Executive

Dear Mr Gloster,

We write to you as frontline clinicians and as representatives of members of the Irish Society of Paramedicine, a staff-driven professional body representing a growing number of pre-hospital emergency care practitioners working across Ireland.

Over recent weeks, a series of developments within the National Ambulance Service (NAS) has caused deep concern among staff throughout the service. These concerns extend beyond any one decision or policy. Rather, they reflect a broader and increasingly serious issue regarding the direction, governance and workforce sustainability of the National Ambulance Service.

For the first time in the history of the service, paramedics and emergency medical personnel felt compelled to travel to Government Buildings to hold a peaceful demonstration in order to highlight the challenges facing their profession.

These were not individuals seeking confrontation or disruption. They were clinicians who attended off duty, standing together to raise concerns about the future of the profession they serve. The fact that frontline emergency workers felt they had no option but to take such a step should be a matter of serious reflection.

The NAS occupies a unique role within the Health Service Executive (HSE). It is a national emergency service, staffed by highly trained clinicians who undergo a demanding academic and operational pathway to deliver pre-hospital emergency care to the public. Paramedics commit years of their lives to education, training and frontline service. They respond to medical emergencies, road traffic collisions, cardiac arrests, and life-threatening incidents in communities throughout the country.

Historically, the pathway into the profession was clear and structured. Candidates competed through a national recruitment process, entered a rigorous training programme, completed their academic qualifications and operational internship, and, upon fulfilling those requirements, transitioned into permanent roles within the service.

That pathway created stability and certainty. It allowed the NAS to retain the clinicians it had invested heavily in training and allowed those clinicians to build sustainable careers within Ireland’s emergency medical system. Recent developments have disrupted that long-standing model. Without consultation, and with as little as two day’s notice, newly qualified paramedics have now been asked to enter a further recruitment process in order to secure permanent employment. Given significant custom-and-practice precedent, this represents a breach of legitimate expectation for these staff members.

These paramedics have already applied, interviewed for their positions, and been paneled through the NRS. They have successfully completed their training programme, obtained their academic qualifications, and maintained professional registration. They have completed everything that the NAS has asked of them. Despite this, they now face uncertainty regarding their long-term employment within the service.

This situation has created significant anxiety among newly qualified paramedics. Many of these individuals have already been working full-time operational shifts while completing their education and training. They have responded to emergencies, treated critically ill patients and represented the National Ambulance Service with professionalism across the country. Yet their future within the organisation now appears uncertain.

The implications of this situation extend beyond this particular cohort of paramedics. It raises broader concerns regarding workforce planning, recruitment sustainability, staff morale and the ability of the NAS to retain the clinicians it trains. At a time when demand for emergency medical care continues to rise, Ireland cannot afford to lose trained paramedics to uncertainty, frustration or emigration.

The training of a paramedic represents a significant investment by the State. When academic education, clinical training, supervision and operational development are considered, the investment in training a single paramedic is conservatively estimated to be in the region of €250,000.

We are already aware of newly qualified paramedics who have already resigned due to the sudden and unexpected change to the employment pathway they were led to expect. Significant numbers of this cohort also tell us that they either will not apply for the permanent positions offered, or will resign if they are placed in locations that make commuting economically nonviable. Each departure represents not only the loss of a highly skilled clinician, but also the loss of a significant investment made by the Irish taxpayer.

The consequences of these developments are already being felt within the service. Paramedics are increasingly questioning whether they can build long-term careers within the NAS. Some are exploring opportunities abroad. Others are considering leaving the profession entirely. This trend should be a matter of concern not only for the HSE but also for the Government.

The NAS plays a critical role in Ireland’s emergency response infrastructure. The sustainability of that service depends upon the recruitment, retention and professional confidence of its workforce. When that confidence begins to erode, the consequences extend far beyond the workforce itself. That ultimately affects public safety and the ability of the State to deliver timely emergency medical care to the public.

The Irish Society of Paramedicine believes that the current situation requires urgent attention at the highest level of the HSE and Government. We therefore respectfully call for the commissioning of an independent audit and review of the management structure and operational decision-making processes within the National Ambulance Service.

Such a review should examine:

• Operational and strategic decisions taken during the current management tenure, and the governance processes through which these decisions were made.

• The impact of these decisions on staff morale, working conditions and staff retention, particularly among frontline clinicians.

• The introduction of contractual arrangements representing a significant departure from established practice, particularly those affecting newly qualified paramedics.

• The circumstances under which newly qualified staff have been asked to sign temporary contract extensions in order to compete for permanent positions, and whether these decisions were implemented in a manner consistent with fair employment practice.

• Whether recent policy changes may conflict with the legal principle of legitimate expectation, given the long-standing pathway through which paramedic trainees historically progressed to permanent roles upon successful completion of training.

• The removal or reduction of Advanced Life Support capability within elements of the service, and the operational implications this may have for patient care.

• The impact of recent contract and workforce policies on recruitment, workforce sustainability and public safety.

• Transparency and accountability in the decision-making processes that have led to the current situation.

• Whether aspects of recent operational or workforce decisions may raise concerns under the Safety, Health and Welfare at Work Act 2005, particularly Section 8, which outlines employer duties in relation to the safety, health and welfare of employees.

• Compliance with employment law, governance standards and broader public service obligations.

• The overall impact of current management decisions on the organisation’s ability to deliver safe, effective and sustainable emergency medical services.

This request is not made lightly, frontline clinicians are deeply committed to the care they provide to patients across Ireland. They are proud of the work they do and of the role they play in protecting the health and safety of the communities they serve. However, they also expect transparency, fairness and responsible leadership from the institutions responsible for the governance of the service. The recent peaceful demonstration outside Government Buildings was an act of concern. It reflected a workforce that cares deeply about the future of the NAS and fears that current developments may undermine the stability and sustainability of the profession.

We believe this moment presents an opportunity for the HSE and Government to demonstrate leadership, restore confidence within the workforce and ensure that the National Ambulance Service remains a strong and sustainable emergency service for the future. Ireland cannot afford to lose the professionals it has invested so heavily in training. We therefore ask that this matter receive the serious consideration it deserves.

Yours sincerely,

The Committee

Irish Society of Paramedicine