Compliance gaps with hiring of overseas doctors at Portlaoise hospital

An internal audit of the HSE’s recruitment of doctors and consultants from outside the EU, including at the Midland Regional Hospital Portlaoise, has found an “unsatisfactory” level of compliance with regulations.

The objective of the audit was to determine whether internationally recruited consultants and doctors were recruited in accordance with policies and regulations.

The HSE Dublin and Midlands Region and the HSE Dublin and North East Region were covered by the audit. A sample comprising 20 international consultants were examined in each region, including five in the Midland Regional Hospital Portlaoise.

The Midland Regional Hospital Tullamore and the Midland Regional Hospital Mullingar were also included in the HSE Dublin and Midlands Region.

The audit looked at doctors who were onboarded in 2024 with no prior experience or training within the Irish health system.

The audit focused on pre-employment and compliance controls, including evidence of Garda vetting, overseas police clearance, right to work, English language competency, professional registration and health clearance verification.

The HSE recruits overseas doctors, including non-consultant hospital doctors and consultants, through both national and local level competitions. International candidates must meet standard pre-employment requirements and hold the right to work through a work permit.

Along with evidence of permit approval, candidates must also have the appropriate visa, Medical Council of Ireland Registration (qualification recognition), independent references, Garda vetting, overseas police clearance, Occupational Health clearance and where required evidence of English language competency.

However, the audit found that the compliance with these requirements were lacking in the two regions examined.

When it came to Garda vetting, the HSE Dublin and Midlands had an “unsatisfactory” 70% compliance rate, with 14 out of 20 doctors and consultants compliant. Deficiencies noted in the audit included one not being available and five obtained up to five months after onboarding.

Overseas police clearance for hospitals in the region was “limited”, with 15 out of 20 doctors and consultants compliant. Two were unavailable, one due to war, and one was reliant on an Irish passport which was held since 2022.

Similarly, 15 out of 20 were compliant with the necessary independent reference checks.

The findings were worse regarding the compliance with language standards and checks. Just 13 out of 20 doctors and consultants in the region were compliant with the English language standards.

One certificate was accepted under the HSE’s required score, two certificates were not available, and two were noted as fluent at the interview stage but with no documented evidence on file.

The report shows that of the 20,962 doctors and consultants in Ireland, 5,830 are international doctors from outside of the UK and EU. This represents over 27% of the total number. The most common countries of origin with international doctors in Ireland are Pakistan, Sudan and South Africa.

The audit stated: “While the overall control assessment indicates that several key controls are operating effectively, a number of weaknesses were identified. These deficiencies reduce assurance that all staff engaged met the required regulatory and governance standards at the point of onboarding and give rise to potential regulatory, patient safety and operational risks.

“The findings indicate a need for strengthened oversight, clearer accountability, and improved consistency in the application of mandatory onboarding controls across the hospital sites and regions. The audit findings indicate that the level of assurance that may be provided to management about the adequacy and effectiveness of the governance, risk management and internal control system in the area reviewed is unsatisfactory.”

In response to the audit, a HSE spokesperson said: “Patient safety is the HSE's foremost priority. The HSE has a comprehensive, standardised process for the recruitment of non-EEA doctors to ensure compliance with legal, regulatory and professional requirements and to verify that doctors are appropriately qualified and credentialed for their roles.

“The HSE is committed to ensuring that these requirements are consistently applied across all services and that the audit recommendations are fully implemented through established governance and oversight mechanisms.”