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SEVEN-DAY ROSTERS in the health system aren’t a new concept.
HSE bosses and health ministers of old have been talking about it for a number of years.
As trolley and waiting list numbers hit the headlines, ramping up pressure on the government, questions would often be raised with ministers as to why the health service did not appear to be running 24/7.
Those working in the hospitals are often at pains to point out that they are working weekends and late into the night and are often under resourced and spread thin.
But it all came to a head this week when Health Minister Jennifer Carroll MacNeill announced that thousands of healthcare staff – including senior consultants, social workers, administrative employees and therapists – will have to work weekends in an effort to curb overcrowding and reduce waiting times.
Since taking on the job, the minister has been doing a deep dive into the rosters of Irish hospitals, doing unannounced visits to wards and, in particular, looking at weekend discharge data.
Carroll MacNeill began poring over situation reports comparing activity across bank holiday weekends, this year and last.
Services undertook significant work in the week preceding the June bank holiday weekend to maximise discharges and patient flow, which she said was the key factor in ensuring that most sites had sufficient capacity to meet demands over the bank holiday weekend.
This resulted in 55% fewer patients waiting on trolleys at 8am over the June bank holiday weekend compared to the St. Brigid’s Day bank holiday weekend this year.
There were 50% fewer patients waiting on trolleys at 8am on Tuesday 3rd June, when compared to the Tuesday after the St Brigid’s Day bank holiday weekend this year.
When compared to the same period in 2024, despite attendances at emergency departments being 5% higher over the June bank holiday weekend (Friday, Saturday, Sunday, Monday), there were 15% fewer patients waiting on trolleys.
Carroll MacNeill is not the first minister to notice the difference in hospitals at the weekend and midweek.
Two years ago, her predecessor, Stephen Donnelly told a meeting of healthcare officials that he believed Ireland’s hospitals would need to move to a full 7-day roster rather than relying on an on-call or emergency service at weekends to tackle overcrowding.
In an interview with The Journal at the time, he said when he engaged with hospital management, he would point out that a lot more doctors had been hired so he wanted to see more patient activity.
He said he would ask if machines and rooms were being utilised throughout the week.
“I’d ask, ‘Well, are you using it on a Saturday? Are you using it at eight o’clock on a Friday?’ And the answer typically is no, we’re not,” said Donnelly.
One of the first concrete steps towards change was getting consultants to sign up to the new public service contract.
Under the contract, consultants can be asked to work 8am to 10pm Monday to Friday and 8am to 6pm Saturday as part of their core 37-hour week. The contract offers basic pay of €217,325 to €261,051 on a six-point scale, with additional remuneration for on-call duties and overtime.
“With that contract, we’re paying a lot more money to be able to say, ‘look, I need you to run clinics on a Thursday evening or on a Saturday morning. This is the new world and you’re being paid a lot more money to do it’,” Donnelly told The Journal.
As of 28 May 2025, 2,970 consultants are now working on a Public Only Consultant Contract. This is made up of 855 new entrants since its inception in 2023 and 2,115 who consultants who have switched to the new contract.
The HSE recently undertook an exercise to review all consultant rosters which highlighted the low number of consultants currently rostered in the evenings and on Saturdays despite the positive uptake of the new contract.
Picking up that mantel from Donnelly, Carroll MacNeill said the health service has to use its resources to the fullest extent possible and the new consultant contract is part of that.
This week, she has also questioned why high-value MRI and CT machines are not being used in the evenings and over the weekend.
This is one issue that officials repeatedly questioned in recent years, stating that they were hearing criticisms that private operators were operating scans late into the evening and on Saturday mornings and they were being posed with questions as to why the public hospitals were not.
In addition to announcing a deal with unions on seven-day week rosters, the health minister also launched a productivity online platform, which provides data as to what hospitals are best and worst in class. It will allow hospital management compare themselves to their peers and it will also be a useful tool for GPs to decide where is best to refer their patient, depending on how hospital wait lists and discharges are looking.
While department officials state the new public platform is not a “stick to beat” hospital management with, it very much feels like government is putting the squeeze on hospitals and asking them to explain why more investment is not translating into more efficiencies.
The minister said this week that for “too long” hospitals have regarded themselves as “independent republics”.
“They are very much part of a state system that is funded by the state, and it’s a reasonable and appropriate process to shine this light in relation to their activity, which, of course, we expect to see change over time, but now we have the mechanism and the metric to do that,” she said.
“We as a government are correctly held to account for the investment that we bring to hospitals. But there hasn’t been, I think, enough focus on local hospital management on the application, the correct and most efficient application, of that increased investment in delivering better patient outcomes.
“So that means more outpatient appointments.That means better use of surgical capacity. That means better use of diagnostic capacity. And I think the productivity dashboard here is a way of making sure that we are holding hospitals and individual specialisms to account to manage themselves better,” she said.
The health minister said that the health budget has grown from 19% of government spend to 23% of government spend.
“It cannot be the case that we continue to invest without getting the efficiency for it,” she added.
“If we’re going to deliver a serious seven day a week, maximum productive public system, this is sort of essential,” she said.
The HSE has asked all regional management teams to have changes to consultant rosters in place by the end-June.
Reacting to the new online tool which monitors productivity, Irish Hospital Consultants Association(IHCA) said in a statement this week that it welcomed the Department of Health’s focus on transparency and performance but cautioned that such productivity data must be presented in proper context.
“This is fundamentally a capacity crisis, not a productivity issue involving any one group of staff. Framing it otherwise risks creating false expectations and undermining collaborative efforts,” it said.
What next? When the summer ends and winter approaches, all eyes will be on whether roster changes are having an impact and whether patients are receiving the same level of care on a Tuesday as they do on a Saturday. Watch this space.
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