The HSE is to pause recruitment in non-frontline roles across significant parts of the country under new measures to deal with overspending in the health service, which hit €250 million for the first quarter of the year.
HSE chief executive Anne O’Connor told her senior management team in a memo on Tuesday that the organisation was now “significantly over budget”. She said the HSE’s financial position had “significantly worsened” over recent weeks.
Figures indicate the level of overspending recorded in the health service accelerated in March.
Under measures to be put in place by O’Connor, three HSE regions – Dublin and South East, Dublin Midlands and the South West – have been placed in what is known as tier three escalation, which will involve the introduction of employment controls and greater scrutiny on spending.
The Irish Times understands that in these three regions, a pause on recruitment will apply across all non-frontline, non-critical posts. Exceptions to these restrictions will require a business case to be approved by the regional executive officer (REO).
O’Connor told senior managers that corrective measures introduced earlier this year had not delivered the improvements required, and additional measures were now being introduced.
“This is a serious position, and one we can and must address through the year,” O’Connor said.
She said the new controls would focus on “discretionary spend, on the use of agency staff and on recruitment”.
“Recruitment can only take place to approved and affordable positions and only after approval by the REO or those authorised to approve posts at the centre [of the HSE]. Decisions affecting clinical services will continue to be made through normal clinical and operational governance, with patient safety as the paramount consideration,” she said in the memo to senior management.
O’Connor said the purpose of the new measures was to ensure that as the year progressed, “we can avoid taking decisions which would affect the services we provide”.
In a separate letter sent to the Dublin South East region – which was seen by The Irish Times – O’Connor sought a savings plan to be submitted by later this week.
The HSE chief executive said Dublin South East had recorded a €37 million deficit in the first quarter – equivalent to 5.7 per cent.
“A variance of this scale, taken together with the composition of the overspend and the insufficiency of the corrective measures advanced to date, is in my judgment a material departure from the financial performance expected of the region under the National Service Plan 2026 and your 2026 performance agreement.”
O’Connor said in the letter to senior management in the HSE Dublin South East area that this escalation (to tier three level) “reflects a loss of confidence in the existing financial controls operating within the region and the need to put strengthened controls in place as a priority”.
Overall, in the first two months of the year the organisation as a whole recorded a deficit of €146 million, the HSE chief said. However, by the end of March this had risen to €250 million.
“The HSE must operate within the annual funded level as set out in the National Service Plan 2026,” she said.
O’Connor said that although the work of staff across the system to deliver care, often under sustained pressure, was fully recognised and highly valued, “at the same time, we are entrusted with significant public funds and we are accountable for their proper use”.
“Acting decisively when the financial position requires it is part of that accountability. The measures I have set out and the levels of escalation applied should not be read as a judgment on the work of staff in any particular region. They are a structured response to a financial control challenge that has emerged across multiple regions in 2026.
“The objective for the remainder of the year is to deliver significant and sustained improvement in the financial position and to restore the HSE to a sustainable financial footing. she said.
Meanwhile, nurses on Wednesday warned the new HSE employment controls were a “precursor to a [recruitment] embargo”.
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Phil Ní Sheaghdha, general secretary of the Irish Nurses and Midwives Organisation, said the union noted that clinical posts will be exempt for the moment.
“But we have to again say that we heard this before,” she said.
“If the HSE are over budget in certain locations, we must ensure that staffing is not the first place they go.”
Ní Sheaghdha said the HSE went “from year to year with a budget that is too small”.
“If the only leeway they have is curtailment of services, that’s the wrong model. We need multi-annual budgeting. We need to know exactly how many staff we’re going to employ, but if this stop-start recruitment keeps going, it is exactly what will force nurses and midwives to emigrate.
“They do not want to work in a system that has a stop-start approach. ”
The group of health unions — known as the staff panel — said it was “deeply concerned” at reports of the HSE’s decision to pause recruitment without prior engagement.
It said the move appeared to breach the 2025 Workplace Relations Commission agreement on the HSE’s pay and numbers strategy and Labour Court recommendation, all of which required meaningful consultation with unions before such measures are implemented.
Ashley Connolly, Fórsa’s Head of Health and Welfare division, said: “Yet again the HSE has failed to engage with the trade unions, and is imposing arbitrary measures which impact on the delivery of services.”