The Health Service Executive is to extend a recruitment freeze to all categories of staff, with the exception of consultants, doctors in training and 2023 graduate nurses and midwives.
In a memo to senior managers, seen by RTÉ News, Chief Executive Bernard Gloster said it needed to address the fact that it is on course to exceed its 2023 funded workforce target, which he described as "neither affordable or sustainable".
The memo states that there are to be no further offers made or obligations entered into, in respect of any posts excluding consultant appointments, graduate nurses and midwives, and doctors in formal approved training programmes.
"Any offers made and not formally accepted, or where a contract has not issued should now be withdrawn," according to the memo.
"There is to be a continuation of the no increase in use of agency staff as set out previously," it states.
According to the memo, exemptions will apply in separate allocations for disability services.
"I know that any slow down or pause in recruitment can be dispiriting for those around the HSE who are working to develop ever better services, interventions and care pathways," Mr Gloster wrote in his memo.
"I would like to emphasise that there is no reduction in ambition here for the future," he said, adding that 2024 will bring an additional allocation to the workforce.
"This move is necessary only because we know now that by year end we will have reached our 2023 ambitions for recruitment," Mr Gloster wrote.
Last month, the HSE announced a recruitment freeze that would exclude approved consulting posts and GP training posts, nursing and midwifery posts, dentists and orthodontists for public service schools and emergency services, health and social care professionals and the National Ambulance Service pre- hospital care.
Minister for Public Expenditure Paschal Donohoe said there had been years of very large recruitment within the HSE.
Over a number of years, 6,000 additional staff members had been recruited each year, including more nurses and doctors, he added.
Mr Donohoe said he understood the HSE was at a point where it is delivering its recruitment targets.
The Psychiatric Nurses Association (PNA) said the extension of the recruitment freeze will worsen the existing staffing crisis in mental health services.
"We now need specific proposals from the HSE Chief Executive Officer Bernard Gloster, and Minister Stephen Donnelly on how they propose to maintain mental health services and meet the growing demand for expanded and new services with a depleted workforce and no prospects of addressing staffing vacancies throughout the mental health services," said PNA General Secretary, Peter Hughes.
Meanwhile, it has emerged that Mr Gloster warned Minister for Health Stephen Donnelly there would be "significant and punitive risks to the public" if the HSE is forced to implement cost controls to reduce its budget deficit next year.
Last month, Mr Gloster told the Oireachtas Committee on Health that the budget deficit for this year remains at €1.4 to €1.5 billion.
He also said there would be no cuts to services, despite the budget constraints.
However, in a letter to Mr Donnelly, released under the Freedom of Information Act to RTÉ's This Week, Mr Gloster said there must be a "clear Government-wide understanding" that "circa three quarters of the deficit cannot be achieved by way of reduction without significant and punitive risks to the public".
"In that context I envisage only one quarter maximum can be contained."
"It is imperative given the recent narrative about financial and resources management within the HSE that Government are in no doubt as to the position."
The letter was written on 9 October, just days before Budget 2024 was announced.
New controls will 'result in other challenges' - Gloster
In the letter Mr Gloster also said that "new controls will reduce expenditure and stop deficit growth in part, but will likely result in other challenges for the public and staff".
He said the purpose of his letter to the minister was to ensure there was "no lack of clarity" about the position ahead of the Budget announcement.
The Department of Heath had sought an additional €2 billion in funding to run the health service next year.
However, ultimately just €708 million extra was provided to meet existing service levels in 2024, along with €100 million for new developments.
Mr Gloster said funding for the health service next year was inadequate.
A spokesperson for the Minister for Health said that he immediately sent Mr Gloster's letter, with comments, to the Minister for Public Expenditure.
Recruitment freeze will 'cripple' health service - unions
Unions have warned that the extension of the recruitment freeze will "cripple" HSE departments as they prepare for the busy winter period.
The unions have requested an urgent meeting with the HSE to discuss the matter but said that, so far, management has declined to meet them.
"This is playing into the hands of other countries such as the UK and Australia who will be only too delighted to offer full time permanent secure jobs to nurses and other healthcare professionals," said Irish Nurses and Midwives Organisation Director of Industrial Relations Albert Murphy.
Kevin Figgis, of SIPTU's Health Division, said members are already carrying deficits due to existing vacancies.
"To have recruitment come to a sudden stop, without any notice, will render many services unable to meet the growing demand for service over the coming weeks," Mr Figgis said.
Anthony Owens, from the Irish Medical Organisation, said that medical teams all over the country are already short-staffed.
"We are seriously concerned that this proposal will lead to worsening conditions for patients and doctors which is all the more disastrous as we head into winter," he said.
Ashley Connolly, National Secretary of Fórsa, said the move will have a considerable impact on health service delivery.
"In addition, the additional uncertainty will leave Fórsa members considering their futures within the health service," she added.
The health unions will consult with their respective executive councils and members on their response to extension of the recruitment feeze.
The Irish Nurses and Midwives Organisation (INMO) said it would immediately engage with members with a view to a ballot for industrial action to protect nursing and midwifery practice and patient safety.
The INMO also said that by its own calculations there are currently approximately 2,800 nursing and midwifery funded vacancies in the health service, which urgently need to be filled.
"This recruitment freeze represents a serious error on the part of the employer, and the impact on the provision of care is going to be disastrous," said INMO general secretary Phil Ni Sheaghdha.
Additional reporting Justin McCarthy, Eleanor Burnhill
