Blunt instrument has left health services reeling

The overnight unplanned exit of over 2,000 staff last December allied to the earlier incentivised retirement and redundancy schemes and the staff moratorium has left the Irish health services reeling, with some services in jeopardy, senior managers double jobbing, and hospitals scrambling to find administrative staff to run Emergency Departments and clinics, writes Maureen Browne.

The overnight unplanned exit of over 2,000 staff last December allied to the earlier incentivised retirement and redundancy schemes and the staff moratorium has left the Irish health services reeling, with some services in jeopardy, senior managers double jobbing, and hospitals scrambling to find administrative staff to run Emergency Departments and clinics.

Maureen Browne
Maureen Browne

The retirement of radiographers, who cannot be replaced under the moratorium is hitting the diagnostic services which, in some cases, are beginning to buckle and it is feared this may have implications for the cancer care programme. There are also concerns for the future of the public health nursing service which has a number of statutory obligations, including child developmental checks.  Consultants and health and social care professionals are spending time typing and filing rather than more usefully spending it with patients and clients.

While health managers would support the need to reduce staff in some areas, they say that the December exit package was implemented in a disastrous fashion, which left them practically powerless to protect vital services

Under the HSE SLA, voluntary hospitals are independent employers and responsible in their own right for services provided, but the sudden exodus of staff has made it very difficult for some agencies to deliver on the requirements of the Agreement.

While health managers would support the need to reduce staff in some areas, they say that the December exit package was implemented in a disastrous fashion, which left them practically powerless to protect vital services. It was not a surgical strike, but a blunt instrument which left gaps in key areas (there appears to be just one exception where a hospital contested and refused applications for departure by a large number of staff in one department which would have made it very difficult to continue providing services for patients).  In general, however, managers could not contest applications for the packages as they were directed to approve all applications. The timeframe meant that managers had literally four weeks (with Christmas in the middle) to see where the gaps would be and to make alternative arrangements. This left no time for an orderly handover, even in the case of the most senior people.

The loss of CEOs, heads of functions, general managers and network managers is causing major problems, as they cannot be replaced and have to be filled either in an acting capacity or through double jobbing.  Said one manager “many of the people targeted in the exit packages were aged 50 or over and if you constantly wash out and flush out the pool, the expertise is gone and it is very difficult to replace this because it is not in the files, even if you knew where the files were.  Many of those who left did so because they had borne intense pressure and stress over the last few years and this pressure and stress is now transferred to fewer people and newer people.”

A total of 597 staff left the voluntary services in December and while some of the larger organisations might have the firepower to deal with this, smaller organisations just do not have the ability to find people with similar skill sets who can be slotted into the jobs.

As one CEO said: “Some departments have been literally wiped out.  I am now doing my own job and trying to assist people who are acting up in two other departments, which in turn have lost most of their staff. It just doesn’t leave me much time for strategic planning and development, which is something I should be about.

While the exit schemes were targeted at “administrators”, in many areas it was front line clerical staff, medical secretaries, admission staff and reception staff who went

“We have also lost staff from areas where we just couldn’t afford to lose them.  There has been a weakening of key organisational functions such as financial control (which has left audit and end of year financial issues) and HIPE coding where it is very difficult to find replacement staff with the necessary experience and expertise and on which a considerable amount of our budget depends.”

While the exit schemes were targeted at “administrators”, in many areas it was front line clerical staff, medical secretaries, admission staff and reception staff who went. The lack of clinical secretaries is killing services in some hospitals. It is causing problems in emergency departments and outpatients for patients, medical staff, nursing and health and social care professionals.  There are difficulties in following up on radiology and pathology investigations, consultants are finding they have nobody to type their letters and many professionals such as physiotherapists, occupational therapists and social workers are doing their own typing and filing, with the result that they have less time to spend with patients. Voluntary hospitals have lost a total of 142 general and support staff and the vast majority of these were “front line” staff engaged in patient support such as running admissions and clinics.  Many catering staff have also left which has led to very serious problems, since it is not possible to buy in replacement staff.

Another manager said that in his hospital clerical staff are working until 8 o’clock at night and they will never get back their hours. “The situation is unacceptable. We have a duty of care to our staff and in my view are failing miserably in that. We cannot protect junior staff and there is certainly nobody protecting managers”, he said.

This view was echoed by many people who felt there had been tremendous good will from management over the departures and this is coming from people “who were being beaten up by the public, politicians and the media, saying they are wasting resources and operating an inflexible system whereas, in effect, they have stepped up to the plate and assumed additional responsibilities without any additional remuneration,” said one.

“It is remarkable that more services are not grinding to a halt but it is not clear whether people will be inclined to continue doing the jobs of two or three people for less money in the long term.  It must also be possible that people are dropping stuff, which may not become apparent for some time,” said another.

Many managers are concerned that while one arm of the HSE or the Minister believes that administrative staff could be lost, all the clinical care programmes have administrative support stitched into them, all seem to require  a number of clerical staff which have to be pulled from existing resources. “We’re getting requests for these staff and also getting requests – or should I say directions – from the HSE centrally to put project managers in left, right and centre and additional nurses and health and social care professionals for some of the clinical programmes, but all this must be done within our core resources and with no reduction in activity in the areas from which we are drawing these staff,” said one very annoyed manager.

There has been a weakening of key organisational functions such as financial control (which has left audit and end of year financial issues) and HIPE coding where it is very difficult to find replacement staff with the necessary experience and expertise

Managers are adamant that any future exit packages must be handled differently and must give managers an opportunity for direct input and real management. They believe all hospitals and other agencies should be asked to lose the same percentage of staff (which would protect smaller agencies) and should be allowed to manage the redundancy programmes themselves.  This would give them a veto on staff leaving (with a view to safeguarding and protecting the services) and flexibility with regard to taking on certain key staff, if they exceeded the number they were asked to shed.  They also want the opportunity to introduce new technology to safeguard services while losing staff.

One manager said he could potentially manage his hospital’s requirement for clerical/admin staff if he was in a position to acquire technology such as voice recognition, which he had wanted for years. “The problem is that there is no flexibility with regard to being able to take on five staff if we shed ten. If I lost 20 staff and could invest €100,000 on a once off basis, I might have a solution which would allow me to continue service while losing head count.  If I was a manager in a private service charged with streamlining and delivering services, I would use this and other strategies, but none of these are available to me.  Whichever way we try health managers are effectively in a straight jacket,” he said bitterly.

Another manager said that the HSE should be driving an agenda to merge smaller organisations, rather than expecting these organisations to do it themselves. “If we go down this road, we are seen as either being takeover merchants or selling out the family silver. This needs to be done in a coherent, structured, transparent way by organisations and with organisations instead of just cobbling things together to reduce the numbers and ending up with a mess. If your core business is not the same it is very difficult to merge and be effective.  If it is you can work logically and rationally and develop a business and organisational model.”