Does the public think Croke Park is delivering?

The vast majority of the large crowd of senior managers who attended the HMI West Forum in Merlin Park Hospital in Galway believed the public did not think that the Croke Park Agreement had delivered. On the other hand, they themselves thought it was delivering on its very challenging objectives in a number of areas.

Mr. Pat Harvey, Chair of the Croke Park Health Sector Implementation Group told the Forum that there were about 96,000 people working in the health service and each one could be an ambassador for the changes that were being made in the health services. “When staff go home in the evening to their families, when they meet their friends, you would like to think they would be telling them the ‘good news’ stories,” he said. “The public may not fully appreciate what is being done and the changes that are being made everyday”.

Pat Harvey
Pat Harvey

“Many of you may feel weary, like you can’t give much more and that you have gone as far as you can with the changes already made. But the national economic picture is telling us that we are very far from the end of the pain. We are only at Year 2 and unless we can squeeze as much again out of the next two years, we will not be living within the economic parameters that may be set out for us”.

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“If we want to maintain the quantity of service we have to deal with price and if we deal with price in a situation where 70 per cent (+/-) is pay…will there be temptation to revisit pay, rates? Will reduction in numbers employed be enough and in the event that emphasis is on numbers reduction can the quantum of service be maintained? These are the debates exercising everyone”.

“If we are in a situation where it might be argued that there can be substantial savings associated with outsourcing a service such as a nursing home, then that begs the question about the cost of running, in this instance, many of the HSE nursing homes. These cases feature.

“In a recent substantial Dublin development which was effectively doubling capacity for a business by way of commissioning a second unit the approach was to operationally design the new second unit with a ‘greenfield site’ approach. None of the existing practices was presumed to be appropriate. Technology was exploited to the maximum. Now interestingly there is a ‘new benchmark’ which the old unit is expected to gravitate towards. This approach is likely to have more universal applicability.

“Pat McLoughlin (former HSE Deputy CEO) is leading out on local authority reform and it is noteworthy in his recent addresses how the number of local authority employees per thousand of the population varied from one county to another, even when weighted variables were taken into account. Has this type of exercise still got applicability within the HSE? It seems it may have.

There are about 96,000 people working in the health service and each one could be an ambassador for the changes that were being made in the health services

“The HSE is looking at support staff in its exercise (‘Support Stat’) comparing ‘hotel type’ costs for catering, housekeeping, portering, security etc across various settings (again weighted).What this will throw up will remain to be seen but no doubt, if there are variances, there will be pressures to equalise. How these costs compare elsewhere will also most likely also surface. Comparisons for other grades will also feature more and more.”

Mr. Harvey acknowledged it was difficult to keep squeezing juice out of an orange and expect the service to remain the same. Some things would have to change.  All traditions, conventions, skill mix, Nurses Vs NCHDs, greater employment of advanced practitioners etc. are all likely to feature. There are prompts when one looks for instance at practices in other settings for instance the Mayo Clinic theatre practices.”

He said Croke Park was a done deal. It had been agreed by the unions on the basis that members would hold on to their pay in return for co-operating with management on the understanding that management engaged with them meaningfully as union members.

“You must tell staff what you have in mind and why. You must engage with them in proper dialogue. If there is another way of doing things this must be explained. There are provisions within the Croke Park Agreement for timelines, for onward referral etc. There is an expectation that people will ‘play ball’ but management has to work as per the agreement. Pace and product are vital and these are embraced within the given timeframes.

“I am neither pro nor anti union; I am fairly and squarely in the middle and I fully appreciate what is being done around the country. A great deal is being achieved and credit is due to all concerned. Activity is being maintained despite nearly €1 billion of cuts, rosters are being changed, labs and radiology departments are being re-organised, shared services are being rolled out, the new clinical service programmes are being rolled out and should result in efficiency savings in one instance alone of about €23 million. These programmes will result in much better services for patients and I think will result in increasing public confidence. There is still a lot to be done but the service is blessed with excellent dedicated staff. These staff appreciate that the least the public expect of us in these challenging times is that we are making the best use of whatever resources are available.”

Mr. John Hennessy, RDO, HMI West and Mr. Adrian Ahern, Chair HMI West welcomed the large crowd of senior managers who attended the forum. It was supported by GlaxoSmithKline.