The possibility that health service staff might be asked to work additional hours for a restricted period, was raised by Mr. Brian Kirwan, newly appointed Interim Chief Operations Officer, Children & Family Service and until recently, head of the HSE’s Corporate Employee Relations, when he addressed the HMI Dublin Mid-Leinster Forum, Maureen Browne reports.
The possibility that health service staff might be asked to work additional hours for a restricted period, was raised by Mr. Brian Kirwan, newly appointed Interim Chief Operations Officer, Children & Family Service and until recently, head of the HSE’s Corporate Employee Relations, when he addressed the HMI Dublin Mid-Leinster Forum on the topic “Making Best Use of the Public Service Agreement.”
In reply to questions from the floor, he said that with fewer people working in the service and nobody wanting to take a pay cut, people might be asked to work an extra three hours a week for a restricted period of, say, three years.
Mr. Kirwan, who has long experience in industrial relations in the health service and other industries, said he believed that any future exit packages would not be open to all staff but would be targeted at areas where so many people were not required.
He said there would be hundreds of millions of euro knocked off the health service budget next year and by 2014 the health service would lose another 6,500 staff.
He believed that any future exit packages would not be open to all staff but would be targeted at areas where so many people were not required.
With less people and less financial resources over the next few years and with the low lying fruit already picked, the challenge would be how best to manage and the tools available to managers.
“One of these tools is the Croke Park Agreement which can bring about change in a very structured process way.
“There are two core components in the Agreement –the overall agreement which the unions do not see as applying to the health sector and the health sector agreement itself.”
He said the health sector agreement was to assist change, its key objective was to make the public service more efficient and effective, to reduce the HSE’s cost base and increase productivity and to implement the HSE Service Plan.
Paragraph 1.4 was the key paragraph in the Public Service Agreement. This stated that “in order to sustain the delivery of excellent public service, alongside the targeted reduction in public service numbers over the coming years, the parties accept that efficiencies will be maximised, productivity increased, work practices revised and other initiatives.”
“Other initiatives open up a whole range of changes which managers can propose and put forward,” he said
“With the exception of pay, there is no limit in the Public Service Agreement, and then of course we ask what is pay? Is it basic pay, premium rates, overtime? Should people be paid premium rates for doing additional hours? Maybe yes, maybe no –depending from where you are coming.
“We are looking at rosters, an extended day, skill mix, matching of staff to activity. We know that in certain areas and disciplines we have more staff of a higher grade than we need. We are looking at that to see how we can change it and change is happening. For example, private community nursing homes probably have 30 per cent nurses to 70 per cent care assistants, but in the public area it is probably the other way around. We are moving to a 50/50 or 60/40 situation. We realise that the HSE probably has patients with higher levels of dependency but we are not sure that there is such a huge difference.”
Mr. Kirwan said that in bringing about change it was important that managers should carry out and consider the following:
- An analysis of need and demand which underpinned the plan.
- Confirmation by management that alternative working arrangements would meet quality and clinical care requirements.
- The impact on human resources – numbers/rosters/earnings across all disciplines
- Information on cost savings.
- The impact of the alternative attendance pattern on family earnings, commitments and personal or social arrangements.
He said it was possible to outsource but managers had to follow procedure. This involved consultation on the development of the service plan, outsourcing options, evaluating existing in-house service and the changes required internally to retain the service in-house. These considerations included the overall cost, the quality of service, effectiveness, and if the public interest would be met.
When you outsource you could be paying an administrative charge of seven per cent or more and 23 per cent VAT on top of the actual charge
“It is important to remember that a decision should not be based on the hourly rates of pay. It is also important that if a decision is taken to proceed you keep in regular consultation with the unions to keep them in the loop.
“There are plenty of hospitals and agencies which have outsourced certain pieces of work and we can also look at outsourcing in organisations outside the health service. Outsourcing is not always cheaper and one of the big issues we have come across is where outsourcing has been done maybe ten years ago, but the contracts have not been managed. Now might be the time to look at your outsourcing contracts to see if you are getting value for money.
“There is no doubt that we cannot reduce the numbers in the public service without some kind of intervention, but this has to be value for money… When you outsource you could be paying an administrative charge of seven per cent or more and 23 per cent VAT on top of the actual charge.”
Mr. Kirwan said that when a dispute occurred there were two key mechanisms – the Labour Relation Commission or the Joint Review Groups (JRGs). After six weeks, mangers could refer a dispute to the LRC/Labour Court for a decision which parties to the Public Service Agreement have agreed would be binding. Trade unions had to co-operate with the implementation of change, pending the outcome of the industrial relations processes.
There were specific processes for dealing with an extended work day, the delivery of service 24/7, a review of existing rostering arrangements and redeployment protocols.
He said that successes of the Public Service Agreement to date included:
- A reduction of over 9,000 WTEs in the public service.
- The redeployment of about 6,000 people, while about 800 people have moved. between different hospitals at corporate level.
- The redeployment of 4,500 people in the health sector.
- Roster changes.
- Reduced budgets.
- Increased activity.
- The implementation of the Clinical Care Programmes which have allowed us to increase productivity with consultant changes and better use of theatres and ambulances.
“The Agreement is a tool for managers to effect real change. It will be successful if we manage timelines, follow the processes, use appropriate mechanisms to resolve disagreements and identify areas of restrictive practice and target these.”