Agreement should provide equivalent of 3,000 WTEs

The additional hours agreed for health service staff under Haddington Road was the equivalent of providing an additional 3,000 WTEs for the service, Mr. Barry O’Brien HSE National Director for HR told the HMI Dublin Mid Leinster Forum in the Dublin University Dental Hospital.  Maureen Browne reports.

The additional hours agreed for health service staff under Haddington Road was the equivalent of providing an additional 3,000 WTEs for the service, Mr. Barry O’Brien HSE National Director for HR told the HMI Dublin Mid Leinster Forum in the Dublin University Dental Hospital.

Barry O'Brien
Barry O'Brien

When the 1,000 additional graduate nurses and the 1,000 additional NCHDs who were being appointed this year were added in, it meant there was the equivalent of an additional 5,000 WTEs in the system.

“The Government wants us to reduce our current headcount by 2,500 and is pointing out that this still leaves us an additional 2,500 WTEs for the same amount of work,” he said.

“We need to deliver real change from Haddington Road. Allowing staff to cut their lunch hour from an hour to half an hour is not an appropriate way to work the additional hours provide for in Haddington Road. That is merely a box ticking exercise, which will not deliver the sustainable change which the agreement is about.

“The Haddington Road agreement required further savings to be made by way of reform, productivity and cost extraction. The Government had indicated that it would seek to reduce the WTE in the HSE. It was seeking to reduce the WTE for the health service to 95,500 by the end of 2014. The health services had already reduced staff numbers by 11,500 from 2007 to the current date.

“The level of management and management/administration staff is now back at 2002 levels.  There is an increase in medical and dental staff. There has been significant increase of about one third in the number of consultants compared to five years ago, there are more NCHDs and more nursing staff, there has been a significant increase in health and social care professionals and a decrease in the whole area of support staff.

“There is very little further scope for dramatic reductions unless we make some very serious decisions about the overall quantum of health services we are going to supply.

While he conceded that it would take a bit of time to reduce agency numbers, he said it was unsustainable to be paying agency staff, if there was an alternative and the service was 2,500 above its staff ceiling.  “In the first six months of this year agency nursing was 11 per cent higher than in the previous year.  If we don’t have a significant reduction in agency staff by the end of August something is radically wrong.”

Mr O’Brien paid tribute already to the work already done by health service managers, saying that health was the key sector which had delivered real,  measurable and sustainable change under Croke Park 1 and Haddington Rd. He said that it was only in exceptional cases that staff could be allowed to retain their present hours by taking a pay cut.  Managers could not afford to lose additional nursing hours in lieu of a pay cut and then employ overtime/agency staff at premium rates

Mr. O’Brien said that when career breaks were advertised 800 of those who applied were nurses and 850 health and social care professionals. “These are areas in which we have prioritised recruitment in recent years and it makes no sense now to allow them to go on career breaks.

He said Haddington Road was a completely different agreement to anything we had previously had in Ireland. It was about reform which was the government talking about less staff achieving more productivity, more hours, and cost extraction.

“The biggest challenge now is for manager to see what Haddington Road is giving them, in the shape of enablers to deal with the unprecedented challenges ahead.”

He said we had to put these challenges in the context of the fact that the country had to save €3.1 billion in the October 15 budget.  The health services had taken the reduction of €3.5 billion in the last few years with the potential for further reduction between €500 million to €800 million for 2014. The whole pace of change had increased dramatically and we would shortly see the introduction of hospital groups, with the advertisements for the CEOs for these groups being placed in the very near future. There was also currently a major review taking place of the 17 Integrated Service Areas and it was anticipated that when this report was completed in November there would be a reduction in the number of ISAs.

“One of the key challenges for managers is the whole issue of building capacity.  We are talking about building an organisation which is capable of meeting the regulatory standards, continuous demands by patients and continuous commentary by the media and by politicians.  In essence, we are talking about maximising efficiencies, avoiding duplication and meeting our legal and regulatory requirements.

“We should ask ourselves if we are actively engaging with our staff and encouraging them to become involved in the whole decision making process and what is the commitment we have from our staff.

“We have a huge number of managers in the health service but the word ‘manager’ does not appear beside their name. We have had an explosion in managers from the professional side. Many of these managers are superb clinicians and have attained their grade from exceptional clinical competence but they may not be great on people management. When there was lots of money about we hired lots of managers to hire more people to spend more money – up to 2007, all the Service Plans were about new posts and new buildings, more money and more people. We need to reflect on the purpose of management which is to provide direction and co-ordinate different elements of the business – things which require skills to achieve without creating huge disengagement, difficulty and stress.

“I think we have forgotten about commonsense. If you respond well to people, they respond well to you.  There is a real issue of people saying they feel overwhelmed day in day out and still they are wondering what they can do individually as managers to manage all that.  Managers need to support each other and need to have a conversation with staff as to what is reasonable to accept, what should be the norm.alth to date has delivered huge change but we are going to have more restrictions in money and being a manager will become increasingly challenging. At present there is very little interest in some senior management posts – the very diversity of the jobs seem to be overwhelming people.  We need to balance between constant change and continuity.”

“One of the things which people need to reflect on is that in some cases there is a need to engage in change process to retain their own viability as providers.  Remember the average cost of care under the Fair Deal Scheme is between €1,400 and €1,500 in HSE nursing homes and between €800 and €900 in private nursing homes. There is a dynamic emerging where organisations will no longer be viable.  There are real challenges like that facing us and we need to engage with staff on them. The alternative to Haddington Road was pay cuts and the unions said they would opt to do a deal rather than see the government introduce legislation for pay cuts.

Mr. O’Brien said Liam Woods National Director of Shared Services was coming up with  a plan to maximise the shared services platform and the challenge would be for every organisation to sign up to this, but to do so they would have to be convinced that shared services could deliver what they wanted when they wanted it and on time.

He said that managers had contributed hugely to change so far and he was committed to providing for their professional development. There were development programmes for managers in Dublin, in the North East, in Galway and in the Midlands and the HSE had just sanctioned 33 people to do a Masters course. “Mangers need to be competent at managing money and drawing up service plans and these are areas to which we are attending.”