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СпутникиРНSpaceXРоскосмосNASAFine line to be walked between staying within budget and ensuring care of patients is not compromised
According to financial advisers everywhere, the best thing a person can do is to live within their means. But for the Irish national health service, this is proving difficult.
A perennial thorn in the side of every individual at the helm of the Health Service Executive, the discussion has changed in recent years.
The emphasis is no longer on the inevitability of overruns, and instead focus is on what steps can be taken to prevent overspending from happening again.
It was April when chief executive Anne O’Connor placed three regions, including the HSE South West region, under what is known as “tier-three escalation”.
This essentially involves the introduction of employment controls and greater scrutiny on spending.
At that point, the HSE recorded an overrun of €250 million in the first quarter. By the end of May this overrun had increased to €400 million.
The Minister for Health and senior health officials have consistently pointed to agency spend as one element driving expenditure that is over and above approved levels.
The desire to rein in spending is having real-world consequences for staff, management and patients around the country.
This was seen most acutely this week when the chief executive of Cork University Hospital (CUH) warned the HSE that delays in approving posts and restrictions on recruitment were resulting in increased patient-safety risks.
“I do not believe that the current position is sustainable, nor do I believe it is safe to enter the winter period with the level of staffing uncertainty that currently exists,” Jennifer Kearney told the HSE in a letter.
[ Cork University Hospital short more than 1,000 staff, says chief executiveOpens in new window ]
Public disclosure of such an argument is relatively uncommon, but rarer still is for unions to back hospital management.
The Irish Nurses and Midwives Organisation described the recruitment approval process as “archaic and bureaucratic”, adding it was “damaging frontline services and staff morale, and impacting on patient care”.
The Irish Hospital Consultants Association, meanwhile, described the situation as “unacceptable”, adding that it was “forcing existing staff to try to maintain increasingly fragile services in the face of ever-increasing demand for hospital care”.
In a largely expected turn of events, HSE South West did not agree with the hospital’s assessment.
In a statement on Wednesday, it said it recognised the increasing demand for services but said CUH was operating at a staffing level of 260 above its approved limit as of last month.
This impasse is not surprising. The health budget has become, in the words of one senior health source, a “bottomless pit”. It cannot keep growing indefinitely, regardless of how many patients require care.
That is why, every year, the national service plan sets out a maximum workforce limit. The approved target for this year is 136,605 personnel.
As of June, the HSE was almost 6,000 below that target, though the health service said this limit was based on what could be supported through the approved pay budget.
“Workforce numbers represent only one element of overall pay expenditure, with regions and services accountable for managing total pay costs across direct employment, agency staffing and overtime,” a spokesman said.
Anyone can see that spending on the health service needs to be curbed. That is why, again and again, the Department of Health speaks about productivity and value for money.
But the State is at a difficult crossroads. Policymakers and management must now walk a fine line between staying within budget and ensuring the care delivered to patients is not compromised on account of those decisions.
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