Senior managers from across the health services have proposed radical and innovative measures to alleviate the impact on the services of the current drastic cutbacks, writes Maureen Browne.
Senior managers from across the health services have proposed radical and innovative measures to alleviate the impact on the services of the current drastic cutbacks.
A HMI survey has shown that they are deeply concerned about the risks to patient safety in the present circumstances, feel that further hardship must not be inflicted on vulnerable patients and are completely disillusioned with what they see as a lack of honesty about which services are sustainable and which are not.
Political leaders need to tell the truth about what can reasonably be expected
A number of major threads emerge from the survey:
- We are well past the point of suggesting we can do more with less and the public must be informed which services are sustainable and which are not, as a result of the cutbacks. Political leaders need to tell the truth about what can reasonably be expected.
- There should be an examination of what is the biggest waste of time in service provision e.g. DNAs and these issues should be addressed.
- There must be less micromanagement by the HSE corporately and local managers must be allowed to manage.
- Communication from the top to managers must be significantly improved. Managers are angry at the lack of information, engagement and consultation.
- There must be new and more flexible ways of working and the Croke Park Agreement must be reviewed if necessary to ensure ongoing service delivery.
The survey covered 135 managers. Eighty per cent were either senior or middle managers and twenty per cent were front line managers. They were broadly representative of staff views in all the major areas of the services.
There was general agreement that as one manager put it, “the moratorium is a blunt and now dangerous instrument. It was described succinctly as “a penny wise and pound foolish method of clawing back funding, whilst unwittingly increasing risk to safety.”
Managers also believe that it is a priority to now identify what is absolutely critical and attempt to protect those services from the worst of the cuts. A floor rather than a ceiling should be introduced for certain services.
National standards should be issued for service entitlement. Health managers should be outspoken rather than being apologetic for decisions made by others.
We should stop trying for large changes and look at what small advances can be made and allow more local autonomy with greater transparency and accountability.
They argue strongly that budgets must be devolved to frontline and service managers, that concrete national priorities should be agreed and there should be more consultation with local mangers to ensure more equity of funding to areas and between areas. Service managers should have more autonomy, with protected budgets to ensure that the staffing is better managed than currently.
The impact of education and training in the health sector for staff’s professional development must be acknowledged
Other recommendations include:
National standards should be issued for service entitlement. Health managers should be outspoken rather than being apologetic for decisions made by others.
Account must be taken of the level of services affected by vacancies/maternity leave and a minimum level set at which a service would be allowed to appoint locums. The organisation CEO /GM must be involved in HR. Filling of posts must be on an organisational wide basis according to the specific circumstances, clinical need and risk to the organisation.
There should be a complete look at top management with at least one layer and probably two removed.
HIQA actions should reflect a balanced approach prioritising safety issues in the current climate.
Clinical Care Programmes should be suspended where necessary until there is a clearer vision of how programmes will be delivered locally.
The ESRI should take a look at making an honest comparison between public and private services.
Lean Six Sigma tools and techniques should be adopted, as what we are doing at the moment is not working, so a new approach is required.
If necessary there should be a review of the Croke Park agreement to allow more flexible ways of working.
Outsourcing must be facilitated by the HSE, staff conditions must be loosened,
Annual leave should not be accrued during sick leave, maternity leave or unpaid leave.
There should be better sick leave management, major restrictions on excessive time off due to flexi leave and absenteeism with regard to uncertified sick leave should be reviewed. There should be more flexible working hours especially for doctors/consultants to manage the crisis
Working hours should be extended to 39.
The number of AHPs being currently trained should be reviewed. Under resourced services cannot cope with
Higher Education Authority’s demands for clinical placements
IT data should be at client level rather than at top management level “which mainly functions to collect statistics”.
Services in the community must be improved to allow swift discharges and ensure community can buy relevant equipment for safe discharge.
The impact of education and training in the health sector for staff’s professional development must be acknowledged.
Some services such as maternity, paediatric and services for persons with intellectual disability are singled out for special mention. It is stated that maternity and paediatric services will find it impossible to respond to the growth in demand with year on year budget cuts in these services. This growth in demand is linked to the birth rate and increasing number of babies being born with very complex medical requirements (also linked to older age of mothers and IVF treatment, multiple birth outcomes).
There is also strong opposition to inflicting more hardship on persons with intellectual disabilities and their families with managers saying we have to question our core values as a society if we continue to target the most vulnerable for savage cuts.
