Senior health managers are seriously concerned at their lack of autonomy and the significant amount of risks they are carrying on foot of the latest tough new HSE employment controls. Maureen Browne reports.
Senior health managers are seriously concerned at their lack of autonomy and the significant amount of risks they are carrying on foot of the latest tough new HSE employment controls.
There is considerable scepticism about the value of devolving the right to recruit “by exception to the recruitment moratorium” from the HSE National Group to a limited number of top managers, with many seeing it as just window dressing in view of the complex rules and criteria surrounding the delegation.
As one manager put it – “Nothing has really changed. The HSE is still firmly holding the reins, while we are holding the risk. We have the responsibility of providing safe services on the ground, but the real authority is at one remove – from the services and the risks.”
Managers are particularly worried at the way staff reductions are divvied out between different agencies by the HSE and budgets reduced to take into account income which they have no hope of collecting.
There is still an issue of trust, in that while the centre might say it is devolving they are still keeping a stranglehold on us. This doesn’t change the game at all.
Provided they meet strict criteria, managers who can now recruit by exception are Hospital Group CEOs, Voluntary Hospital CEOs, HSE National Directors, Heads of Service, Regional Directors of Operations and Community Agencies’ CEOs; although it is open to this group to delegate further where it is deemed appropriate.
“This whole devolution idea is just optics. Corporately, they can stand back and say we are devolving, but apart from the HSE National Service Plan posts, the constraints are as rigorous as ever and managers are continuing to carry a significant amount of risk,” said one HSE manager. “There is still an issue of trust, in that while the centre might say it is devolving they are still keeping a stranglehold on us. This doesn’t change the game at all.”
A voluntary hospital CEO said that while they all appreciated the financial difficulties of the country and the need to manage within budget, he thought that managers should have the wherewithal to control their budgets and that just wasn’t happening at present.
“We made cases for some critical front line posts, but it took the HSE six months to approve this and in the meantime I had to put acting arrangements in place – under the radar of course.
“I have no difficulty in terms of the employment control ceiling or the budget. Where I do have difficulties is that I have had money taken off my budget this year for systems, processes and procedures that are not even in place yet. Take incentivised career breaks for example – I have nobody taking or likely to take an incentivised career break, but my budget has been reduced as if I had people on career breaks. Then there are the deductions for the income we are supposed to get from private patients in public beds. The deductions have been made, but there is still no sign of the legislation which would allow us to implement the changes and get in the income, which would help with our budgets and with critical recruitment.”
A manager, who has had significant difficulties in keeping his services running efficiently and safely said “Those of us on the front line are best placed to make the call to ensure safe and effective services for patents. If I am unlucky enough to have a consultant leaving, I can’t just replace her or him with the money from the vacated post – I have to find the money by suppressing another post or posts. Then if I suppress two NCHD posts to replace a consultant, I fall foul of the European Working time Directive, as I won’t be compliant and that could cause worse trouble for me… The whole thing bears no resemblance to reality. I am happy to sign the budget and the employment ceiling, but then let me go and manage the hospital.”
This is a complaint which is running right through the system. A manager who has lost a number of front line posts last year pointed out that the HSE response to his dilemma was neither appropriate nor speedy.
“We made cases for some critical front line posts, but it took the HSE six months to approve this and in the meantime I had to put acting arrangements in place – under the radar of course – to keep the show on the road.
“The crazy situation where we have to spend more on agency staff than we would if we employed them is also still on-going.”
Managers who fail “in meeting their responsibilities under delegated authority may find themselves subject to possible disciplinary action.
Another area of anxiety for managers is the aggregation of the reduction in employment numbers over different agencies. “Last year I was told I could increase my staff numbers to provide for new services but then I was told I had to reduce them by far more as my contribution to the national reduction. So, I ended up with considerably fewer staff.”
HSE National Director for HR, Mr. Barry O’Brien has directed all HSE and voluntary hospital managers that replacement posts can only be filled “by exception to the recruitment moratorium,” and then only if they meet four strict criteria.
He has told all hospitals and agencies that “the primary focus of all recruitment decisions with regard to vacancy management has to be the impact on front-line services. Reductions in employment levels require reconfiguration of the current workforce in order to be able to deliver more with less.”
He has directed managers that before seeking to fill any replacement post they must satisfy the following four criteria:
- Identify that the vacated post remains a critical front-line post and due to service impact is required to be filled.
- Have exhausted all redeployment, restructuring and reorganisation of workloads in addressing critical front-line vacancies as they arise prior to seeking it to be filled as an exception from the moratorium on recruitment.
- Ensure that the decision to recruit does not compromise adherence to budget and that there is sufficient funding to maintain the post into the next financial year, if so required.
- Ensure the appointment does not compromise the approved employment ceiling at the time as well as the achievement of end of year approved employment ceiling/target reduction.
“The effect of these criteria, which are deemed to be the absolute minimum, is that they require identification of live vacancies and their suppression, and transfer of associated budgets as part of the process of seeking decisions to recruit by exception. Suppressions of a financial value, at least equal to the financial impact of the approval to recruit by exception, must be made in all cases and across all grades/categories of staff,” he wrote to managers.
Managers who fail “in meeting their responsibilities under delegated authority may find themselves subject to possible disciplinary action,” according to Mr. O’Brien.
He says that new service development posts, as set out in the National Service Plans will be controlled and monitored under a separate process, where a primary notification of approval to recruit is issued with the relevant details pertaining to the funded and approved post once formally authorised by the relevant National Director/Service Lead. The 2013 National Service Plan provides for over 1,000 new service development posts and Mr. O’Brien said the health sector has to ensure capacity in employment terms is maintained vs a vs its approved employment ceiling/end of year employment targets and budget allocations, this employment growth has to be offset by reduction elsewhere.