Embargo an ‘undesirable instrument’

OVER 200 employees left primary, continuing and community care services in the Mid-West over a 15-month period, a senior health manager has revealed.
Mid-West primary, continuing and community care manager, Bernard Gloster, recalled the number of employees on the payroll in his sector dropped from 2,900 on January 1, 2011 to 2,684 on March 1, 2012. These figures included those who were job-sharing and excluded temporary help staff and voluntary agency workers.
The overall management of health services in the Mid-West is delivered across two distinct sectors – acute hospitals and primary, continuing and community care. The Mid-Western Regional Hospitals in Ennis, Limerick and Nenagh; St John’s Hospital, Limerick; Croom Orthopaedic Hospital and St Munchin’s Maternity Hospital are all managed under one structure. The rest of the services, including GPs, mental health and public health nursing, come under primary, continuing and community care.
The Fianna Fáil-led Government approved a voluntary retirement scheme, which incentivised public servants to retire before February 29 last when their pension and lump sum was based on their pre-pay cut rate.
As a result of this retirement scheme, Mr Gloster lost about 120 employees between Christmas and the end of February and a much higher percentage of these were frontline staff, compared with the voluntary redundancy scheme, which was largely targeted at management in administrative grades.
Following the loss of a large number of public health nurses and psychiatric nurses, Mr Gloster explained a judgement call had to be made concerning the provision of a safe level of service after so many people had left the system. This was achieved by developing contingency plans to meet this challenge and reconfiguring the non-hospital services in Clare for clinical reasons.
He stressed the reorganisation of Clare Mental Health Services was done because it was clinically appropriate and not because employees had left. However, this reconfiguration had the benefit of reducing the impact of the retirements.
While the HSE managed to retain most of their services after the retirement period, Mr Gloster said the Clare Mental Health Service continued to use agency staffing, where appropriate.
Earlier this year, there were nine vacancies in the Clare Mental Health Services and Clare Primary, Community and Continuing Care and this was expected to increase to 14 for the former later in the year. A successful application was made to fill 10 nursing posts in the Clare Mental Health Service, as a result of maternity leave.
As someone who is involved in managing and working in front-line public services for over 20 years, he described the national recruitment embargo as a very “undesirable instrument” for managers.
While he acknowledged the necessity of the embargo because of the economic recession, he noted the purpose of the embargo is to reduce the number of public service employees.
“In all of the cases, we need to take a balanced approach to the embargo. There is no doubt that the mental health system on the nursing side did feature highly in the retirements this year, which is recognised across the country. It is a challenge and it’s one we keep looking at and we are also making some replacements,” he said.
Asked about the use of agency staff compared with hiring newly qualified psychiatric nurses, he pointed out the HSE, through its procurement process, started new contracts for agency staff, which achieved substantial price reductions nationally.
Acknowledging the cost factor of hiring agency staff is traditionally higher than permanent staff, he noted new EU directives concerning the payment of agency staff would essentially bring this eventually back into line with all HSE staff.
“The conversion of agency staff is desirable in certain situations. Apart from the cost issue, the conversion of agency [staff] is something we have, in the past, considered and we have utilised in some of our services because we felt that the level of dependency we had on agency [staff] has gone too high.
“If you go over a certain threshold, you can affect the whole continuity of care that you’re trying to achieve in a particular setting.
“There have been experiences in the past in mental health and other services where we have either converted over time into jobs or we have converted agency into our own staffing and we have still ended up at some point in the not-too-distant future after that, where costs have gone back up through high levels of absenteeism or other demands to come into the service.
“It is a balancing requirement all of the time. I have certainly looked recently with my own mental health management team, to say ‘ok, here’s your level of agency’.
“Realistically, if we’re going to continue with that into the long-term future, we have to look at converting some of it. I think there will be a debate to be had about how much we use,” he said.