HSE report: One-in-10 financial managers qualified

Just one in 10 financial managers in the HSE tasked with preventing a €500m overspend this year are qualified for the role.

A leaked draft report drawn up for Dr James Reilly, the health minister, said the system — which is already €280m over-budget for 2012 — has a major weakness at senior management level.

According to the draft document, which is part of previously highlighted moves by the minister to improve financial controls in the HSE, just one in 10 financial managers in the health service are qualified accountants.

This compares to one in four in Britain’s NHS system, which is regularly criticised for similar problems to what is faced in Ireland.

While “extreme budget reductions” are being implemented in an attempt to cut costs, the report’s author — NHS chief executive for the North West, Mark Ogden — said if anything they are making the problems worse.

This is because the targets set for hospitals and other sectors are “not realistic”, with a “limited systematic quality risk assessment to assess the safety impact of reductions”.

This specific issue was also raised by individual doctors in response to a HSE letter to hospital managers last Friday, which called on them to further tighten their spending — a move the letter said could be done without comprising patient care.

Among the proposed cutbacks put forward in the letter were a reduction in the time patients spend in hospitals, staff overtime and a better implementation of the “near zero tolerance” approach to costly agency staff.

Hospitals regularly claim the overtime and agency spend is the direct result of a recruitment embargo, and that the amount of time a patient spends in a facility is linked to a lack of step- down services.

The draft document — which a spokesperson for Dr Reilly said is being “validated” and also includes comments on financial strengths — also said the health service is racked with a lack of motivation and a self-serving approach to budgets.

It warned of a culture “leading to people [ie hospital managers] with surpluses either ‘hiding’ or spending them in the belief that unless they do they will be taken away, and people with deficits not being incentivised enough to control or reduce them”.

Further issues include staff “inertia”; “recession fatigue”; “uncertainty about accountability arrangements”; and claims the Croke Park deal is “no longer sufficient” to cut costs.

The report concludes that HSE spending is “not driven by any health needs analysis” but by a “formula”, and that hospitals are repeatedly being given “unrealistic” budget cut targets that only perpetuate problems.

The report was sent to Dr Reilly a fortnight before HSE chief executive Cathal Magee confirmed on Wednesday he is to leave the role this autumn.

Mr Magee said there were tensions between himself and Dr Reilly, but that this was not why he decided to step down when structural changes begin this autumn.