HSE overtime bill - Patients and taxpayers put at risk

THERE could hardly be more glaring or costly proof of the need for reform of the health service than today’s revealing report on the sheer scale of overtime payments to HSE staff.

With the health system creaking, the economy in tatters, 400,000 people unemployed, and tens of thousands of families mired in poverty, the spiralling level of overtime, especially for hospital registrars, is alarming.

Even more disturbing than the financial figures are the implications for patient safety in understaffed hospitals, where jaded doctors have to work unacceptably long hours.

Today’s front-page story reveals that hard-pressed taxpayers forked out more than €400 million in the past two years to cover the overtime bill. In a worrying trend, the payments in 2007 and 2008 show the number of staff earning more than €100,000 in overtime has increased year on year. Clearly, with the overtime earnings of 20 registrars at hospitals around the country topping €100,000 last year, and with the five highest ranging from €113,781.44 up to €156,688, reform is urgently needed.

Resolving this problem will not be easy. The latest breach of contract dispute was settled on the steps of the High Court as the Irish Medical Organisation (IMO) and six doctors blocked HSE moves to cut overtime and allowances for 5,000 junior doctors by €40m.

From a positive perspective, both the taxpayer and hospital patients will derive a measure of satisfaction from this outcome. The HSE was forced to withdraw its controversial package of cuts but at least the settlement deal opened the door for fresh negotiations with the IMO to agree a strict timetable for the introduction of new rosters and a fresh overall contract.

Given the long and bitter history of negotiations between the IMO and HSE, it is questionable whether the July deadline for setting rosters for non-consultant hospital doctors will be met. The same might be said of the Christmas target for a new contract with junior doctors.

Crucially, the roster must comply with the European working time directive that comes into force in August, limiting the working week to an average of 48 hours. And unless both sides sign a new contract by the end of the year, there could be chaos in the country’s hospitals because all existing agreements would then lapse according to the settlement deal.

Meanwhile, patients are at risk of being forgotten in the interminable wrangling over pay and conditions. There is an onus on highly paid HSE managers and doctors to keep the patient at the centre of the health service at all times. It makes little sense for the HSE to impose a moratorium on recruitment while at the same time paying hospital registrars more than €100,000 in overtime. Not only is that self-defeating, it is costly for taxpayers, exhausting, albeit lucrative, for doctors and potentially dangerous for patients.

If reform is to mean anything, the HSE and doctors must agree rosters and contracts that put the interests of patients at the core of the health service.