Ireland’s shambolic health service has been compared by embattled Health Minister Dr James Reilly to a massive tanker that can’t be turned around overnight.
Ironically, his analogy could turn out to be prophetic because when huge tankers run aground they invariably cause major disasters and the HSE is now perilously close to the rocks.
Financially, the Government’s biggest spending department is not just strapped for cash — its budget overrun is so big the HSE is preparing to embark on a potential collision course with the unions in a bid to save money by squeezing every last ounce of work from the Haddington Road agreement.
Hammered out in eyeball-to-eyeball sessions between health officials and public service unions, among the terms and conditions produced by that agreement were an additional 5.2m working hours a year. The Health Service Executive has been ordered by the troika to deliver on those terms to the letter of the law. And, as expected, even tougher instructions are being handed down by the departments of the Taoiseach and public expenditure and reform in the course of their penetrating scrutiny of the job Dr Reilly is doing.
Whatever the explanation, an extremely strong dose of medicine is prescribed in a letter to its managers by the HSE’s human resources director Barry O’Brien. The upshot is that public servants are being asked in no uncertain terms to meet their side of the Haddington Road deal by delivering on the increase in standard working hours as promised in negotiations with the unions.
Not alone is this demand likely to worsen the already strained relations between HSE management and its workforce, it will also intensify the unpopularity of the Fine Gael-Labour Coalition in the eyes of public servants who feel they have already been squeezed to the limit financially.
Ultimately, the aim of the HSE is to use the 5.2m worth of working hours to reduce its dependency on overtime and costly agency staff, an ambitious objective in an organisation where staff numbers have been cut to the bone. The problem is that fewer staff are being asked to do more for less reward.
Despite the offer of a sweetener by way of incentivised career breaks from the HSE in return for working the extra hours, the early signs are that this approach will not go down well. If it misfires, it could possibly lead to a fresh outbreak of industrial problems.
The HSE argument is that by achieving greater efficiency it will reduce the need for more cuts in a health service under severe financial pressure. So out of control are its finances that Dr Reilly knows he has to achieve savings of at least €666m 2014.
If further cuts are carried out, the result would be disastrous, according to the chief executives of four of Dublin’s largest hospitals. In the face of rising demand, they warn the HSE that hospital funding cuts seriously threaten the quality and safety of patients services and point to “unacceptable delays” for some cancer patients in accessing treatment.
Inexplicably, Taoiseach Enda Kenny continues to back Dr Reilly. While that lasts, despite his lacklustre performance in health, he will get the automatic support of Fine Gael and Labour TDs in the Dáil. But amidst dark mutterings in the corridors of Leinster House, the knives are being sharpened, though few, if any, will covet his difficult job.
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