Dáil Éireann debate -
Tuesday, 15 Oct 2002

Vol. 555 No. 2

Priority Questions. - Health Board Staff.

Liz McManus

Question:

81 Ms McManus asked the Minister for Health and Children the number of vacancies which will be left in each health board area as a result of his instruction to cut 800 posts; if he received a letter from the chief executive officers of the health boards warning that such a reduction in numbers could not be done without impacting significantly on service levels, service quality and service developments; if he will read the text of the letter into the record of Dáil Éireann; and if he will make a statement on the matter. [18036/02]

Mr. Martin:

The Deputy may wish to note that since 1997 there has been an increase of almost 27,000 in the approved employment ceiling for the public health services in whole-time equivalent terms, bringing the approved ceiling to 92,500.

The volume of direct employment in the system has increased beyond this level for a variety of reasons. These include: demographic pressures and record levels of funded activity; the need to provide for additional replacement staff due to changing work practices; changes in the composition and structure of employment growth, reflecting, for example, improved skills mix; and reductions in vacancy levels resulting, for example, in reduced dependence on agency staff.

This year alone 6,000 new posts were approved. Against this background, the Government decided that an indicative number of 800 posts should not be filled as a corrective measure. This represents less than 1% of the total numbers employed.

In mid-July last my Department advised each health board of a range of measures to be taken to ensure that health expenditure in 2002 remained consistent with the approved levels for the year. In this context, each health board was requested to achieve savings through an adjustment in planned employment growth. All health boards were informed by my Department at that time that the adjustment in employment growth was to be undertaken in such a way as to have minimal impact on services. On 17 July the chairman of the Chief Executive Officer Group of the health boards wrote to a senior official in my Department regarding the planned employment adjustment, highlighting the potential impact on services from a concentration of the measure on the management-administrative grade category. The letter also drew attention to the need to review the management-administrative classification since the current grade category encompasses a very broad range of personnel, many of whom are engaged in direct patient services. I am happy to provide the Deputy with a copy of this letter.

Following further consultations with the health boards my Department again wrote to the chief executive officers in early August agreeing that the measures to be taken would be applied across the entire employment profile for 2002 and the scope for non-filling appropriate posts across all grade categories would be considered. This letter emphasised that the adjustment in the numbers of posts previously notified to the boards was indicative only and reiterated that front-line services were not to be affected by the adjustment. This decision was taken in view of the breadth of functions, including many clinical support and service provision roles, embraced by the management-administration category.

Since responsibility for the precise measures to be taken to yield the planned result in service and cost terms rests with each health board, my Department has worked closely with the chief executive officers of the health boards to establish clearly the parameters of the required employment adjustment. This is also against the backdrop of very rapid growth in employment levels in recent years and the need, in any event, to manage employment levels within the approved employment ceiling for each health board.

My Department is in ongoing discussions with the chief executive officers about the measures required to ensure more accurate and timely monitoring of employment trends and to ensure measures to be put into effect in 2002 serve the twin objectives of minimal adverse effect on service levels and effective management of overall resources.

Ms McManus:

I thank the Minister for giving me a copy of that letter which I was denied under the Freedom of Information Act.

Will the Minister accept there is a clear conflict between the spin he put on these job losses and his statement that there will not be an impact on patient care and the clear warning given by chief executive officers that "administrative-managerial posts cannot be reduced by the numbers required without impacting significantly on service levels, service quality and service developments."?

An Ceann Comhairle:

Quotations are not in order at Question Time.

Ms McManus:

They also stated in the letter that this will cause considerable industrial unrest and will impact on morale and service delivery. Surely the people working at the coalface who are trying to keep the health service going advised the Minister in clear and certain terms that what he was doing would impact on service delivery. Despite the spin he made in relation to increased funding for health services – nobody is arguing the figures – will he accept that health boards are severely over budget, hospitals cannot cope because of the increased demands for many services and they cannot keep within the budget requirements set by the Minister without that having a direct impact on patient care? Will he come clean about the impact of the statements he made and the decisions made by the Government as soon as the election was out of the way? During the election the Minister stated on RTE that there would be no cutbacks. Despite the extra money invested in the health services, will the Minister accept they have been subject to cutback after cutback in terms of the care provided and the job cuts outlined in terms of the 800 posts he named?

Mr. Martin:

I disagree strongly with the Deputy. I do not know whether she listened to the reply.

Ms McManus:

I listened.

Mr. Martin:

I expected a reply of that type from the chief executive officers. To be fair to the health boards, the chief executive officers would respond in such a manner. When I examined the Department's census in terms of employment levels in 2001, a matter on which we worked with the health boards, we discovered that from July the health boards were in excess of their approved ceiling. The matter of the famous 800 posts arises against a different backdrop. Originally the backdrop was that 6,000 jobs were to be created in 2002 because of the estimate that had been allocated, but at the end of 2001 health boards were considerably in excess of their employment ceiling levels. It is difficult to accept that the measures we announced could have the type of effect on front-line services articulated in that letter.

Subsequently two boards did not lay off staff. They were able to effect the savings under subheads other than the employment subhead, and that gives the lie to that letter. Some chief executive officers took different routes to resolve the issue and come up with the indicative savings which did not affect their employment profile.

Ms McManus:

Some 85 posts in the Western Health Board area were not filled as a consequence of the Minister's decision and another approximately 80 jobs were lost. Either those jobs are necessary for service delivery in the health boards or they are not. If they are necessary, how can the Minister justify those cuts and if they are not, what were the health boards or the Department doing in permitting this to happen?

Mr. Martin:

I understand from a note that the bottom line in terms of the Western Health Board is that it accepts the indicative figure of 85 posts, which my official advised at that time and which was the subject of some dispute. The key point is that the census indicated to us that at the end of 2001 the board had 400 posts over its ceiling.