Fórsa Trade Union warmly welcomes the opportunity to address the Oireachtas committee on the issue of workforce planning in the health sector. The Fórsa delegation today consists of myself, head of health and welfare division, and my staff colleagues at the Fórsa national health office: Mr. Chris Cully, Ms Catherine Keogh and Mr. Diarmaid Mac a Bhaird. Fórsa represents more than 30,000 workers in the public and voluntary health sector across a broad diversity of grades, groups and categories. A large portion of the Fórsa-represented workforce consists of health and social care professionals including physiotherapists, speech and language therapists, occupational therapists, dietitians, podiatrists, psychologists, social workers, social care workers, pharmacists, physicists, audiologists and orthoptists. This list is far from exhaustive. Fórsa also represents a very large cohort of clerical, administrative and management grades.
The concept of workforce planning is widely accepted as planning to place the right number of people with the right skills in the right place at the right time. In the area of healthcare, this should be designed with the sole ambition of providing improved patient outcomes which, in turn, deliver better care and improved quality of life. There are a number of contributing factors which militate against effective healthcare workforce planning and thus bring about a much-reduced capacity to achieve such improved patient outcomes.
To address taking a step back and reactive planning, the Irish health sector has been pieced together over 90 years as a composite of State and voluntary services. It has traditionally been dominated by the acute hospital sector. It is, at best, disjointed. The Irish health service is resourced with highly-competent workers who work honestly and diligently. However, such diligence is often compromised by a systems failure which consequently fails to deliver the required levels of improved patient outcomes. The social and political measurement of the performance of our health services is often based upon the number of patients waiting on hospital trolleys and the length of hospital waiting lists. This crude measurement leads to reactive and pressure-based planning. The cyclical nature of system failure and reactive planning will never bring about an integrated healthcare system which focuses on health promotion and improvement, community-based health intervention and appropriate acute hospital healthcare. Effective workforce planning requires taking a step back and planning to resource the type of health system envisaged in the Sláintecare model.
The current model whereby the annual funding allocation is distributed is not fit for purpose for an effective integrated healthcare system. Inevitably, as overspends arise, a cap-in-hand approach applies in whatever area of healthcare is attracting the most noise at a particular point in time. For example, if a particular controversy arises in mental health, unplanned supplementary resources are provided to ease political pressure. This approach can only lead to turf warfare in funding and, accordingly, we will never get to a point where preventive interventions realise their full value to society. If the fundamental principles of Sláintecare are to be achieved, multiannual budgeting will be a necessity.
The responsibility for recruitment of staff lies with national recruitment services, NRS. NRS is resourced with a cohort of highly-dedicated staff and is, quite simply, operating way beyond its capacity to generate timely staff recruitment. NRS is inhibited by rules surrounding the recruitment licence in addition to the sheer size of the task of recruiting staff on a national basis. Furthermore, the lack of a formal staff mobility policy ensures that there is a residue of workers seeking geographical relocation while at the same time residing on placement panels from which they are offered positions in areas outside of a geographical preference. A mobility policy would greatly ease the pressure on the system in this regard. The crude instrument of a recruitment freeze also introduces layer upon layer of derogation processes which take months to overcome, leaving vital posts remaining vacant or the utilisation of agency workers at a demonstrably higher cost to the State.
There exists a chronic situation with regard to vacant health and social care professional, HSCP, posts. The direct effect of this is felt by patients in need of interventions. The rate of churn of HSCPs is in excess of 7%, second only to hospital consultants. The Sláintecare model references the need for an additional 1,400 HSCPs. This figure does not even take into account the number of alarming and critical gaps in the current structure. As we seek to move to a model which places more emphasis on community-based health intervention which frees up acute hospital services to deliver what is needed in that area, HSCP recruitment cannot simply be an option. Without significant HSCP recruitment, the model simply will not get beyond the starting line. On an ongoing basis, the built-in excess whole-time equivalent planning which applies to cover maternity and parental leave in nursing should apply to HSCPs as 80% of HSCP staff are female. Additionally, there should be automatic progression from basic to senior grade therapist after five years' practice, subject to competency validation. This would be of great benefit to isolated rural areas as a therapist who has built up an intervention-patient relationship would not need to move from that rural area to attain career progression. There is also a clear need for a HSCP advocate in the Department of Health, which would operate in its own stream and not within a nursing reporting arrangement.
With regard to community healthcare organisation, CHO, primary care networks, Fórsa has given its support and co-operation to the establishment of nine learning sites, one per existing CHO, in the area of primary care. The establishment of the nine learning sites brings about significant change in the way HSCPs currently work. In order for the learning sites to succeed, they must be adequately staffed. If the Minister for Health’s proposal to create six integrated care organisations to replace the current configuration of nine CHOs and seven hospital groups comes about, it is likely that the network model trialled in the nine learning sites will continue. It is therefore imperative that, if the nine sites are deemed to be a success with adequate staffing, growth into more geographical networks are adequately staffed in the same way.
On clerical, administrative and managerial grades, there is an accepted lazy narrative in social and political circles that the health sector is awash with administrative staff and managers. This is neither true nor fair. In fact, the proportional number of administrative staff in the Irish health sector is lower than in many international comparators. Clerical staff are charged with tasks such as paying the wages of doctors and nurses and are often the first point of contact for members of the public. The acceptance of the narrative referenced above is demoralising for this group of workers, many of whom bore the biggest brunt of the cull in staff numbers during the financial crisis, at great personal cost.
Health sector managers are vilified for lack of performance and accountability whereas, in reality, the system is failing due to ad hoc planning. Fórsa is supportive of a performance system for senior managers as such a system would at least protect senior managers from a generic allegation which is made without any real basis. It would be hard to find, for example, many workers in the health system with as onerous a responsibility as that borne by heads of social care in the CHO structure. In fact, the dangerous level of risk borne by these workers has been independently verified. Recently there was an announcement in the national media, without any reference to this union, of the need to whittle down the number of managers in the system. This assumption is made without any meaningful analysis. In fact, this approach was tried before, resulting in a massive deficit of corporate and intellectual knowledge which, in turn, generated a subsequent re-establishment of previous numbers.
Fórsa once again thanks the committee for its attention and time. We will endeavour to answer any questions members may have either today or in further correspondence.