Health Sector Action Plan 2012 by Annette J Dunlea
The HSE have now published their Health Service Action Plan 2012 .This revised Action Plan is designed to support the delivery of the HSE’s 2012 National Service Plan by facilitating the fast-tracking of measures required to deliver essential health and personal social services across the country within the context of further reductions in funding and staff numbers. The implementation of the National Service Plan, approved by the Minister for Health on 13 January 2012, represents a major challenge to the health services and comes at a time of major reform of the public health system.Essentially, all those working in the health service have to commit to delivering the maximum level of safe services possible for the public within reduced funding and employment levels while at the same time implementing a wide-ranging reform agenda.
The service impact of both the ‘grace period’ retirements and overall HSE budget reductions of €750 million for 2012, are reflected in this year’s National and Regional Service Plans. The National Service Plan envisages 3,313 retirements yielding a pay bill reduction of €160 million in 2012. The health service will also have to cover a range of unavoidable costs within its lower allocation, such as increments, general non-pay inflation, the EU Temporary Agency Work Directive and the VAT increase. The service will also have to cope with the increase in health and social care needs arising this year from population growth, ageing and increased disease incidence.The service must also deal with the ongoing reduction in staffing numbers in order to achieve an end-of-year target of 102,100 WTEs. In particular, the concentration of retirements in the period from late 2011 to February 2012 poses significant challenges. Recruitment priorities are outlined in the HSE Service Plan and the 2012 employment control measures will require that vacancies may only be filled on an exceptional basis in essential frontline health and social care services and to facilitate reform under the Programme for Government.
Within and across all key service areas, reform will see changes in way care is delivered as well as in governance and management structures. Some of the major developments are summarised below.Each hospital group will have a single consolidated management team, with responsibility for performance and outcomes, within a clearly-defined budget and employment ceiling. The management team will have autonomy to reconfigure services across the group, subject to an agreed policy framework and approval process. The Framework for Smaller Hospitals being developed by the Minister for Health will set out a set of key criteria and principles to which all reorganisation of hospitals, smaller and larger, will adhere.Given the need for a high-performing emergency ambulance service with appropriate integration with the acute hospital and primary care services, there is a need to achieve the rationalisation of ambulance control facilities, adoption of new technology and changes in work practices as a matter of urgency.
There is no standardisation of working hours for staff employed in the health sector but all staff must fulfill their contracted hours over a defined period of time.Given that the PSA has established the core working day as 8am – 8pm for all grades there is now an opportunity for all staff who avail of time off with pay and who also are remunerated for being on call and receiving premium payments to make up their contracted hours.What is being proposed is that all staff would at a minimum work their contracted hours each quarter e.g. theatre nurses would be required to work 37.5 hours per week multiplied by 13 weeks. for each quarter requiring them to complete 487.5 hours for this period. Likewise Consultants would be required to work at a minimum a total of 481 hours for a thirteen week period.The impact of this proposal would be to free up significant additional hours thus reducing the requirement for locums, agency staffing, overtime etc.
Some of the key requirements are:
1. Deliver the maximum level of safe services possible within the allocated budget.
2. Average expenditure reduction of 7.8% and a reduction to 102,100 WTEs by 31st December 2012.
3. More cost-effective provision of public nursing home services as alternative to contractions in capacity;
4.A reduction in the volumes of overtime (15%), allowances (10%) and agency (50%) expenditure
5. Deliver 2% efficiency measures in disabilities services across the country.
6. Deliver the targeted reductions in patient waiting-times in emergency departments and for elective procedures.
7. Achieve national target of 3.5% absenteeism rate for staff across all services
8.. Organisational changes within the HSE
9. Establishment of hospital groups;
10.Continued strengthening of primary care services by the development of multi-disciplinary Primary Care Teams (PCTs);
11. Development of mental health services.
12. There are a number of major reforms already underway in 2012 or which will proceed this year where staff will co-operate with these reforms, including adopting flexible models of care provision including, as appropriate, multiple work locations including institutional, community and home settings.
13. In addition, reform of the health service will involve certain reassignments of functions between the HSE and the Department of Health. Co-operation with these changes, including, as appropriate, with cross-sectoral mobility (HSE/Civil Service), will be required.
One of the key requirements of the action plan is the need to deal with the departure of more than 4,300 staff from the services between September 2011 and the end of February 2012. Management want to acknowledge the impressive level of staff commitment, flexibility and increased productivity which has already been provided by staff across the country to deal with this challenge.Continued co-operation in moderating the impact of these departures and ensuring continuity of safe service, particularly during this period will be necessary and the following measures, in particular, will be implemented.All local managers will review current rosters to establish whether they are optimised to meet current and expected service needs. The rostering reviews will also include an examination of skill-mix. New rosters will be developed as necessary to make the optimum use of staffing resources in line with the principles moving beyond the 12-hour model and ensuring that service needs,including “peaks and troughs”, are catered for. Rosters will continue to be open to flexible and dynamic change at local level. Managers will be required to report regionally and nationally on the changes effected.There will be an increase in staff productivity, especially in primary care, whereby scheduling of clients in PCT should increase by 30% over the course of the year.The elimination where it exists of the double payment of on-call and premium payments in addition to time off in lieu.Reviews of staffing levels will, as a result of the retirements, be undertaken where appropriate. Internal health service redeployment will continue to be pursued strongly, within the 45km radius provided for in the PSA. This will,as necessary, include mobility across geographical/administrative boundaries and between organisations, where this will facilitate the most appropriate delivery and management of service. The HSE will track this though a redeployment/mobility register.
Management and Clerical staff face changes:a reduction in management layers to consolidate numbers and to better reflect more streamlined management roles.Extensive redeployment of clerical and management posts across the public health service.A review of the existing flexitime arrangement, where it is in place, to ensure that it continues to meet the needs of the service.The Allied Health Professionals will see the introduction of the extended working day across all therapy grades.There will be a reduction in the numbers working in management grades to achieve an optimal match between staffing levels and service level activity.A productivity increase of 30% in the daily scheduling of patients and clients in primary care settings.The introduction of the extended working day for radiotherapy grades in NCCP centres.Support Gradeswill have a full implementation of the benchmarked standards identified in the Support Stat process to achieve greater productivity. This system of measurement of economy, efficiency and effectiveness of performance of facilities management services is live since 3rd January 2012, with 49 participating hospitals.They will implement the findings of the work practice review of the ambulance services. The rationalisation of ambulance control facilities and adoption of the necessary new technology will be addressed within specific timeframes in 2012 and 2013.Full co-operation with the laboratory modernisation project.
It is also the intention to introduce a new acting up policy.To enable change to happen quicker and to shift the emphasis from a centralised process to a more devolved process with responsibility and ownership at local level, every service unit is currently working on their change plans, including contingency for the end of the grace period. This adjustment will ensure that real change is implemented at local level,supported at both regional and national level by management and trade unions. This is a critical requirement for responsive change management in the current environment.
Key initiatives will relate to achieving enhanced value for money in the pricing and reimbursement of drugs and medicines. A target for procurement savings has been set for 2012. The introduction of reference pricing for drug in 2012 will be a key enabler.The HSE’s logistics and inventory management structure will move towards a National Distribution Centre, supplying nine regional hubs supporting point of use management for high usage stocks. National, public health sector,regional and local contracting strategies to leverage economies of scale,maximise efficiencies and effectiveness and achieve best value for money will also be implemented.
The INMO state they are concerned about a number of points. There has been a €1.75 billion reduction, in health expenditure,in 2010-11, the health service but there was an increase in its activity.In 2012 the allocation has been reduced by a further €750 million; 8,700 staff have left the service and have not been replaced.Since 2007; there is to be a further reduction of 3,000 staff in 2012.The HSE must reduce its pay bill, by €183 million, in 2012;the HSE plans to close 555 public nursing home beds and reduce home help hours by 4.5%.There will be an increase to 23,611, in the number of persons supported by the Fair Deal and a reduced acute bed capacity arising from a 7.8% cost reduction requirement for all acute hospitals.The allocation of €35 million, from the overall budget, to support/restore mental health services and the allocation, from within the budget, of €38 million for the development of primary care services including the replacement of priority posts and the allocation of GP only visit cards to all persons with a long term illness.The health budget will be cut buy €746 million in 2011 and a total of €1.4 billion by 2014.A reduction of 6,000 staff by 2014 to be achieved through “natural wastage”.Continued shift to community services, reduction in in-patient beds and increase in day and five day services.Implementation of flexibility and redeployment measures with reviews of staffing levels and rosters as stated in Croke Park Agreement. Salaries will be cut for all new entrants to the public service including nurses and midwives i.e.10% cut plus starting on the first point of the scale. The retirement terms, based on 2009 salary levels.
The INMO stated: this plan will inevitably result in the further closure of acute beds in many hospitals across the country;this, in turn, will lead to increased levels of overcrowding, in emergency departments;the development of the clinical care programmes, which have been so successful, will be negatively affected by the curtailment of services throughout the acute hospital system;care of the elderly services will be severely affected via a combination of the proposed bed closures and the loss of staff through retirement;the proposed transfer of services, from the acute sector to the primary care sector, will be severely hampered by the very significant loss of frontline posts in community nursing/midwifery services; and regardless of what configuration, or efficiencies, are brought forward, the health service cannot lose, in an uncontrolled and unmanaged way, over 3,200 staff, in the month of February, over 1,600 of which will be nursing/midwifery.