How many senior managers are needed to run Irish hospitals at a time of budget cuts and reductions in both nursing and medical support staff? Since 2011, the number of senior administrators working in acute hospitals operated by the Health Service Executive (HSE) has risen by 11 per cent. But over the same period the numbers in staff nurse core grades have declined sharply, with 744 fewer employed there. HSE figures also show a fall in the number of support staff, with a reduction in the number of cleaners, caterers and porters.
This rationalisation of the health service reveals a strange pattern.
More administrators, it would seem, are managing fewer health care professionals who must deliver medical and support services to an increasing number of people.
The latest quarterly employment figures show that overall public sector employment has fallen from its peak (427,300 in 2008) to 370,300 – with the health sector recording the largest decline.
The HSE has justified the increase in the number of senior managers now employed, claiming it as part of a “regularisation process” under the terms of the Haddington Road agreement on public service pay and productivity. It also points out that since 2007 the number of senior managers employed in acute hospitals has fallen by over 8 per cent.
The HSE, in a report to the Government’s joint monitoring committee for the health service, has said the number of managers employed is not excessive given the size of the hospital sector.
The HSE employs 48,000 people and its pay bill exceeds €3 billion.
Productivity is difficult to measure in the health service, given that the time and attention required to treat patients may vary with the nature of their particular condition.
A higher turnover of patients may be seen as one measure of productivity, but perhaps at the cost of compromising patient care.
Quality of care matters, and a balance needs to be struck between achieving and maintaining a high standard of treatment while also ensuring medical and other costs are kept within budget limits.
That is a challenge that faces both the administrators and the health care professionals.
Is the HSE better placed to meet that challenge given the limited restructuring that has taken place since the onset of the financial crisis?
At present the HSE is carrying out a national survey of its employees to find out their attitudes – both to their employers, to work practices, and to the culture and communications that operate within the health services.
The survey results will be used, as Health Minister Leo Varadkar said, "to improve the working lives of staff, leading to better care for patients".
But whether HSE staff view the appointment of more senior managers as a help or hindrance in achieving these goals may well be one of the survey’s most interesting findings.