'Action plan' bursting with radical changes


The new action plan for the health service sets out reforms for living within the new budget, writes MARTIN WALL

TRADE UNIONS representing health service staff will meet management next week to discuss proposed new reforms under the Croke Park agreement which set out significant work practice changes for virtually all grades

The new “action plan” drawn up by management contains some of the most radical proposals for change put forward so far for any part of the public service. Essentially, the plan sets out the work practice reforms which management believes are essential to live within budget cuts of more than €700 million, the departure of more than 4,000 staff and to prepare for wide-scale structural changes as the Government moves towards the system of universal health insurance.

The document says the new “action plan” is designed to support the delivery of the HSE’s national service plan (its agreement with the Government on how its €13 billion budget is spent). It says it will do this “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”.

Apart from dealing with budget cuts and falling numbers of personnel, in its new “action plan”, health service management is also seeking to invoke the Croke Park deal to secure support for the major health reforms which have already commenced or will get under way this year. It says this will include “adopting flexible models of care provision, including, as appropriate, multiple work locations including institutional, community and home settings”.

One proposed change which had been widely flagged in advance by the Minister for Health James Reilly is the reform of staff rosters.

Many of the rostering changes being sought focus on nursing personnel. “Crucially these proposals centre on changes to the common work period of 12 hours for nursing. This change is consistent with the report from the Commission on Nursing Hours which concluded that the 12-13 hour day is in many cases sub-optimal and considered that the practice of the 12-13 hour roster should be largely discontinued as it did not reflect ‘peaks and troughs’ of daily routine.

“Currently a typical nurse/midwife will fulfil his/her hourly commitment by working three days every week, with a fourth day once in every four weeks. While at a general level this work pattern may satisfy the needs of an establishment, a lack of flexibility in such rosters fails to optimise the nursing/midwifery resource and accordingly requires change.

“Therefore management now require that a six-hour roster is accepted across all public health sector providers in building and developing appropriate rosters. The rationale for the six-hour shift must be based upon the requirement to match staffing needs with varying activity levels as they occur throughout the 24-hour day.”

Nurses also face other significant changes as the document proposes staffing levels in the public system should be based on similar ratios applying in the private sector. Nurse managers would have to take on greater responsibilities. It says directors of public health nursing would have to cover additional service areas while directors of nursing in the community and in hospitals would take on responsibility for additional facilities.

It does propose expanding the role of the nurse – something long sought by unions. However, there would be no extra money involved. It proposes “the introduction of advanced nurse practitioners in targeted services to substitute for non-consultant hospital doctor service posts”. It says there should be a further expansion at no additional cost of the role of nursing across all care settings to include IV fluid balance, blood transfusions, etc.

Hospital consultants would also face changes. It suggests some could be rostered on any five out of seven days – a major reform as at present they are contractually entitled to extra payments for weekend work. Consultants would also have to co-operate with measures to achieve greater collection of income for public hospitals from insurance companies – the HSE has argued millions are outstanding due to delays in doctors signing forms. Consultants would also have to support the introduction of advance nurse practitioners and be compliant with private practice limits as calculated by a currently disputed measurement system.

Management grades would face another cut in numbers while clerical staff would see a review of existing flexitime working arrangements. Therapy grade staff would see an extended working day while the document also calls for a 30 per cent rise in the number of patients scheduled in primary care settings. For support grades the document says management wants to see the full implementation of the “support stat” system of measuring economy, efficiency and effectiveness of performance of facilities management services.

The plan also calls for the implementation of the findings of a review of work practices in the ambulance service and the double payment of on-call, and premium payments in addition to time-off in lieu, will be eliminated.