Health chief questions public service pay-for-change formula

The secretary general of the Department of Health has questioned the traditional practice in the public service of paying staff additional money to co-operate with change or reform programmes.

Addressing the annual conference of the Irish Hospital Consultants Association (IHCA) in Cork today, Jim Breslin said openness and commitment to appropriate ongoing change designed to secure improvements in services to the public "should be a core part of our ethos".

Mr Breslin said his belief that many people were in their role because of a commitment to public service led him to question the previous formula whereby pay increases were seen as a means of incentivising co-operation with changes to how services were delivered so as to better meet the interests of the public or the patient.

“I am not talking here about the normal bargaining between the Government and employees about what represents a fair level of remuneration nor even about compensation for loss of earnings which can result from certain changes,” he said.

“However, it should be a core part of our ethos that there is an openness and commitment to appropriate, on-going change designed to secure improvement in services to the public. This should be part of business-as-usual for a modern, flexible and innovative service.”

Mr Breslin said that that encouraging innovation and productivity could be supported by improving organisational incentives.

“Efficiently and effectively meeting patient needs should have a direct bearing on organisational finances and growth. Our existing hospital budgeting system is overly rigid and too much a function of history.”

He told the conference that the forthcoming Budget was unlikely to deliver sufficient funding to the health service for next year that could “match that required to meet all of the demands and priorities we would wish to see addressed”.

”There is no doubt that 2015 and subsequent years will continue to demand a focus on financial performance throughout the system.”

“In fact, the demand arising from demographic change, technological innovation and growth in public expectations means effective use of resources will be a continuing requirement. What can be provided will always be constrained by what can be afforded and we must have good systems to prioritise, manage and secure value within this financial constraint.”

Mr Breslin also said he hoped that in future the proceeds from efficiencies generated in the health service could be reinvested in patient care rather than, as has been the case in recent years, surrendered in savings to the exchequer.

He also maintained that while the economic bust had been a hugely challenging time for everyone in the health services, “the boom years were not always as productive as they might have been”.

“On occasion resources were used to develop parallel services that did not lead to more fundamental redesign and integration with existing services.”

Mr Breslin said the Government’s new system of establishing networks of hospital groups represented a “win win” situation for both smaller and larger institutions . “Through reconfiguration and consolidation of services, demonstrably better outcomes can be achieved for patients.”

Mr Breslin told the conference that the new proposed higher salary rates for new consultants went a long way towards reversing the controversial 30 per pay cut for these doctors put in place by the Government in 2012.

He said the Department of Health was “committed to rebuilding trust following the difficult times we have experienced these past numbers of years” and was taking measures to improve this by trying to attract and retain new entrant consultants to the health service.

Mr Breslin acknowledged that the IHCA had chosen not to sign up to the Haddington Road agreement on pay and productivity in the public service and said the consultants’ organisation was entitled to this stance.

However he suggested that it should look again at this position.

“The question I put to you is can you fully influence change if you are not fully involved in the State’s public service processes?? If we work together we can address the issues and create solutions.”

A senior HSE executive told the IHCA conference that many of the problems affecting the State’s hospital system stem from side effects from the implementation of the Government’s austerity programme which had not been intended.

Dr Tony O’Connell, HSE national director for acute hospitals said that the 30 per cent cut in pay for new entrant hospital consultants which was put in place in 2012 had undoubtedly led to the falling attractiveness of senior medical posts in Irish public hospitals.

He said that all 19 doctors who had graduated from the training programme in anaesthesia had indicated that they planned to leave the country.

Dr O’Connell also said that “a fairly blunt instrument” to reduce the cost of labour had been put in place n the form of a ceiling on the number of permanent staff that could be employed in the health service.

He said most of the savings generated from reducing the number of employees and the benefits of the Haddington Road agreement on pay and productivity had been eroded by the cost of taking on agency staff.