The Minister for Health's belief that cutting absenteeism in the health services can deliver major cost savings is not widely shared, writes PAUL CULLEN, Health Correspondent
ON ANY particular day, more than 5,000 staff are out on sick leave in the HSE, with massive repercussions for services. Appointments are cancelled, operations postponed and beds closed as an already struggling health service struggles to plug the gaps caused by the absence of key staff.
High rates of sick leave are compounding the problems caused by cutbacks, often with serious effects. Parts of west Cork were left without an accident and emergency service for a period when a single paramedic went sick, local TD Noel Harrington recently claimed.
In Co Wicklow, a respite facility was forced to close when staff took sick leave and maternity leave and the hospital was unable to hire staff to cover for them.
The enforced absence of a specialist can force the rescheduling of all of his or her appointments.
Absenteeism has major financial ramifications for the HSE, which in many cases is forced to engage expensive agency staff to provide cover in essential areas.
Last year, certified sick leave added €255 million to the cost of the health services and uncertified leave €35 million, and these figures are likely to rise this year if the problem isn’t tackled.
Minister for Health James Reilly has identified this as an area that can deliver major cost savings, thereby obviating the need for other, less palatable options such as ward closures and cuts in services.
However, the likelihood of achieving a significant reduction in absenteeism rates in the short term, with attendant cost savings, seems remote.
“It is wishful thinking for the Minister or anyone else to think they can wave a magic wand to reduce sick leave,” said Liam Doran, general secretary of the Irish Nurses’ and Midwives’ Organisation.
“The health service is a very difficult place to work. You have to be on top of your game all the time. I wonder how many TDs would survive working in an overcrowded medical ward.”
Mr Doran doesn’t believe there is much fat to be cut off the figures and points out that health managers already have the power to interview staff who are throwing “sickies” on Mondays or showing other patterns of unacceptable absenteeism.
“Management already has the tools to minimise absenteeism in cases where blackguardism is going on.”
The same point is made by Niall Shanahan, communications officer of Impact, which represents 30,000 health workers. “Management has a system to deal with any perceived abuse of the system. We don’t tolerate abuses of sick leave but it’s up to management to manage.”
If anything, absenteeism is on the rise, notwithstanding official expressions of concern and promises of action.
The latest set of figures from the HSE show that absenteeism in the health services in May was 4.81 per cent, up from 4.7 per cent in April and 4.63 per cent in May 2011. This is well above the target for 3.5 per cent.
In recent years, the rate has consistently bobbed around the 5 per cent mark, going slightly above it in winter months and dipping somewhat in the summer. In May, the rate was 5.24 per cent in the HSE but lower figures in the voluntary hospitals and agencies reduced the overall figure to under 5 per cent. Rates of sick leave in the HSE run at about twice the levels seen in the private sector.
Stress levels and exposure to sick patients could play a contributory role but ironically staff with the highest workload and the greatest exposure to stress are often the least likely to go off sick. Absenteeism among doctors and dentists, for example, is only 1 per cent.
According to Mr Doran, however, it isn’t fair to compare the health service with other work situations such as offices which are less problematic.
He also complains that the HSE tends to bracket sick leave with maternity leave. “Nursing is a predominantly female employment, which leads to higher levels of legitimate sick leave. This is just a fact of life which we have to deal with.”
It’s worth noting that absenteeism rates in the Irish health service are broadly similar to those in the UK, and lower than among Irish teachers at first and second level.
According to Fine Gael Senator Colm Burke, there is no quick fix for absenteeism, but he said the problem was as much about employers as employees. More research was needed to help managers identify and manage situations involving high absenteeism levels, he said.
“If you’re feeling unwell, you are far more likely to call in sick before a 12-hour shift, than if you were working a normal eight-hour day,” he pointed out.
Senator Burke said one study found that half of all pregnant nurses were on sick leave for four weeks before their maternity leave began.
“It’s clear that these staff cannot be required to lift elderly patients or stand in theatre all the time. There needs to be a system where they are assigned to other duties.”
Last month, a Labour Court decision cleared the way for the Government to halve sick leave entitlements for public servants, including those in the health service.
Uncertified sick leave will be cut from seven days in any 12-month period to seven days in any two-year period and the entitlement to sick leave for those with a certified illness will be halved to three months on full pay and three months on half pay.
The changes are likely to have a significant impact on the health service, but not immediately.
Legislation is required first so the new rules won’t apply before 2014, long after Dr Reilly’s timeframe for cost savings.