The number of staff nurses in the health sector must be reduced by 700 as a matter of urgency, according to a new circular issued by the Health Service Executive today.
The circular, issued to hospital managers and also to health unions, states that these posts will be filled instead by student nurses on placement.
The document, which deals with employment control and the moratorium on recruitment in the health sector, states that where possible vacancies which arise should be filled by redeploying existing staff.
Overall it says the HSE's employment ceiling will be reduced by 1,035 whole time equivalents.
It stresses managers must abide by the strict new rules now in place for filling vacancies, including vacancies that become vacant in emergency situations. Breaches of these "may result in disciplinary action being directed against the service/line manager".
The first version of the HSE's service plan for this year, published last December, also referred to the need to cut staff numbers this year. It said savings would be achieved in 2009 partly by a 3 per cent reduction in management/administrative payroll costs in the HSE and the voluntary hospitals.
A reduction in expenditure by about 3,000 whole-time equivalent staff in pay costs, which it said would be achieved "through actual staff reductions, staff redeployment and pay related savings as a result of changing how some services are provided" was envisaged in the plan.
A statement from the HSE said the circular had been circulated to the unions for feedback.
"The proposals contained in the document seek to operationalise the Government’s moratorium on recruitment and will inform ongoing discussions with the unions/stakeholders regarding this matter," it said.
Unions have warned that the plans would be "vehemently opposed".
The Irish Nurses Organisation branded the circular "insulting to hard working staff" and said its implementation would be harmful to patient care, reduce the availability of frontline services, and cut essential frontline staff.
The union said the HSE has agreed to re-draft the circular and a further meeting between the HSE and unions is set to take place next Monday.
"The staffing cuts proposed by this draft Circular would render the delivery of safe care, to patients and clients, impossible. Local managers would no longer have the authority to ensure safe and adequate staffing levels and, furthermore, would be threatened with disciplinary action if they did not adhere to the terms of the Circular," said INO General Secretary Liam Doran.
"While the INO recognises the severe financial challenge facing the government, in managing the public finances, we will not accept, or cooperate with, the introduction of staffing cuts in frontline services which will inevitably cause unsafe practice and a reduction in the quality of care available to patients."
Labour Party spokeswoman on health Jan O'Sullivan branded the HSE's proposals a "panic reaction" to its budgetary crisis.
"While the plan to divert resources from administration to front line community health services is welcome, some of the other proposals will cause very serious difficulties and may further damage health services," she said.
"The exemption to the filling of vacancies is very limited and does not, for instance, include key health professionals, such as physiotherapists."
Ms O'Sullivan expressed concern over proposals to reduce the number of staff nurses by 700.
"Nurses in most hospitals are already badly overworked and such a major reduction in numbers would be bound to undermine the level of care," she said.
Fine Gael's health spokesman Dr James Reilly said there were serious concerns for patient care.
"The reduction in 940 administrative and management staff, with 500 in management, seems like a step in the right direction. However, today's leaked announcement is not evidence of the sweeping reform needed in an organisation which is well known to be a bureaucratic black hole that sucks spending from key service areas. Meanwhile 700 staff nurses are also in the firing line which flies in the face of any HSE claims to be protecting the front line," he said.
"I am seriously concerned that the front line is on the staff cutting agenda and cannot see how patient care which is already suffering from budget cuts will not be affected. The reported plan to only create a new hospital consultant post when two junior doctor posts are cut will also need to be subject to serious scrutiny so it can be guaranteed there will be no reduction in care.
"It is difficult to see how this can be achieved given the current deficit of consultants in hospitals as evidenced by waiting lists, cancelled operations and A&E trolley jams."
Sinn Féin said it would cause chaos in the health services and warned that "savage health cuts" could not be "dressed up" as reform.
Health spokesman Caoimhghín Ó Caoláin described the cuts as "the latest blow" to public health services.
"Hospital waiting lists and A&E queues are as bad as ever and will worsen with the massive cuts in jobs in the public health service," he said.
"Successive Fianna Fáil-led Governments refused over the past 12 years to bring in real health reform and to build an equitable, efficient and sustainable public health system when unprecedented resources were available to do so. Now they are attacking the public health system and doing so under the banner of reform."