Health staff warned of ‘more demanding phase’ amid health cuts and thousands of staff departures
Staff in the health service have been warned that new “more demanding” reforms under the Croke Park agreement required for next year may involve changes to attendance patterns, work practices and reporting relationships.
With the HSE facing further budget cuts of up to €1 billion and thousands more staff expected to leave in 2013, the new reform plans maintain that the health service will have to enter into a “more demanding phase” of the implementation of the Croke Park agreement.
The new draft “action plan” for implementing the agreement says that delivering services “requires co-operation with a range of measures designed to maintain high-quality patient services while reducing costs and accelerating the reduction in staff numbers, to enable the achievement of Government targets ahead of schedule subject to the maintenance of quality and clinical performance”.
Staffing levels
Among the reforms required will be a more productive match between staffing and service activity levels while at the same time safeguarding quality and clinical performance. “This may entail changes in attendance patterns, clinical and non-clinical work practices and reporting relationships in areas where this has not been demonstrated to date.”
The draft plan proposes reforms for all grades of staff in the health service.
For nurses and midwives, it says there will be an expansion of roles while some will be given a broader scope of responsibility. It says advanced nurse practitioner positions will be introduced in targeted services to substitute for non-consultant hospital doctor posts. Also proposed is “a further expansion of the role of nursing across all care settings to include IV fluid balance, blood transfusion, etc.”
Senior management
It says there will be a reconfiguration of existing senior general management structures and a delegation to directors of nursing and midwifery of “all authority required of the person in charge role as stipulated in Hiqa standards/regulations”.
For consultants, the draft Croke Park plan seeks full co-operation with the reforms to work practices which emerged from the talks at the Labour Relations Commission last September and a subsequent Labour Court recommendation.
These would allow for new rostering arrangements, including having consultants available in some specialities in some hospitals on a round-the-clock basis.
For management and administrative grades the draft document includes provision for a review of existing flexitime working arrangements “to ensure that it continues to meet the needs of the service”.
It says there will be a reduction in the numbers in management grades in the health service. It also says there will be a rationalisation of management structures following the introduction of the Government’s plans for new hospital groups and trusts.
It calls for new work practice changes for allied health professionals to include the introduction of an extended working day across all therapy grades.
It also includes provision to “achieve an optimal match between staffing levels and service level activity, and a review of scheduling practices in primary care to increase productivity”.
Radiotherapy staff
The document also seeks the introduction of an extended working day for radiotherapy staff in the National Cancer Control Programme. Under the plan’s proposals there will be rationalisation of ambulance control facilities, while the adoption of new technology will be addressed within specific timeframes in 2012 and 2013.
It says the findings of a review of work practices in the ambulance service will also be implemented.
The document signals that new measures to achieve greater productivity from support grades will also be put in place.
Staff in the health service will be obliged to co-operate with plans for outsourcing services provided these meet the criteria in the area set out in the agreement and are progressed in accordance with the agreed procedures. The document says efforts will be made to maximise skill mix options “consistent with fully meeting patient/service user need at every level of service delivery”.
Vision for change
In clinical areas, it says there will be continued implementation of the clinical programmes and the proposals in the Vision for Change blueprint in mental health services. The document proposes that all human resource functions in agencies funded by the HSE should be transferred to the HSE’s human resources shared service using processes set out in the Croke Park agreement.
It says that staff will also continue to co-operate with organisational change and reform within the HSE.
These include: new governance and management structures at national and other levels; the building of close and effective working relationships with all stakeholders; secondment arrangements where necessary to support appropriate policy functions of the Department of Health; the establishment of hospital groups and implementation of Smaller Hospitals Framework; the adopting of flexible models of care and the continued development of multidisciplinary primary care teams.
