Health providers fear curtailing staff will lead to clash with Hiqa

The Department of Public Expenditure warned in a report published a year ago that the health service was recruiting 371 whole-time staff each month on average at a time when it had a budget to take on only about 150.

Such a level of recruitment, the department argued, was unsustainable given other spending pressures such as pay and pharmaceutical costs.

The HSE believes its staff numbers will grow this year but it wants this to take place "in a way that is planned and affordable". The health authority has since early this year put in place measures aimed at controlling staff level growth.

However, HSE chief executive Paul Reid told his new board in June that there were 1,030 whole-time equivalent staff on the payroll above its official limit of 117,858.

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Mr Reid has insisted to his managers that achieving a break-even financial position this year while operating safe services must be the HSE’s main priority. He has directed that no manager has authority to overspend their allocation and they would be held to account should this occur. This message about controlling expenditure has now been passed on by the HSE to hospital and disability service operators.

The most recent official figures show that to the end of April the health service had recorded a deficit of €116 million, including €52 million in hospitals and €20 million in the disability sector. Mr Reid told the HSE board that his target was to limit overspending in these operational areas to €100 million for the year.

If this was to be achieved, he said it would require significant focus on the part of management and, separately, support from Government.

“It will also require external support around the necessary approach to limiting cost growth so that there are coherent internal and external messages from the highest levels around the requirement to absolutely minimise any deficit in 2019,” he added.

Level of resources

However, Mr Reid also warned that other statutory regulatory bodies, operating under the aegis of the Department of Health, would have to have "due regard" to the level of resources available to the HSE. This is seen to be a clear reference to the health watchdog Hiqa.

In the disability sector, in particular, there are concerns that the HSE’s directive to live within budget will clash with separate instructions put in place by Hiqa for facilities and services to be enhanced to maintain their registration.

One organisation that believes it is facing such a dilemma is Stewarts Care, a publicly funded body which assists about 1,000 people with intellectual disabilities.

Stewarts Care invested heavily in about 80-100 additional staff as well as in new structures, facilities and training in the past year or so to allow it deal with criticisms set out by Hiqa.

However, this led to a €6.2 million unauthorised deficit last year and a potential overrun of more than €5 million this year.

Stewarts Care last week told trade unions that on foot of the new HSE directive to live within its budget, it would have to put in place staffing restrictions. It would also have to curtail non-pay expenditure and operate essentially only a “safe service” without add-ons for those in its care for the rest of the year.

The reaction of Hiqa to these measures is, as yet, unknown.

However, there are wider financial problems across the disability sector – both in the State operators, known as section 38 bodies, and those private organisations that receive grant aid from the HSE, known as section 39 organisations.

Internal HSE reports maintain there is concern about “substantial deficit challenges” in section 38 and section 39 organisations. HSE documents say it has advised the Department of Health of “high-level risks” about both the finances of these organisations and in relation to the delivery of services.

The HSE said a joint group would be established with the Department of Health to examine financial overruns in disability services to date and identify measures to limit potential deficits in this year. The Department of Health said the deliberations of this group were ongoing.