TALKS BETWEEN the Health Service Executive (HSE) and health sector trade unions on some of the most extensive cost-containment measures and work practice changes proposed in years are reaching a "crunch" period, according to highly placed sources.
The HSE is seeking to generate savings of about €325 million through measures such as reducing overtime across all grades by 50 per cent and significant work practice changes including more flexible working arrangements.
The talks on the cost-saving measures and work practice changes were adjourned yesterday and are due to reconvene today. The HSE's service plan and budget for next year is based on new efficiencies and work practice changes being delivered early in the new year.
However, in the first protest against the proposed cutbacks, Siptu has begun a ballot of about 9,000 health sector workers including porters, catering staff and security personnel for strike action if changes are introduced unilaterally.
At the heart of the HSE's plans for work practice change is greater freedom to re-deploy or re-assign staff. Such re-deployment arrangements could generate considerable savings in overtime or payments on using agency workers in hospitals and other healthcare settings.
The talks between management and unions, which have been under way for some weeks now, are aimed at putting in place a framework at local and national levels for dealing with cost-containment measures and more flexible working practices.
This could possibly involve a two-stage process whereby it would have to be shown that measures proposed by management would actually save money as well as a mechanism for dealing with staff grievances.
However, any agreement between unions and management in the HSE is unlikely to be finalised without further talks with the Taoiseach and senior ministers early in the new year on a number of key policy issues.
The unions are extremely concerned that any agreement they might reach locally with the HSE on cost savings could be overtaken later in the year by further unanticipated spending pressures leading to a demand for further cost-containment measures or work practice changes.
Following the publication of its service plan last week, the HSE indicated that it could need to save a further €400 million in 2009 to deal with emerging risks.
The health sector trade unions have raised a number of "high-level policy issues" which the HSE has said are matters for Government. Some of these measures would allow for hospitals to generate further income for themselves, if implemented.
Among the measures put forward by the unions for discussions with the Government are greater Exchequer funding for "demand-led schemes" such as the medical card if unemployment continues to rise.
As part of its cost-containment proposals the HSE has also sought to save €50 million by ending special grants, payments and allowances made to non-consultant hospital doctors. However, it is likely that it will have to enter into direct talks with the Irish Medical Organisation on this issue in January.
It is understood that at yesterday's meeting there was a row over remarks made by the HSE's director of human resources, Sean McGrath, in a Sunday newspaper earlier this month where he suggested that the HSE would press ahead with the changes unilaterally if there was no agreement with the unions.