HEALTH: An independent three-person committee has reported an escalation in employment in the health sector beyond limits approved by the Department of Finance
Responsibility for employing staff in the health service which was devolved to health boards two years ago needs to be urgently returned to the Department of Health and Children, according to a report published yesterday.
The report from an independent three-person committee which reviewed expenditure in all Government Departments, also expressed "serious doubts about the efficacy of the existing health board structures".
It found employment in the health sector escalated beyond limits approved by the Department of Finance after control of staffing was devolved to health boards.
Last year's health service census disclosed that total employment in the sector was nearly 4,000 above the employment ceiling which had been approved by the Department of Finance, the report said. "Centralised control of health service employment needs to be re-established by the Department of Health and Children as a matter of urgency," it added.
The review group said the rate of growth in health spending in recent years (from €3.6 billion in 1997 to a projected €8.3billion in 2002) "simply cannot be sustained".
It is essential this was understood, the group said, so that public expectations about the scope for continued expansion in the health services in the period immediately ahead could be moderated. "The first priority is to improve delivery of existing services before new programmes/
activities are started."
The report added: "We believe there is a growing recognition that shortage of funding may no longer be the key issue in the health services. There is insufficient relationship between increased funding and actual delivery of services.
"Fundamental structural changes are required to promote greater efficiency in delivering services. In particular, we have serious doubts about the efficacy of the existing health board structures."
It said the work underway by the National Task Force on Medical Structures and the Audit of Structures and Functions needed to be brought to a conclusion and implemented.
Furthermore, the review group said the system of giving large block grants to health boards "inhibits monitoring, control and performance assessment".
The review group included former Central Bank governor Mr Maurice O'Connell, former head of the Revenue Commissioners Mr Dermot Quigley, and Mr Kevin Bonner, former secretary general for the Department of Enterprise, Trade and Employment.
Regardless of whether or not control of health sector staffing is returned to the Department of Health, further large-scale recruitment to the sector this year seems unlikely following the announcement of a cap on public service employment in yesterday's Budget.
The Irish Medical Organisation (IMO) severely criticised the Government for its total failure to identify and allocate the funds necessary to implement the National Health Strategy and the Primary Care Strategy.
IMO president, Dr Kate Ganter said: "The National Treatment Purchase Fund, established to reduce the waiting list and waiting time for patients, has been cut by more than 50 per cent. Whatever about the merits or otherwise of this initiative, such a sudden reduction in the planned funding programme is of major concern."
Dr Ganter added: "The capping of public sector employment will totally undermine the Government's National Health Strategy, Primary Care Strategy and will undermine the work of the Task Force on Medical Manpower Planning that is due to report on proposed initiatives to implement the EU 48-hour week Working Time Directive for hospital doctors."
The general secretary of the Irish Nurses' Organisation (INO), Mr Liam Doran, said this move had the potential to seriously damage areas of the health service if applied "in a blunt and inflexible manner". He said the INO would be seeking immediate clarification from the Minister for Health on how the decision would be implemented in the health service.
