The HSE defends its staff's expertise despite tendering for financial services, writes Theresa Judge
The HSE has rejected allegations that its decision to tender for a range of specialist financial services, valued at up to €10 million, is an indication that staff appointed to senior financial positions over the past two years do not have the necessary expertise.
A mistake in the tender notice giving a maximum value of €100 million rather than €10 million drew further criticisms of the management of the health services in a week when the HSE also came under fire for its handling of the process to select a site for a new national children's hospital.
There was criticism too from the Irish Hospital Consultants Association (IHCA). In a letter to Minister for Health Mary Harney, the IHCA said there was "widespread disenchantment" among senior doctors with the HSE because it was not possible to identify who was responsible for certain decisions.
However, a HSE spokesman insists that a perception that the establishment of the HSE has led to greater inefficiencies is not correct, and that over coming years the centralised system will lead to cost savings.
Fine Gael health spokesman Liam Twomey says the latest €10 million tender calls into question appointments made two years ago when the HSE was being set up.
"These senior jobs with salaries of more than €100,000 were all filled from existing health board staff and it was implied that they had the expertise that were needed but now they are saying they need specialist financial services," Twomey says.
He says about half the applicants for these jobs were from the private sector but the impression given by the HSE then was that it did not need to bring in people from outside.
Labour's Liz McManus says that given that HSE chief executive Brendan Drumm already has a group of highly paid advisers and that a team of very senior managers has also been appointed, "it is extraordinary that along with this elaborate structure of experts that they still have to go out and get more experts".
However, the HSE spokesman defends the €10 million tender saying it is for very specialist services that are likely to be needed only occasionally. "We might never use their services - we are just putting them on a list should the need arise."
He says services such as forensic auditing, which could be needed in the event of a fraud investigation, and ICT audits are highly specialised and general staff could not be expected to have these skills.
He argues that it does not make sense to train HSE people in such areas as they would then be likely to move to the private sector.
The figure of €10 million was stated as a maximum value, as required by an EU directive, he says, but the HSE estimates that the value of the services, "if fully procured", will be about €1.5 million a year. It is the HSE's argument that services such as value-for-money studies and corporate tax services will save money in the long term.
However, various groups within the health service appear to be united in the view that the HSE's establishment has led only to an additional layer of bureaucracy.
Finbar Fitzpatrick of the IHCA says it was expected the new structures would take some time to bed down, but after two years it is still difficult for doctors "to know who is responsible for decisions".
"In the old health board system, there was a structure there with programme managers and the chief executive of the board and doctors could raise issues with them.
"Now you go to the local office, and then you have to go to the national hospital's office and then it goes to Parkgate Street [where Brendan Drumm and his senior advisers are based]," says Fitzpatrick.
He says there is a continuing "state of flux" with people moving to different positions and "they are unsure of their authority to take decisions".
He gave an example of a cardiologist trying to set up a service who had a number of requests that were inexpensive yet crucial, but who found that local managers could not make a decision on the issue.
"We have a huge monolith of an administration that is growing rather than slimming," Fitzpatrick says.
He also challenges an assertion by the HSE that the vast majority of 17,000 administration staff work in front-line services. "It is very hard to get a breakdown of the figures but we would dispute this," Fitzpatrick says.
Last June Brendan Drumm said there would be "a significant reduction" in some 3,500 "backroom administrative people" in the HSE over the coming years as services such as human resources and finance were shared across old health board areas.
Drumm said then that other administrative categories that bring the total to 17,000 were "front-line" people such as secretaries in clinics and people typing patient reports.
In the statement this week, the HSE again says that out of a total of just over 100,000 staff "only 3,000 work on what might be termed purely administrative work" and adds: "It is not considered excessive and compares favourably with other large organisations."
The HSE statement also says that "the numbers of managers and administrators working purely in corporate roles has reduced since the formation of the HSE" but specific figures are not given.
It says "significant numbers of management/administrative staff have been redeployed to areas where there was an identified need for additional personnel to ensure all staff are used to their optimum".
However, an agreement reached with the Impact trade union at the time the 11 health boards were being merged into the HSE has limited the potential to make savings, as it ensured that former managers who were not appointed to senior positions in the new system retained their pay while new managers received the higher pay scales as well.
Liam Doran of the Irish Nurses Organisation (INO) says he can not comment on whether there are managers sitting in offices receiving the same pay but without the authority to make decisions. "When you centralise decision-making and leave the same number of people in the system you have to ask what value is being added to the speed of decision-making," he says.
Doran says there has been "a disempowerment of local managers and yet all the local managers are still there" and union officials have to negotiate with them. He believes these managers are also very frustrated in the new system.
The filling of posts is now "more laborious, with more forms to be filled".
He says the establishment of the HSE has not resulted in the "streamlining of decision-making" nor "the empowerment of front-line clinicians" that people had wanted and expected.
However, the HSE spokesman insists cost-savings will be felt over coming years.
The HSE is achieving economies of scale in buying services and medicines that were not possible before when the health boards operated independently.
Under new purchasing and procurement procedures launched in 2006, savings of €65 million are expected to be made.
He says very significant savings have also been made in new agreements with manufacturers of pharmaceuticals.
He says there is also a new national consistency in such areas as nursing home inspections and the processing of medical card applications.