Unions and HSE management may have agreed a framework for new work practices, but there is still a long way to go, if the €320 million cost-saving target is to be reached, writes Martin Wall, Industry Correspondent
TRADE UNION leaders and management in the Health Service Executive (HSE) believe the new framework agreement for implementing highly controversial work practice changes and cost-containment measures in the health service could prove to be hugely challenging for all sides and represent a real test of the partnership process.
HSE management wants to generate savings of about €320 million this year under its new work practice reforms and cost- containment programmes.
The new deal, which was reached over Christmas, provides for consultation between management and unions on the measures to be put in place at local level. The HSE will not have a free hand to do what it likes and will have to act in partnership under the terms of the framework.
There will also be a mechanism for dealing with disputes. However, there are no vetoes for staff contained in the agreement.
Many of the cost-saving initiatives are likely to centre on re-deployment or re-assigning of staff. This could become important in the context of wards, for example, being restricted to five-day operation or hospital services being centralised in the year ahead.
In any event, management believes that greater freedom to re-deploy staff should save money which would otherwise be spent on using more expensive agency workers.
The HSE also wants to look at millions of euro paid out in grants and allowances to groups such as non-consultant hospital doctors and also to examine the operation of travel and subsistence arrangements, sick leave schemes and money spent on supports to staff undergoing academic courses.
The issue of the grants and allowances for doctors is not covered in the framework agreement and is likely to be addressed as part of separate negotiations with the Irish Medical Organisation.
While both sides have welcomed the new framework, the implementation of the agreement is conditional on progress being made in forthcoming talks between the Government and unions on high-level policy issues.
Some of the areas put forward by the unions for these talks would generate additional savings for the HSE. However, the unions also want to ensure that everyone, including those at the very top, should have to share in the pain over the coming year.
The unions want assurances that if expenditure on demand-led schemes such as the medical card increases significantly in the months ahead - due to higher unemployment, for example - that further Exchequer funding would be provided to the HSE and that it would not have to go back to staff looking for further cuts to make up the shortfall.
The unions also want public hospitals to have a greater scope to treat patients under the National Treatment Purchase Fund (NTPF). A 10 per cent cap is currently in place on public hospitals carrying out such work.
The trade unions also want the Government to examine the subsidy to private patients being treated in public hospitals.
The Irish Times revealed official figures recently which showed that the cost of this subsidy is now more than €100 million per year.
However, it has been official Government policy for more than a decade to remove this subsidy over time by increasing the cost of private beds in public hospitals.
However, a consequence of this measure is that it pushes up the price of health insurance significantly for the two million people who currently have such cover.
The unions also want savings to be made in the HSE by either reviewing the system of hiring special advisers to work with the chief executive Prof Brendan Drumm or by looking again at the bonus arrangements paid to senior managers which in 2007 cost about €1.4 million.
The new framework will place much of the onus for delivering the work practice changes and cost-containment measures on local management who will have drawn up the initial proposals.
However, there will also be significant roles for trade union representatives at local level also.
The framework states that at individual service locations, teams comprising union and management representatives will be established to oversee the implementation of agreed changes, to verify their effectiveness and to ensure that industrial relations issues are dealt with efficiently.
It also says that health service staff will be "encouraged to table proposals for savings in their department/section. These will be considered as part of the local level consultation."
The agreement states that talks with union representatives at local level would take place on cost-containment measures which are considered necessary by management.
It says that such plans will be put forward by management within 21 days of the proposed implementation date and will contain an analysis supporting the proposed measures, assurances regarding protection of the quality and safety of patient care, details of the impact on staff numbers, rosters and earnings as well as the planned duration of any curtailments.
"Management will be required to demonstrate that cost- containment measures when implemented will not have resulted in a diminution in the quality of services to the public," it says.
New committees involving senior management and full-time trade union officials will be established to review on a monthly basis all cost-containment measures proposed or implemented.
"In addition to overseeing cost-containment measures, the area committees will have responsibility for ensuring that initiatives are taken to identify patient-centred service improvements, other savings or efficiencies that could be achieved and to achieve the elimination of waste," the document says.
The agreement also contains provision for dealing with any local disputes arising from proposed cuts including referral, in some cases, for independent adjudication which would be accepted by both sides.
The document also notes that while the sick leave scheme will continue, there will be an intensive joint effort to reduce levels of absenteeism.
It notes that while travel and subsistence arrangements will be maintained, "individual or workplace budgets that have the effect of restricting or capping the actual amount of travelling undertaken may be introduced".
A review of the academic support scheme is to be undertaken which will aim to provide limited financial assistance for the current year only.
With the framework now agreed, attention will now turn to the range of specific measures to be proposed by local management in the weeks ahead and to the reaction to these of health sector staff - some of whom are already balloting on industrial action.