Last year was a busy one for the HSE with more patients, more complaints and more staff. Eithne Donnellan, Health Correspondent, peruses the HSE's 2006 annual report due out this week
The number of people classified as working in management and administration with the Health Service Executive swelled by 555 last year, according to the executive's latest annual report.
It shows some 17,254 staff were working in management or administration at the end of 2006, up 3 per cent on 2005.
Overall staff numbers in the organisation grew by over 4,000 last year, the bulk of these being nurses and staff dealing with "other patient and client care".
But the HSE's number of general support staff fell by 2,068. These include maintenance, cleaning, laundry, catering and caretaking staff.
A total of 106,272 staff were on the HSE's payroll at the end of 2006.
HSE chairman Liam Downey says the additional 555 staff categorised as in management or administration include staff who have transferred from the Department of Health and other agencies.
"Don't assume from that that those people are people we went out and hired . . . part of the thing the HSE has been doing is consolidating a lot of bodies . . . these are not people that we went out and recruited. There would be questions about that but these are people that fell out of that consolidation simply," he says.
In his first media interview he tells The Irish Times it is "a big challenge" for the HSE to try to keep staff numbers under control. But he says it is important numbers are kept in check as staff pay is absorbing about 80 per cent of the organisation's budget.
That said, though, he stresses that the quality and commitment of staff is of a very high standard and they don't get enough credit for it.
"I think they get a lot of criticism, unjustified, around the numbers issue . . . I think that's something that needs to stop frankly, it needs to change, we do need to recognise the fact that these people are very professional in what they do by and large, including the management people and that they're highly committed to delivering the reform programme," he says.
Furthermore he says the definitions of who fall into the management and administration category of staff as opposed to others is part of an inherited classification system which requires review. "These categories are not as clear perhaps as they could or should be."
An employment monitoring unit has been established within the HSE and is working on this. While there has been some criticism of this new unit for failing to make decisions quickly on replacement staff for people on leave, Downey defends it saying if it wasn't there the organisation would also come in for some stick.
"It's a tough balance," he says. "I think it's the appropriate level of management control and governance for an organisation of this size where people costs are such a huge part of it."
Earlier this year the HSE ordered hospitals and voluntary organisations, as well as the ambulance service, to reduce their staff numbers by 1,000 before the end of the year in order to comply with the organisation's employment ceiling.
Meanwhile, the further roll-out of PPARS, the controversial computerised payroll and human resources system for the health service, is still on hold, according to Downey. A full evaluation of the system is under way and the HSE board is due to receive an update at next month's meeting, he says.
More than €130 million had been spent on the Personnel, Payroll and Related Systems (PPARS) project. However, its roll-out was suspended in November 2005 by the HSE's chief executive, Prof Brendan Drumm, amid concerns at escalating costs. It is currently operating in three health service regions and in St James's Hospital, Dublin.
The Comptroller and Auditor General strongly criticised how the project had been managed and delivered. It was initially expected to cost about €9 million.
Downey says the HSE inherited the system but has taken full responsibility for addressing the issues with it and that is why a review is under way. Based on the outcome of this the HSE "will move forward again either with further roll-out of PPARS or some modification of it to address the needs", he says.
It is crucial, he says, that people in the HSE are not discouraged as a result of "the PPARS experience which wasn't good obviously" from investing in an appropriate way in IT technology to drive efficiency in the health service in the interests of patients.
"The role of technology in delivering health services is really important," he says.
"We need to obviously research these things well . . . we need to fund them in an appropriate way and, most importantly, we need to project manage them carefully to completion," he says.
Meanwhile, the HSE's annual report also shows that activity levels in its hospitals increased in 2006, with A&E attendances up 3.3 per cent to 1,268,991; inpatient discharges up 3.2 per cent to 594,059; outpatient attendances up 6.8 per cent to 2,778,602; day cases up 6 per cent to 542,671; and births up 7.3 per cent to 62,745.
Complaints to the HSE about acute hospitals are also up - they increased by 23 per cent to 2,764.
Downey says the HSE rolled out a new complaints system to encourage people to give "feedback" on services last year and he attributes the surge in complaints to this.
He describes the volume of patients dealt with last year as "quite staggering".
This means, he says, that the HSE has exceeded commitments in its service plan, but it has at the same time rolled out some new services and taken "major steps forward in the implementation of the reform programme" and has done it all within budget.
"Now, that, I think, has not been the history of the health service traditionally and I think that's something we can take pride in," he says.
It also put paid to commentary that the health service was in disarray and in crisis, he claims.
"Of course there are huge issues still to be addressed and I think there is a huge amount of work still to be done but the fact is this level of service delivery is taking place day in, day out, without fuss and within our resource allocation and at the same time we are moving forward with the reforms that are necessary to deliver better services to patients in future," he says.
Attendances at A&E units were also up again in the first six months of this year, he says.
This may be due to population growth but also the way health services are configured. Better primary care services has to be provided, he stresses, to take pressure off hospitals. He points out that 10 primary care teams were in place at the end of 2006 and another 87 were in development.
Downey admits he would like to see this process of establishing primary care teams "moving quicker" and the plan is to have 200 teams in place by the end of this year.
"It's something we would like to really accelerate but it's not simple to do. It requires the co-operation of a lot of people working together."
But he says the hospital co-location project, which has been heavily criticised, is on track. He confirms the HSE board will shortly decide which developers have tendered successfully to build six private co-located hospitals on public hospital sites.
"It will be coming back to the board for a final decision . . . we may need a special meeting if everything is ready . . . if it's not it will come to our next meeting in July," he says.
The HSE, he says, is implementing Government policy in overseeing the tendering process for the construction of these hospitals. And it is his view that there has been a lot of misinformation around the co-location plan. The initiative is about making more beds available to public patients in public hospitals, by transferring the private patients who occupy them to adjacent facilities, he says.
And he emphasises "very good safeguards" are in place in the scheme with arrangements for profit share with the public sector, for rental income to be paid and discounted rates for treatment of public patients in the new facilities. Public patients will be the winners, he says.
Only time will tell.