Health service unions go head to head with the HSE over its recruitment ban, writes Theresa Judge.
Consideration should be given to scrapping the HSE in favour of four health boards where there would be "a real interface between public representatives and health managers" and where there would be greater accountability, according to Fine Gael health spokesman Dr James Reilly.
"I think we need a debate on the issue because there is a huge democratic gap at present," says Reilly, responding to a growing controversy over HSE cutbacks.
Health service unions will attend a Labour Relations Commission (LRC) hearing tomorrow to argue that the current HSE ban on recruitment contravenes the terms of the national agreement, Towards 2016, because there was no consultation.
Under the ban, hospitals are not allowed to take on extra agency or locum staff or to sanction extra overtime.
Health unions have instructed members not to take on additional duties arising from staff shortages.
Reilly, a former member of one of the old health boards, says he accepts that there were problems with the old system but says the current lack of transparency and accountability is unacceptable.
He also points out that an Oireachtas committee on health - one of the main mechanisms through which HSE managers must account to public representatives - has still not been formed since the election at the end of May.
He says this is "a poor reflection" on the Government's commitment to health.
"Normally the health committee would have been set up before the summer," he adds.
According to Reilly, he had asked a parliamentary question before the summer recess on why spare trolleys could not be kept at Beaumont Hospital's A&E department to ensure ambulances were not delayed at the hospital and he had received a reply only last week and then it did not address the specific question he had asked.
"The Minister must take responsibility for her own invention and for the fact that it [ the HSE] is not delivering," he says.
After a week when the HSE was criticised, not only by medical and nursing unions and Opposition parties but also by Cabinet Minister Éamon Ó Cuív, attention focused again on the huge increase in the number of health service managers earning six-figure salaries as more details of cutbacks emerge.
The HSE has admitted that the number of grade 8 managers now exceeds 500 while there were fewer than 10 of them in 2000.
Critics are also pointing to a report from the Comptroller and Auditor General which criticises the HSE's financial accountability.
Meanwhile, medical and nursing unions are warning that the impact of the cutbacks will worsen over the coming weeks.
Last week the HSE confirmed that operations had to be cancelled at Cavan General Hospital because a consultant anaesthetist was going on holidays.
This followed reports of other cuts in services in some 12 different locations across the State, including a reduction in breast cancer services and delays and restrictions in MRSA and smear tests in Galway.
A senior consultant in one of the State's main hospitals, who says he is afraid to give his name because he would be targeted by managers and sidelined if he goes public on the problems he is seeing, says cutbacks are "adding extra strain to an already chaotic system".
He gives examples of operations that have been cancelled over the past week and says some of the people affected are cancer patients.
"Brendan Drumm can say what he likes but we have no beds and operations are being deferred constantly. The cutbacks are another nail in the coffin of our public health service.
"We are talking about patient dignity, and patients are not being treated in a dignified way."
"The implications for the patient and their families and the stress it causes them is unacceptable," the consultant said.
While consultants are being depicted as greedy and overpaid, he is at his "wits end" and "completely depressed" trying to get the best care for public patients, while the effect of Government policy is to drain resources and expertise from the public system and support private developers in building hospitals.
"I don't believe the willingness is there to develop a system that is equitable for everybody," the consultant adds.
Irish Medical Organisation (IMO) president Dr Paula Gilvarry says morale among the medical profession is "at an all-time low" and that there is a complete lack of communication and consultation over the cutbacks and over other reforms such as the recent cancer strategy.
The IMO wants the recruitment embargo lifted and supplementary funding provided rather than a continuation of the cutbacks to address a HSE deficit of €220 million, according to the latest data.
Both the IMO and the Irish Nurses Organisation (INO), two of the unions attending the LRC hearing tomorrow, are arguing that their members are in the bizarre predicament of being penalised for being too productive.
They also go into the hearing knowing that the Government's industrial relations trouble-shooter, the National Implementation Body (NIB), has already criticised the HSE for introducing cutbacks without consulting the trade unions.
Two weeks ago the NIB expressed disappointment at "a marked absence of partnership and joint problem-solving" by the HSE.
INO general secretary Liam Doran says workers in the health service have "exceeded every relevant target" and are being penalised for being over-productive.
A significant proportion of the overspend - €150 million - was on demand-led services where the precise level of demand could not be predicted but where people had a right to those services, he says.
"No one has control over what the demand for these services will be and we will be arguing that it makes no sense that the overspend on these has to be recouped elsewhere," Doran says.
Regarding a comment from Minister for Health Mary Harney that the possibility of giving nurses a 37.5-hour week had to be in question when job cuts of "200-300 a month" could not be accommodated in a staff of 120,000, Doran says the Minister is not comparing like with like.
The reduced working week for nurses will be introduced in "a planned, controlled way" with the agreement of all parties, he says.
In contrast, the recruitment ban means that on a day-to-day basis there is no one to cover for sick leave, maternity leave or annual leave.
"There is no planning to this - it's crisis management," he says.