How will HSE budget overrun impact staff recruitment?

News that the HSE overspent its budget this year by €250m up to the end of March does not bode well for health unions concerned about staffing numbers.

To try and control budgets, health regions have been told by HSE CEO Anne O' Connor to introduce new controls on overtime, the use of agency staff and recruitment, to help rein in the budget.

A recruitment pause is being introduced in some areas and the impact of this on services is unclear at this stage.

But it is early in the year to have such a large overrun.

The new controls appear to particularly apply to three health regions at this stage.

At the Irish Nurses & Midwives Organisation (INMO) annual conference in Dundalk this week, the union expressed concern that there were already around 5,000 nurse and midwife vacancies around the country.

They have warned this is resulting in unsafe staffing.

INMO General Secretary Phil Ní Sheaghdha said that Ireland is currently staffed for what was needed a decade ago, given the huge population growth, the ageing population and the extra health needs today.

While there is no suggestion at this stage of industrial action, the union noted that improvements for its members were secured after nursing strikes in 1999 and 2019.

Health unions are unhappy as they say they were not consulted about the new recruitment pause.

The INMO has insisted that the new recruitment controls must not include nurses and midwives.

Nurses represent one third of the entire staff body of the HSE.

The HSE says that 49,678 nurses and midwives work in the public health system.

It compares with 39,917 nurses at the end of 2020, up over 9,700 in five years.

Nurses say that unsafe staffing is a danger to both patients and health staff.

Given the latest HSE overspend, ahead of planned spending by over 10.6%, health staff have questioned whether the annual HSE budget allocation is ever realistic.

The service this year received over €25bn in day-to-day spending, its highest allocation.

At the end of most years, there is the predicable sight of a supplementary health estimate, to cover millions of euro in overruns.

With the recent introduction of the new six health regions, it is more difficult to get an overall picture of the impact of restrictions on overtime, agency use and recruitment.

This is because each region now has its own budget and staffing cap and what happens in one region may not necessarily be replicated in another.

The HSE said that the six health regions are now responsible for planning and delivering services, as well as managing their own ring-fenced budgets.

Within that budget, it said the regions can replace and recruit staff, according to the priorities in their regions.

But this overrun also has implications for cutting long public hospital waiting lists, with close to one million patients waiting for some kind or care or outpatient appointments.

Minister for Health Jennifer Carroll MacNeill said this week that the HSE needs another €300m.

She said the reason for the overrun is that demand is significantly up this year.

An extra 7,500 patients over 75 years of age have attended hospital emergency departments.

The minister also said the HSE needs to demonstrate it is in charge of its budget as a move to multi-annual budgets is being considered.

She pointed out that if the service is overspending on agency staff, it is not filling vacant posts.

Minister MacNeill said the big issue is to have the reforms in the health service implemented, in particular the public-only consultant contract, across the country.

She wants to see the time that nursing staff start work aligned to the time that theatres start, so that overtime and allowances are not being run up.

INMO President Caroline Gourley said that nursing is a safety-critical profession and is completely dependent on sufficient, qualified and skilled nurses and midwives.

She told the union's conference that staffing and skills are the basic tools to provide patients with a safe level of care.

She warned that nurses cannot provide safe care when the first port of call in every health budget overrun is to stop the essential recruitment.

HSE chief Anne O'Connor said that all parts of the HSE are being asked to prioritise recruitment to funded posts to reduce reliance on higher-cost agency staff.

She has sought to reassure the public that all spending decisions will protect patient care and safety.

Health staff will be watching closely to see what impact all of this will have on existing waiting lists and hospital pressures.