Unwelcome truths behind Limerick hospital dispute

The IMPACT dispute over executive pay and corporate governance in the mid-west hospital cluster, which goes to the Labour Relations Commission tomorrow (Wednesday 30th July), is unusual to say the least.

The hospital staff – mostly admin workers – who voted 90% in favour of industrial action aren’t looking for anything for themselves. Rather, their work-to-rule is an expression of exasperation at an employer who’s presided over huge cuts in entry-level admin support staff, yet has no difficulty in paying over twice the going rate for the services of one consultancy-supplied senior manager.

Pay cuts and pension levies still hurt, and everyone’s working additional hours since the Haddington Road agreement came into force. But staff have been galvanised into action by the sheer injustice of hiring a management consultant on €250,000 a year when even the HSE director-general admits that additional clerical staff are needed to provide vital services to patients in the mid-west.

The dispute came to a head as IMPACT published figures showing that the number of HSE admin staff has fallen more than almost any other group since the crisis began in 2008. Clerical, administrative and management staffing fell by over 13% between March 2009 and July last year.

Top and bottom

Interestingly, the biggest decline has taken place at the top and the bottom of the category. The biggest percentage fall in staffing (22.5%) occurred among clerical officers (grade III), who are also by far the largest single bloc in admin staffing. (Clerical officers make up almost 40% of HSE administrators and the figure rises to almost 70% when you add the second lowest group – grade IV).

Services are suffering as a result. For, contrary to the long-standing and convenient myth beloved by politicians and commentators, most health service admin staff actually provide direct support to the ‘front line’. The HSE’s own figures show that by far the largest number work in acute hospital services (almost half of the total) and non-acute hospital services (over a third of the total). So you cannot simply keep cutting and expect hospital services to muddle through.

Meanwhile, the second largest fall in HSE clerical, admin and management staff – over 19% – has been at the senior ‘director’ level. And just last week, IMPACT national secretary Louise O’Donnell told the MacGill summer school (among other things) that the HSE is finding it  impossible to recruit chief executives for new regional hospital clusters. Recent competitions have been successful in recruiting just two out of the six CEOs sought. One of them has already jumped ship.

Not red tape

It’s easy and convenient to dismiss administrators and managers as wasteful bureaucrats or worse. Politicians and commentators do it without reference to the facts to allow them claim health spending can be cut painlessly. “Were not hitting ‘front-line’ services, we’re just eradicating wasteful red tape,” they cry.

But in today’s Irish health service, this habitual refrain is simply ignoring the reality on the ground, where as few as 2% of all health service staff work in non-front line clerical, administrative and management staff roles.

Cuts in staffing – including clerical, administrative and management grades – ultimately mean cuts in service levels and quality. IMPACT members in Limerick, Clare and North Tipp have had enough of this, and they’re not alone.

We need to see an easing of the public service recruitment straightjacket as we slowly come out of the crisis. In the public health sector we need a rational and realistic staffing and HR policy to replace decades of ad-hoc practices – often crisis-driven – that have helped create the mess in the mid-west.

Managers would do well to talk to staff in the Limerick group of hospitals, and elsewhere, about how it might be done.

Bernard Harbor