Recruitment freeze might focus HSE minds

If there is any one issue or crisis that has highlighted the problems that exist in the Irish health service, and pointed to the fact it is out of control and unmanageable in its present form and structure, it is the recent announcement of a near blanket ban on recruitment of new staff.

I believe the decisions made by Bernard Gloster, CEO of the HSE, should have been made many years ago when it became apparent that normal financial controls could not contain the budgets, and over-runs became the norm. I am no financial, business or management wizard, but a total moron would know that regular budget overruns are an indication of poor controls in different divisions of the service.

And before trade union members start writing to the Editor to tell him about staff shortages and everything else that is wrong in the health service, I wish to say that a blanket ban on recruitment is a very blunt instrument. It will penalise areas of service where there is a genuine need for new staff members. It may lead to some professionals deciding to emigrate, and it will inevitably lead to a surge in recruitment when the ban is lifted.

What it will do, however, is focus minds on the awful crisis that exists, and has existed for years in the provision and funding of health services in this country. An in-depth examination is urgently needed into the way our health services are organised, managed and funded. I hope that the radical action taken by CEO Mr Gloster is the first step in moving to a critical analysis of a monumental horror in our midst. Health services and, indeed, the HSE are too important to society to be allowed to move from one crisis to another.

Former Minister Brian Cowen described the health portfolio as being like Angola, which was then in the grips of a landmine crisis. It was a throw-away remark but it still signified the attitude of political leaders to what was, and is, the daunting task of bringing health spending under some control, while at the same time providing modern services. It has been obvious over the past number of years, as the health service expanded, that politicians were prepared to throw money at it while avoiding the tough job of making it fit for purpose and value for all the money put into it.

There are areas where the level of provision is scandalously low. Mental health services, especially for young people, are a scandal, equally so is the ridiculous situation where patients remain in acute hospital beds because public health services are unable to provide services for them at home. There are many, many other areas, of contradictions and gaps in service provision, that no one appears able to sort out.

With all of that said, I can testify from family experiences, and from friends, that everyone who got through the trauma of the awful accident and emergency waiting times, and got a hospital bed for a variety of treatments, were all in awe of the level of services, the efficiency of service and the totality of care. It is sad that such an extraordinary level of care and medical treatment should be tarnished by the inability to deal adequately with annual budgets and with areas that cause crises and reputational damage to the entire service.

Mr Gloster, when he announced the freeze on recruitment, said the service was on course to exceed its 2023 funded workforce target, which was neither affordable nor sustainable. It was reported that he wrote to Health Minister Stephen Donnelly to tell him there needed to be a clear government-wide understanding that circa three-quarters of the deficit cannot be achieved without significant and punitive risks to the public.

The Department of Health budget allocation for 2023 was €23.4 billion. Recently, the Oireachtas Committee on Health was told the budget deficit for this year would be €1.4 to €1.5 billion.

Hopefully, this is the start of a new era and attitude in dealing with the demands of providing a modern and comprehensive health service.