Ivan Yates: 'Nurses can't be allowed to hold HSE to ransom'
The Taoiseach's temerity to question front-line hospital staff Christmas rosters was met with howls of derision. How very dare he, given the four-week Dáil recess, question the festive capacity for handling diagnostics.
Leo Varadkar duly received the full whack of nurses' anger, despite the pent-up patient demand from the holidays, which ramp up chronic new year overcrowding.
The debate never got past the issue of staff morale. It was an "insulting distraction", "inflammatory", "hurtful deflection" - take your pick.
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Missing was any discussion of the optimum use of our acute hospital beds, costing €856 per day.
The structural reform of all in-patient systems from five to a seven-day week would transform elective treatment capacity.
Better still, without any extra capital costs. Arranging routine rosters to eliminate weekends could yield a 20pc increase in hospital output. But again, patients' interests are secondary to vested interests.
The trolley crisis, with 40,000 patients spending more than 24 hours in makeshift surroundings, is worse than ever.
All we have to show for €1.7bn extra spending is an additional 240 hospital beds this year and the promise of a further 79 next year. Extra resources are being swallowed up, apparently due to delayed discharges, costing the system 114,000 bed days.
This leaking bucket needs fixing.
Heightened public disquiet has presented the Irish Nurses & Midwives Organisation (INMO) with the opportunity to launch a special pay claim for a 12pc increase for all nurses. To be paid the same as physiotherapists.
In early September the Public Service Pay Commission (PSPC) issued a detailed review into the recruitment and retention problems in the health sector. It concluded that current pay arrangements were not a significant impediment to nurse recruitment.
Money wasn't the main issue where staff shortages existed. It recommended €20m of additional incentives to be targeted at nurses who acquired additional qualifications or accrued long continuous service.
A 20pc increase in some nursing allowances - based on locations in 13 areas of the service and improved access to some senior posts within 17 as opposed to 20 years - is specifically advocated.
These location allowances would provide extra benefits of up to €558 annually, but in the likes of maternity services could increase salaries by €2,300. This would involve the acquisition of postgraduate qualifications.
The commission's international comparisons did not reflect under-payment. Australia and the UK did not exceed the average nurse/midwife Irish incomes of €57,602.
The INMO responded with derision with 94pc voting to strike. The PNA (psychiatric nurses) followed suit.
They're threatening industrial action through work stoppages, rolling work-to-rule mayhem and maybe even an all-out strike. They insist on an across-the-board pay hike for all 37,520 of their profession.
Do the sums: 12pc of €2.16bn equates to an additional €259m. Departmental estimates claim it will cost €300m. This must be seen in the overall context of the public sector payroll policy as agreed in the Public Service Stability Agreement.
It provides for a 7pc increase in public sector pay up to 2020, the restoration of increments and more favourable pension contributions, and a €200m package for post-2011 recruits as a basis for pay parity.
All of these general concessions are being rejected as uniquely inadequate for nurses.
We learned from benchmarking, pre-crash, that conceding extra pay without productivity gains doesn't result in one additional hospital bed, operation or treatment.
You get the same inefficient service, except it costs even more. Industrial peace and political popularity based on open access to a mythical public ATM is unsustainable.
Other aggrieved public sector unions will consequently seek a rope ladder effect from any unilateral concessions to the INMO/PNA. They'll lodge their own special pay claims.
The PSPC did reveal medical/clinician recruitment and retention difficulties. Hospital consultants, represented by the ICHA, can rightly point out to unfilled posts and even unqualified untrained junior doctors being exposed in the High Court.
General practitioners, represented by the IMO and NAGP, are negotiating a revision to their 1972 contract. The Fempi cuts remain to be unravelled.
The latest panacea of Sláintecare threatens to worsen public hospital finances. The €600m of private healthcare revenue will be lost if a rigid apartheid of public/private separation proceeds.
Restrictions to private practice will likely drive the best doctors out of State hospitals. Private clinics will cherry-pick the most lucrative specialities, leaving taxpayers with the long-term burdens of costly and unprofitable chronic rehabilitation.
Health Minister Simon Harris is clearly preoccupied with the cervical cancer scandal and introducing an indigenous abortion regime. In fairness, both require his leadership. But his main day job nonetheless is to ensure the effective performance of the HSE. He hasn't gained much traction.
The full board has yet to be established, with just the announcement of a designated British-based chairman, Ciaran Devane. Directors, and a CEO to replace Tony O'Brien, have still to be identified. Legislative governance structures are still being drafted.
So no oversight for 130,000 staff. And no structure of accountability.
The Government could do worse than appoint O'Brien as a HSE board director. His recent comments, beyond his embittered attack on politicians and media, contained some insightful and useful overdue reforms.
For Emergency Departments, he argues that we need to consolidate 24/7 ED cover into fewer hospitals - citing Portlaoise and Navan as having inadequate throughput to warrant rationalisation. Dublin EDs should be reconfigured into three rather than seven hospitals, with establishment of a first national trauma centre.
Alarmingly, Siptu has successfully resisted amalgamation of the ambulance service in the capital from the dual system currently operated by the Dublin Fire Brigade and HSE. The current on-call/deployment procedures is simply indefensible and unsustainable on grounds of efficiency and speediest response times.
Politicians look the other way when it comes to confronting vested interests. Shallow, superficial healthcare debate in political/media circles doesn't extend beyond the politics of the latest dire waiting lists.
Public opinion therefore disdainfully dismisses those challenging vested interests.
Being held ransom to unsustainable unaffordable pay demands by nurses can't be countenanced.