Health staff face sweeping promotion restrictions under spending controls

About 100,000 staff across large parts of the health service face restrictions on promotions as part of incoming controls on filling new posts and vacancies. The move has been described by doctors as a “de facto recruitment freeze which presents clear and significant risks to patients”. Nurses said staff and patient safety have been “thrown out the window”.A new four-stage recruitment authorisation process has been introduced which culminates in each individual position now having to be approved by the Department of Health – even in cases where posts had previously been authorised within the Health Service Executive.[ Health budget no longer based on evidence, consultants’ conference toldOpens in new window ]“The above sanction requirement applies to all recruitment, replacement, promotion and conversion posts without exception, including graduate appointments, agency conversions and any other category of appointment or internal progression that would impact the overall pay bill,” a directive to top-level HSE management, which came into effect in recent days, states.READ MOREThe new measures, which have no specified end date, come as the latest HSE forecasts to Government maintain it will face a €1 billion cash deficit by the end of the year. The projections suggest the health service will overspend its official pay budget by €142 million. HSE regions which overspent on staffing this year are now expected to have to make cuts to recruitment in 2027. The new enhanced control measures will apply to four HSE regions which have gone 2 per cent or more above their official pay bill. These are HSE South West, HSE Dublin South East, HSE Dublin and Midlands and HSE West and North West.While the new controls stipulate that the department will make the decisions on sanctioning recruitment and promotions, they also indicate “the HSE remains responsible for managing the identified clinical and service risk at all times, including while an application is prepared or considered”. “Submission does not transfer risk to the Minister [for Health] or department and does not relieve the HSE of its obligation to implement safe interim arrangements,” notes the Government document on the revised recruitment/promotion financial sanction process – which is quoted in the memo to senior management.The president of the Irish Medical Organisation, Dr Matthew Sadlier, on Friday warned that “with this measure, the reality is there will be no new services or expansion of capacity while those currently in place could be under threat. It is obvious that the Government’s aim is to reduce the number of people delivering care, not increase them.“Where will accountability lie for the introduction of this measure when it inevitably has a negative effect on doctor numbers, waiting lists and patient outcomes?” The Irish Hospital Consultants Association (IHCA) said the move to cede authority over HSE recruitment to the department represented a “watershed moment” which set a dangerous precedent.Its president, Prof Gabrielle Colleran, said the authority of the HSE chief executive had “not only been undermined but usurped”. “I cannot see how this move can possibly align with patient safety, the required drive to cut hospital waiting lists, or the idea of a fit-for-purpose HSE,” she said. [ Senior hospital doctors criticise Minister for Health’s ‘closed-door’ approach to engagementOpens in new window ]General secretary of the Irish Nurses and Midwives Organisation Phil Ní Sheaghdha said: “The Department of Health is essentially telling hospital and community care managers that they need to find ways to not fill posts. The department will not use patient safety and risk as a reason to fill a clinical post. This is unheard of in a country that has never been wealthier with a growing and ageing population.”She said the Government had essentially torn up every staffing agreement aimed at protecting the physical and mental health of staff and of the nation as a whole. “It is baffling that the HSE board have seemingly gone along with these new measures. The HSE board must now outline exactly if it has sanctioned the decision to throw patient and staff safety out the window.”The new rules state that regions seeking to fill posts “must demonstrate consideration of all reasonable alternatives, including service redesign, redeployment, alternative grades or professions, roster changes, shared services and wider regional resources before seeking additional staffing”.