Mr. Paul Bell:

I confirm the appreciation of SIPTU for the invitation from the Chair and the committee to meet them today to discuss workforce planning for the health service. The SIPTU health division represents approximately 45,000 workers in the health service. Our membership is based across the public health system, private healthcare and section 39 employers. Our division is organised into several sectors which include support grades, nursing and midwifery, health and social care professionals, healthcare assistants and the National Ambulance Service. Our division represents members in all areas of the health service, including acute mental health, intellectual disability and care of the older person. In addition, SIPTU health division supports our members in all industrial relations aspects arising within the hospital groups and community health organisation areas. Our network of organisation and support includes national representatives, local officials and shop stewards, activists and members.

We are proud to represent these members.

In consideration of our presentation today, we note the following definitions of workforce planning which have been published previously. In 2017, the Department of Health said: "Workforce Planning is a core process of Human Resource Management which is shaped by the organisational strategy and ensures the right number of people with the right skills, in the right place, at the right time to deliver short- and long-term organisational objectives". The Department of Public Expenditure and Reform has said:

Without adequate skillsets where and when they are required, objectives cannot be achieved. Workforce Planning aims to draw together all of the various factors – including staffing, skills, learning and development, financial resources, succession planning – to develop a cohesive plan for the medium term.

In his 1996 book, Mr. Peter Reilly defined workforce planning as a "process in which an organisation attempts to estimate the demand for labour and evaluate the size, nature and sources of supply which will be required to meet that demand."

To summarise our submission with regard to the funding model, while our members note the principles of an effective workforce planning system, most do not recognise it within their workplace. The health service is overcome with consistent funding issues which are apparent from the end of one year to the end of the next. The current model of funding for our health service does not work and must change. If policies such as Sláintecare are to have any chance of succeeding, the model of funding approved for the health service must provide for the needs of the service and ensure it achieves the right number of people with the right skills, in the right place, at the right time to deliver short, medium and long-term organisational objectives.

In our opinion, the current model of funding for our health service is destined to fail each year. Concerning workforce planning, the current model requires line managers to prepare plans for the needs of the service in the following year. When this is completed, it is subject to various levels of scrutiny before being submitted to senior HSE management. While we do not have an issue with oversight and scrutiny, which we accept is required, our concern remains that, following the multi-layer overview by senior HSE management and officials of the Department of Health and Department of Public Expenditure and Reform, the final approved funding plan generally looks nothing like the original one submitted at department level. This results in a continuing battle playing out in each department where line managers are left struggling to provide for the ever-expanding needs of service.

In order to achieve the full aims of Sláintecare, support for staff to develop and expand their roles is essential. There is distinct evidence that SIPTU members embrace the development of their roles when supported through resources and funding. The examples of the development of the roles of paramedic and advanced paramedic from the previous title of ambulance driver in the national ambulance service and the development of the role of health care assistant are demonstrative of staff within the service embracing change and upskilling of their roles. Equally, within the area of health and social care professionals, radiographers have expanded their role to include cannulisation and the administering of contrast in computed tomography, or CT, scans and to undertake duties formerly assigned to dosimetrists. The committee will also be aware that nurses and midwives have expanded their roles to share duties previously assigned to medical staff to ensure the most appropriate staff member undertakes responsibility of a task at any given time or on any given day. These are just a few examples of changes which have been undertaken to provide a better, more efficient service to the patient or service user. We contend that these examples, of which there are more, demonstrate the willingness of staff to embrace greater responsibility, a pushing of boundaries and a new model for the provision of healthcare in Ireland. Unfortunately, our members argue a significant percentage of this responsibility is left on their shoulders only.

SIPTU members also contend that the focus of the HSE, the Department of Health and the Department of Public Expenditure and Reform with regard to health management is almost entirely on cost reduction from day one of each year. This results in departments not receiving approval to recruit identified safe staffing levels and those in employment not having guaranteed access to funding for postgraduate courses which are undeniably essential to the service provided. Our union argues there is something materially wrong in our model of healthcare when, for example, a department requires radiographers to upskill and undertake a postgraduate course in ultrasound but the members of staff are asked if they can provide the funding themselves.

On the system for approving recruitment within the HSE, the system of approval for the filling of vacancies or for submitting business cases for staff in new and existing posts is designed to frustrate and does not do what is needed, which is to fill vacancies. Line managers and staff within the system are left totally demoralised by the extensive effort and repeated procedures required to fill vacancies for essential posts. Even where replacement of a post is approved, it is common for recruitment to take well over a year to complete. During this time, staff are left carrying the demands of the service, all too often with insufficient staffing levels. This does not just affect the replacement of vacancies as it is the same procedure which also undermines the replacement of those on maternity leave and so on. In such circumstances, it is commonplace for the HSE to confirm a replacement for the person on maternity leave literally weeks before the staff member is due to return to the workplace. As a result, managers and staff have informed SIPTU that they use the system for the replacement of posts without any expectation that their application will be approved or, if it is approved, of when such approval will be received. The system of recruitment within the HSE is designed purposely to cause this frustration and is extremely damaging to our health service.

The current system of approval requires business cases to be submitted at multiple levels of the organisation. This results in a situation where staff, department level management and hospital and group management can all agree on the need for replacement staff in a given a post but national central management, which is not connected in any direct way, must provide final approval or no one will be recruited for the position. This is very narrow-minded and counterproductive for the HSE as it results in the loss of eligible qualified candidates for employment to the private sector and overseas opportunities. Evidence of the level of recruitment for our key grades over the past number of months and years is provided in the text of this presentation.

SIPTU contends that the recruitment procedure in the HSE must be overhauled immediately. National officials within the HSE and Department of Health reject the suggestion that there are instructions for a recruitment embargo, freeze or moratorium. While it would appear they are seeking to steer away from the stigma of these labels and their effects in the past, they are very much present in all their former aspects, albeit under the disguise of business cases and multi-layer approval bureaucracy.

In the context of the challenges of gaining approval for the filling of an accepted vacancy, money is spent on other expensive forms of employment, such as hiring agency staff, as an alternative. We trust the committee will be aware that the most recent estimate of the costs associated with agency expenditure in the health service for 2019 is in excess of €200 million. This includes a figure of over €60 million on healthcare assistants and €50 million on nurses and midwives. The data also suggest our health service has purchased in excess of 500,000 working hours this year to date through expensive agency arrangements rather than direct employment. SIPTU contends that the system of refusing approval for recruitment while utilising hundreds of millions of euro on expensive external employment options must be revised.

The reality is that many agency workers are employed in the same hospital or ward for years rather than the HSE deciding to recruit. Agency work may have a place in our health service for short-term, immediate or unexpected replacements. It cannot, however, be used as a replacement for direct employment for the filling of vital front-line health worker posts.

We need the right person in the right place at the right time. In this submission, we have highlighted some of the central principles required to successfully incorporate a concept of workforce planning within the health service. The modern-day health service utilises a multigrade, team-based approach. SIPTU believes the maintenance and development of this model will serve to benefit staff and patients alike. We are acutely conscious of the cauldron which is faced every day by staff providing services and, indeed, by those seeking to gain access to services from the outside.

SIPTU believes it is crucially important for all stakeholders to work to change the experience for staff and service users. We believe that a successful workforce planning model will be of assistance in supporting the change that is required to achieve this. There is no doubt that staff want to provide services in an environment that respects the dignity of all. SIPTU contends that the "right person, right place, right time" principle supports such an environment and presents an opportunity for staff to upskill or focus on duties and responsibilities which are in accordance with their qualification standards and their professional registration.

We note the recent framework for a safe skill mix between nursing, general staffing, specialist medical and surgical care settings in adult hospitals, as launched by the Minister in 2018. We contend that an examination of the appropriate skill mix and the safe staffing levels is crucial when services are being provided to patients and service users. It is noted that some grades are suffering from the effects of chronic understaffing and the restrictive labour market. This is due to pressures from the private sector and foreign employment opportunities. We believe there is merit in examining the possibility of seeking agreement on new methods of service provision. We think it would be appropriate for all stakeholders to be involved in this. There is a need to ensure the skills, duties and responsibilities of graduate-qualified staff who are at the pinnacle of their qualification or registration are maximised to provide support as part of a team-based skill mix approach. SIPTU believes such a model is challenging on several fronts, but will result in a changed environment for those who are providing services and for those who stand to benefit from it.

A significant focus on the development model of healthcare is recommended within the Sláintecare report. In that context, it is appropriate for our submission to be accompanied by a brief comment. SIPTU is actively aware of the challenges that are being experienced in communities where people are facing the realities of a two-tier health system as they seek to access services. When citizens face having to access healthcare, their last concern should relate to how much money they will need to afford private treatment. This model breeds inequality and forces an additional burden on the public system through longer waiting lists. Equally, we note that barriers to care in our community are being experienced in areas where they have never before been experienced. This can be attributed to the insufficient number of medical doctors in general practice in many towns and cities. Existing GPs are unable to cope with the level of demand.

While there will be many challenges in implementing the Sláintecare report, we support the principles underpinning it. As a union, we are seeking to bring an end to the bottleneck in accident and emergency departments. The never-ending and ever-expanding waiting lists must be dealt with. Community services must be developed. There is an urgent need for additional bed capacity. If the prescribed future for healthcare in our country is to succeed, lessons must be learned from the existing failed model of service delivery. Staff must be given opportunities to develop and upskill. The concept of multi-grade team-based working, which ensures that when duties are being allocated, they are assigned to the most appropriate person at the right time and in the right place, must be further enshrined. We must support our staff through career opportunities and education supports. This will ensure the public health service is the first choice for health workers in this country.

SIPTU would like to convey its deep concern regarding the slow pace of progress in securing the necessary funding to support the advancement of Sláintecare. In our opinion, a token level of funding is being afforded to this project as part of an effort to convey the optic that implementation is proceeding. We note that €20 million a year has been earmarked for the HSE and for Government Departments to date. This is insufficient to tackle the current challenges in funding the necessary actions to bring about real change. As I make this point, I note that funding of approximately €680 million per annum has been identified for Sláintecare.

We thank the committee for its time. Our submission includes a brief outline of the key sectors of our union within the public health service in reference to workforce planning. Before I conclude, I would like to mention an aspect of this issue that is not normally discussed. I refer to the arrangements put in place by some agencies when the health service identifies permanent posts. If a person who is registered with an agency goes to take such a post, the HSE must pay a fee that is demanded by the agency. We discovered recently how expensive this can be. In some cases, it is as if the employee is bonded to the agency in some way. This must be investigated by the HSE and perhaps by this committee.