Health officials call for cuts in overtime and agency work

Health officials have called for cuts in overtime and temporary work after reporting a sharp increase in such spending ahead of the Covid-19 pandemic despite the hiring of thousands of new health service staff.

“A decrease in reliance on these staffing arrangements should be continued,” Department of Health staff said in a review released Friday by Public Expenditure Minister Michael McGrath.

“Previous studies have shown that not only are these temporary staffing arrangements a more expensive way to provide long-term health care, but they have also been linked to adverse patient outcomes.”

A second spending review – by officials in Mr McGrath’s department – found a ‘consistent overrun’ for disability health services despite budget increase of 37% in five years to more than € 2 billion Last year. “This trend continued in 2020, when the disability rate was estimated at 2.1%. [or €44 million] on the starting budget by the end of the year.

Health Minister Stephen Donnelly welcomed the findings on salary spending, suggesting they promote better understanding. “The (…) document provided one of the most detailed analyzes of agency spending and overtime in the Irish health service to date,” he said.

The review looked at trends in 2012-2019 before the outbreak of the coronavirus last year resulted in another sharp increase in staff overtime and agency utilization. During the same period, the number of full-time equivalents in the health service increased by 15,000 to reach 120,000 in 2019.

Annual expenses for agency staff have increased 97 percent in seven years, according to the review. “Agency spending has seen an almost constant increase since 2012 [€214.9 million] to 2019 [€423.3 million], with the only drop recorded in 2015, when spending fell by 3 percent [€9 million]. ”

The review then highlighted that annual overtime expenditure rose to just under € 300 million in 2019, up € 92 million from 2014.

Determining factors

While acknowledging the increased reliance on this work to provide health care, authors Emer Hanney and Claire Doyle said the factors behind this work were unclear.

“One of the potential causes is that the growing demand for agencies and overtime is due to staff shortages, implying that changes in permanent staff levels are inversely related to the use of agencies and overtime, ”the study said.

Another theory is that the increase in agency and overtime spending is driven by the growing demand for healthcare, implying that the increase in agency and overtime spending is correlated with higher activity levels. ”

Short-term services, where full-time staff grew 24% after 2013, posted the weakest growth in agency spending. At the same time, the “relative stagnation” of staff in other services “may be at the root of the need for agency staff”.

There has been “significantly higher growth” in agency spending on mental health care than in any other area. According to the review, mental health had the second smallest workforce and the highest agency spending after 2016.

In a third document released on Friday, officials from the health and public spending departments said “careful targeting of services and effective cost control” could help limit the expected spike in spending with the promised introduction of ‘a legal scheme to help people live in their own retirement homes.

“The funding model for the program has not yet been determined. The results of a review of the scope of the available literature suggest that the implementation of a legal home support scheme has the potential to significantly increase the costs of long-term care, ”they said.


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