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‘Productivity’ is the HSE’s theme for 2025. The word is used throughout its National Service Plan (NSP) 2025. This was also true of the 2024 plan, in which CEO Mr Bernard Gloster admitted “the traditional use of this concept [productivity] might be in the negative”, but that “our mandate from the Minister is to use it in the positive and not to cut services”.
Assurance of productivity in any public service is basic good governance. Capacity is finite and demand ever increasing. Pockets of waste, inefficiencies, and suboptimal ways of working should be identified and addressed. Unexplained variances in performance should be investigated and acted upon.
But context is key. Last July, the Department of Health published “data and insights” on health service productivity. The Department highlighted “significant variations” in the average number of outpatients being seen by consultants in the same specialty. It also referenced “a big reduction” in the overall number of outpatients being seen “per patient-facing consultant” (between the years 2016 and 2023).
In response, the IMO referred to multiple factors that could influence this trend and which had not been addressed in the Department’s report. These included consultant access to clinics; level of multidisciplinary team supports across all sites; patient treatment complexity and case mix; urgent vs non-urgent care; and access to diagnostics, beds, and theatres, which may mean patients are making repeat visits while awaiting inpatient care. It called for further analysis so that all the factors at play were understood and appropriate supports put in place.
Both the IMO and IHCA have stated that the chronic shortage of bed capacity and under-staffing have resulted in lengthening waiting lists.
Indeed, it is natural to be sceptical about missives on productivity while the capacity crisis remains unaddressed. It is reasonable to be concerned that ‘productivity’ will be used as a smokescreen for ‘cost containment’.
Neither the 2025 NSP nor the draft Programme for Government have offered substantive assurance on staffing and beds.
For example, the draft Programme committed to delivering 4,000-4,500 “new and refurbished” inpatient hospital beds, but the NSP has promised just 297 acute beds in 2025.
The draft Programme pledged an unspecified increase in doctors and ‘public-only consultants’, as well as undertaking to “act on” the final report of the NCHD taskforce.
This newspaper asked the HSE to clarify the number of consultant posts funded under the NSP, but it had not responded by press time. Implementing the recommendations from the expert steering group on consultant recruitment and retention in model 3 hospitals and the recommendations from the NCHD taskforce are listed among the NSP’s ‘focus areas’ in terms of the workforce.
A timeline for implementing a national electronic healthcare record (EHR), a key enabler of productivity, is also lacking. According to the NSP, the HSE will gain approval for an EHR business case and commence procurement. The draft Programme promised to “work towards” the full digitisation of Irish healthcare records and information systems.
Oversight of implementation of the public-only consultant contract (POCC), and ensuring hospital productivity, are emphasised in both documents. However, it is imperative that a robust methodology is used (as advocated by the IHCA and IMO, see news story on p3). Ireland has among the lowest proportions of specialists in the OECD and consultants also rely on the availability of other staff. Where resource deficits are preventing optimal implementation of the POCC, these should be clearly outlined and addressed.
Any delay in funding posts or infrastructure, based on incomplete assessments, would risk worsening the problem of access. And that wouldn’t be productive.
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