A new report has warned that massive job cuts in the HSE are posing a threat to safe and efficient services being delivered.
The HSE report reviewing its system of internal controls says the level of staff cuts has led to some services being at risk of not being delivered.
The review warns that the HSE needs to address risks to its ability to deliver safe services in light of staff reductions and financial restrictions 'and ensure these risks and related controls are identified, communicated and that management continuously seeks assurance on the effectiveness of these controls'.
The number of whole-time equivalent health service staff has been cut by 12,500 since 2007, with a further cut of 2,600 planned for this year.
The report also reveals concerns among HSE managers about the implementation of the current health service reform plans.
The HSE report, completed in May 2013 but not published, warns that the staff cuts have led to an increased risk or errors and to staff being at times asked to 'act-up' into other positions without having the relevant experience or qualifications.
Staffing restrictions, the report says, also lead to:
* A lack of formal training on a continuous basis for new and existing staff.
* Frontline staff forced to work in breach of EU working time limits.
* Delays in payments to HSE suppliers and other issues relating to the processing of financial transactions.
* The prioritising of staff cover in frontline services at a cost to clerical and administrative staffing.
* Difficulties in the retention of expertise, especially in nursing and childcare, due to the non-filling of vacant posts.
The report says there is significant pressure on staff to perform additional duties as a result of the job cuts.
Staff numbers have plummeted in the HSE in recent years as a result of a freeze on recruitment an dearly retirement/voluntary redundancy schemes.
The report says a continuation of the freeze on recruitment could lead to a deterioration in the current operation of control systems.
The report says in order to mitigate the staff cuts, the HSE has moved to implement work practice changes and redeployment and has tried to tackle staff absenteeism. It says the controversial graduate nurse employment programme would help provide additional nursing capacity.
It says the level of staff reductions and their impact led to some services being at risk of not being able to be delivered in 2012.
The absence of key employees, the report found, had led to ad-hoc arrangements and emergency planning being put in place.
"These alternative less formal approaches have become more difficult to maintain due to the non-replacement of staff over the last number of years."
The review said the HSE needs to address risks to its ability to deliver safe services in light of staff reductions and financial restrictions 'and ensure these risks and related controls are identified, communicated and that management continuously seeks assurance on the effectiveness of these controls'.
The review of financial controls in the HSE, released to irishhealth.com under FOI, was drawn up by its Finance Directorate at the instruction of the HSE board.
The report also expresses concern about the planned reforms in the health service.
It says absence of clarity around structures and transitional arrangements involved in the reform process could weaken governance. Also, the timeframe for reform may not afford adequate time for due diligence, the report warns.
The reform programme challenges includes changes in the way that hospital services, including smaller hospitals, are funded and managed, the disaggregation of childcare services from the HSE, the establishment of a new directorate structure, the establishment of a patient safety agency and ensuring that services including mental health, disability and primary care are fit for purpose.
The review found that some managers in the HSE were sometimes unsure what was expected from them in terms of the reform changes.
In some cases, they did not in all cases fully understand the specific actions and behaviours needed from them to supports a change effort, the report said.
They also 'may not hold the appropriate skills and tools to be successful at leading their direct reports through the reform changes.'
The report identified challenges involved in implementing health service reform 'under the most stringent fiscal constraints experienced for decades'. The HSE says it is planning to develop formal training programmes for managers to prepare them for the changes.
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