Martin Daly proposes HSE staff bank to cut agency costs

I would also agree with the comments made by Deputy Cullen-Ann in relation to the reliance on agency and outsourcing and insourcing, which just really reflects a lack of capacity in our health service. Part of it is capacity. There was a last decade probably after the crash where we just couldn't properly fund what we wanted to fund. We're playing catch-up, but we really do need to have a more planned approach. I won't labour this point, but we need a more planned approach in relation to capacity. I agree with your stance on the public-only contract, because that will allow a more consolidated approach within hospitals where people are working in teams rather than in silos. Also, in relation to outsourcing and agency, we need some flexibility in the system while we develop capacity, but we also must be conscious of the cost of agency and the cost of outsourcing. We also need to be aware, as we know from our discussions previously in relation to CHI, the moral hazard that's in the system if you have people where work has been insourced or outsourced who are already in the public system and supposed to be providing service there. But I don't think this is the place for this amendment. Thanks very much. Thank you, Chair. First, may I just correct myself immediately to say that the multi-annual budgeting amendments are to be at report stage. I just had that confused in my head, so forgive me, please. I don't want to mislead the committee. So, in relation to agency, Deputy, thank you for the amendment and thank you for the opportunity to discuss it, and I totally understand the way in which you've structured the amendment and the purpose of it to have better accountability in relation to this. I don't believe it's for legislation, because I sort of think we should be doing it anyway, and I might suggest a couple of ways of doing that. Let me first give you my own reflection on what we've been trying to do on agency over the past period. Last September, I would have met with, September, October, and I think I updated the committee on this, I met with the HSE director of people, Anne-Marie Hoey, expressed my very, very strong concern around agency use and also the slowness with which many people in the health system are recruited, Deputy Cullinan has referred to it there. It takes an inordinately long time to recruit a nurse. The structure of the use of panels, for example, is something of a complexity that you certainly wouldn't start with, but we seem to be here with it, and I don't believe that it results in faster recruitment. It's, you know, some days you feel as though it's quicker to recruit the CEO of the HSE than it is to recruit a specific nurse. I'm being a little bit facetious, but only a little bit facetious. I think the structures that have grown up over time don't necessarily serve quick recruitment, which is what this committee wants, is people recruited into whole‑time positions and a massive reduction in the role of agency. So we're trying to do a couple of different things, and then I might suggest to the committee a way in which we could take it forward together. The first is tightened authorisation controls, including removing delegated approval for agency bookings at site level when required. Formal directions by the regional executive officer to sites on agency limits, controls and required actions. Restrictions of agency use to defined exception areas. Direct recruitment and agency conversion, which is by far the most important piece. And what I really want to do is establish our own agency. I want to establish our own HSE agency. I am tired of paying agency fees to third parties. I don't see any value in it. I believe there is a role for agency in the future of the health system, insofar as we will need a certain measure of flexibility, as Deputy Daly has said, as Deputy Cullinan has said, but where we do need that measure of flexibility, I do not want to pay a third‑party entity for the privilege of it. It is reasonable that we establish our own HSE staff bank. It is something I asked for last October and is being progressed now in the HSE. It should be possible, if you want to do extra hours, if you are available to do extra hours, to apply to our own agency, to say you are available for additional hours. But it is also important that where we are doing agency, that the site is directing the hours that are done and not individual, people are not signing up, I suppose, for the most advantageous shifts, as it were. Do you know what I mean? That the site is in control of when we are using agency to cover what the site needs, as opposed to any situation in which agency is controlling the hours, which is something I have seen in different places and I think we need to be very careful. We do need our own HSE staff bank to reduce the reliance on third parties while still allowing some measure of flexibility, but we do need better conditionality on the use of agency as well. That might result in some kick‑back from people who have been used to working in this way and I would ask for your support if that is so. We also need to get to the point where if we establish a staff bank in the way that I'm describing, that we end the sort of off framework model, and that is going to result in a sort of a rupture. I would ask the committee's support for when that happens, if we do that and we take that important step, rather than saying this is fine in perpetuity and you should get to it when you can, fix it when you can, lads. At some point we will have to say here is our staff bank and thereafter we are not doing it outside of this structure. And that will result in some disruption and I would ask for your support when that happens, because in order to make a change, you have said here you have been talking about this with many ministers, you have been talking about this with many executive officers, many members of the senior level of the HSE, all the time trying to get down the budget on agency, all the time trying to recruit the permanent positions, all the time trying to change a culture that is site by site, that has built up over time. If we are going to make the kind of change that I think is the one that is necessary to be effective, I'm going to need your support and I would ask you to help me with that and let me describe to you what we are thinking, describe to you the parameters that we want to put on it in 2026 and describe to you where I think there might be difficulties and ask for your support in making that transition. Could I suggest to you that it should be the case that, could I suggest rather boldly, Chair, that you invite the OREOs, the regional people, directors of people and the regional clinical directors in to describe to you what they are doing in terms of agency conversion and speeding up recruitment of permanent positions, that they describe to you what is happening in their areas in relation to the establishment of a staff bank. There is a programme, a directed programme by the CEO at the moment in relation to agency conversions. What we are seeing is that it's more difficult in some regions, Dublin, Mid Leinster for example, the hospitals there have a much, much higher proportion reliance on agency than hospitals in other areas. And that is a huge cost, the bulk of it is a huge significant cost and it's also not the right way to be working. But then there is another side of it, which is smaller in numbers but very expensive, which is consultants being recruited on agency or temporary positions, temporary and locum. I think we have about 450 consultants that are on temporary or locum positions and that is expensive. And my question to the regions and to the sites is, are you sure there is nobody within the hospital that is already qualified? Or positions that are recruited but not filled for maybe a year or 18 months, are you sure that's necessary? I think we have to be rigorous site by site about the different vacancies and the different positions. And I do think given this launcher care support for the regional structure, it would be a reasonable thing for the committee to look at it region by region, given that the regions have been tasked with this very activity, so that I can come back and describe to you a systematic change that will last and one that's going to have an important budgetary implication but also more importantly going to give the health system much more predictability about rostering and who is available. So I would suggest to the committee that they take, without needing to legislate for it, that they take control of this and bring in the different regions to have that detailed conversation. I would ask you to support me on the establishment of a HSE staff bank and the necessary change that will come from that to say, right, this is the new way and we're going to have to end the old way and to help us through the different issues that will come as a consequence of that. And that would be my suggestion for how we collectively deal with this issue that we collectively have.