Once again in recent weeks, the health service has been at the forefront of media coverage, with great focus on the apparent overspending of its budget allocation.
In the middle of this furore we have had confirmation, yet again, that the public health service has overspent its budget, exceeding its service plan by over 7%. In other words, more sick people have been treated, more injured people have attended emergency departments, more patients have been admitted for day procedures, the average length of stay has been reduced, and more home visits have been made. In summary, the Irish public health service has been doing more with less resources through the dedication and excellence of its staff.
There is now a renewed demand for cuts of €130 million, much of which will come from a unilateral and arbitrary reduction in the volume of essential agency staff and a blanket elimination of overtime.
The INMO has never been in favour of an over-reliance on agency staff or overtime. However, due to the recruitment embargo, this is how essential frontline posts are maintained. Without agency staff and overtime, patient care would be compromised, beds would be closed and the remaining frontline staff would be excessively overworked.
I recently heard the newly-appointed director general designate and deputy CEO of the HSE, Tony O’Brien, being interviewed on RTÉ radio. During the interview, he confirmed that, in implementing any cost reductions, all initiatives must be evaluated for risk, and where the risk is too great, services must be maintained.
This clarification is most welcome and is fully consistent with the stance of the INMO: the needs of patients must come before the balancing of books. However, this correct weighting of competing priorities is not being adhered to by many local managements who continue to prioritise budgets over everything else.
In recent weeks, the INMO has reaffirmed its message to its members (particularly those in frontline and senior management positions) that there can be no compromise on patient care. Now is the time when nursing and midwifery must clearly evaluate and decide the volume of service that can be safely delivered within the available staffing resource.
Nurses and midwives of all grades, with our absolute support, must undertake a risk assessment and, through exercising their clinical judgement, determine the number of beds that must be closed, or the volume of service that must be constricted, if general management imposes unilateral and arbitrary staffing cuts.
Once a decision is made, nursing and midwifery management must make this known to general management and fellow clinicians, particularly our consultant colleagues. They must be told that any attempt to deliver services above that determined safe by nursing/midwifery staff, will compromise the care of all patients and they must take responsibility for this.
Safe practice and safe care are not just phrases that roll off the tongue. They are real concepts that can only be assessed and evaluated by nurses and midwives. No one else can determine what care can be delivered safely and no one must be allowed to overrule this decision once taken.
Now, more than ever before, nurses and midwives must come together to redraw the boundaries of care and service that can be provided.
They must insist that all other parties accept and respect our judgement. To do anything else would be to fail patients and that is something the INMO and our members will never allow.
General Secretary, INMO
|Editorial - Patient safety is our duty|