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HSE management and admin appointments outpacing clinical staff hires, says DPER

Department of Health urged to put cap on numbers in management and administrative grades, which have grown by a third in recent years

A cap on the number of managers and administrators in the health service should be put in place, the Department for Public Expenditure and Reform (DPER) has told the Department of Health, as such hires outpace those of clinical staff.

Efforts by the HSE to control growth in numbers of such staff have “proven ineffective”, the department said as it highlighted an increase of more than a third in recent years.

In correspondence to the Department of Health, the DPER argued that a specific maximum ceiling on the numbers in management and administrative grades should be introduced “to prevent an excessive growth relative to clinical staff”.

DPER said the management and administrative category of the workforce recorded the largest percentage increase in staff in the health service last year, at 8.8 per cent.

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The HSE insisted that the vast bulk of personnel in the management and administration category operated in frontline health services.

The HSE’s most recent health sector employment report, published in March, shows that there were 18,851 staff in the management/administrative category in December 2019. In March 2024 this number had increased to 25,477, up more than 35 per cent in that period.

The report says that in December 2019 there were 38,209 nursing and midwifery staff, rising to 47,823 in March 2024, up 25 per cent. There were 10,857 personnel in the medical/dentistry category, which includes doctors, in December 2019. By March 2024 this had increased to 13,873, up almost 28 per cent.

Separately, it has emerged that there are now 181 staff at the senior management grade of assistant national director in the HSE and voluntary hospitals and healthcare bodies (known as Section 38 organisations).

Figures given by the HSE to Fianna Fáil’s Jim O’Callaghan show that the number of staff at assistant national director level has increased by 30 since 2020. Staff at assistant national director level – just below national directors and the chief executive of the HSE – are paid between €110,000 and €134,000.

In a letter sent to his counterpart in the Department of Health Robert Watt, the secretary general of the DPER David Moloney said his officials had “consistently highlighted the need to control the growth in the level of management and administrative staff”.

“The measures introduced by the HSE during the course of last year have proved ineffective, with this staffing category having the largest percentage of any category in 2023 (+8.8 per cent) and it has increased by 33.6 per cent since the end of 2019,” the letter said, using figures current when it was sent.

The HSE told The Irish Times that 80 per cent of posts in the management and administrative category of the workforce were located in frontline services such as outpatient departments, wards, emergency departments, primary care teams and patient discharge.

“These posts play a big role in releasing clinical time and resources. The remaining 20 per cent of this category work in areas such as finance, ICT, HR, procurement and payroll.”

The HSE said that “just 10 per cent of management admin posts are at Grade VIII (the first management position) or above”.

“The current measures in relation to controlling recruitment to these grades are proving effective,” the HSE said.

In its letter to the Department of Health on managing spending this year – dated January 30th – the DPER also urged that savings arising from a new medicines sustainability taskforce be used to deal with “wider spending pressures” as well paying for new drugs.

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