What's going on with HSE agency spend?

MegamanBoo

I've seen reports lately saying that the HSE is overspending to the tune of 1 billion this year and most of this is being blamed on agency costs.

If this is the overspend, does anyone know how much we spend in total on agency staff?

I worked in healthcare myself until a career change about ten years ago. At the time, and in the disability services where I worked, agency staff were paid broadly the same hourly rate as employed staff.

But for each hour worked, the agency would be paid the same again.

At those rates, suppose we spend 2 billion on agency staff, 1 billion is effectively wasted.

Is that correct? If not, how much of this huge spend actually goes to these agencies, does anybody know?

Gregor Samsa

Here's the HSE's Annual Report and Financial Statements for 2022: https://www.hse.ie/eng/services/publications/corporate/hse-annual-report-and-financial-statements-2022.pdf

Here's the breakdown of staff pay and pension expenditure for both HSE and Agency staff (clinical and non-clinical). This is on page 172

The 2023 one won't be published until mid next year.

MegamanBoo

https://www.boards.ie/discussion/comment/121214238#Comment_121214238

This article, based on a FOI request, has the total figure in 2022 at 690 million.

https://www.echolive.ie/corknews/arid-41200039.html#:~:text=The%20HSE's%20spend%20on%20agency,between%20January%20and%20October%202021.

Those figures you shared suggest to me 300 million?

And how much goes to the agency itself, and how much to the agency worker?

Kerry25x

Agency staff are mostly paid the same as HSE staff. I think there's a couple agencies that will pay one pay band higher so maybe an extra grand a year. Also agency staff don't get pensions or sick pay. Most people I know doing agency do it for the flexibility, it's very hard to get part-time contracts in HSE unless you're taking parental leave hours.

MegamanBoo

https://www.boards.ie/discussion/comment/121214502#Comment_121214502

Thanks that's certainly helpful!

I wonder how much the agency gets paid though?

I'm pretty sure in my time it was the hourly rate again. I think there was also additional premium payments going to the agencies, such as shift allowances.

It's an awful lot of money wasted if that's still the case.

Tom Mann Centuria

All bar two agencies are no longer used in my local hospital. They're promoting Nurse bank (HSE internal agency type thing) In my hospital, they will pay time and a half for first four hours of extra shift and double time after that. I think that highlights just how much they must be paying agencies if that's the cheaper option.

Mrs OBumble

https://www.boards.ie/discussion/2058317402/whats-going-on-with-hse-agency-spend

The money paid to the agency has to cover employer PRSI (11%) annual leave 8%, sick leave (2%), payroll processing and administration, as well as profit for the agency (cos they're not in business for love). All but the last would have to be paid even if the staff were direct employees. And if they were direct, there would also be pension and training costs.

So it's not exactly "wasted".

MegamanBoo

https://www.boards.ie/discussion/comment/121214682#Comment_121214682

Sure, but that still only makes up 21%, the rest is profit?

Where I worked agency staff were trained with regular employees.

And I'm not even sure that double rate figure I was aware of didn't allow for the additional costs (PRSI etc) too.

I think we need to know a lot more about this.

Healthcare employers have to play ball with staff and there will be fewer agency staff, offer part-time and flexible contracts, don't tell a newly returned from maternity leave midwife that they can't have the handy hours contract their older colleagues have, don't take months to sort out contract in one case I know a community nurse who was waiting 9 months for her contract.

MegamanBoo

https://www.boards.ie/discussion/comment/121214590#Comment_121214590

In didn't sink it with me initially just how much that is...

Is that only for HSE nurses, for hours on top of their regular hours?

Tom Mann Centuria

https://www.boards.ie/discussion/comment/121215506#Comment_121215506

Anything under 37.5 hours is normal rate (and I think time in lieu but might be wrong about that, only saw the leaflet briefly). So part timers might not bother with it.

MegamanBoo

https://www.boards.ie/discussion/comment/121215666#Comment_121215666

Ah ok, but it's still only for HSE nurses is it, the NurseBank?

Presumably the other agency nurses wouldn't be working with the HSE part-time or anything like that?

Tom Mann Centuria

https://www.boards.ie/discussion/comment/121215750#Comment_121215750

Yeah sorry don't know about other workers, think HCA are offered same terms. HSE nurses can do agency shifts, just not in their place of work. So they could go to nursing homes or other hospitals.

Ger Roe

I remember getting sound blast treatment for a kidney stone condition a few years ago and the machine and operating technician came across in a van , at regular intervals from Scotland, to do the rounds in various Irish hospitals. The tech operator told me that this was because of an equipment budget constraint in the HSE - the hospitals couldn't buy the gear, but they could hire it at an overall greater cost. The hire process was paid for from a different budget that wasn't under restriction at the time. Once the equipment purchase budget came in on target (low spend), no one cared that there was actually a greater cost incurred in providing the service.

That was what I as told and I have heard it said that the same approach applied to agency staff - "look how we met our targets on this budget.... but don't look at that other one".

MegamanBoo

https://www.boards.ie/discussion/comment/121215798#Comment_121215798

Stupid question, but what's HCA?

Tom Mann Centuria

https://www.boards.ie/discussion/comment/121215932#Comment_121215932

Not a stupid question, I should have been clearer, it's a Healthcare Assistant.

Agent Coulson

The HSE is just so badly run and no one is answerable to the waste of money.

€22B budgeted for this year alone that works out at about €4.4k per person in the Country.

The €30m a year spent on Taxis over the last 4 years is mind blowing to me.

https://www.thetimes.co.uk/article/hospitals-spending-millions-on-taxis-r39zs3zcf

Tom Mann Centuria

https://www.boards.ie/discussion/comment/121215978#Comment_121215978

We send people to appointments in other hospitals by taxi if they're well enough, cheaper than private ambulance and you can't get a public ambulance any more. Samples get sent to regional lab by taxi as well.

https://www.boards.ie/discussion/comment/121216006#Comment_121216006

Also taxi vouchers if you’re discharged from hospital with no way home in my experience.

Once had a hospital pay €35 to get me home because I had literally no other way.

Jinglejangle69

https://www.boards.ie/discussion/comment/121216046#Comment_121216046

Surely this should be paid back???

MegamanBoo

https://www.boards.ie/discussion/comment/121216006#Comment_121216006

I knew someone quite well who worked in one of the labs that was outsourced in what would become the Cervical check scandal.

After they moved the work to the US there was nothing for the HSE lab.

They spent months going into work with nothing to do until they were reassigned. Their boss started bringing in board games and they just played them all day. (Pre smartphone I guess)

I don't know how long it went on for but certainly months.

MegamanBoo

https://www.boards.ie/discussion/comment/121215978#Comment_121215978

I never realised it was 4.4k per person!

And most people paying for GPs, meds, often private insurance on top of that

holliehobbie

My daughter is a student nurse. She’s also working with an agency as a HCA. She went in for a 6 hour shift two weeks ago and was asked to do another two hours as someone went home sick. She’s just back now from a 12 hr, 10 to 10 shift. She would have work all week every week only she needs to go to college at some stage during the week! She has no lectures on Monday before anyone says anything! The whole situation is bonkers.

headtheball14

https://www.boards.ie/discussion/comment/121216063#Comment_121216063

well having a bed free for Someone on a trolley in a and E might be considered worth it. and to be fair if you are discharged from hospital and have noone who is in a position to pick you up then maybe it's not the worst thing. I think if you could you would make your own arrangements

headtheball14

a relation of mine lived on her own in the country..ended up.on dialysis 3 or 4 times a week. the taxi was literally a lifeline. 2 to 3 hours a day travel. they kept them going physically and mentally

Mrs OBumble

https://www.boards.ie/discussion/comment/121216523#Comment_121216523

Bonkers. But they are using temps so don't have to pay pensions etc, and don't have any ongoing liability for the employees. That's the tradeoff.

MegamanBoo

https://www.boards.ie/discussion/comment/121216665#Comment_121216665

Which would be fine if it were only being used where that's justifiable, filling short-term gaps etc.

The rate at which it's being used suggests it's being used to make up for recruitment shortfalls, and at massive expense to the taxpayer.

The other problem with it, is that the HSE is ultimately the only real employer for nurses and healthcare workers in the state. It seems that because so many of it's services are outsourced to private nursing homes and ngo's, it now has to compete with the agencies it funds for nursing staff, again at massive taxpayer expense.

https://www.boards.ie/discussion/comment/121216665#Comment_121216665

The HSE is not run like that nor are private hospitals they do it because it comes from a different budget and because they have no choice they need staff in the HSE, in private hospitals because they have no choice they have to use agency staff if they are short-staffed, a friend of one of my brothers is the owner of a small health care agency, its a license to print money.

There may be some private healthcare providers who only want agency staff they don't care as long as they are making money. A friend of mine was telling me about a healthcare provider that's well known for taking anyone as long as they can stand up, give out meds, and phone an ambulance if anything goes wrong what a sleazy way to run anything let alone treat the elderly or mentally ill like that.

MegamanBoo

I missed this when it came out but it seems the budget overrun could run to 2.2billion.

https://businessplus.ie/news/hse-overspend/

I see Stephen Donnelly is blaming it on increased demand this year but I believe the budget was increased last year to allow for that.

Interestingly another area he's blaming is high costs of medicines. Correct me if I'm wrong but doesn't the HSE buy most of it's medicines through reimbursements on medical cards.

Given what Irish pharmacies charge in comparison to other parts of Europe that seems like another huge waste.

Kerry25x

https://www.boards.ie/discussion/comment/121215750#Comment_121215750

We don't call it NurseBank in my hospital but they've always promoted nursing staff taking on extra bank shifts on top of their regular shifts. It basically means you put your name on a list with Nursing Admin and tell them what extra days/nights you'd like to work, you can pick any shifts you want because there is always a nursing staff shortage. Then you get paid overtime rates for that shift.

The difference between doing bank shifts vs regular overtime is that they'll send you anywhere in the hospital that needs you (A&E more often than not), if you're doing a regular overtime shift it's generally on your own ward/area.

Where I work I don't think they encourage nurses to do extra bank shifts to cut down on costs of agency staff, it's more that we aren't anywhere close to having enough agency nurses to keep up staffing levels so we need both.

How is the ban on agency staff and junior doctors going to work in real life, they can't leave a ward unstaffed?

Goldengirl

Maybe they are expecting the patient's to get off their trolleys and fo a bit of work ? Or the relatives?

Like people are just getting too uppity asking for trained staff to look after them and a bed in a ward !

Floppybits

https://www.boards.ie/discussion/comment/121243907#Comment_121243907

That wouldn't surprise me. I remember my dad was dying and all they wanted to do was get him out of the hospital promising my mother the sun, moon and stars if she would take him home. Only when I went in with her and started asking questions did they admit that my mam who is in 80's would be doing most of the caring with someone coming in maybe once a day to check on my dad and then they asked me whether the family could take a leave of absence from work to help my mam out. Stood firm and said no and luckily got a place in St Francis Hospice. I think if we had taken him home we would have been burying my mother as well. So much for a caring profession all they wanted was him out from under them.

monty_python

I do agency work as a chef in various healthcare facilities, some of which are HSE

I get 23.50 per hour and the HSE employed chefs get 16

I also get double on Sundays or bank holidays

MegamanBoo

https://www.boards.ie/discussion/comment/121246485#Comment_121246485

Thanks for that, I'm trying to figure out too what the agency gets. Have you any idea in your case?

Back when I worked in healthcare I'm pretty sure it was the hourly rate again. If that's the case the HSE would be paying 47/hr for you, against 16/hr + prsi etc for HSE staff.

monty_python

They pay holiday pay and insurance on top. I'm not sure but I think they pay another 10 or 15 per hour on top of that again but I'm not sure

bigroad

It would be interesting to see who owns these agencies and have they any friend/family connections to HSE top brass or political people.

and how do they win these contracts.

monty_python

https://www.boards.ie/discussion/comment/121246566#Comment_121246566

The one I work for doesn't have any connections in the HSE. They supply chefs, catering assistants, nurses barmen and waitress to healthcare and hospitality facilities. They are very big and act as a kind of union for staff aswell

AndrewJRenko

https://www.boards.ie/discussion/comment/121246566#Comment_121246566

They win these contracts by submitting the Most Economically Advantageous Tender in response to the HSE invitation. Check out etenders.gov.ie for all the details.

MegamanBoo

https://www.boards.ie/discussion/comment/121247089#Comment_121247089

Are you sure? For agency staff?

I wouldn't have thought that very practical in my experience, but I could be wrong.

It certainly wasn't the case when I worked for one of the HSE funded services, which is where a lot of the 22 billion budget goes.

MegamanBoo

https://www.boards.ie/discussion/comment/121247162#Comment_121247162

It turns out I'm partially incorrect.

There is a tender process but multiple agencies, at least 14, have been approved.

And that would only be for within the HSE itself, not the various outsourced services.

AndrewJRenko

https://www.boards.ie/discussion/comment/121247162#Comment_121247162

Yes, that's how contracts are awarded. A tender will go out detailing the type of services, the approximate quantity expected, the locations, the skill mix and the relevant time period. Agency businesses will respond with quotes, best MEAT responses wins the contract. HSE sets up a framework with one or more providers, and hospitals drawdown services under that framework.

Here's a current example specifically for OT services; https://www.etenders.gov.ie/epps/cft/prepareViewCfTWS.do?resourceId=2291176

How else would it work, if not through procurement?

MegamanBoo

https://www.boards.ie/discussion/comment/121247205#Comment_121247205

When I worked in services we'd just ring around a list of agencies if stuck.

And how much do they pay the agencies?

This article says 66% higher in some cases.

https://www.breakingnews.ie/ireland/hse-costs-up-to-66-higher-in-cork-kerry-region-for-using-agency-staff-instead-of-direct-recruitment-1531129.html

Whether that's tendered or not it's still terribly wasteful.

AndrewJRenko

https://www.boards.ie/discussion/comment/121247369#Comment_121247369

The list of agencies was probably the list of those within the framework agreement.

This is a bit off topic but maybe someone can answer.

When looking at the job vacancies on the HSE website, The roles are listed as Internal / External.

Does anyone know what is ment by this?

Goldengirl

https://www.boards.ie/discussion/comment/121244477#Comment_121244477

Sorry for your loss .

Some people do want their loved ones at home but this should never be forced on people .

Those bad experiences which are a direct result of lack of beds and resources are not going to get much better unfortunately.

crusd

https://www.boards.ie/discussion/comment/121247418#Comment_121247418

They can hire for the position either internally from employees in another role or externally from the market.

FG wins the PR on this one, I don't know fully the ins and outs of this, no organisation can hire staff whenever they like there have to be cost controls and a business case for hiring staff. The management in the HSE does seem very poor for some reason.

keeah91

As an agency nurse I can tell you I make € 45-60 per hour, no paid holidays or pension contributions!

Clo-Clo

https://www.boards.ie/discussion/comment/121247369#Comment_121247369

Government can't just ring around. They have to tender and as part of the tender process would get a list of companies approved to get contracts from and would have agreed rates

The HSE uses contractors because they don't have the staffing number to take on full time staff. A contractor doesn't have to be paid pension etc. Plus they are only hired for a short period and if let go the HSE wouldn't have to pay redundancy.

The question in most cases comes down to would it be cheaper to hire these people full time including pension payment etc, or is it better to pay contractors so they can let them go. Of course a contractor could be working in one hospital one day and another hospital the next day. A full time HSE employee like a nurse would be in a set hospital as far as I am aware and wouldn't be jumping from one to another.

MegamanBoo

https://www.boards.ie/discussion/comment/121391625#Comment_121391625

Thanks for that.

For me the relevant questions are...

1) Is the HSE overusing agency staff, because of failures to recruit enough permanent or contract staff, at great cost to the taxpayer.

2) If such a volume of agency staff is required, why doesn't the HSE operate it's own agency function. Why all the middlemen?