Staff Numbers in Health Service June 2010

CONTENTS
1. Health Service Personnel Census
2. Current Staffing – end of 2009 and change from 2008
3. Change in Staffing since establishment of the HSE
4. Impact of Government Moratorium on recruitment
5. Compliance with approved employment ceiling

1. Health Service Employment

Health Service Personnel Census
Health Service employment is measured through the Health Service Personnel
Census which collates employment data in respect of the Health Service
Executive, Voluntary Hospitals and certain Disability Services which are
covered by the employment ceiling as set by the Department of Health &
Children in conjunction with the Department of Finance. In the absence of a
national integrated HR payroll system, employment information is collated
from reports based on former Health Board payrolls (14 payrolls) and 61
other payroll sources (17 voluntary hospitals and 44 other agencies) on a
monthly basis – a total of 75 sources. The sum of the agencies covered
equate to the agencies embraced by the employment ceiling as set by the
DoHC/ Dept. of Finance but not all Health Service providers are embraced
by the census as the remit excludes non-ceiling agencies/section 39
agencies but which are included in the Health Vote.

The current methodology under which employment figures is as set by the
Department of Health & Children and includes student nurses at 50% WTE
(wholetime equivalence) value to comply with replacement ratios but
excludes home helps. It is important to note that the basis on which the
information is compiled changed, on the instructions of the DoHC, during
the course of 2007 with the addition of in excess of 2000 WTE personnel not
previously included in subsumed agencies, other posts in certain projects
(all largely in the Management/Administrative stream) together with the
inclusion of student nurses and chaplains. This change was undertaken to
represent health service employment on a like-for-like basis with
employment ceilings and to more accurately represent a reconfigured health
service’s employment information. As a result of this change 04-09
year-on-year figures are not directly comparable.

2. Current Staffing
While the number of staff employed in the Public Health Service fell by
1,272 (-1.1%) personnel in wholetime equivalence terms in the year to 31st
December 2009, it is worth noting that the service impact of this reduction
has been moderated through a substantive rebalancing away from indirect
services functions and grades e.g. Corporate Functions (-3.1%) and indirect
services grades (-1,081 WTE). Also it is important to note that
Environmental Health Services largely retransferred from Primary &
Community Services to Population Health in this period.

The following table provides pertinent data based on service function and
broad staff categories and classifications:

Health Service Staffing (31 December 2008 & 2009)1
Summary by Service Function
Pillar2 WTE December 2008 % of Total WTE December 2009 % of Total Change %
Change
Acute Hospital Services 51,741 46.6% 51,019 46.5% -722 -1.4%
Ambulance Services 1,398 1.3% 1,466 1.3% 68 4.9%
Primary and Community Services 54,052 48.7% 53,068 48.4% -984 -1.8%
Corporate 3,217 2.9% 3,117 2.8% -100 -3.1%
Population Health 617 0.6% 1,082 1.0% 466 75.5%
Total Heath Service: 111,025 100% 109,753 100% -1,272 -1.10%
Summary by Grade Category.
Staff Category WTE December 2008 % of Total WTE December 2009 % of
Total Change % Change
Medical/ Dental 8,109 7.3% 8,083 7.4% -26 -0.3%
of which are Consultants1 2,248 2,317 69 3.0%
Nursing 38,108 34.3% 37,466 34.1% -642 -1.7%
of which are Public Health Nursing 1,523 1,558 35 2.3%
of which are Staff Nurses/ Midwives 27,461 27,011 -451 -1.6%
Health & Social Care Professionals 15,980 14.4% 15,973 14.6% -7 0.0%
of which are Occupational Therapists 1,081 1,103 22 2.1%
of which are Physiotherapists 1,449 1,469 20 1.4%
of which are Social Workers 2,079 2,139 61 2.9%
of which are Speech and Language Therapists 750 776 26 3.5%
Other Patient & Client Care3 18,230 16.4% 18,714 17.1% 484 2.7%
of which are HCA, Nurses Aide, etc. 13,497 13,333 -164 -1.2%
of which are Emergency Medical Technicians 1,174 1,246 73 6.2%
Sub-total (Clinical/direct Patient-Client Care)
6: 80,427 72.4% 80,236 73.1% -191 -0.20%
Management & Administrative4 17,967 16.2% 17,611 16.1% -357 -2.0%
General Support Staff5 12,631 11.4% 11,906 10.9% -724 -5.7%
of which are Household Services 5,967 5,728 -239 -4.0%
of which are Portering 1,968 1,841 -127 -6.5%
Sub-total (indirect services grades)
6: 30,598 27.6% 29,517 26.9% -1,081 -3.50%
Total Heath Service: 111,025 100% 109,753 100% -1,272 -1.10%
Source: Health Service Personnel Census (All figures are expressed as
rounded wholetime equivalents)

Note 1: The number of Consultant posts shows persons employed in both a
permanent and non-permanent capacity.
Note 2: Service Function level information is subject to change following
reconfiguration.
Note 3: The staff category Other Patient and Client Care includes Ambulance
Service staff, Health Care Attendants, Care Assistant and other direct care
staff involved in day-to-day clinical services to patients and clients.
Note 4: The staff category Management/Admin includes many staff who are
providing direct service to the public. These include Consultants’
Secretaries, In and Out-Patient Departments’ clerical staff, Medical
Records Personnel, A&E functions, receptionists and telephonists, and other
‘clerical’ staff who are engaged in front-line duties on a day-to-day
basis. Analysis of the work provided by staff in this category has shown
that approximately 66% of overall numbers can be categorised as providing
direct services to the patient, client and public. The balance of such
personnel can be loosely described as non-frontline staff/back-office
functions in the following areas: Senior Management, Payroll, Human
Resource Management (including training), Service Managers, IT Staff,
General Management Support, and Legislative and Information Requirements.
In an analysis carried out in Hospitals, Local Health Offices and Voluntary
Agencies in late 2008, the percentage of management/admin staff providing
such support was between 9%and 17% of staff in this category and as little
as 3% of total WTEs in the hospital/LHO/Agency.
Note 5: General Support Services Grades include such key services as
Catering, Housekeeping, Laboratory Support Services, Maintenance and
Portering without which clinical services could not operate. As an example,
Portering, Catering and House-keeping employment at the end of 2008 was of
the order of 7,800 WTEs. This comprises some 68% of this staff category at
that time. Note 6: The table aggregates the first four staff categories
from the latter two to reflect a comparison of staffing between
clinical/direct patient-client care, and Management/Admin and General
Support Services. As already referred to, in the latter two staff
categories, many such staff are engaged on a daily basis in direct services
to the public, patients and clients as well as providing essential services
in direct support of clinicians.
Note 6: The table aggregates the first four staff categories from the
latter two to reflect a comparison of staffing between clinical/direct
patient-client care, and Management/Admin and General Support Services. As
already referred to, in the latter two staff categories, many such staff
are engaged on a daily basis in direct services to the public, patients and
clients as well as providing essential services in direct support of
clinicians.

3. Change in Staffing since establishment of the HSE
The composition of Health Service staffing (see table below) has changed
radically since the establishment of the Health Service Executive:
 Medical Staffing has increased by 1,070 WTE (+15.3%) personnel and
has increased from 7.0% to 7.4% as a proportion of the overall workforce
 Nurses and Midwives have increased by 3,153 WTE (+9.2%) and is
unchanged at 34.1% of the workforce
 Health & Social Care Professionals (which includes
Physiotherapists, Psychologists, Counsellors /Therapists, Occupational
Therapists and Social Workers) have increased by 3,143 WTE (+24.5%) and has
risen from 12.9% to 14.6% of the overall workforce.
 Management Administrative staffing (which includes Consultant
Secretaries, Payroll Staff, Out-patients personnel together with general
administrative grades) exhibits the smallest overall increase +1,454 WTE
and has fallen from 17.6 % to 16.0% of the overall workforce.
 General Support Staff combined with Other Patient & Client Care,
which should be considered as one for the purpose of this comparison due to
training, reassignment and other developments, has increased by 2,210 WTE
(+7.8%) and fallen from 28.4% to 27.9% proportionately.
Full details are set out in the following table:

Note1: Management/Administration includes staff who are of direct service
to the public and include consultant’s secretaries, outpatient department
personnel, medical records personnel, telephonists and other staff who are
engaged in frontline management duties together with staff in the following
categories of payroll, human resources management (including training),
service managers, IT staff, general management, support and Legislative and
information requirements.

4. Compliance with approved employment ceiling
In overall terms the Health Services is within the notified approved
employment ceiling of 111,800 WTEs by some 2,047 WTEs (-1.83%) as at the
end of December. As this figure of 111,800 includes adjustments pertaining
to 2009 developments yet to be put in place and some further 2008
developments in process, a more appropriate ceiling to measure ceiling
compliance against outturn at the end of December is 111,580 WTEs and is
thus 1,827 WTEs or 1.64% within that ceiling. It should be noted that
there is a quantum of posts in the recruitment process in grades with
delegated sanction from the general moratorium on recruitment, as well as
some sanctions provided by the Department of Health and Children/Department
of Finance in respect of non-delegated grades/posts. When these are
coupled with the outstanding 2008/2009 development posts in the recruitment
process but not yet activated, this figure currently is assessed as being
of the order of over 700 WTEs should be added to the December outturn when
considering performance against approved employment ceiling. Therefore the
ceiling variance, based on the projected end-of-year ceiling of 111,300 is
of the order of 731 WTEs before any adjustment downwards arising from the
moratorium on recruitment.