Workforce Planning, Analytics & Informatics, National HR Directorate, Health Service Executive, Swords Business Campus, Balheary Road Swords, Dublin, Ireland.
Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland.
Hum Resour Health. 2017 Sep 11;15(1):62. doi: 10.1186/s12960-017-0230-3.
The global economic crisis saw recessionary conditions in most EU countries. Ireland's severe recession produced pro-cyclical health spending cuts. Yet, human resources for health (HRH) are the most critical of inputs into a health system and an important economic driver. The aim of this article is to evaluate how the Irish health system coped with austerity in relation to HRH and whether austerity allowed and/or facilitated the implementation of HRH policy.
The authors employed a quantitative longitudinal trend analysis over the period 2008 to 2014 with Health Service Executive (HSE) staff database as the principal source. For the purpose of this study, heath service employment is defined as directly employed whole-time equivalent public service staffing in the HSE and other government agencies. The authors also examined the heath sector pay bill and sought to establish linkages between the main staff database and pay expenditure, as given in the HSE Annual Accounts and Financial Statements (AFS), and key HRH policies.
The actual cut in total whole-time equivalent (WTE) of directly employed health services human resources over the period 2008 to 2014 was 8027 WTE, a reduction of 7.2% but substantially less than government claims. There was a degree of relative protection for frontline staffing decreasing by 2.9% between 2008 and 2014 and far less than the 18.5% reduction in other staff. Staff exempted from the general moratorium also increased by a combined 12.6%. Counter to stated policy, the decline in staffing of non-acute care was over double than in acute care. Further, the reduction in directly employed staff was to a great extent matched by a marked increase in agency spending.
The cuts forced substantial HRH reductions and yet there was some success in pursuing policy goals, such as increasing the frontline workforce while reducing support staff and protection of some cadres. Nevertheless, other policies failed such as moving staff away from acute settings and the claimed financial savings were substantially offset by overtime payments and the need to hire more expensive agency workers. There was also substantial demotivation of staff as a consequence of the changes.
全球经济危机导致大多数欧盟国家出现衰退。爱尔兰严重的经济衰退导致医疗支出削减具有顺周期性。然而，卫生人力（HRH）是卫生系统中最重要的投入要素之一，也是重要的经济驱动因素。本文旨在评估爱尔兰卫生系统在人力资源方面如何应对紧缩政策，以及紧缩政策是否允许和/或促进了人力资源政策的实施。
作者采用了 2008 年至 2014 年期间的定量纵向趋势分析，主要数据源是卫生服务执行局（HSE）员工数据库。在本研究中，卫生服务就业被定义为 HSE 和其他政府机构中直接雇用的全职公共服务人员。作者还检查了卫生部门的薪酬账单，并试图在 HSE 年度账目和财务报表（AFS）中建立主要员工数据库和薪酬支出之间的联系，并与主要的人力资源政策建立联系。
2008 年至 2014 年期间，直接雇用的卫生服务人力资源的实际总全职等效（WTE）削减了 8027 个 WTE，减少了 7.2%，但远低于政府的说法。对于一线人员的配置有一定程度的相对保护，2008 年至 2014 年间减少了 2.9%，远低于其他人员 18.5%的减少。也有 12.6%的豁免人员总数有所增加。与既定政策相反，非急性护理人员的减少幅度是急性护理人员的两倍多。此外，直接雇用人员的减少在很大程度上被机构支出的显著增加所抵消。
这些削减迫使大量削减人力资源，尽管在追求政策目标方面取得了一些成功，例如增加一线劳动力，同时减少支持人员，并保护某些干部。然而，其他政策却失败了，例如将工作人员从急性环境中转移出去，声称的节省资金被加班费和雇用更多昂贵的代理工人的需要大大抵消。这些变化也导致了员工的大量不满。
