HSE Director General Tony O'Brien has indicated that some health service administrative functions may in future be outsourced to allow a greater number of existing staff perform functions that directly support patient care.

In an interview with irishhealth.com, Mr O'Brien also say he does not believe staff numbers in the health service can be reduced much further, if at all. He admitted that recent voluntary redundancy and early retirement schemes, due to the way they were structured, deprived the HSE of some of its most experienced administrators and managers.

He said the 'grace period' early retirement scheme in 2012 led to a 5% downsizing of the HSE 'pretty much in a single day'. As a result of the exit schemes, many parts of the HSE, but for the deployment of temporary staff at great expense, 'would have ceased to function', he believes.

The Director General said it is also envisaged that large numbers of nursing staff currently provided through agencies will be converted into regular long-term temporary staff, providing greater job stability and, through the benefits of consistency, greater quality of care.

On the outsourcing of admin functions, he says work such as back-office financial processing could be contracted out to other service operators, but this, he stressed , would have to have due regard to processes under the Haddington Roard Agreement. "As part of the overall reform programme, I feel it is something we definitely have to look at."

On the future of maternity services, he says there is a question over whether some of these services are sustainable safely. On hospital emergency departments in Dublin, Mr O'Brien indicates there are too many hospitals in Dublin doing both planned and emergency treatments.

He says hospitals, including larger hospitals, will have to transfer some of the work they are currently doing to primary and community care. "This means some of our hospitals need to downsize a little bit in order to concentrate on the things they are really good at." He admits this 'will not be pleasant for them' but it has to be done.

On improving patient safety in the wake of many treatment scandals, Mr O'Brien says he was shocked at the revelations about quality of care and patient communication in the Portlaoise scandal. He stresses that the new Patient Safety Agency will assist and advocate for patients who have issues with treatment, and it will not be perceived, as may sometimes be the case when the HSE investigates these matters, as an apologist for a service that has gone wrong. 

On the controversy over the withdrawal and downgrading of medical cards from people with special needs or medical conditions, Mr O'Brien says there have been 'no cuts per se' to the medical card system.

He said the issuing of discretionary medical cards, as it has to stick to the terms of the 1970 Health Act, could be perceived as a 'blunderbuss' approach, but says this system may be changed to make it more case sensitive.

Read the full interview here