Fórsa has agreed to cooperate with the establishment of nine ‘learning sites’ to pilot new HSE community health organisation (CHO) structures. But the union has warned that the approach must be abandoned if the pilots don’t deliver more productive services, while maintaining effective clinical governance in the health and social care professions (HSCP).

Specifically, Fórsa has insisted that HSCP managers must retain “direct and active input into the line management function” to ensure that effective clinical governance is not compromised once new ‘network manager’ posts – and accompanying reporting relationships – are established.

The approach, which was agreed on foot of a lengthy Workplace Relations Commission-brokered process and extensive consultation with Fórsa branches and groups of health and social care professionals (HSCPs), will deliver substantially improved career structures for the professions, These will include the expansion of ‘in charge III’ posts and smoother progression from basic to senior grades.

On Fórsa’s insistence, the agreement will also secure a commitment that there will be no reduction in the number of therapy manager posts. This is a reversal of the HSE’s original position.

Furthermore, the union has insisted that an agreed review of HSCP career structures must begin immediately. This process is rooted in the Expert Group Report on Allied Health Professions, which was published in 2000. But it will be supplemented by the recommendations of a later ‘McHugh-Doran’ report, which took account of more recent advances in the professions.

The union says this process will examine a range of matters, including the role of advanced practitioners and clinical specialists.

The management proposals for the nine ‘learning sites,’ with new reporting relationships following the establishment of network manager posts, were tabled at the WRC earlier this year after Fórsa and the HSE reached overall agreement on a network model last September.

The agreement also included specific measures on improved staffing structures across the health grades, including job evaluation and competitions for clerical and administrative staff. The WRC has been clear that the career-strengthening measures for all grades are contingent on agreement on line management and reporting relationships.

Fórsa’s Head of Health, Éamonn Donnelly, said progress on community health organisation structures are crucial for Fórsa members, and for the future development of community and primary health and care services.

“Our health service is too hospital-centric. Investment in primary care close to citizens is a public good in its own right. And it would also free badly-needed capacity for those who really have to go to hospital, where our members are struggling against the odds to deliver quality services and to develop professional specialisms to meet today’s medical and social needs,” he said.

But, in a letter to the HSE earlier this week, Donnelly underlined the concerns about the model, which many HSCPs had surfaced in union consultations.

“Our HSCPs are firmly of the view that the proposed reporting model is seriously flawed and implicitly creates risk. Fórsa has stated that the provision of safe and effective clinical governance is compromised if there isn’t direct and active input into the line management function.

“The nine ‘learning sites’ provide an opportunity to move from theoretical arguments to actual and real assessment of the feasibility of the model. Our position is that, if such assessments clearly show that the model is not feasible, it would not continue to be rolled out,” he said.

The union’s HSCP vocational groups have said they do not oppose the proposed network model in principal, but they believe that reporting and line management matters are ‘red line’ issues.