Fórsa will cooperate with the establishment of nine ‘learning sites’ to pilot new HSE community healthcare organisation (CHO) structures, which the union says will be central to the implementation of the ten-year Sláintecare programme. The move comes after a year of WRC-brokered negotiations on the implications of the change for staffing, reporting relationships and career structures.

But the union has warned it will withdraw support if the pilots don’t deliver better 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 health and social care professions include speech and language therapists, social care workers, social workers, psychologists, physiotherapists, occupational therapists and dietitians.

Speaking at the union’s biennial Health Division conference in Sligo last week, Fórsa’s Head of Health Éamonn Donnelly said the model had the potential to bring better health services closer to communities, while easing pressures on A&E and other hospital services.

But he said a culture shift from a “hospital and doctor-centric health service” was needed, along with substantial medium-term investment in staffing and capital projects. He pointed out that the Sláintecare programme, which has cross-party political support, envisages the recruitment of around 1,300 extra HSCPs over time.

At the conference, the union’s Health Division Executive put forward a number of motions that broadly supported – but sought safeguards over – the new CHO model. The Executive also successfully sought remission of a number of branch motions that opposed the reform on the grounds that its changed reporting relationships could put HCSP clinical governance at risk.

Éamonn said the union had agreed to back pilots of the new structures following a lengthy Workplace Relations Commission-brokered process and extensive consultation with Fórsa branches and groups of health and social care professionals. He told the conference that, as well as improving community services, the approach had the potential to deliver improved career structures.

The WRC-brokered agreement between Fórsa and the HSE will trigger an immediate review of HSCP career structures in a process rooted in the Expert Group Report on Allied Health Professions, and supplemented by the recommendations of a later ‘McHugh-Doran’ report, which took account of more recent advances in the professions.

The agreement also included specific measures on improved staffing structures across the health grades, including job evaluation and a resumption of recruitment of various health grades. The WRC was clear that these measures were contingent on agreement on line management and reporting relationships.

Éamonn said progress on community health organisation structures was crucial for the future development of community and primary health and care services.

“Our healthcare model is too hospital-centric, and we need a culture shift from an overly doctor-centred health service. Long-overdue investment in primary care, close to citizens, is a public good in its own right. It will also free badly-needed capacity for those who really have to go to hospital, where our members are also struggling against the odds to deliver quality services and to develop professional specialisms to meet today’s medical and social needs,” he said.

He added that the country’s 18,000 health and social care professionals had been neglected in health service planning and delivery, and that 80-90% of final year health profession students were considering emigration as a more attractive option than working in the Irish health service.