Fillable Form A1 - New Senior Manager: APPENDIX Health (Ireland - Health Service Executive)

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Form A1 - New Senior Manager: APPENDIX Health (Ireland - Health Service Executive)

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Country of origin: IRELAND
File type: PDF

Ireland forms for Health Service Executive

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Page 1 of 5
Version 1 March 2022
Created by Strategic Work Force Planning & Intelligence
Informal inquiries to seniormanagers@hse.ie
Please forward completed forms to seniormanagers@hse.ie
Section B Summary Detail of Funding Source
Confirmation of funding (If funding confirmation is not provided this application will not be progressed)
Full year costs of post - € Free text
Confirmation the service is currently operating within its
funded allocation as per Pay and Numbers Strategy and/
or has a sustainable and balanced financial plan in place
(i.e. that this post is affordable)?
Select from drop down list
Please choose one of the following funding sources:
1. Service development
National Service Plan
Select from drop down list
Initiative Select from drop down list
NSP 2021
Other (provide details):
NSP 2022
Winter Plan 2021/2022 (free text)
Budget funding source total allocation
Free text
2. Reconfiguration – This is use of funding sources from other areas/ other posts to fund the current application either in full or
in part. If in part the other funding source below must also be completed to provide the detail on the total funding source
Total funding available through reconfiguration - €
Free text
Grade(s) of post being supressed
Free text
Grade
Grade Code
Post 1.
Post 1.
Post 2.
Post 2.
Post 3.
Post 3.
Post 4.
Post 4.
If the above identified posts for suppression are not
vacant please provide the date/s as to when post(s) will
become vacant in order to provide the necessary
funding source
Free text
Vacant Date/Date when
post will become vacant
Position Number
Post 1.
Post 1.
Post 2.
Post 2.
Post 3.
Post 3.
Post 4.
Post 4.
€
€
€
APPENDIX
1
Form A1 - New Senior Manager
Health Service Executive - Approval to Hire Form A1 – New Senior Level Posts–Management/Admin
(All sections below must be fully completed)
Section A Details of New Senior Manager Post where sanction is sought to fill
Location
Select from drop down list
Service Area
Select from drop down list
Hospital Group / Hospital / CHO / Function / Location
Select from drop down list
Grade & Grade Code
Select from drop down list
Job Title
Free text
Contract Type
Select from drop down list
Contract duration
Free text
If fixed term/ specified purpose, confirm that the
appropriate contractual arrangements with review will be
undertaken;
Select from drop down list
Free text
WTE
Select from drop down list
Please confirm that the post has been reviewed by the
appropriate Service/Line Manager and HR at local level
and it is deemed necessary for filling
Expected Date that Recruitment will be completed
Free text/drop down list
Page 2 of 5
Version 1 March 2022
Created by Strategic Work Force Planning & Intelligence
Informal inquiries to seniormanagers@hse.ie
Please forward completed forms to seniormanagers@hse.ie
If funded Post(s) suppressed above do not provide sufficient funding please complete section 3 below (Other Funding Source)
3. Other funding source – Whereby the reconfiguration above does not provide full funding for the post, or where the post/s
funding is neither funded via a New Service Development or Reconfiguration
Source of funding- specific and detailed information
must be provided, including clarification if this post is to
be funded / part funded from non-pay.
Free text
Total funding available -€ Free text
Confirmation on whether funding source is Recurring
/Once off funding
Select from drop down list
4. Full compliance with sanction
Confirm that this
position
will be recruited in
compliance with the Code of Practice prepared by the
Commission for Public Service Appointments (CPSA).
Tick box to indicate
confirmation
Confirmation of compliance with Public Sector Pay
Policy / Norms including standard terms and conditions,
avoidance of grade drift and management delayering
where relevant.
Tick box to indicate
confirmation
Section C Overarching Business Case
(All Sections below must be completed with sufficient detail to enable progression of the application)
1. Background Context
(This section should set out the context in which this post is being proposed to be used from an overall context)
2. Justification for the Grade
(This section should clearly set out the justification for the requirement of the grade/s at the level being requested – specific
evidence should be provided on the level of responsibility, authority and accountability, with comparability to other roles both
within and/ across other services / functions that justify the grade level. This section must also set out how this application
does or will not constitute grade drift to such senior roles)
€
APPENDIX
1
Form A1 - New Senior Manager
Page 3 of 5
Version 1 March 2022
Created by Strategic Work Force Planning & Intelligence
Informal inquiries to seniormanagers@hse.ie
Please forward completed forms to seniormanagers@hse.ie
3. Reporting Relationships/ Organisational Fit within Current Structure
(this section should clearly set out the reporting relationships and the associated grades of those relationships, both up to the
grade that is the subject of the application, and the role and grade for which this new post will report to. An organisation chart
is also required to be included in this section showing where this grade fits within the organisation both locally and across
service as applicable – e.g. within local hospital structure and within the overall Hospital Group Structure).
3a. Consideration of this role in the context of Regional Health Authorities
(this section should set out where, and how this role will fit in the context of the planned Regional Health Authorities and
the consideration given to filling this role through redeployment)
4. Key Role, Responsibilities, and Expected Outputs
(this section must clearly set out the role and function, key responsibilities and expected outcomes/ deliverables from this role)
5. Impact of Not Filling this New Post
(this section must clearly set out the impact of not filling this post, inclusive of an assessment using the HSE Risk Assessment
Tool and Rating (click here), with justification as to the rating applied)
APPENDIX
1
Form A1 - New Senior Manager
Page 4 of 5
Version 1 March 2022
Created by Strategic Work Force Planning & Intelligence
Informal inquiries to seniormanagers@hse.ie
Please forward completed forms to seniormanagers@hse.ie
Confirmation of Recommendation by; CEO – Hospital Group/ Chief Officer – Community Health
Section E
Organisation / CEO Voluntary Hospital/Agency / National Ambulance Service / Head of Function
Signed:
Printed Name:
Title:
Recommendation:
Date:
National Director Confirmation & Approval Section F
Post fits within current or future organisational structure as
noted above
Select from drop down list
Confirmation that the above post does not contribute to
grade drift
Confirmation that this post/new service development has
been agreed in advance with the relevant line unit in the
Department of Health
Free Text
DoH line unit:
National Director Confirmation that the funding source identified by the service in Section B above is correct and approved. Complete
either Section 1, 2, 3 or combination of same as applicable (If funding confirmation is not provided this application will not be progressed)
1. Where the post has been identified as funded via a New Service Development
Confirmation that the NSP year and initiative identified in
Section B above by the services is correct
Tick box
Confirmation that budget allocated under NSP for this
initiative has adequate budget available/remaining to fund
this application
Tick box
Confirmation of remaining budget available for this NSP
initiative after this post has been funded - €
Free text
2. Where the post has been identified as funded via Reconfiguration
Confirmation that budget in available through
reconfiguration is as outlined by the services in Section B
Tick box
3. Where an ‘Other’ funding source has been identified
Confirmation that the budget is available through other
sources as outlined by the services in Section B
Tick box
Section G Executive Management Team Member Confirmation & Approval
Date:
Recommendation:
(Electronic Signature also accepted)
Select from drop down list
Recommendation:
Date:
Printed Name:
Title:
Signed:
(Electronic Signature also accepted)
€
Signed:
(Electronic Signature also accepted)
Name:
Funding Confirmation by Local Finance Manager
Section D
Signed:
(Electronic Signature also accepted)
Printed Name:
Title:
Date:
Recommendation:
APPENDIX
1
Form A1 - New Senior Manager
S
igned:
(Electronic Signature also accepted)
Version 1 March 2022
Created by Strategic Work Force Planning & Intelligence
Informal inquiries to seniormanagers@hse.ie
Please forward completed forms to seniormanagers@hse.ie
Section H Recommended by Executive Management Team
Date:
Recommendation:
Section I Decision of Department of Health
Date:
DoH Decision:
Section J Approval to initiate recruitment process
Stamped Strategic Workforce Planning
& Intelligence
Approved/Not Approved:
SWP&I log Number:
Primary Notification Number:
Position Number:
Page 5 of 5
Check List (Please Tick √)
Final Job Description(please note draft job descriptions will not be accepted)
Organisational Chart included in business case
Supporting Documentation where required
Signed by National Director or equivalent
Signed by relevant EMT Member
Signed by CEO - HG / CO - CHO / CEO Voluntary Hospital/Agency / NAS / Head of Function
APPENDIX
1
Form A1 - New Senior Manager
Signed by local Finance Manager
S
igned:
Ms Anne Marie Hoey,
National Director HR
O
n Behalf of EMT
Health Service Executive
(Electronic Signature also accepted)
(Electronic Signature also accepted)
S
igned:
Ms Margaret Campbell,
Principal Officer, People, Pay & Superannuation Unit
Department of Health
Signed:
(Electronic Signature also accepted)
Dr Philippa Ryan Withero
Assistant National Director
Strategic Workforce Planning & Intelligence
Health Service Executive
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Form A1 - New Senior Manager: APPENDIX Health (Ireland - Health Service Executive)

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Completed 19 April 2022

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