Healthcare not about 'cost overruns' but investment

OPINION:Budget plans to reduce spending on care for ordinary people arise from a systemic failure to see the value of the resultant wellbeing

THE DECEMBER budget process is well under way. Reigning back the so-called health “overspend” is now a key policy theme and one that may be used to justify further cutbacks and the closure of more capacity.

Indeed, the International Monetary Fund has incorporated this into its analysis of the Irish economy and in its policy prescriptions. The seventh quarterly report of the IMF-EU-European Central Bank troika, in mid-2012, said: “Measures to address the emerging spending overruns in the health sector are to be specified before the end of September 2012.”

That there are such “overruns” is a myth and one that is destructive of morale within the public health system.

Furthermore, that a government (or troika) actually believes that cutting €23 million from home help, homecare and disability services can contribute to stabilising the economy is incredible – these latest cuts are clearly counter-productive.

In the Health Service Executive plan for 2012, the total quantifiable cost reduction target was €750 million. This followed two of the toughest years in the recent history of the health service, with the HSE experiencing total budget reductions of €1.75 billion.

Endogenous pressures were explicitly acknowledged, but not resourced. Assumptions built into the plan were problematic.

There is therefore no meaningful sense in which the budgetary outcomes of the HSE service plan 2012 can be categorised as “cost overruns”. Budgetary slippage was absolutely inevitable from the very outset.

If you set impossible targets, there are going to be shortfalls. It follows that there is no realistic basis on which 2012 “overruns” should be subject to “corrective action” in the December budget.

The real problem lies in efforts to obscure a fundamental reality. Ireland’s stressed fiscal position and the manner in which it is being “corrected” have resulted in lower public healthcare funding and, consequently, reductions in healthcare capacity, activity levels and service provision.

Risks to health status have increased. So too has rationing. Even senior medical and nursing staff have been emasculated of responsibility: “You want some more stationery? Send in a business plan.”

This is foolishness: it does not save money – it costs money.

The limits to “doing more with less” and similar management-speak platitudes within the system as it stands have been well and truly reached. Meanwhile, there is an affordability crisis in the public health sector, transmitting further pressures to the system.

Mythical “cost overruns” serve a useful purpose in these circumstances. They divert attention and make it easier to take refuge in a mindset that says, in effect: it’s their (ie junior doctors, consultants, nurses, healthcare providers – whoever) problem. If only there were a little more legislation, a few more powers, a little more control and public expectations of quality, equality in healthcare could be delivered.

Not so. The problem goes deeper than this.

In the 2012 service plan, the HSE points out that “healthcare is a people business”. So it is. But “people” should encompass not only those who need care but, also, those who struggle to deliver such care and who see through the whole “cost overrun” mythology. Many are frustrated. Some are worried and even fearful.

The 2013 health budget, to be credible, needs to accommodate some realities.

The first is realistic budgeting so that impacts are visible and can be debated. The HSE has tried to do this. It is difficult for the Government. But a must do/can’t do dialogue is no basis for planning, let alone delivering, healthcare.