Troika says further health cuts can be made without affecting patient services

Further savings can be made in the health system without affecting services to patients, the EU-IMF troika has said.

The HSE still has some way to go to fully reform the health system and reduce costs to acceptable levels, troika officials advised in a media briefing yesterday.

The cost of patented and generic medicines was again singled out by officials as being unacceptably high, despite the measures taken by the Government to reduce costs.

The HSE needs to make further improvements to its financial management system to allow it get a handle on costs, they also said.

Significant cost savings could also be achieved through the introduction of a single health identifier for all patients as well as a system of electronic prescription.

Officials emphasised the need for Ireland to drive forward a systematic approach to healthcare reform even after Ireland’s programme ends in December. Ultimately, it came to Ireland making choices about where to reduce costs in such a way that services were not affected.

Having said on a previous occasion that it cost twice as much to see a GP in Ireland as in Brussels, officials said this information had been checked and it actually cost more than twice as much to access a doctor here.

Patient safety
The troika's assessment follows the intervention in the debate on health cuts by the chief executives of four Dublin hospitals, who have warned that hospital funding cuts, together with increased demand, have begun to seriously threaten the quality and safety of patient services.

As a result, they say in a letter to HSE director general Tony O’Brien, “unacceptable delays” have emerged in accessing treatments for some cancer patients as a result of the overwhelming pressures on services.

“Paradoxically, the consequences of these quality and safety problems place an even greater long-run financial burden on the hospital system,” the letter from the heads of Our Lady’s Hospital for Sick Children, Tallaght hospital, St James’s Hospital and the Mater hospital warns.

A spokesman for Minister for Health James Reilly said he had already made clear to the HSE a requirement to make patient safety a priority within the service plan.

“Despite the hugely competing demands on the service plan’s budget, he will not accept an insufficient allocation for measures supporting safe patient care.”

The National Cancer Control Programme said it hadn’t been contacted by any of the four chief executives about delays in cancer treatment, and it wasn’t aware of any acute problems. Delays of up to four days in providing children with cancer treatment were reported yesterday by Owen Smith, an oncologist at Crumlin.

Two other big Dublin hospitals did not sign the letter, which was leaked before it reached Mr O’Brien: St Vincent’s, which disagreed with the approach taken by the other institutions; and Beaumont, whose chief executive was away when the letter was being drafted.

Service plan
The HSE is drawing up a service plan for 2014 which will set out in detail where cuts will be made to services i to meet a spending reduction target of at least €666 million, as flagged in the budget last month. There is considerable resistance within the Department of Health, the HSE and hospitals to the level of cuts being demanded.

The four hospitals claim they have been doubly impacted by funding cuts resulting from the economic downturn and “disproportionate” reductions in the hospitals budget compared to other programmes.

As a result, their budgets have been cut by €206 million, or more than 20 per cent, since 2009. “Evidence would suggest that these reductions have been determined and applied arbitrarily both to and within the acute sector,” they claim.

The chief executives are also critical of Dr Reilly’s plans to introduce a “money follows the patient” model next year. While supporting this funding approach, they say the systems aren’t “even close” to being ready for application in 2014.