Estimated HSE savings could be destroyed by hospital presentation rise

There was something for everyone in the audience of health group representatives who attended the launch of the Health Service Executive’s service plan for 2015.

But in the nature of these things, and given the times the health service has been through, the gifts were modest enough. Indeed, modesty and caution were the themes running through the presentations by Minister for Health Leo Varadkar and HSE director general Tony O’Brien about their spending plans for next year.

A 1 per cent increase in funding for an already rickety health service doesn’t add up to a lot of goodies, as both men knew.

Varadkar invoked scripture, by quoting the parable of the loaves and fishes, to illustrate the impossibility of meeting all the various demands made on the service.

First,though, he rightly marked the good news that an extra €115 million was coming on stream next year, after seven straight years of cuts.

The HSE will still be hoping to make savings of €130 million, bring in €10 million in extra revenue and put in “mitigating measures” (more savings) to meet a “residual financial challenge” amounting to €100 million. Spending less on drugs, procurement and agency staff will bring in some of this money, but other targets for savings will have to be found.

The plan is predicated on a number of assumptions that may not hold. Even a small increase in the number of people turning up at hospitals for outpatient or emergency treatment could see further significant increases in trolley counts and waiting lists. Demographic factors alone could see to that – the number of over-80s in the population is rising by 4 per cent a year – but so too could a bad winter or an outbreak of Ebola.

Delayed discharges

The main problem currently is the number of hospital patients occupying beds when they are clinically fit to be discharged. The number of so-called delayed discharges has risen to an all-time high of 850.

Many of these patients are waiting on a nursing home place under the Fair Deal scheme, where the waiting time is now over 15 weeks.

The plan at least recognises these related issues have to be tackled. An extra €10 million for Fair Deal will support 300 extra long-stay beds, though it hardly amounts to a long-term solution. There is more money for homecare packages and short-stay beds, particularly in Dublin, where the problems are worst.

Agency staff

The HSE hopes to replace €140 million spent on agency staff with full-time employees costing €80 million, which sounds like a win-win solution if it works. Yet successive HSE service plans have promised to reduce agency staffing, along with waiting lists, without any improvement occurring on the ground.

The underlying problem is that there aren’t enough beds in the system, but creating them would require the €1-€2 billion extra that Varadkar said he would like to have to fund an ideal system. He’ll have to become taoiseach before that happens.