Health chiefs warn €1 billion in cuts needed

MARTIN WALL and PAUL CULLEN

Cuts of up to €1 billion will be needed in the health service next year - around €350 million more than announced in this weeks 2014 Budget - if promised initiatives such as upgrading maternity facilities in the wake of the Savita Halappanavar case are to be implemented, senior health service sources are warning.

Senior health figureslast night maintained that either there was no money specially provided or else funding was only available from once-off sources to finance a number of key developments and to deal with service pressures.

These included complying with the Galway maternity report, implementing the new deal on working time rules for doctors and providing capacity to deal with increased demands for radiotherapy for cancer patients.

Highly-placed health sources maintained that if the cost of these and other initiatives and services had to be met from existing resources, the cuts required in the health budget next year would be in the region of €1 billion and not the €666 million set out by the Government in the Budget.

Separately there is also deepening concern within the HSE about the impact of the Government’s controversial move to reduce tax relief on health insurance subscriptions which was also announced in the Budget.

Highly placed sources maintained this could destabilise the private health insurance market and pile additional pressure on the public health system.

The proposed health spending announced in Tuesday’s Budget has been the focus of controversy all week, particularly in relation to the €666 million ear-marked for health savings in 2014 and the €113 million which is supposed to be generated by means of “probity” measures in relation to the medical card scheme.

Minister for Education Ruairi Quinn has said a "stand-off" between ministers in relation to medical card spending and the projected savings in health from the Haddington Road Agreement was only resolved last Sunday by an agreement that the figures would be validated by a process involving the Department of the Taoiseach and the Department of Public Expenditure and Reform as well as the Department of Health.

The concern within health relates to services which are either currently not provided or are provided but funded from once-off sources, and for which no allocation was made in the Budget figures.

Demographic pressures such as the ageing of the population and the growth in the birth rate mean that demand for health service is increasing automatically, but a range of new service pressures is also helping to push spending upwards.

The recent Hiqa report into the death of Ms Halappanavar drew attention to under-staffing in Irish maternity services and called for a national review of the sector. This will have “resource implications,” the chief executive of the West/North West hospital group, Bill Maher, pointed out yesterday. He said he would be raising the immediate implementation of Hiqa’s recommendations with the HSE and the Department of Health.

The deal recently struck with non-consultant hospital doctors (NCHDs) to shorten their working hours will also have significant cost implications for hospitals. The provision of bilateral cochlear implants for profoundly deaf children, described by the Minister for Health James Reilly as one of his top priorities, will cost over €12.5 million a year, while similar amounts will be required to fund home care packages for children with significant medical needs.

Other areas seen as giving rise to significant extra costs include renal services, living and deceased donor programmes, and the increased demand for radiotherapy.

Separately highly-placed sources said there was “deeping concern” in the HSE at the Government’s decision to cap tax relief on health insurance subscriptions at €1,000 for adults, a move which will increase premium costs for hundreds of thousands of people.

Sources said this move could generate a “triple whammy” for the health service. They forecast it could lead to increased demand on an over-stretched and increasingly under-funded public hospital system next year .

Senior health service figures also maintained it could also mean to less income being generated from patients with health insurance who are treated in public hospitals at a time when this amount was scheduled to rise.

Sources also maintained that the Government move could adversely affect moves to realised an “accelerated” provision of funding from health insurers by the end of the year.