Controversial proposals by HSE aimed to deliver savings of €200 million across the board if industrial action by Impact had continued, writes MARTIN WALL
SENIOR HSE executives considered closing two hospitals as part of a contingency plan to save €200 million in the event that recent industrial action involving the Impact trade union had continued.
The hospitals earmarked to be shut down as part of the confidential draft proposals were those in Monaghan and Mallow. The HSE believed that the move could save it more than €12 million.
The HSE also considered restricting the operation of emergency departments in a number of hospitals around the State to 12 hours daily. It said that two of the hospitals concerned would be in the south, three in the midlands and two in Dublin.
The HSE believed the curtailment of emergency department operations could generate savings of €17.3 million.
The proposals, which are marked private and confidential and were drawn up in late April, also suggested that a cap could be placed on the prescribing of all high-cost drugs such as Tsyabri and certain oncology medication.
It said that clinical protocols could be drawn up to support the implementation of such a move.
The document also proposed that there could be an effective 44 per cent reduction in the provision of home help hours each month to the end of the year. It said that this could save €35 million.
The HSE plan also said that it could introduce an immediate “extraction” of 1,900 day care places per week. It said that this could generate savings of €10 million.
The proposals would have seen the HSE trying to save another €20 million by negotiating further cost reductions with suppliers.
The document envisaged that an additional € 8 million in savings could be generated by introducing further restrictions on travel for each staff grade.
It also said that it could stop all non-statutory and non-mandatory training. It forecast that this measure could save €6.7 million.
The draft plan, which was drawn up internally for discussion among top-level HSE staff, was put together at a time when they did not know the state of the organisation’s finances as a result of the industrial action by Impact members.
As part of this campaign against Government-imposed pay cuts, Impact members refused to provide key financial and performance data to central management.
At the time of the plan, HSE senior management said they had no adequate knowledge of whether the organisation was adhering to the commitments set out in its national service plan – its agreement with the Government on how its €14 billion budget would be spent.
Neither was it aware as to whether the €400 million in cost-saving targets, on which delivery of the national service plan was dependent, were actually being achieved on the ground.
As part of measures to deal with this situation, HSE management sought to draw up a contingency plan to generate a reserve of about €200 million, which could be used to shore up any financial shortfall that may have emerged during the period when it had no actual financial data to hand.
However, HSE management was very aware that the proposals would prove highly controversial.
“The achievement of a further €200 million in cost-containment measures will put further pressure on service delivery within the regions,” the draft plan states.
“The significant levels of savings achieved in recent times means that further cost base reductions will impact directly on patient services.”
The draft plan proposed that more than €60 million in additional savings to go towards generating the financial reserve would come from the Dublin/Mid-Leinster region of the HSE, with between €44 million and €47 million being derived from each of the other three regional areas in the organisation.
The implementation of the controversial cost-saving measures set out in the draft document would have involved the HSE seeking the approval of Minister for Health Mary Harney to change the national service plan.
However, in late April Ms Harney signalled that HSE management should take action against staff involved in the industrial action rather than make savings by cutting patient services.
Ms Harney said that in the first instance money had to come “from those who are not doing their job”.
“I, as Minister for Health, could not stand over any situation where the HSE could take money away from services to patients and still pay people who aren’t doing their jobs.
“It is not acceptable to me, to patients or to taxpayers.”
The need to draw up the €200 million financial reserve was not required as agreement was reached with Impact on the provision of the financial data following the intervention of the Labour Court.