HSE plan to tackle rapid rise of healthcare provision costs

New waiting lists, possible cuts in services and up to €110 million in “probity” savings are proposed in the 2016 Health Service Executive service plan as ways of containing steeply rising costs.

The plan to be published on Wednesday says there are specific financial pressures and challenges in the areas of hospital spending, medical cards and drugs, disability and older people. It acknowledges “it will not be possible to address all the challenges identified”.

Free GP care extension

The proposed extension of free GP care to under 12s will take place in the last quarter of 2016. This is subject to negotiations with the

Irish Medical Organisation

and there is no forecast in the plan of the number of extra GP visit cards this will involve.

Commitments about the level of service next year come with multiple caveats; for example, the plan commits to delivering services at 2015 levels or at an increased level “to the greatest extent possible and consistent with the safe delivery of services” and “where this is supported by the funding available”.

The plan envisages savings of €110 million through a “targeted reduction” in prescribing and drug costs. “This will involve a review of areas such as probity and the costs associated with prescribing.”

Two years ago, there was controversy when the Government announced deeply unpopular measures in the budget to check on people’s entitlement to a medical card. This time, the measures seemed to be aimed at reviewing claims submitted by primary care contractors such as pharmacists and doctors.

The plan envisages the number of medical cards will fall by 125,000 next year, to 1.6 million, but the Cabinet has cut this reduction to 50,000.

The number of GP visit cards, which do not cover the cost of drugs, is forecast to rise by 50,000 to 485,000, but this does not take account of the new cards issued when free GP care is extended to children aged 12 and under.

There is no provision for extra money for the high-tech drugs scheme next year, despite the rapidly escalating costs of treatments. Spending on the scheme has doubled in the past five years, to almost €500 million last year; compared to one new treatment for cystic fibrosis alone, which the HSE says will cost €92 million a year if approved.

Ensuring there is no increase in spending in this area is dependent on the HSE’s ability to “contain” approvals for new medicines and on the outcome of talks with the drugs industry, according to the plan.

Exceeding budget

The HSE says in the plan if medical card and drug costs start running over budget next year it will flag to the

Department of Health

what measures, including policy changes, it believes are needed.

Of the €100 million available for new developments, €35 million is going to mental health, in keeping with a commitment in the programme for government. Home help hours and provision for homecare packages are being maintained at current levels only through an injection of 20 million in “time related savings”, ie, unspent monies.

The plan says waiting lists will be established for home care and transitional care to manage the allocation of services in as fair a way as possible.

An extra 650 people will be funded on the Fair Deal nursing home scheme next year, giving a total of 23,450 places. If the number of applications increases beyond this number, the plan warns, the current four week waiting period will increase.

The plan also provides for mandatory “adaptation programmes” for overseas nurses to be completed before they register to work in the Irish health service.

Other proposals in the 172-page document include:

– €3 million on patient-safety improvements, including the creation of a national patient safety office;

– €2.5 million to augment the immunisation programme for schoolchildren

– Continuing the extension of BreastCheck to women aged 65-69 years (€1.5 million); and

– 10,000 minor surgeries to be transferred from hospitals to GPs (€13.5 million).