HSE running just to stand still, with plan based on false economy

The strains on an unreformed health service wrestling with increasing demand, older patients and more expensive drugs are not immediately evident from the HSE’s 2016 service plan.

At first glance, the 173-page document sets out a rosy year ahead for the health service, with extra money available for various innovations, such as the extension of free GP care to under-12s.

The reality is very different, however, as a more careful reading shows. Of the €817 million in extra funding that is available, the lion’s share – €720 million – is needed to maintain services at existing levels.

That leaves €97 million to fund welcome new developments, with two-thirds of this money coming from funds held by the Department of Health for specific initiatives. HSE director-general Tony O'Brien would need the miracle of the loaves and the fishes to make this amount of money go far in the context of a €13 billion overall budget.

Alarmingly, the document refers to a €150 million “preliminary funding shortfall” in acute hospital spending, though this is reduced to €100 million thanks to a commitment to accelerate income collection.

Cutting services

So how will this shortfall be addressed? The report says “aligning activity levels to the funding available” – cutting services, in plain terms – is a “last resort” because of the potential impact on patients and on staff morale.

The plan suggests hospitals will address the shortfall by controlling costs, reducing waste and increasing efficiency, although few specifics are provided. You only have to look at the performance of the HSE in previous years to have reason to doubt the attainability of these targets.

One way of saving money is to dilute your existing targets. Tens of millions of euro have been spent this year on extra clinics and private outsourcing in order to meet Minister for Health Leo Varadkar’s waiting-list targets, and even then they haven’t been reached. For next year, the minister’s “zero tolerance” approach is being replaced by an acceptance that most lists can’t be completely cleared of long waiters.

The HSE plans to maintain home help hours and the number of home-care packages at last year’s levels using €20 million made available as a result of “time-related savings” – ie, it wasn’t spent for the original purpose and is now being redirected.

Ageing population

Even so, the plan warns the model of provision of home care is to be reviewed in view of the ageing of the population and this may “necessitate maintaining waiting lists”.

Every service plan has winners and losers and certainly the new initiatives planned for 2016 will be warmly welcomed by those who benefit. These include funding for GPs to perform 10,000 minor surgeries and to provide them with direct access to X-ray and ultrasound services for patients, extra staffing for maternity units and day care places for 1,500 young adults with a disability. More money is also being provided for the ambulance service, respite beds, organ transplantation and cancer services.

There will be a three-year plan to reduce alcohol consumption, more investment in vaccination programmes and initiatives to reduce waiting lists for speech and language, psychology and orthodontic services.

Overall, though, the picture is one of a health service desperately trying to run just to stand still.