The McCarthy report recommends cuts of about €1 billion to health services. But will such measures leave a legacy as damaging as the cuts of the 1980s, asks CARL O'BRIEN, Social Affairs Correspondent
AS POLITICAL slogans go, it was devastatingly effective. “Health cuts hurt the old, the sick and the handicapped. Vote Fianna Fáil,” urged the billboards, which flooded the country in the weeks before the 1987 general election.
Within months of being elected to Government, the same party embarked on a series of health spending cutbacks on a scale which amazed even the Opposition parties.
Thousands of hospital beds were taken out of the system, thousands of public servants were made redundant and plans to take patients out of crumbling mental institutions were shelved. The cuts package worth just under £500 million at the time also hit the most basic of medical supplies; one low point came when incontinent patients in public hospitals were told their supplies of nappies were being rationed.
Twenty years later, the long-term scars of those slash-and-burn cutbacks remain. Despite a significant increase in funding over the past decade and improvements in waiting times for operations, we still have a lower than average supply of beds and health staff compared with our European neighbours.
Many will be forgiven for feeling a sense of deja vu when the McCarthy report – dubbed An Bord Snip Nua – was published last month. It is similarly audacious, identifying more than €1 billion in potential cuts across the health service, or one-fifth of overall cost savings.
The proposed measures include reducing HSE staffing levels by up to 6,000, opening up contracts with GPs and pharmacists to tendering, There is much in the report that makes sense, and could address much of the wasteful spending that characterised increases in health budgets during the boom years.
Yet, it also has the potential to widen health inequalities even further, placing the most vulnerable such as medical card holders and older people under greater financial pressure.
The decisions to be made over the coming months may well have profound consequences for decades to come over the kind of health service we are willing to provide to ordinary citizens without access to private healthcare.
Even before we get to the McCarthy cuts, it’s clear that cuts are already having a severe impact on the lives of thousands of vulnerable citizens.
The first to feel the scalpel even before the economy tanked were people with mental health problems and the disabled; development funds to modernise these services were diverted into other parts of the health sector.
The McCarthy group advocates reducing €50 million to the voluntary groups which provide disability and mental health services, as well as suspending recruitment to psychological services for children.
Groups such as Inclusion Ireland warn these cuts are counterproductive and would cost the State much more in missing out on the opportunity to help maximise the potential of disabled children.
“For the last three years, schools have experienced major delays in getting assessments for children with special needs. Assessments are vitally important to a child’s development,” Inclusion Ireland says.
Older people’s advocacy groups also argue that many of the cuts will simply serve to marginalise a group which had traditionally received shoddy treatment from the State.
A hike in nursing home costs under the Fair Deal scheme, together with cuts in pensions of 5 per cent and increases in prescription charges, could tip many people into poverty.
“The proposals are for very drastic cuts for older people,” says Eamon Timmins, Age Action’s spokesman. “These are proposals from economists looking only at cost cutting. The challenge for any Government is to protect its most vulnerable citizens, and this is the job which faces our leaders as they sift through the options in the coming months.”
Of all the measures with the potential to hit the most vulnerable, revising medical card eligibility thresholds downwards is it. We know that those in poverty, or at risk of it, can’t afford private care and are statistically more likely to fall ill.
To groups such as the Society of St Vincent de Paul, it simply beggars belief that the Government could reduce access to the medical card, while simultaneously claiming to protect the most vulnerable.
Yet, there will need to be cuts. And with just over 110,000 staff in the health sector, a reduction of 6,000 doesn’t seem too onerous, particularly given the extraordinary lack of redundancies when the health boards changed over to the Health Service Executive (HSE).
In addition, the health service – as economist Colm McCarthy himself said – has accumulated not just a large number of administrative staff but there has also been an inflation in grades.
Redundancy packages, we are told, will soon be available for middle management grades no longer needed in the newly restructured HSE. It makes eminent sense – but if the job cuts hit vital management or senior frontline staff who are needed to provide greater efficiency in delivering targets and running services, the move could prove counterproductive.
Making greater use of generic drugs is another measure which the McCarthy report conservatively estimates could save the State €30 million. Some health experts believe this could be ramped up closer to €100 million or more through greater use of the generic drugs and negotiating better deals.
However, Sara Burke, health policy analyst and author of Irish Apartheid: Healthcare Inequality in Ireland, has argued that most of the proposed cuts are misguided and we should look more towards cutting waste rather than hitting patient care. For example, she says, banning the use of private management consultancy firms and advisers could save more than €50 million, while a €2 tax on cigarettes could yield some €420 million.
Ultimately, of course, the McCarthy report is just a “menu” of cuts.
The Government will have to balance the competing needs of the most vulnerable with the need to rein in Exchequer funding. It will need to tread carefully. If the 1980s has taught us anything, it’s that short-term cost-saving measures can have damaging long-term effects.
McCarthy report: proposed health savings
- Reduce HSE staffing levels by 6,000 (saving €300 million).
- Greater efficiencies, such as cuts to overtime and premium payment for staff (€90 million).
- Revise down income eligibility for medical cards (€100 million).
- Charge medical card holders for prescriptions (€70 million).
- Revise upwards the Drugs Payment Scheme threshold (€37 million).
- Open up contracts with GPs, pharmacists and medical card patients to tender (€370 million).
- Increase contribution of older people to nursing home care (€50 million).
- Means test home care packages for older people (€24 million).
- Charges for private facilities in public hospitals (€50 million).
- Increase hospital charges (€6 million).
- Switch to generic medicine (€30 million).
- Save on non-emergency transport costs (€10 million).
- A proposed cut of €50 million in funding to voluntary disability organisations providing disability and mental health services.
- A €60 million reduction to the funding of special needs assistants.