The warning by the chief executives of four Dublin teaching hospitals that hospital funding cuts are seriously threatening the quality and safety of patient services is unprecedented. In a letter to Health Service Executive (HSE) director general Tony O’Brien last week, they say that, as a result, “unacceptable delays” have emerged in accessing treatments for some cancer patients. And in an apparent reference to the recent Hiqa report into the death of Savita Halappanavar, they note that the threat to patient safety is highlighted by the emergence of “highly publicised sentinel events in the acute system”.
Set against the current HSE efforts to draw up a service plan for 2014 to accommodate a spending reduction of at least €666 million, the move reflects a fundamental resistance to the level of cuts being demanded by the Departments of Finance and Public Expenditure and Reform. Many observers believe the actual savings needed will be closer to €1 billion, when an overrun on this year’s health budget is accounted for as well as a likely difficulty in delivering planned savings in the medical card and other demand-led schemes. In a reference to a more than 20 per cent cut in their funding since 2009, the four hospitals say there is evidence to suggest that these reductions have been “determined and applied arbitrarily”.
All of which represents a significant threat to the safety of patients across the health system. Even with full resources, it is estimated that about 10 per cent of hospital admissions are associated with an adverse outcome for patients; about half of these are preventable. But with resources stretched to the extreme, there is a real and present danger to the quality and safety of patient care. Minister for Health James Reilly’s assertion that he has made clear to the HSE that despite the severe budgetary constraints he expects it to make patient safety a priority within its service plan is hardly reassuring. Not when the Halappanavar inquiry unearthed evidence that, in times of budgetary plenty, the HSE failed to implement important safety directives across the maternity system.
Adverse outcomes for patients resulting from treatment readily come to mind when considering issues around patient safety. But patients can also suffer from acts of omission and it is in this context that the warning from the chief executives is especially stark. Delays in the timely administration of cancer treatments represent a real threat to people’s lives. A delay in initiating treatment modalities such as chemotherapy and radiotherapy represents the most fundamental failure of a modern health system. Bland reassurances from the Taoiseach and Minister for Health are not enough. Patient safety is non-negotiable; the Government must respond to this week’s warnings with alacrity.