Varadkar needs to put down firm marker on hospital budgets

Thu, Aug 21, 2014, 01:01

Hospitals are always first in the queue for available health funding. But, as has become evident in recent years, when they don’t get what they want, they simply overspend. The money is found elsewhere and, as a result, primary community care and mental services are starved of resources. This year, the overrun is expected to be in the region of €500million. The most important task facing Minister for Health Leo Varadkar will be to ensure that hospitals keep within their budgets.

A report from Comptroller & Auditor General Seamus McCarthy suggests that, on occasion, hospitals play dirty in order to dominate healthcare and retain high levels of funding. Five years ago, the Health Service Executive nominated 24 medical procedures that should, where possible, be conducted on a day care basis and advised all acute hospitals to meet a target of 75 per cent. Some hospitals did well in treating the specified conditions; others made little progress and a handful of consultants carried on as before. Significantly, however, there was a sudden increase in the incidence of other minor surgeries being undertaken.

It appeared that hospitals and clinicians, in order to retain income, were misclassifying minor treatments as elective surgery. The view from the Department of Health was that a significant proportion of these day cases did not require hospital admission at all.

Dysfunction is a word regularly used in relation to the health system. It steers away from specific abuses and personal responsibility. Like the excuse of “systemic failure” when things go wrong within the wider public service, it represents a defeat for accountability. There is no such thing as a victimless wrong. Abuse of their powerful positions by some acute hospitals and clinicians has gobbled up financial resources that might have been used more effectively elsewhere. Primary healthcare within the community has been neglected in favour of costly hospital services. Powerful lobbies are determined it will stay like that. Mr Varadkar has a fight on his hands.