The Health Service Executive has said it will have to save more than €900 million next year in order to live within its budget.
In a statement this evening it says that while its service plan for 2009, which was published today, makes it clear that savings of around €530 million will have to be made next year it now believes, given the economic downturn, that it may also have to save a further €400 million next year.
It said the service plan, recently approved by health minister Mary Harney, had been completed almost two months ago and the savings listed in it were based upon known information at that time.
It said: "Health services are directly impacted by downturns like this – more people require medical cards, more people require hospital services and unfortunately, even areas like mental health. We had anticipated significant increases in demand in October – we may now be faced with revising this. The HSE has identified that a possible additional up to €400m of cost reductions may be required in light of the emerging situation".
"We will do everything we can to ensure we protect delivery of services but many of the developments we had included may be challenged. But we obviously cannot confirm any of this now," it added.
The Health Service Executive is planning to review current arrangements whereby eight hospitals in Dublin and three hospitals in Cork city provide adult emergency departments around the clock seven days a week.
Reviews of acute hospital services in the midlands and the south east will also take place next year.
The move, outlined in the HSE's service plan for 2009, follows similar reviews of services in the north east and the mid west.
The service plan, which has been approved by Minister for Health Mary Harney, also states that a review of the need for the three children's hospitals in Dublin to provide 24 hour emergency services will also be undertaken and intensive care at these three hospitals will be developed as a single/joint clinical department.
Furthermore, the report states that a reconfiguration of critical care services at hospitals across the State will begin next year, as will the reconfiguration of maternity care services in Dublin hospitals, in line with a review of these services undertaken by KPMG earlier this year. The KPMG report recommended that the three Dublin maternity hospitals be relocated to sites adjacent to the Mater, Tallaght and St Vincent's Hospitals.
In a foreword to the service plan the chief executive of the HSE Prof Brendan Drumm said 2009 will be "financially very demanding" and that maintaining 2008 service levels will be a major challenge "with no scope to fund any unanticipated escalation in demand for service level activity, including demand led schemes, beyond levels outlined in the plan".
He added: "We will therefore have to do more with what we have. We will have to make a special team effort to maximise our efficiency where we can, streamline how we do things, trim costs, cut out duplication, reduce the over reliance on high cost acute hospitals and provide more integrated community based care".
The report says these savings will be achieved by a three per cent reduction in management/administrative payroll costs in the HSE and the voluntary hospitals. A voluntary redundancy scheme is being worked on.
The service plan assumes a reduction in expenditure by approximately 3,000 whole time equivalent staff in pay costs, which it says will be achieved "through actual staff reductions, staff redeployment and pay related savings as a result of changing how some services are provided".
The plan allows for an additional 81,000 medical cards to be handed out next year, given more people are losing their jobs, but the report says if more than this are required the HSE will have to cut services elsewhere if it is to live within its budget.
The plan also makes provision for more procedures to be done on a day case basis next year and reduce dependence on inpatient beds. It also proposes reducing the length of time patients spend in hospital, controlling elective work, and seeing more new patients in outpatients by reducing the number of patients returning for checkups.
A target of a six per cent reduction in MRSA infections has also been set for next year.
In a letter to the HSE on December 9th, Ms Harney said she was approving the service plan. She said she wanted all patients awaiting colonoscopies, which are a crucial diagnostic test for bowel cancer, to be seen within one month. Recent figures from the National Treatment Purchase Fund (NTPF) show some patients can be waiting eight months for these tests, which could result in patients having a delayed cancer diagnosis, as happened in the case of the late Susie Long.
Ms Harney said she wanted monthly progress reports from the HSE next year on this issue. She also said the HSE "needs to give consideration, to where necessary, directing co-operation with the NTPF including through the imposition of financial penalties for hospitals that are failing to refer patients who could benefit from NTPF funded treatment".
The NTPF arranges private treatment for public patients waiting more than three months for treatment.