Clarity needed to determine if HSE plan built on sand

On a number of occasions over recent years, Fianna Fáil leader Micheál Martin has strongly criticised the Government for producing health spending plans that were "bogus".

Certainly on some occasions there has been justifiable criticism that the annual blueprints for Health Service Executive services contained ambitious cost-saving measures that did not have a hope in hell of being realised.

Most notoriously the plan for 2014 contained a hole of €108 million attributed to “unspecified pay savings”. No such savings emerged and the shortfall ultimately ended up being met by a supplementary estimate at the end of the year.

The 2016 plan given to Ministers in recent days, which will be launched on Thursday, also contained provisions that raised strong suspicions that they too could be based on sand. However, on Tuesday, after details of the service plan were published in The Irish Times, the Cabinet moved to head off one of these potentially controversial areas as it was deemed politically too risky.

Assumption

Part of the manner in which the

HSE

had envisaged making ends meet next year was by means of an assumption that the number of people covered by a medical card would fall by 125,000. As medical cards cost, on average, about €1,000 a year the levels of savings anticipated from this provision would be significant.

The service plan made clear this was one of a number of working assumptions underpinning the primary care budget for 2016 that had been developed “in detailed discussions with the Department of Health”.

The intention was that medical card numbers would fall naturally as a result of economic growth and more people returning to work. The number of people covered by medical cards dropped 36,000 this year.

However, to Ministers the very mention of a reduction in medical card numbers obviously brought back deeply unhappy memories of the great medical card debacle of early 2014 that politically cost the Government very dearly.

A botched attempt to generate savings originally of €113 million from medical card probity measures – which was furiously resisted at the time by the HSE and the then minister for health, James Reilly – eventually produced a litany of horror stories of sick people having their discretionary medical cards removed against their will.

Ministers were on Tuesday concerned that the 2016 service plan could be misinterpreted by the Opposition in the run-up to the general election as a return to the days of cuts. The anticipated levels of reduction in medical cards numbers earmarked for next year were as a result scaled back considerably.

Funding originally scheduled to pay for dealing with negligence and other claims against the health service will now be shunted across to fill the gap in the HSE’s primary care budget for 2016.

However, there are also other potentially controversial areas in the service plan.

The document makes clear that the HSE does not believe acute hospitals have received sufficient money and warns of a funding shortfall of about €100 million.

It signals that while this may have to be filled by means of reductions in services for patients, this would be a last resort. Rather it proposed generating savings in the first instance from cost controls, eliminating waste and promoting efficiencies.

A table produced in the service plan also included proposals to withhold the payment of incremental pay rises from thousands of staff in a bid to save up to €21.9 million.

It is inconceivable that the Government would allow the HSE to renege on paying increments to just one group of public servants while they continued to be paid to all others, however.

If there are to be no supplementary estimates in future to deal with health overruns, this may be one area to watch in the second half of next year.