Junior doctor shortage problematic, says HSE


A SHORTAGE of junior doctors may have an impact on the ability of the HSE to deliver services in some areas next year, especially in some hospitals in the northeast, the executive has acknowledged.

Publishing its national service plan for 2011 yesterday, the executive said it would face an “immense challenge” to deliver the same levels of service provided in 2010 with net reduced funding of some €683 million for 2011.

HSE chief executive Cathal Magee said the gross reduction in funding was €962 million, taking into account the extra funding required for other programmes such as medical cards, new services, pensions costs and the clinical indemnity scheme.

Identifying risks to the delivery of its service plan, the executive also said the Government plans to accelerate payments to suppliers would cost it up to €100 million next year if it were to proceed. It said the move would have “financial and business effects” and unless separately funded it would impact on the delivery of a balanced vote in 2011.

Total Government funding for the executive next year will be €13.457 billion.

The executive noted the moratorium on recruitment may “cause challenges to the maintenance of the volume, quality and safety of services”. It said prioritisation of recruitment next year would be targeted at minimising these risks.

According to the plan, the HSE and its agencies are experiencing “significant challenges” maintaining 2009 staffing levels for non-consultant hospital doctors (NCHDs) in certain specialities and locations.

HSE national director Laverne McGuinness said cross-cover arrangements were in place in the Dublin northeast region for junior doctors, including in Drogheda. Some consultants would also be asked to cross-cover between hospitals. The executive was “almost confident” it would be able to manage on that basis until NCHD posts were filled from outside the country. This is expected to happen by April.

A new framework agreement for the provision of agency NCHDs will be in operation from January 1st. Community, or demand-led schemes, will be cut by some €424 million next year. Some €200 million has been set aside for a reduction in drug costs.

Earmarked savings of €123 million from the redundancy scheme for administrative, management and support staff will also not be achieved.

The saving, which is net of pension costs, was based on 2,250 staff taking the package but just over 1,700 have signed up. The HSE said it “assumed” it would not have to provide for this shortfall. It will engage in discussions with the Departments of Health and Finance once the final figures are known at the end of the month.

Inpatient admissions next year will be cut by 2 per cent to 574,400 compared to 586,102 in 2010. Separately, the HSE also announced the implementation of a number of national clinical programmes, including an acute medicine programme led by Prof Shane O’Neill and Prof Garry Courtney.

Prof O’Neill said the development of acute medical assessment units would remove 20 per cent of medical patients currently in inappropriate settings in emergency departments. Patients should be seen by a doctor within an hour, have diagnostics in a timely fashion and be discharged within six hours. About 70 to 75 per cent of patients who needed admission to hospital should be discharged within 48 hours under such a system.