Despite a 6 per cent rise in funding, consultants predict bed closures and service cutbacks, writes Dr Muiris Houston, Medical Correspondent

With an additional €520 million signalled in the recent Estimates, bringing the gross health allocation for 2003 to €8.9 billion, one might think that both health professionals and consumers would be reasonably happy - especially in comparison to the minimal increases and even reductions in funding facing other Government Departments.

However, developments promised in the National Health Strategy alone would have cost approximately €1.2 billion, so despite the 6 per cent increase in funding, the Department of Health faces a very difficult juggling act in the year ahead.

Unless Minister for Finance, Mr McCreevy can pull a rabbit out of the hat in the form of additional borrowing, taxing the old reliables of alcohol and tobacco may be one of the few Budget moves to please health professionals.

The Irish College of General Practitioners (ICGP), in its pre Budget submission, said: "The ICGP strongly supports the imposition of additional taxation on tobacco and alcohol as a key part of social policy directed at reducing the present harmful consumption of these products."

The Irish Medical Organisation (IMO), in its pre-Budget briefing, focused on two areas in particular: medical card eligibility and the perilous state of mental health services.

Pointing out that the mental health of the nation was continually neglected, Dr Kate Ganter, president of the IMO, called for additional resources.

"Suicide continues to claim more lives annually than road traffic accidents. The waiting list initiative and National Treatment Purchase Fund do not apply to mental health beds and do not address the issue of any increase in bed capacity and treatment for people with mental health problems," she said.

General practitioners are incensed that the Government has failed to honour the Programme For Government's commitment to increase the number of people eligible for medical cards.

"The decision not to extend medical card eligibility to over 200,000 people is bad enough; however, it is unforgivable and incomprehensible not to extend it to anyone, which could be done on a phased basis," according to the chief executive of the IMO, Mr George McNeice.

Individual family doctors are extremely concerned about the growing number of young families and low earners who simply cannot afford even the most basic healthcare.

There is increasing anecdotal evidence of children with chronic conditions such as asthma not receiving adequate preventive treatment. Young adults with potentially serious symptoms are delaying seeking medical help until very late in an illness.

It has even been suggested the inadequate medical card numbers are contributing to the rise in suicides, simply because depressed young people cannot afford to access primary health care.

Consultants have predicted bed closures and service cutbacks following the publication of the Estimates.

It is clear that no additional beds, over and above the 700 already commissioned, will be funded. This is despite an acknowledgement by all sides that a minimum of 3,000 beds are required just to reverse the serial bed closures of the 1980s and 1990s.

Manpower problems represent a looming crisis. Without ring-fenced funding to increase the number of doctors in training, it is now predicted that certain parts of the State will become "no-go" areas for young general practitioners. And if people really want a consultant-based health service, manpower initiatives are needed now in order to make a difference in ten years' time.

On a positive note, funding to begin implementing the primary care strategy has been confirmed.

Heart/lung transplants will commence in the Mater Hospital next year, thus doing away with the difficult trek to Newcastle and London which transplant patients and families have faced until now.

The cardiovascular strategy has been promised €7 million in extra funding, which will lead to eight additional consultant cardiologists and teams of ancillary staff in various health boards.

From the patients' perspective, the health system is riddled with inequity and poor accessibility.

Why is breast cancer screening limited to the eastern half of the country? Why if you have lung or breast cancer and live in the west or midwest are you much less likely to be offered radiotherapy?

Why is there better treatment of heart disease for men compared with women? Why is there a two-fold difference in the prescribing of preventive heart drugs depending on where you live in the State? And why are you more likely to die from a stroke if you live in the Republic compared with Northern Ireland?

With fundamental change needed to even begin to address these inequities, this week's Budget is unlikely to change the pall of despair which has descended on the health sector since the Estimates.

For complete coverage of Budget 2003, visit Ireland.com's Budget site at: www.ireland.co/focus/budget03/