Hospitals overspend HSE budgets by over €80m in first four months of year

The State’s hospitals have overspent their budgets by more than €80 million in the first four months of the year, according to a new HSE report. Waiting lists, meanwhile, continue to rise, including an 350 per cent increase in patients waiting over a year for an outpatient appointment.

The €81.2 million deficit in the acute hospital sector represented more than 75 per cent of the HSE overall deficit of €107.5 million at the end of April, according to the latest HSE performance assurance report. Minister for Health James Reilly told the Dáil this week that the deficit had since risen to €158 million at the end of May.

The biggest overspends identified in the report were in large hospitals outside Dublin. Limerick Regional Hospital was €8.4 million, or 24.5 per cent, over budget, Waterford Regional recorded a deficit of €5.2 million and University Hospital Galway overspent by €4.1 million. In Dublin, the biggest overspenders were St Vincent’s Hospital (€3.9 million), Beaumont (€3.8 million) and Tallaght (€3.1 million).

The report says the HSE is not flagging any new financial risks beyond those set out in the service plan at the start of the year, “with the exception of the emerging risk in the acute hospital income”.

“The scale of the risk and challenge in achieving financial breakeven by year end is extremely significant as predicted in the service plan.”

The HSE is expected to record a deficit of between €300 million-€500 million by the end of the year; a supplementary budget is regarded as inevitable.

Outpatient waiting lists have grown for four consecutive months after recording a sharp drop at the end of 2013. The total on outpatient lists at the end of last year was 300,752, but this increased to 309,496 in January, 323,304 by the end of February, 331,281 at the end of March and now stands at 338,943.

Although no one is supposed to be waiting more than 12 months for an outpatient appointment, the number of such “long waiters” has soared from 4,937 at the end of last year to 22,746 at the end of April. The rate of increase, which saw about 6,500 patients added to the list in the space of a month, is accelerating.

The report says the increase in patients waiting over a year is disproportionately distributed between specialties and hospitals. ENT and orthopaedics contribute more than a third of the growth. Similarly, Tallaght (26 per cent) Waterford (12 per cent) and Galway (9 per cent) contribute almost half of the growth in long waiters nationally.

The numbers waiting between one and two years for an outpatient appointment increased from 3,990 at the end of last year to 20,880 by the end of April. The numbers waiting between two and four years for an appointment jumped from 903 to 1,803. Some 55 patients are on the list over four years, down from 112 patients a month earlier. There are 28,415 on University Hospital Galway's outpatient waiting list, 26,804 at Tallaght Hospital and 21,229 at Beaumont Hospital.

Meanwhile, the waiting lists for inpatient/day case operations and treatments continue to grow. Just four adult patients were waiting over eight months for treatment at the end of 2013, but this figure grew to 1,764 waiting at the end of January, 3,490 at the end of February and 4,350 at the end of March and 4,462 at the end of April. This is still slightly lower than the 5,302 recorded a year earlier but the trend is inexorably upward.

The number of children waiting over the target time of 20 weeks for inpatient and daycase operations and treatments increased from 193 at the end of last year to 930 at the end of April. Over the same period, the number of patients waiting for referral for a routine colonoscopy soared from 96 to 1,463.

The performance of emergency departments improved, although they still fall short of targets. Over 66 per cent of patients at emergency departments are discharged or admitted within six hours, compared to a target of 95 per cent. More than 81 per cent are dealt with within nine hours, compared to the target of 100 per cent.

The number of attendances at emergency departments is up 3 per cent and the numbers admitted rose by 1 per cent. St Vincent's Hospital's emergency department was 28 per cent busier after the downgrading of Loughlinstown hospital, while the Mater Hospital and the children's hospital also big increases in traffic. The trolley count is down almost 9 per cent year-on-year.

The report says the health service faces significant challenges in making progress with the European Working Time Directive for junior doctors. However, improvements have been made and compliance with a maximum shift of 24 hours is widespread.