The Health Service Executive will have to make at least €80 million in savings next year despite receiving the biggest budget in its history, according to its 2019 service plan.
The savings are needed to make up for a shortfall in funding and to fund any increase in demand for services compared to this year.
Among the areas were cost reductions are being sought, or higher income generation targets set, are legal and consultancy costs, procurements, agency staff, drugs and disability services.
In other areas, spending increases will be limited to the available budget. These areas include the Fair Deal nursing scheme, disability residential places, elective work, new drugs and the implementation of the women and infants’ programme.
The HSE’s budget for next year is €16.05 billion, an increase of €848 million or 5.6 per cent over 2018.
The plan says it will not be possible to respond fully to the level of needs expected in 2019.
“Inevitably, difficult choices will have to be made, in order that we continue as far as possible to respond to the most pressing patient and client needs while operating within the resources available.”
One of the operating assumptions underlying the plan is that the volume of activity to be delivered will “fail to respond adequately to need”.
The plan says “every effort” will be made to maintain the waiting list of the Fair Deal nursing home scheme to the current four-week level, and an additional 700,000 home support hours will be provided for older people.
The number of short-stay beds is being cut by 80-100 as the overall public bed stock is reconfigured “to a more sustainable level”.
According to the plan, there is evidence that surgical waiting lists contain patients who do not require surgery and could be provided with “alternative clinical pathways”.
The funding allocated to the National Cancer Control Programme next year will not enable the service to meet the demand for referrals for radiotherapy, rapid access cancer clinics and diagnostics, the 140-page document warns.
As part of the plan, 75 extra acute beds are to be provided in 10 hospitals this winter and 202 in 14 hospitals next winter, although the latter won’t be ready until the start of 2020.
New services to be introduced next year include abortion, the extension of the HPV vaccine to boys and as yet unspecified services to be delivered under a new GP contract.
The implementation of the Scally report into the CervicalCheck programme and a revised open disclosure programme will also be implemented next year.
In disability services, 8,568 residential places will be provided, an increase of just 39.
Some €567 million is being allocated for capital infrastructure, and €85 million for information technology.
The preparation of a plan that was financially balanced and met requirement posed the HSE a very significant challenge, according to acting director general, John Connaghan.
“Responding adequately within available funding to support the delivery of all key service developments and augmentations is not possible. Instead, we have sought, as far as possible, to respond to the most pressing patient and service user needs while also prioritising some small investments in critical transformation and reform programmes of work.”