Illogical cuts could clog up system within weeks


Without homecare, more people will be admitted to hospital and fewer discharged, writes DR MUIRIS HOUSTON

WHAT AN extraordinary week, even by the standards of the never-dull health system in the Republic. At a political level, the apparent U-turns gave us some unexpected theatre, and have set Minister for Health James Reilly up for some uncomfortable weeks ahead. But for those who depend on health and social services on a daily basis, what are the implications of the cuts, both planned and postponed?

It started with a Health Service Executive announcement of €130 million in cutbacks, aimed at home help hours, homecare packages and personal assistant hours. Following days of intense controversy and distress for those affected, the personal assistant element was formally withdrawn by the HSE. But the other cuts remain and will be implemented.

The Centre for Independent Living was just one advocacy group to react with incredulity to the proposals. It pointed out the cost of a bed in an acute general hospital was €899 a day or €328,000 a year. This compares with the cost of providing a personal assistant service, which for the average user is about 100 hours per week, of €23 per hour. This equates to €119,000 a year, representing a saving of €209,000 a year compared with the cost of the person occupying an acute hospital bed.

“The Centre for Independent Living has many members who receive 15 or fewer personal assistant hours per week, at a cost of €18,000 per annum. Yet without these hours they would have to go into institutions, costing the State hundreds of thousands of euro in the process,” the advocacy body said in a statement.

The same calculations can be broadly applied to older people and others with disabilities who rely on homecare services in order to remain in their own homes. Patricia Conboy, director of advocacy group Older and Bolder, said there could be no sugar-coating the injustice of the homecare cuts.

“There has to be recognition that cutting frontline services is not only deeply unfair but makes no economic sense,” she said. “Cuts to homecare services which support older people to remain living at home and within their own communities will result in earlier admissions to nursing homes, longer stays in acute hospitals and anguish for families who wish to care for relatives suffering from illness, frailty and disability at home.”

But it is the cut to homecare packages that has the potential to cause the most disruption. It could clog up the hospital system within weeks. Most admissions to hospitals are of older people with multiple co-morbidities. Even after intensive rehabilitation and appropriate medical treatment, these patients are often un-dischargeable without the elements of a homecare package being put in place. And it’s not just a threat to public hospitals; many private hospitals rely on these packages to discharge the growing number of patients with multiple diseases they routinely treat.

So, we could very quickly see the entire health system gummed up to a level of severity never seen before. Throw in a winter with a potent influenza virus and a resulting increase in hospital admissions and we could easily face healthcare Armageddon.

The whole thrust of these cuts is so illogical as to beggar belief. It suggests that everyone involved, from the Minister down, simply doesn’t understand the basic mechanics of our health service. All of the suggested cuts are going to result in more people being decanted into hospitals while at the same time fewer will be fit for a safe discharge home. Both private and public hospitals will burst at the seams.

As well as flying in the face of our stated health policy to deliver more services in the community, these cuts also contradict the maxim that an appropriate balance between healthcare spending and social-support spending is crucial. Experts point to a threshold for useful spending on traditional healthcare delivery. In other words, if we develop the acute hospital sector at the expense of less technical, simpler (and cheaper) community care, overall population health will suffer.

Or, in the recent words of a Canadian expert: “A society that spends so much on healthcare that it cannot or will not spend adequately on other health-enhancing activities may actually be reducing the health of its population.”

Some observers have suggested the €130 million cuts package was put together in haste in order to placate an unhappy troika. Even if this was the case, it is an inept and illogical move that must be reversed. With 70 per cent of the health budget spent on salaries, the focus must now shift to this sector for savings.

Services have been cut to the bone: the time has come for those in senior positions in the health service to take a significant pay cut.

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