ANALYSIS:Predicting where the axe will fall has become something of a perennial activity in the health service, where budget cutbacks and spending overruns are the order of the day.
The service plan for 2013 published by the HSE yesterday lacks the detail contained in previous plans, but there is still plenty to pore over for those concerned about imminent cutbacks. And cuts there surely will be, despite the drip-drip way in which information is being released.
The details of cutbacks in specific areas, hospitals and sectors will not be known until regional and operational plans are published at the end of this month, but the service plan shows that a further €721 million is being lopped off the health budget this year.
That means €3.3 billion will have been taken off in the five years since 2008, or almost one-quarter of the budget.
This year, hospitals are being spared somewhat in recognition of the increasing demand for their services and the deficit they are carrying forward from last year. That means areas such as disability, older people and children and palliative care will feel the pinch commensurately more. Almost half of the savings, or €323 million, is projected to come from the primary care reimbursement scheme, which covers areas such as medical cards and drugs.
Cost of drugs
Some of these measures we already know about – savings in the cost of drugs, a tripling in the prescription charge, cuts in fees to doctors and restrictions in eligibility for medical cards.
Another €60 million in cuts in this area was signalled yesterday, to come from the further delisting of items currently covered under the medical card scheme, savings on high-tech drugs and “probity measures” on medical cards. The details of all these measures, when eventually published, are sure to provoke a strong response among medical card holders and other users of the health service.
Some €150 million in “unallocated” savings is projected from changes to the Croke Park agreement, even though negotiations have yet to start, agreement seems unlikely and no indication of the measures contemplated has been provided.
The HSE is expecting almost 4,000 staff to leave this year on top of the 11,000 who have already departed since 2007. This seems an optimistic figure given that staff have already had the chance to avail of three schemes for accelerated departure in recent years.
The plan contains a number of commitments that were made last year but not seen through, notably in the areas of mental health and primary care staffing. The commitments given are welcome, though reaction is likely to be tinged with some scepticism arising from the failure to meet earlier promises.
Financial straitjacket
Given the financial straitjacket imposed by the troika, the new targets set for patient treatment are also welcome.
The aim now is that no adult should have to wait for more than eight months for an elective procedure and that 95 per cent of people attending hospital emergency departments will be discharged or admitted within six hours of registration.
By comparison, in the UK patients are promised access to treatment within 18 weeks and face a maximum four-hour wait in emergency departments. So while Irish targets are going in the right direction, they still have some way to go.
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