The dust is now settling on Budget 2013 and it is an opportunity to reflect on how changes will impact on people’s health. Unsurprisingly, with some €780 million removed from the health vote, it is difficult to pinpoint any positive outcomes. Even the preventive effect of increased duty on “old reliables” was diluted by the disproportionate increase on a bottle of wine, despite the well-established cardiovascular benefit of moderate intake.
But it is at a community level the cuts will hit hardest: a tripling of the per-item prescription charge for someone requiring medication for a number of chronic diseases will hurt and raises the possibility of patients not adhering to prescribed drugs; and older people losing their full medical card must now face paying for medicines. Possibly the most damaging effect of losing a full medical card was not spelt out by the Minister in his statement. A doctor-only card means losing access to the public health nurse, home care packages, community occupational therapy and physiotherapy and certain in-patient public hospital inpatient services.
Cuts in the social protection budget also impact on health. Family members provide many hours of personal care to those with disabilities; it is often a full-time occupation carrying a high risk of burnout. Having access to even one week’s respite from the caring role is essential which makes the cut in the annual respite care allowance seem almost spiteful. And the removal of the electricity allowance was another example where joined-up Government thinking was absent. It has been shown that older people will cut back on either fuel or food when financially stretched. The resultant fuel poverty risks an increase in excess deaths from hypothermia and other diseases.
The commitment to ring-fence funding for the development of community mental health services is welcome. However, with further details of specific cuts yet to be announced, James Reilly’s stated aspiration to “cut the cost of services and not the services themselves” in the overall health budget appears unachievable.