Health service after the cuts


MINISTER FOR Health Mary Harney has claimed the €724 million cut in next year’s health budget will “minimise the impact on services to patients”. Although the reduction in spending is devoid of headline-hitting measures with immediate effect, a number of slow-burn changes will ignite after the Minister makes an exit from office next spring.

Take the 21 per cent rise in charges for private/semi-private beds in public hospitals. At one level a welcome step in eliminating a two-tier system in these hospitals, it will lead to a significant increase in the cost of private health insurance next year. Families already struggling to pay expensive premia may be tipped over the edge of affordability, especially when an increase in insurance costs coincides with substantial tax rises. This will place additional pressure on the public health system, as patients who heretofore accessed secondary care in the private sector will no longer be able to do so.

A similar lack of joined-up thinking is evident in the budget decision to cut €48 million from primary care services. Although committed in principle to a policy of shifting patient care from hospitals to the community, a severe reduction in investment in the staff needed to achieve this goal is counter-productive. And while it is good news that an additional 120,000 medical cards will be available next year, the deserving recipients will face a fight to access care from a sector with no choice but to downgrade the level of service it provides in 2011.

GPs face cutting staff hours and even jobs after the Minister reduced employment grants again. Practice nurses will be forced to see fewer patients with a likely negative effect on childhood immunisation rates, asthma care and the health of people with diabetes and heart disease. The halving of fees for looking after nursing home residents will reduce the kind of preventive healthcare needed for older, vulnerable people in this sector. And disabled people in the community will now have to pay for aids and appliances from reduced social welfare benefits and grants.

Hospitals must shoulder some €150 million in cuts next year. Some of this reduction may be achieved by treating additional patients on a day-case basis and by reducing length of stay for inpatients. However, public hospitals face treating more patients with fewer resources which suggests these patients will spend longer on hospital trolleys and face increasing waits for investigations and procedures.

Dental health is another loser in the Budget. Having undergone severe cuts last year that left spending at 2008 levels, this year some 1.6 million people with medical cards are left with nothing but a limited emergency service. On a positive note, Ms Harney heeded concerns from mental health advocates to protect their sector from across the board cuts; mental health budgets will see 1.8 per cent sliced from this year’s funding. The reduction of €200 million in the price of drugs next year is also welcome. However a key question remains unanswered: is it possible to safeguard quality of care and patient safety with cuts of this magnitude?