AFTER BUDGET cuts of €724 million for 2011 followed by a further €550 million in 2012, the health system faces even greater challenges in the year ahead.
Minister for Health James Reilly has acknowledged that frontline services will suffer. Both capital and day-to-day spending have been severely pruned and may have to be cut further as demand-led schemes such as medical cards and drug repayment schemes exceed projected expenditure. What will this mean for people who rely on this State’s public health services?
Unfortunately, the track record of the Department of Health and the Health Service Executive (HSE) is one of concealment of the detail of cuts so that it can be difficult for patients to be sure that a service they availed of in the recent past is still available to them. Examples include the provision of aids and appliances for people who have suffered a stroke or have a progressive neurological condition, to enable them to resume independent living at home; dental care for medical card holders; and inconsistencies in the treatment abroad scheme.
Where sensible ways of cutting costs have been mooted in reports commissioned by Government, such as the introduction of reference pricing and an increased use of generic medicines, there has been a singular failure to implement these policies. The State’s spend on pharmaceuticals is among the highest in Europe. Between 1997 and 2007, the annual cost of drugs under the community drugs schemes reached €1.74 billion, a 500 per cent rise. Reference pricing, if it were in place, could save the exchequer up to €100 million this coming year.
Additional funding for the mental health sector is welcome. But it must be matched by action to improve services on the ground. The HSE’s failure to recruit some 100 mental health professionals in 2011, although specifically allowed for under a derogation from the public service jobs embargo, is inexcusable. Acute hospital services face considerable challenges in the coming year. Patients needing emergency department care will likely experience longer queues and prolonged waiting on hospital trolleys. Those fortunate enough to be able to afford private health insurance will see a reduction in cover as excess payments per claim rise and the cost of maintaining 100 per cent coverage continues to climb. But perhaps the biggest threat to current entitlements will be access to private beds in public hospitals, as the cost of these beds to insurers is set to double.
Funding for new health service development has been halved for the year ahead. This cut cannot be allowed to halt the development of the HSE’s national clinical programmes. These are focused on standardising care for common conditions such as stroke and diabetes so that patients in all parts of the country can, for the first time, expect the same level of care. With frontline health services under severe threat, every effort must be made to protect the most vulnerable in society in the year ahead.