FIGURES CONTAINED in the Health Service Executive (HSE) draft service plan for 2010 have, for the first time, shown the nature of cuts which patients can expect in the coming months. Until now, we were aware the health budget would be €1 billion less than last year. The draft plan, which may yet be subject to modification by the board of the HSE and the Minister for Health, suggests the closure of hundreds of hospital beds in the public health system this year. But the key figure in it is the aim to reduce the number of people admitted to public hospitals by some 54,000, representing a cut of 10 per cent on 2009 admissions. However, the number of day case admissions will rise by only 769. What is to happen to the 53,000 patients who were cared for in hospital last year whom the HSE will be unable to look after in 2010?
There are some worrying answers in the draft plan. It says that some in-patient cuts will be achieved by “emergency admission avoidance”. Given that emergency admissions account for about 80 per cent of activity in many of our acute hospitals, this suggests a significant number of people whose condition warranted acute in-patient care in the past will no longer receive this level of treatment. It also suggests medical and nursing staff will be expected to turn away rather than facilitate sick people, a dynamic likely to clash with their professional instinct to look after patients in a way that minimises risk and harm. Yet, the plan also promises to admit people who require hospital admission within six hours of registering at the emergency department.
Can the other 53,000 or so treatments be offered in the community? While the HSE signals that alternative community-based services will be provided, patients could be forgiven for questioning whether they will materialise. The provision of alternative services will happen only if the HSE transformation programme, designed to redeploy existing staff to community care, is implemented. However, public service unions, still smarting from the collapse of pre-budget talks with Government, have said they will oppose any changes in work practices identified in last month’s negotiations. Indeed, Impact has confirmed industrial action in the health service will begin on Monday week, with a ban on overtime and a work-to-rule. Even if significant redeployment could be achieved in the short term, the suitability of providing many of the “missing” hospital treatments in a community setting must be questioned.
Mary Harney has 21 days from the date the HSE plan is sent to her office to accept it or seek amendments. The focus on cutting services to patients is disappointing. While it would be naïve to expect services to escape entirely in the current economic climate, the Minister must ask the HSE board if it has exhausted all other avenues of expenditure reduction. It would be easy for a poorly-managed health service to repeat the draconian cuts in patient care of the 1980s. The lesson from this era is that the old and disadvantaged suffer most when such reductions are introduced. We cannot afford the indiscriminate cuts of the past.