Little clarity on HSE spending for 2013

The 2013 HSE Service Plan is so deluged with figures for gross spending, net spending, over-runs, savings required, unavoidable budget pressures, reductions, risks and caveats that it is difficult for ordinary mortals to work out exactly how much money will be available to the different services, writes Maureen Browne.

The HSE Service Plan for 2013 is a model of opacity, a high level document, with little clarity as to how much money will be available to the different providers this year.

Maureen Browne
Maureen Browne

It is so deluged with figures for gross spending, net spending, over-runs, savings required, unavoidable budget pressures, reductions, risks and caveats that it is difficult for ordinary mortals to work out exactly how much money will be available to the different services.

Where there are increases, many of these would appear to be wiped out by savings required simultaneously and, in some cases, even where spending is  held at last year’s level, this is also dependent on savings being made.

One major caveat states that “one of the key risks facing the HSE in 2013 is that much of the additional spend including the funding of the incoming deficits is dependent on the achievement of savings.” It warns that “there is a risk if the savings are not achieved and the new costs are incurred there will be a growing deficit.”  Other potential risks to delivery of the service plan include dealing with demand for services beyond planned level, ability to afford staffing levels and delivery of regulations and legislation to support the planned savings.

The service plan states that budget holders will be “empowered to identify and respond to financial issues as they arise thereby reducing the likelihood of a financial crisis in the latter part of the year”.  There is however no information on how this will be done.

What is clear plan is that the gross voted Estimate for the HSE for 2013 is 13.404 billion, which is a reduction of €3.3 billion or 22 per cent on the 2008 figure.

The Service Plan says this reflects a net increase of €71.5 million or 0.54 per cent.  It says this net increase includes new spending and unavoidable pressures of €748 million and savings of €721 million.

Well, it seems to me that it depends on how you look at it.

It is projected that there will be a further reduction of 4,000 staff through projected normal retirements/departures of 1,500 and a further 2,400 WTEs through a targeted voluntary redundancy programme.

Since the HSE received a total of €13.677 billion last year (an initial allocation of €13.317 billion plus a supplementary budget of €360 million) it would appear that what is involved this year is actually a reduction of €273 million.

Community services will generally be maintained at 2012 activity levels, although in view of the fact that last year’s levels were extremely inadequate and in view of the projected increased demand, this will of course represent a cutback.  Statutory community services will be allocated a budget of €4.355 million and voluntary community services €42 million

The Primary Care Reimbursement Scheme faces a cost reduction of €383 million. An additional 100,000 medical cards and an additional 130,000 GP Visit cards are to be provided but 40,000 medical cards are expected to be lost as a result of eligibility changes. The HSE expects to save €25 million from delisting products from the GMS scheme, €10 million on high tech drugs and a further €10 million from what is described as “probity measures on medical cards.”

There will be 22,761 Fair Deal residential care places funded and it is anticipated that a waiting list for the scheme will develop during the year.

On the acute hospital side it envisaged that funding will be increased by 3.5 per cent. Hospitals are starting the year with a projected deficit of €271 million, which presumably will swallow up much of that. In addition hospitals are expected to collect €31 million from expected legislation to charge all private patients in public hospitals – legislation promised and not delivered in 2012.

The HSE Plan says that for the first time allocations to voluntary providers will be based on 2012 outcomes.  There will be financial penalties for hospitals which breach their budgets and voluntary providers will have to cap their overdrafts at €152 million. The HSE says it will move to a “money follows the patient” approach on a shadow basis in 2013 and will commence funding on this basis next year.

There will be financial penalties for hospitals which breach their budgets and voluntary providers will have to cap their overdrafts at €152 million.

Hospitals will receive a total of €2.41 million and voluntary hospitals will receive a total of €1.707 million, including projected income of €554 million. The Service Plan says that funding is being provided for 600,887 in patient activity and 830,165 day cases.

A further €35 million is being provided for the mental health services and an extra €17 million for the increased cost of cancer drugs. Funding is being provided for the roll out of the colorectal cancer screening programme and the diabetic retinopathy screening programme.

There will be a €20 million investment in primary care services to support the recruitment of prioritised front line PCT posts and to further develop community intervention teams.

Employment levels in the health services are to be brought down to 98,995 by the end of 2013.  Since 2009, there has been a reduction of over 10,000 WTEs. This year it is projected that there will be a further reduction of 4,000 staff through projected normal retirements/departures of 1,500 and  a further 2,400 WTEs through a targeted voluntary redundancy programme to be implemented in a way that will protect frontline services. Absenteeism rates are to be reduced to 3.5 per cent.

More than 470 mental health staff and more than 260 primary care posts are being created.

The Plan contains a number of treatment targets:

No adult will wait more than eight months for an inpatient or day case elective procedure.

No child will wait more than 20 weeks for an elective procedure.

Nobody will wait longer than 52 weeks for an OPD appointment (at the end of November last there were approximately 115,000 people waiting more than 12 months).

Nobody will wait more than 13 weeks following a referral for a routine colonoscopy or OGD.

Seventy five per cent of elective inpatients will have their principal procedure conducted on the day of admission.

Eighty five per cent of elective surgical patients will have their principle procedure conducted on the day of admission.

Ninety five per cent of attendees at EDs will be discharged or admitted within six hours of registration.

Speaking on the service plan, Health Minister, Dr. James Reilly has stated that he would like to move towards a different pattern of working. He said that at present consultants were seeing some patients who could be seen by GPs, GPs were seeing some patients who could be seen by nurses and nurses were seeing some patients who could be seen by health care assistants.

Legislation for free GP care for people with specific illness is to be introduced in the first quarter of this year.