Re-balanced hospital budgets

HSE allocations to voluntary hospitals have been particularly controversial this year, following the HSE decision to “re-balance” hospital budgets, writes Maureen Browne.

HSE allocations to voluntary hospitals have been particularly controversial this year, following the HSE decision to “re-balance” hospital budgets, rather than continuing to fund the hospitals on a largely historical basis.

The move away from “historic budgeting”, which resulted in some hospitals being forced into the red each year by budgets which had been clearly shown to be unworkable over many years has been generally welcomed. However, the way it appears to have been carried out has resulted in allegations of unfairness by some hospitals which “lost out”.  Even not all the so-called “winners” are happy, with some saying that while the re-balancing is an excellent idea in principle, it should have gone further and taken historic deficits into account.

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There is also general annoyance at the lack of information provided to the hospitals, with many managers saying they were well into their normal budget planning when they discovered the new system was on the way.

While the principles on which the re-balancing was carried out are not known, it appears in many cases to have been based on the 2012 outturn, minus three per cent.

This has led to complaints that some hospitals were being rewarded although they had run up deficits in 2012.

The HSE regional plans for its four administrative areas outline details of €721 savings for 2013, which were signalled earlier this year in the HSE national service plan. Despite the cuts, the HSE said extra beds would be opened in some hospitals.

In Dublin Mid-Leinster, some hospitals are facing substantial cuts, with Naas General, St. Vincent’s and Loughlinstown Hospitals both just under 5% down on their spending for last year, and Tallaght Hospital down 4.2%. The service plan for Dublin North-East shows funding this year will be cut by 3.5% for acute hospitals

Mallow Hospital’s emergency department is to close shortly and Bantry Hospital’s ED will be replaced by an urgent care centre with emergency surgery moving to Cork University Hospital. Mallow and Bantry hospitals will continue to provide services that “are appropriate for the hospitals and for the local population, delivering non-complex care as close as possible to patients’ home”, according to the HSE.

In the south east, implementation of the national clinical programmes will allow for the opening up of additional beds in Wexford, Kilkenny and South Tipperary, with Waterford set to gain new consultant posts in areas such as emergency medicine, dermatology and acute medicine.

In mental health, 102 acute inpatient beds will be closed, although inpatient services for children and adolescents are being increased.

Among the capital projects due to be completed this year are a 44-bed psychiatric unit at Beaumont Hospital and accommodation for 54 residents at Grangegorman.

Some €383 million is to be cut from the budget for community schemes such as medical cards.

The following are the 2013 allocations:

  • The Children’s University Hospital, Temple Street, Dublin, €76.688m
  • The Adelaide & Meath Hospital, incorporating the NCH, Tallaght, Dublin, €173.851m
  • Coombe Women and Infants University Hospital, Dublin, €47.564
  • Our Lady’s Children’s Hospital, Crumlin, Dublin, €117.310m
  • St James’s Hospital, Dublin, €299.890m
  • St Vincent’s University Hospital, Dublin, €193.463m
  • St Michael’s Hospital, Dun Laoghaire, €24.600m
  • National Maternity Hospital, Holles Street, Dublin, €44.235m
  • Royal Victoria Eye & Ear Hospital, Dublin, €19.786m
  • National Rehabilitation Hospital, Dublin, €24.224m
  • Dublin Dental School and Hospital €5.790m
  • Leopardstown Park Hospital, Dublin €3.676m
  • The Royal Hospital Donnybrook, Dublin, €12.753m
  • Our Lady’s Hospice & Care Services, Dublin, €22.419m
  • St John of God Hospital, Dublin €81.534m
  • Peamount Hospital, Dublin, €21.043m
  • Stewarts, Dublin, €41.238m
  • St Columcille’s General Hospital, Loughlinstown, Co. Dublin, €37.435m
  • Naas General Hospital €54.479m
  • Midlands Regional Hospital Mullingar, €56.547m
  • Midlands Regional Hospital Tullamore, € 80.944m
  • Midlands Regional Hospital Portlaoise, €45.234m
  • Beaumont Hospital, Dublin €238.14 million
  • Cavan/Monaghan Hospital Group €81.27m
  • Connolly Hospital, Dublin €84.72m
  • Mater Hospital, Dublin €209.6m
  • Cork University Hospital Group (inc MGH & CUMH), €269.281m
  • Bantry General Hospital €16.966m
  • Mercy University Hospital, Cork, €55.421m
  • South Infirmary Victoria University Hospital, Cork, €43.905m
  • Kerry General Hospital, €68.097m
  • Waterford Regional Hospital, 132.939m
  • Wexford General Hospital €47.792m
  • St. Luke’s General Hospital (incl. Kilcreene Hospital) €54.875m
  • South Tipperary Hospital €45.532