An extremely bleak year for the Irish health services

The HSE is being asked to meet an increased demand from an ageing population for more and more expensive services with a budget which has been effectively slashed by over €1 billion and a staff which it plans to cut by a further 3,600 WTEs during the year. Maureen Browne reports.

Dr. James Reilly, T.D.
Dr. James Reilly, T.D.

While an accountancy qualification would be useful in trying to sort out the overall financial implications of the allocations, cuts, deficits, projected income, mandatory savings employment controls and pay and flexibility reductions in the HSE National Service Plan, it is clear that 2014 will be an extremely bleak year for the Irish health services.

The HSE is being asked to meet an increased demand from an ageing population for more and more expensive services with a budget which has been effectively slashed by over €1 billion and a staff which it plans to cut by a further 3,600 WTEs during the year.

At the same time, the National Service Plan contains a plethora of performance indicators and targets which providers are directed to meet with their depleted resources.

The HSE would be required to reduce overall staff numbers by approximately 3,600 WTEs in the course of this Plan.

The Executive has received a total of €13.12 billion to run the health services in 2014, a reduction of €272 million on its 2013 allocation. In addition it will have to find savings of €619 million and €419 million to fund 2013 overruns and the €126 million cost this year of developments introduced last year.

These will include pay and flexibility reductions totalling €268 million, of which the Haddington Road Agreement is expected to deliver €140 million, €20 million will come from what is termed “employment control” and €108 million must be found from “unspecified” pay savings. The National Service Plan says that the delivery of these reductions is a central component of the 2014 Plan and a national assurance process has been put in place to work with service managers to identify and implement measures to deliver the savings.

Additional budget adjustments and cost containment measures of €129 million have also been identified. These include savings in the areas of procurement €30million, shared services €10million, value for money €10 million, hospital reconfiguration €7.5 million, energy efficiency savings €15 million and full delivery of the 2013 cost containment plans of €56.5 million for hospitals.

In addition to the €13.12 billion allocated to the HSE from the Exchequer, the HSE believes it will receive a total of €1.54 billion from other sources.  Of this, the general public is expected to contribute €386 million in hospital charges this year and €124 million in prescription charges, while €524 million will come from staff in the form of pension levy receipts and pension contributions.

This will take place against the backdrop of the health service requirement to reduce its workforce to approximately 98,000 WTEs in 2014. This would mean a net reduction of 2,600 WTEs. Approximately 500 new service development posts will also be provided for under this Plan and this, coupled with the ongoing recruitment process for key front line staff, means that the HSE would be required to reduce overall staff numbers by approximately 3,600 WTEs in the course of this Plan.

The additional savings totalling €619 million required in 2014 will bring the total level of reductions to almost €4 billion over six years.

Since September 2007, the health service staff has been reduced by over 12,500 or around 11%. In order to operate within the staff ceiling, the numbers must reduce by a further 3,600 staff over the next 12 months. The NSP says consideration must be given to assess the exceptional challenges involved in finding appropriate exit mechanism for such a high volume of staff to safely provide the services expected with 3,600 less staff.

Between 2008 and 2013 the health service budget has reduced by €3.3 billion (22 %.) The additional savings totalling €619 million required in 2014 will bring the total level of reductions to almost €4 billion over six years.

There are forty-eight acute hospitals in the Irish public hospitals system with a bed complement of 13,576 (11,513 of which are inpatient and 2,063 of which are day beds/places). A wide range of emergency, diagnostic, treatment and rehabilitation services are provided on these sites. Serving a population of 4.59 million, over 1.4 million people receive either inpatient or day case treatment each year. There are over 1.1 million attendances at 33 adult EDs each year; of these, over 400,000 people are admitted on an emergency basis. Across the 19 maternity units, there are nearly 70,000 births each year

Under the NSP, acute care services will receive a total of €4.303 billion (0.4 per cent up on last year), PCRS will receive €2.433 billion (3.5 per cent down), Primary care €725.6 million (0.2% down), Social Care €3.055.3 billion (0.5% up),  Health & Wellbeing €234.3 million (2.6% up), Mental Health €765.8 million (1% up), Children & Families €536.7 million (0.2 per cent down), Ambulance Services €138.5 million (2.3% up) ,Multicare Group 121.5 million (7.3 per cent up) and “Other” €3.3 million (70.6% down).

A total of €178m in additional funding is being provided for vital service developments including bilateral cochlear implants (€3.2m), additional medical cards (€35m), organ donation and transplant services (€2.92m), medical oncology and haemato-oncology (€3.8m), home care packages to support the discharge of special care babies from hospital (€1.2m), the implementation of recommendations following the Galway maternity reports, (€1.48m), diabetic retinopathy (€4.5m) and continue the roll out of BowelScreen (€2m)

Through Programme for Government commitments, a total of €57m has been provided for GP services for children aged 5 years and under (€37m) and mental health services (€20m).

HSE Director General, Mr. Tony O’Brien admits that it will be very “challenging” to meet demands due to budgetary constraints and says some service priorities and demographic pressures may not be met.  He says his principal focus is to continue to deliver the same level of frontline services with a reduced budget while ensuring that quality and safety is not compromised in any way.