Uncertainty on how services will be funded in 2015

Senior managers in the health services are facing into 2015 in a cloud of uncertainty regarding their budgets, whether they will be able to maintain services this year at 2014 levels and how they are expected to fund the Minister’s priorities.  Maureen Browne reports.

Maureen Browne
Maureen Browne

Senior managers in the health services are facing into 2015 in a cloud of uncertainty regarding their budgets, whether they will be able to maintain services this year at 2014 levels, how to deal with electives cancelled during the recent ED crisis and how they are expected to fund the Minister’s priorities for reducing the number of delayed discharges, the length of time patients wait in Emergency Departments for admission and lengthening waiting lists.

As we approach the second month of the year the majority of hospitals have still not received either their budgets for 2015 or indicative figures as to what their spend might be.

While managers agree that these targets are necessary they query how they are to be achieved without substantial additional funding.

An exacerbating factor in the delay in informing hospitals of their budgets this year is the fact that for the first time ever they have to go through the new Hospital Groups which receive the total allocation for the hospitals in their networks and then have to allocate them individually. This is already being criticised by managers who say the networks should have got their budgets earlier so that they would be in a position to give hospitals their allocation at the beginning of the year.

The new Community Health Organisations are also facing major challenges in coping with the establishment of the new areas, the structural changes involved and the projected transfer of a significant amount of healthcare to the community. At this stage they are scarcely up and running and facing high pressure demands.

The best most of the acute hospitals been able to do is to get an indication that they should go with last year’s budget, with the removal of “once off” funding.

“However, this is extremely unsatisfactory, not to say confusing as the 2014 budgets were proved to be totally inadequate and had to be supplemented at the end of the year,” said one manager.

“On top of this we have to factor in demographic changes which will inevitably lead to increased demand on our services, the rising cost of medicines, particularly those for haematology/oncology and the underlying very real costs that resulted in the 2014 budget overshoots and which we still have to fund in 2015. And this is all before we look at the Minister’s priorities for increased activity.”

Health Minister Dr. Leo Varadkar has said that his priorities for 2015 include reducing the number of patients on trolleys in EDs waiting for admission for over nine hours by one third to less than 70, reducing the number of patients with delayed discharges by one third to less than 500 and developing and implementing a plan to address waiting lists with a focus on very long waiters so that by mid 2015 nobody will wait longer than 18 months for in-patient and daycase treatment or an outpatient appointment, with a further reduction to no longer than 15 months by the end of the year.

We need an actuarial review of the superannuation arrangements on an equitable basis so that there is proper funding in place.

While managers agree that these targets are necessary and they would like to see them exceeded on behalf of their patients, they query how they are to be achieved without substantial additional funding.

“We really want to work to these targets but we are at the pin of our collar to try and fund our existing service at the 2014 level. We exceeded our budget last year and we will need to get that additional funding this year just to maintain services. In addition, we are facing huge increased costs in the area of haematology/oncology treatments and other new and very expensive drugs which are coming on the market. These are vital for our patients but the only way we can fund them at present is if we take the money from services, which would be unequally unjust,” said a manager.

While the Minister says he does not have precise figures for the number of electives cancelled during the ED crisis he says that it would be in the region of “a couple of thousand.” Dr. Varadkar says that wards which would normally be closed might be kept open during the summer to facilitate these additional treatments. This will obviously again require considerable additional funding.

In addition to trying to cope with increased demand for services, some of the major underlying reasons why hospitals exceeded their budgets last year were inaccurate calculations by the authorities on projected Haddington Road savings and the massive costs of funding retirement packages for those who took early exit packages.

In the voluntary hospitals these retirement costs have to be funded from revenue which has been an enormous drain on their resources in the last few years.

“When people took early retirement we had to fund both their once off lump sum payment of once and a half times salary plus their pensions. This meant that in the year they retired we had to pay out twice what it would have cost us if they had continued working. Then in subsequent years we have to fund pensions for a vastly increased number of people and in addition with increased life expectancy we are now liable to pay pensions for much longer time. The theory is that the money we take in from the 6.5 per cent superannuation payment by staff should fund our pension scheme. However the reality is the number of our pensioners has increased significantly while the number of staff has decreased, with a consequent decrease in their payments. Then of course we will not be getting any superannuation payments from new staff, as under the new consolidated scheme this money has to be reimbursed directly to the Department of Public Expenditure and Reform, a manager told Health Manager.

“We need an actuarial review of the superannuation arrangements on an equitable basis so that there is proper funding in place either through ourselves or through an individual agency which will deal with superannuation. We just cannot continue to fund it out of revenue. No HSE hospital carries a superannuation deficit.

There is also concern about the funding of the Fair Deal scheme and if the €25 million provided for in the 2015 budget will be sufficient to enable delayed discharges to be moved to nursing homes and cope with the demand from elderly people still living at home.

Then there is the problem of capacity, with many of the older state homes in serious need of refurbishment. Unless money for this is provided in the capital programme, it is difficult to see how this is going to work. In Dublin, much will depend on the role of Mount Carmel when it is reopened as a community hospital.