Hospital Managers Fear Budgets Inadequate

Many senior hospital managers are concerned about their ability to deliver timely services for patients this year within the allocations which they have received from the HSE, writes Maureen Browne.

The seven Hospital Groups have received a total net allocation of €4,443,644,019 to run their services this year.   This compares to their 2016 net allocation of €4,352,349.

Three of the hospital groups – the South/South West Group, the RCSI Group and the UL Group – had their net allocations reduced this year compared to last year

In addition to their activity based funding, which constituted the major portion of their allocations, hospitals groups received €62,438,226 in block funding.

They are generally concerned that with the reduction in the numbers using private health insurance they will be unable to meet their income targets – totalling over €1 billion

They are expected to raise over €1 billion in income during the year which means their total spending for the year should be €5,478,981,903.

Managers point out that this increase – which is just shy of €93 million on 2016 – is expected to cover the increased demand for services for the year, new services due to be introduced in 2017, the increased costs of drugs and other clinical non pay costs and hospitals’ 2016 overruns.

It will also have to meet full year costs of ED nurses, additional costs this year for 2016 developments, inflation related price increases and costs deferred in 2016 to achieve financial outturns.

Managers also say they will be unable to replace outdated equipment and they are generally concerned that with the reduction in the numbers using private health insurance they will be unable to meet their income targets – totalling over €1 billion – stipulated by the HSE as part of their overall allocation.

There is widespread anxiety that service demand this year may go well beyond what has been planned and funded by the HSE

There is widespread anxiety that service demand this year may go well beyond what has been planned and funded by the HSE.

Managers point out that chronic diseases are on the rise which, fuelled by the shortage of GPs in some areas, will place increased demands on hospitals which will be challenging for all hospitals, and particularly so for those trying to maintain and increase tertiary services.

Some groups and hospitals have a large number of national specialist services, complex critical care and cancer centres.

A number of managers are also concerned about maintaining safe staffing levels with the current difficulties in recruiting and retaining staff in an environment where a number of hospitals are increasingly dependent on locum and agency staff.

They also point out that insurers have advised of the intention to reduce the two week grace period to allow patients to be accommodated in a nursing home to one week. This change will have an income impact on hospitals, particularly where there are delayed discharges

There is also concern about managing within the limitations of our clinical business information, financial and HR systems to support an information driven health service

Under activity based funding and almost €62.5 million in block grants, the seven hospital groups have received almost €4.5 billion between them to provide services for 2017. This is the second year when they have been funded on an activity based funding basis.

The HSE expects them to generate income of over €1 billion during the year, which would bring their total available for spending for the year to almost €5.5 billion.

The Ireland East Hospital Group has received an allocation of €873,041,733 from the HSE (compared to €872,694 for 2016) and is expected to rise over €216 million, bringing its total spending for 2017 to €1,089,102,886.

The Dublin Midlands Hospital Group has been allocated €826,521,407 by the HSE (it received €815,209,000 in 2016) with a target income of €212,646,783, bringing its total spending to €1,039,168,190.

The South/South West Group has received €746,817,078 from the HSE (it received €747,154,000 last year) with an income target of €193,409,767, which brings its total available money for the year to €940,226,845.

Saolta Healthcare has received €710,451,287 from the HSE (in 2016 it received €704,288,000) and is expected to raise €109,769,831 to bring its total income for 2017 to €820,221,118.

The HSE has given the RCSI Group €681,279,184 (last year it received €681,763,000) and an income target of €156,579,543, to bring its total spending for the year to €837,858,727.

The UL Group receives €277,730,651 from the HSE (in 2016 it received €279,540,000) with an income target of €77,991,053, to bring its total money for the year to €355,721,704.

The Children’s Hospital Group receives €265,364,454 (it received €251,701,000 last year) and is expected to raise €50,879,754 which would bring its available money for the year to €316,244,208.