The plan says significant savings must be found from major drivers of spending including free or subsidised medical care and treatment. We will probably have to wait until the Budget or perhaps later to learn which schemes will carry charges in future and when these will be imposed.

Among the schemes that would come under the category of "demand led schemes" targeted for savings next year are the medical card schemes, the long term illness scheme, community welfare services, disability services and the Drug Payment Scheme, in which the State subsidises the drug cost of anyone, regardless of income after they spend more than €120 a month on medicines.

This subsidy threshold will certainly be raised, or perhaps abolished completely, although specific details of schemes that could be ended, of new charges, or abolition of subsidies for some services, are not given in the four-year National Recovery Plan.

Health Minister Mary Harney has referred to "graded benefits" being introduced and more graduated eligibility in relation to many schemes, but this remains to be clarified.

The Minister has indicated that for the time being anyway, there are no plans to tinker with medical card eligibility.

While some of the €444 million savings earmarked for the demand-led schemes may come from drug cost savings, the exact measures to be implemented next year have not yet been specified.

What is certain, however, is that there will be a significant increase in charges for private and semi-private beds in public hospitals, eventually to reflect the full cost of the hospitals providing these beds. This extra cost will be passed on to health insurers and will lead to major hikes in their subscription rates.

Currently, public hospitals charges insurances companies just over €910 per day for a private bed in a public hospital, but this is clearly seen as a largely untapped resource for generating valuable public hospital income.

There are to be further cuts in hospital bed numbers, and has already been happening, and the service is to be reformed "to provide a greater range of services in community settings, particularly through primary care teams and social care networks"

Critics, however say this process to date has not been not working, with beds being closed before adequate community services are put in place.

With further cutbacks to be made, the planned change in focus from inpatient to day care and community care could be "challenging" - a phrase the HSE is using with increasing frequency.

And with HSE staff levels falling back to 2005 figures (and this is largely a good thing in terms of admin staff) the task of maintaining a decent level of service will prove challenging with some staff missing from key services.

The Government plan provides us with the consolation that the staff that remain in the service, or whatever services are left, will work more efficiently and flexibly.

Much of the health reform section of the programme has already been signalled in the Croke Park deal, and few will argue with need for these reforms to be pushed through in order to eliminate waste and inefficiency.

The plan reiterates existing proposals for an extended working day - 8am to 9pm - and an extended working week.

There will be overtime and allowance cuts and staff redeployment where needed.

In another planned reform which many patients will welcome but some doctors probably won't, previous restrictions on entry of fully-trained GPs to the medical card scheme will be lifted.

The move is intended to increase competition and to deal with a shortage of GPs. GPs and other health professionals will also be hit by a further cut in their fees, and newly appointed hospital consultants will be hit by the 10% pay cut on public service entrants.

There is little or no good health news in the programme, despite it being called a "recovery" plan.

View the full four-year plan here

anony  Posted: 26/11/2010 20:41

This four-year-plan puts many patients on 'death row' instead of the recovery room. Frontline services will be severely cut or curtailed due to lack of staffing numbers and resources. Many services which are now staffed by agency nurses etc will have to go as it is unsustainable to maintain services with the cost of agency staff. Fewer beds in the system will mean that there will be longer waiting list, bigger numbers on trolleys and more medical adverse events due to pressure on staff; Fewer admin staff will cause chaos with appointment and record keeping; Staff working more efficiently and flexibly will lead to further pressures causing more problems for patients; more day-case surgery etc wil require more home treatment but the community care is being cut and cannot sope at present and Primary Care system is not working either; treatment at home will also mean a family member taking responsibility for the sick patient at home; etc etc etc - I am very surprised that Mary harney did not think of the obvious solution to all this - have patients treated by 'volunteers' at home, along the roadside, in the supermarket, in a mobile hospital, or wherever. FAS could run courses for unemployed to train as doctors and nurses, these courses to be given by retired/redundant HSE staff and administered by retired/redundant HSE administrators and supervised by retired/redundant HSE senior managers hired as private consultants under contract.

Anonymous  Posted: 30/11/2010 16:11

It;s an absolute disgrace. Defunct banks have swallowed billions which we will never see even a fraction of and will be wound up in weeks while the health service if cut any more will be non-existent. And could people stop describing these services as free they are NOT free. They are paid for several tikem over by our taxes, our PRSI, health levies VAT and health insurance. That is NOT free.

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