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Time to tell the Troika where to get off?
[ by Niall Hunter, Editor www.irishhealth.com]
Many years ago we were reminded during an election campaign that health cuts hit the old, the sick and the disabled.
This may seem like an obvious statement, but it's something that appears to be lost on the Troika when it complains about the HSE's mounting deficit.
The 'optics' of the newly-announced €130 million in cutbacks are that our banks get bailed out, some people continue to be paid very nicely indeed while the poor and the sick get clobbered.
And with more cuts on the horizon in 2013 and even a senior HSE official questioning the sustainability of further budget reductions, it's beginning to get very scary out there for those who must rely on our public health service.
Make no mistake, despite assurances given by the HSE about minimising the impact of cuts, the latest measures are a direct attack on the most vulnerable in our society.
These are, lest we forget, the elderly, the disabled and those on low incomes depending on the medical card scheme and public hospital services.
The cuts to home help hours, home care packages and personal assistant hours to support disabled people will adversely affect the quality of life of many depending on these services.
Not only that, but they will have a knock-on effect on under-pressure hospital services.
Fewer home care packages means elderly people cannot be discharged to these packages from hospital beds, thereby reducing the number of beds available.
People with serious conditions and disabilities could end up in hospital as a result of cuts in vital supports, campaign groups have warned.
So much for Health Minister James Reilly's plan to provide more care for those who need it close to their homes in the community.
The latest cuts only serve to confirm what we suspected already. That much of the talk about more care in the community is just that - talk and nothing else.
The new cuts also mean that hard-pressed hospitals will have to close beds and theatres to cope with the reduction in agency staff spend and overtime.
Hiring agency staff and paying people to do overtime is not a luxury in the health service. It exists to fill service and staff gaps caused by the spending cuts of recent years, including what is now a ban on practically all recruitment.
It should be remebered that there are 10,000 fewer staff in the health service than there were four to five years ago.
The recruitment freeze is a blunt instrument, hitting admin and frontline staff equally and hitting hospitals with high and relatively low workloads with equal force.
Medical card patients will no longer get the anti-obesity drug Orlistat, omega-3-triglycerides taken to protect against heart disease or the nutritional supplement glucosamine free of charge.
The HSE says there were some doubts about the effectiveness of these products and it had to save on drug costs somewhere. But you have to ask why private patients should continue to have the choice of accessing these products while medical card patients are now denied this choice.
It's yet another depressing sign of our 'rich man, poor man' health service.
The latest round of cuts is a direct result of poor service planningand bad financial management.
The HSE's funding and service plan at the start of this year did not seem to take into account that the demand for hospital services, medical card and other schemes would rise.
A no brainer that one, surely, given our ageing population, the continuing recession and the current initiative to clear hospital waiting lists.
Services were given less money to deal with greater demands. Target activity levels in the plan bore no relation to the realities of healthcare provision.
To make things worse, expected income from private patients in public hospital beds and from drug cost savings through increased generic prescribing did not materialise, as the Government delayed on legislation needed to allow these initiatives to take place.
If they had taken place, perhaps the old, the infirm, the disabled and the poor wouldn't be getting hit quite so hard with health cuts right now.
The service plan also underestimated the likely extent and cost of the 'grace period' retirements earlier this year.
As James Reilly signed off on a service and funding plan that was essentially a work of fiction, and as his department is now in direct control of the HSE board, he must take most of the blame for the current health service funding mess.
The pachyderm in the seomra, however, is that the constant health cuts are no longer sustainable. Even the HSE is admitting this.
You cannot take €2.5 billion off the health budget between 2010 and the end of 2012, and then plan to take perhaps up to €700 off it next year and hope to run anything like a reasonable healthcare system that provides quick and equal access to services.
The HSE has admitted that between 15% and 20% of the budgets of individual hospitals have been lopped off over the past three years.
Notwithstanding hospitals implementing necessary efficiencies to reduce their spending, such large budget reductions ultimately hit patient care.
So perhaps the Government needs to back up the truck a bit on this health cuts fiasco.
Instead of continuing to swing the cutbacks scimitar indiscriminately, the Health Minister should tell the Government to tell the Troika to back off, and agree with it to avoid further damage to the health service by looking elsewhere in Government spending for significant savings.
Health is clearly taking a disproportionate amount of punishment in the austerity plan. The time has come to call a halt to indiscriminate and escalating health cuts.
Yes, we can save some money by looking at areas such as work flexibility, rostering and rates of overtime pay and allowances.
There would be inevitable and depressing industrial relations consequences from such measures. But even if they are implemented on largely moderately paid staff who have already cooperated with flexibility measures, they would not fully address the ongoing health service budget crisis, caused by Troika diktat and financial mismanagement.
If sacrifices are to be made in the pay and conditions area, however, something certainly needs to be done about consultants' pay.
Now obviously, while we are grateful that our consultants are high quality professionals, you can't escape the fact that their current public salaries are a constant theme in the debate about health service spending.
Dealing with this issue, while it would not on its own resolve the funding crisis, would, however, send the right message out to ordinary people who are suffering during these difficult times.
As an interim measure, and as an alternative to the industrial relations process dealing with this issue, the Minister should request consultants to take a voluntary pay cut for their public work for the foreseeable future.
In the present climate, most reasonable people would feel that no consultant should be earning more than €150,000 a year for working in a public hospital.
Such a move too, would boost the public image of consultants as a group.
But if the Government, as is likely, is reluctant to 'flip the bird' to the Troika, and we are to have further major health cuts next year, the Minister and the HSE should come clean at the start of the year about exactly what's in store.
They should plan the savings and income measures properly so we are not left with any major surprises that hit vulnerable people later in the year.
Meanwhile, to paraphrase the new HSE CEO, would the last person to leave the HSE please turn off the lights.
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