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Health cuts - the worst is yet to come
[ by Niall Hunter, Editor www.irishhealth.com]
Following the Government U-turn on disabled personal assistance cuts, it is emerging that further major health cuts are on the way before the end of the year, followed by an unprecedented level of health cuts next year.
Far from being over the worst in terms of health cuts, we may now be entering an era of unprecedented measures which could seriously damage service provision.
As regards this year's cuts, never mind the Armageddon ahead in 2013, the public is still largely in the dark about the true extent of the cuts planned. This year alone, a further €129 million in cuts and savings measures in addition to the €130 million announced last week have yet to be fully revealed.
The past week has seen confusion, poor communication, anger and U-turns on health cuts, with both Health Minister James Reilly and the HSE doing a poor job in terms of explaining and coordinating the planning of the savings measures.
The confusion continues following the Minister's latest comments on the Prime Time programme.
To recap, the HSE announced cuts of €130 million last Thursday, largely hitting low income and vulnerable groups, at an 'off the record' briefing for journalists that was not attended by HSE CEO Tony O'Brien or Health Minister James Reilly.
Following the announcement, Mr O'Brien indicated the following day that while the Minister was aware of the extent of cuts necessary, the final detail of where the axe was to fall was decided on by the HSE.
He said the selection and analysis of areas where the cuts were to be made had been a matter for the management of the HSE.
Mr O'Brien told told reporters that one of the reasons he did not attend the cuts announcement was that he had been preparing for an address to a major conference at TCD the following day on implementation science.
Health Minister James Reilly, having been accused of 'going missing' was 'doorstepped' by the media last Friday.
His tack appeared to be: 'if you think these cuts are bad, you ain't seen nothing yet.'
Dr Reilly indicated that the €700 million in savings needed next year may not be achievable without a renegotiation of the Croke Park Agreement, to provide for cut to areas such as premium staff pay and allowances.
Then, after public furore and political tensions festered over the weekend on the planned cuts to personal assistant hours, home help hours and home care packages, the HSE was instructed on Tuesday to reverse the personal assistant cuts and look for saving elsewhere in the disability sector.
Why it couldn't have done this in he first place was anybody's guess.
Following the cuts announcement last Thursday, it also emerged that the HSE had failed to mention that as part of these measures, in addition to cutting three free treatment products from the medical card other and State reimbursement schemes, it was also removing gluten-free products from these schemes.
The cutbacks farce looks set to run and run, with the Minister now dentying he madfe a U-turn on the personal assistant disabilty cuts, while implying that he had no say in the plans and rejected them just after the HSE announced them.
So the Minister appears to be saying that he didn't make a U-turn because he had no say in the HSE's initial plan to cut personal assistant hours for the disabled - although to be honest, precisely what the Minister is saying and the HSE is doing at this stage is very unclear.
The confusion has been added to by the Minister indicating that he also feels the planned home help cuts are unacceptable.
All this confusion is worrying enough, but the €130 million in cuts announced so far are only part of the picture.
The HSE needs to find a further €129 million in savings measures before the end of the year. At the announcement last week, it was indicated that this shortfall would be made up through measures such as getting quicker payments from health insurers for private treatment in public hospitals and by using surplus cash from the National Treatment Purchase Fund.
This is far from the full extent of these measures, however, and Minister Reilly is expected to announce further details soon.
It is now emerging that funding already allocated to expanding mental health and primary care teams may be deferred in order to make the necessary savings.
These were key policy initiatives spearheaded by junior health ministers, Labour's Kathleen Lynch and Roisin Shortall, so the political repercussions from this move remain to be seen. Again, a cut in these initiatives will affect lower income groups and the vulnerable.
In addition, questions will also be asked as to why this funding, which was announced early in the year, had not yet been spent.
Similar questions will be asked as to why there are surplus funds available from the NTPF, which, with the Minister's Special Delivery Unit, is tasked with cutting waiting lists and ED trolley waits.
This year, €40 million had been allocated to cut treatment waiting lists, a further €10.5 million was allocated to cut trolley waits, and a further €5.5 million was earmarked to deal with outpatient lists.
Will the limited progress that has been made to date in these areas now be stymied by a cut in waiting list initiative funding?
The HSE has said any treatment commitments entered into with waiting list patients to date will be honoured. However, questions will be asked as to why surplus funding exists, and if diverting this funding to the deficit will lead to an increase again in waiting lists.
The 'elephant in the room' of course, which Dr Reilly alluded to, is where exactly the Government is going to get the €700 million or more in savings which will probably be demanded under Troika diktat next year.
The Minister has said it may be impossible to deal with such a cut without revisiting the Croke Park agreement and stepping on the hallowed ground of allowances, premium pay, increments, overtime rates and other hot potatoes such as consultant pay.
However, even if that mountain was climbed and some progress was made on cutting back on these pay areas, it is still difficult to see how the level of savings required to meet the €700 million plus target will be achieved in 2013.
Some of the savings could be met if Dr Reilly finally got around to implementing long-delayed plan to increase generic prescribing and to charge private patients for occupying public hospital beds.
But such is the size of the savings target for next year, it is difficult to see how these measures plus any public service pay measures would meet help meet it without the Government having to seriously cut service delivery as well.
So in 2013, we can expect further curtailments to hospital and other care services, plus hidden surprises like cutbacks in medical cards.
Meanwhile, as hospitals try to cope with the planned cuts to agency staff and overtime spend, more bed and theatre closures are expected to be announced in the coming days and weeks.
So, four years after the start of austerity, nearly two years after the Troika stepped in, and 18 months after we elected a new Government to set things right, the worst may well be still to come for our unfortunate health service.
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