Austerity ends, but not for health service

  • Deborah Condon

2013 started of with the usual gloom we have become accustomed to in recent years, yet ended with Ireland's exit from the bailout and promises that the age of austerity was ending - but not for the health service, unfortunately.

2013 is ending in the same way as 2012, with warnings of severe health cuts next year.

To add to the overall perception of gloom and dysfunction in our health service, 2013 was also dominated by the fallout from the Savita Halappanavar case, concern over cuts to medical cards, and controversial ‘top-up' payments to health agency managers.


Following another bruising Budget in December 2012, the New Year began with hikes in health service fees, protests against the HSE and that familiar old problem - patients on trolleys.

A hike in prescription charges for medical card patients, from 50 cent per item to €1.50, was introduced and nurses and midwives gathered in Dublin's Croke Park to protest against a new HSE initiative aimed at hiring up to 1,000 graduate nurses on a reduced salary.

Meanwhile just 10 days into the New Year, hospital EDs (emergency departments) reported an upsurge in trolley numbers, which was placing huge pressure on the health service.

This month also saw the first report relating to a story which would run and run - the discovery of horse DNA in beef burgers.

And what New Year could be complete without a private health insurance premium hike. This time, it was the turn of VHI, but other insurers would follow suit.


A new report on the Magdalene laundries revealed 'significant' State involvement in these controversial institutions, including direct State financial assistance. Later in the month, the Taoiseach, Enda Kenny, apologised ‘unreservedly' to women incarcerated in them.

The latest statistics from the HSE showed that almost 10,000 patients were waiting more than four years for a hospital outpatient appointment.

Temple Street became the first children's hospital in the State to become an entirely smoke-free campus. However, in other smoking-related news, anti-smoking group, ASH Ireland expressed concern about the high cost of nicotine replacement therapy here compared to the UK and other European countries.


The Health Insurance Authority revealed that some 64,000 people had dropped their private health insurance cover in 2012.

A new study revealed that taking or texting on a mobile phone while driving is as dangerous as drink driving.

Meanwhile figures showed that the number of patients waiting more than nine months for hospital treatment had skyrocketed over the previous two months after falling significantly in 2012. At the end of February 2013, over 2,100 adults and children were waiting over nine months for a procedure compared to just 109 patients in the same period in 2012.

A new survey revealed that people who required prescription medications were being charged different prices depending on which pharmacy they went to. Some pharmacies were found to be charging twice as much as others for the same drugs.

The husband of Savita Halappanavar finally received the report by a HSE-appointed inquiry team into the circumstances surrounding his wife's death. She was 17 weeks pregnant when she died from septicaemia at Galway University Hospital last year, having reportedly been refused a termination.


Praveen Halappanavar would go on to say he was unhappy with the 108-page report, as he felt there were shortcomings in it. The report stated that there was an overemphasis by the hospital on an unviable foetus and an underemphasis on Ms Halappanavar's seriously deteriorating health.

Later in the month, a verdict of medical misadventure was arrived at by the jury in the coroner's inquest into the death in Galway.

In other news, Diabetes Ireland warned that the health service was struggling to cope with the number of people seeking treatment for diabetes. HSE services were becoming ‘simply overwhelmed', the charity said.

Meanwhile the Irish Nurses and Midwives Organisation claimed that in the previous four weeks, over 1,300 patients had been placed on beds or trolleys in hospital inpatient wards when those wards were already considered full.

And Wicklow woman, Marie Fleming, who was in the terminal stages of multiple sclerosis, lost a Supreme Court appeal in which she had been fighting for the right to end her own life with assistance. (She passed away at the end of the year.)


The Government published draft legislation to clarify the legal position on abortion where the mother's life is at risk. The Protection of Life in Pregnancy Bill stated that terminations could occur when there was a real and substantial threat to the mother's life, including the threat of suicide.

Donal Walsh (16), who had battled cancer for four years and who had openly appealed to young people not to take their own lives, passed away in his home in Blennerville in Kerry, surrounded by his parents and sister. He had openly admitted that he was angry with young people who considered suicide as he had been ‘given a timeline' on the rest of his life. He urged people to appreciate what they have and know that ‘there are always other options and help is always there'.

A radical hospital revamp was announced by the Minister for Health, which would see the country's hospitals being organised into six groups, and smaller hospitals having some major services transferred to larger centres.

US actress, Angelina Jolie, admitted to having undergone a double mastectomy earlier in the year after discovering she had an 87% increased risk of developing breast cancer due to the fact that she carries a faulty version of the BRCA1 gene.

A Prime Time documentary caused uproar around the country, due to its disturbing footage of staff mistreating babies and toddlers in three creches. A Breach of Trust showed children being shouted at, cursed at and threatened. Some children were also strapped into chairs for long periods - up to two hours in some cases - with no stimulation. Others were manhandled and held down at naptime.


A new study from Galway found that cutbacks in autism services were leading to increased stress levels among parents.

Meanwhile, for the first time in decades, a case of leprosy was recorded in Ireland.

A new report commissioned by the Irish Cancer Society found that Irish men are at greater risk of getting cancer and dying from it than women.

The Government published the Protection of Life During Pregnancy Bill, which listed 25 hospitals as designated centres for abortions.

The public was finally allowed to see the HSE's report into the death of Savita Halappanavar. It identified inadequate assessment and monitoring, failure to offer all management options and non-adherence to clinical guidelines relating to the prompt and effective management of sepsis on the part of University Hospital Galway (UHG) as the factors that led to the death of Ms Halappanavar in October 2012.


Waiting lists continued to rise, with the latest figures showing that the total number of patients waiting over six months for inpatient and day treatment had jumped by 96% since the end of 2012. Figures also showed that over 91,000 people were waiting for at least 12 months for an outpatient appointment in a public hospital.

Praveen Halappanavar confirmed that he would be suing the HSE for alleged negligence in relation to the death of his wife, Savita, in Galway University Hospital in 2012.

The controversial abortion legislation was passed after 127 TDs voted in favour of it. It was signed into law later in the month by President Michael D. Higgins. A woman now has a right to an abortion if her life is at risk, including if her life is at risk from suicide. Fine Gael's Junior Minister for European Affairs, Lucinda Creighton, voted against the Bill and was immediately expelled from the Fine Gael party. She also resigned from her ministerial post.

Meanwhile, new figures from the UK Department of Health revealed that in 2012, almost 4,000 women who underwent terminations in the UK provided Irish addresses.

The Irish Medical Organisation launched a major campaign to highlight the ‘dangerously long' working hours of junior doctors.

And a new report on mothers returning to work after having a baby found that grandparents were heavily relied on when it came to childminding.


The Irish Medical Organisation (IMO) began balloting junior doctors on industrial action over the ‘dangerously long hours' many of them were working. By the end of the month, the ballot was complete and an all-out strike by the doctors was expected to take place in the coming weeks.

New research revealed that the rate of emergency caesarean sections in Irish mothers was nearly twice that of Eastern European women who were having babies in Ireland. It also found that Irish women giving birth were more likely to be obese, to smoke and to have induced births.

Alcohol Action Ireland expressed serious concern about figures from the Central Statistics Office, which showed that Irish people spent €6.3 billion on alcohol in 2012. At 7.7% of total personal expenditure, this was more than twice what people spent on clothing and footwear in the same year.
In an poll of our readers, 83% of people rated the performance to date of Health Minister, Dr James Reilly, as ‘poor'. Just 3% gave him a ‘good' rating.


The Irish Cancer Society warned that poorer people in Ireland were up to 70% more likely to develop certain types of cancers, such as lung, cervical and stomach cancer. Meanwhile research from the National Cancer Registry of Ireland reveled that rates of the most common types of skin cancer had jumped by up to 39% between 2002 and 2011

Junior doctors announced that they would hold a one-day national strike. This would take place on October 8.

The results of unannounced visits by health officials to various hospitals were released by the Health Information and Quality Authority (HIQA). They identified a number of issues that could present ‘a serious risk to the health and welfare of patients receiving care there', including poor hand hygiene, dusty and dirty equipment and potential access by patients to dangerous chemicals, medication and equipment, such as syringes. These hospitals included Dublin's Beaumont, Merlin Park in Galway and Tullamore Regional.

A new survey found that the biggest health problems experienced by Irish workers were stress, anxiety and fatigue.

New research also reveled that 19% of Irish three-year-olds were overweight and 6% were obese. However a separate report found that almost 17% of young girls are on some kind of diet, including one in 10 girls aged just 10 and 11.


Launching a new tobacco policy, Health Minister, Dr James Reilly, said that he wanted Ireland to be tobacco free by 2025.

The junior doctor strike on October 8 led to widespread disruptions to hospital services, with emergency departments working on a Sunday basis and elective services and clinics being suspended. The dispute was subsequently settled with a promise by the HSE to reduce doctors' hours, although the working hours issue could well flare up again next year.

The HIQA report into the death of Savita Halappanavar found that University Hospital Galway failed to provide the most basic elements of care to her, identifying a number of missed opportunities to intervene in her care and possibly save her life.

That dreaded time of the year was upon us - Budget 2014. As expected, it was announced that children aged five and under would receive free GP care. However the income threshold for qualification for a full medical card for people over 70 was lowered and prescription charges for medical card patients were increased to €2.50 per item.

A pack of cigarettes also increased in price by 10c. A pint of beer or cider also went up by 10c. The Bereavement Grant - a one-off payment to help with the cost of a funeral - was scrapped and Maternity Benefit was also reduced.

Not surprisingly, after the Budget, Minister Reilly warned that 2014 would be a ‘massively challenging year' for the health service.


The chief executives of four of the country's largest hospitals wrote to the HSE Director General warning that cuts in funding and rising demands for patient services, had begun to seriously threaten the quality and safety of patient services. St James's Hospital, the Mater, Tallaght Hospital and Our Lady's Hospital for Sick Children in Crumlin also warned that there had been 'unacceptable delays' in treatment access for some cancer patients.

The Health Minister announced a hike in private health insurance levies payable by insurers. This levy is likely to contribute to further increases in premiums for all customers in 2014.

Junior doctors voted to accept settlement proposals in the dispute over excessive working hours, bringing an end to concerns about further strikes.

The term ‘top-up pay' became very common in the media after it emerged that a number of health agencies, including some hospitals, were providing extra pay to senior management from private sources, in contravention of public service pay guidelines. This issue really exploded at the end of the month when it emerged that the Central Remedial Clinic (CRC) has used money donated to it by the public to top up the salaries of some senior staff.

Meanwhile, a controversy had been raging for some months over an apparent major cull of medical cards. The HSE and Department of Health claimed there had been no changes to policy in granting cards, yet the media, public representatives and patient groups told a different story, with accounts of seriously ill adults and children losing their cards or having them downgraded to GP visit cards. The issue came to a head this month at the Dail Public Accounts Committee.


The CRC story continued to run during December, after a stormy appearance by senior figures from the Clinic before the Dail Public Accounts Committee. The chief executive, Brian Conlan, had already resigned but initially declined to appear before the Committee. Then on Friday the 13th, all members of the board of governors also resigned. The entire episode did serious damage to the charitable sector, with many charities confirming that they were receiving fewer donations as a result.

In other news, a study by Safefood revealed that the amount of sugar found in some brands of cordial and diluted juice drinks was the same as, or higher, than the amount found in fizzy drinks such as Coca-Cola and 7UP.

Meanwhile, the Government confirmed that the HSE would need to be bailed out to the tune of just under €200 million for 2013.

The year staggered to a conclusion with the top-ups controversy rumbling on and the health service facing effective cuts of around €1 billion in 2014. So much for the age of austerity coming to an end!









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