HSE planning for a grim future

  • Niall Hunter, Editor

The yearly publication of the HSE's service plan arrives with us around Christmas amid much media hoopla.

It invariably comes filled with sometimes wildly hopeful service targets and budgetary projections, couched in accountancy sleight of hand, infuriating vagueness and impenetrability, tinged with bromides about patient safety and service quality.

It's the type of health service presentation that cries out for Plain English tuition.

The media and the public will now go on a treasure hunt to find out where the cutbacks will really fall, while waiting for more detailed regional or local service plans.

The statement made at the launch of the 2014 HSE Service plan this week by HSE chief Tony O'Brien is not untypical of the service plan process - he said the targeted savings of €619 million next year (not €666m? What a relief!) coupled with a carry-over deficit of €419 million from this year did not in fact represent over €1 billion in cuts/savings in 2014.

No, they represented a 'challenge' of €1 billion for next year. He said the figure also represented a 'swing', but many present at the launch (ok, just me) didn't really understand this terminology.

Whether it's a cutback, or a saving, or a challenge, it's definitely not good news. And anyway, whatever happened to all this end of austerity talk ?

The service plan's deathless prose informs us that 2014, (like 2013, 2012, 2011 and all those bad years in the 1980s) 'will be one of the most financially challenging yet faced by the health service'.

A key figure in the service plan is €3.92 billion - the amount that by the end of 2014, will have been removed from the health budget since 2008.

Can any health system that has had over one-fifth of its budget unceremoniously taken away in a relatively short period hope to guarantee anything but a service that can only hope, rather than plan, not to cause unintended harm?

The service plan refers to its overarching aim to protect core services and patient safety. Many will feel that this is a meaningless mantra, especially after the dire warning by some hospital CEOs in recent weeks about the cumulative effect of continuing cutbacks.

And the HSE very appositely points out in its 2014 plan that it has less and less money to cope with factors it cannot control, including growing population, greater numbers of older people, continuing high unemployment, and an increase in chronic diseases.

These factors all lead to an increase in demand for services, especially hospital services, which by the way must make do with up to €250 million less next year, due mainly to a carry-over deficit from 2013.

This year, we saw waiting lists increase as cash-strapped hospitals tried vainly to cope with greater patient demands due to a longer than usual winter- we could have more of the same next year. And despite all the talk of reform, we have seen no movement on the promise to take pressure off hospitals by transferring a good deal of their services over to primary care.

While the service plan, with its targets and projections, might look like a business plan, healthcare, especially resource-starved healthcare, cannot always be run on business lines, due to its unpredictability if nothing else.

The service plan does contain some good news, such as money for the free GP care plan for under sixes, although some would doubt the widsom of such an investment when the money could perhaps be more usefully used to plug holes elsewhere or to give some seriously ill people back the medical cards they lost this year.

A patient safety agency might be good news, and had been flagged for some time. However, you can have as many safety agencies as you like, but safety surely cannot be guaranteed in a system that has been so emasculated financially in recent years.

So amid all the positivity about protecting service provision and quality despite the slings and arrows of the Troika, what we can glean from the service plan includes:

* More people will see their medical cards removed or downgraded next year. The HSE will claim this is a fair process based on financial probity, but the chronically ill elderly and disabled dependent on these cards may disagree.

* Hospital activity levels will be affected. While there may be a cut in waiting lists at the turn of the year, cuts in funding and rising demands may see these lists creep up again.

* Population health will be hit by the shelving of a plan to extent BreastCheck to older women.

* There will be cuts in real terms to home care packages and home help hours, although there is to be a new intensified home care package initiative intended to reduce 'bed-blocking' patient numbers in acute hospitals.

* Services will suffer through the loss of a further 3,600 wholetime equivalent staff.

* 'Unspecified pay savings' of €108 million sounds ominous.

* No downward change to current waiting list maximum wait targets of eight months for procedures and 12 months for outpatients in 2014.

* A likely repeat in 2014 of the failure to achieve emergency department patients waiting time targets nationally, as seen in 2013.

* Some more emergency departments may close as a result of reconfiguration plans.

And finally, a cheap shot that illustrates perhaps the innate pointlessness in much of these service plans.

Under a list of performance targets for 2014, the HSE promises to strive to attain the 'national average or lower' in terms of the normally-accepted rate of mortality in hospitals.

In other words, the HSE is promising that its hospitals won't kill an excessive amount of patients next year.

A laudable aim, but it's probably best not to put that in your mission statement.

€1bn in targeted cuts/savings

Service will struggle to meet demands-HSE


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