News stories about the Irish hospital system

Unprecedented health service cuts

Unprecedented health service cuts including bed closures in the acute and elderly sectors and reductions in community services will result from a massive €750 million slashing of the HSE's budget for this year.

This follows cuts of €1.75 billion over the past two years.

HSE CEO Cathal Magee, speaking at the launch of the executive's 2012 service plan today, warned that it will be a very challenging year for health and social care services and there would be significant challenges for the acute hospital system.

The service plan warns that frontline care will be impacted directly to a greater level than ever before. Over the past two years, it says, savings largely did not directly impact frontline care as they were mostly achieved through pay and fee cuts, drug cost reductions, procurement savings, and increased charges.

However, this year, the service plan indicates, the scope for further efficiencies in these areas is limited and the plan says the savings will impact increasingly directly on frontline care. It says much efficiency has already been delivered and it is not possible to protect services from cuts in 2012.

The situation will be worsened by the fact that an additional 3,300 staff are quitting the service to avail of the ending of favourable tax status on severance payments. Already, staff levels have reduced by over 8,700 since 2007.

More than half of the 3,300 additional staff due to retire before March are medical and nursing staff. Mr Magee said as 85% of the staff due to leave were frontline delivery staff, this made the service plan quite challenging.

The HSE says while it will be impossible to avoid impact on frontline care this year, reform plans aimed at delivering care more efficiently and in alternative settings to hospitals must be accelerated.

It says there is a need, through the national clinical programmes, to move to models of care which treat patients at the lowest level of complexity and at least cost, such as in primary rather than hospital care.

However, progress on implementing these alternative and more streamlined care programmes has been slow, and the programmes are only this year receiving funding of €24 million they were due to receive last year.

Acute hospitals alone face a reduction of 7.8% in their budgets this year, including the carry-over from deficits run up last year. Mr Magee said 6% of this cut had a service delivery impact.

The service plan says hospital bed capacity must be reduced in line with the cut in funding but increased efficiencies through efficiencies under the national clinical programmes should ensure that as many patients as possible will be seen.

Therefore, the HSE said it expected to be able to limit the reductions in hospital activity to an average of 3%. However, it says western hospitals will be particularly challenged to deliver services within their budgets, given the level of deficit they have carried over from last year.

The HSE said the will be an increase in its income collection target for hospitals and other agencies of €143 million, which would be very challenging to implement.

The HSE expects 100,000 additional people to be granted medical cards this year.

Planned health cutbacks this year will include:

* Reductions in hospital services including bed closures. However, the HSE says increased efficiencies should limit the reduction in hospital activity.

* The HSE has warned that the Fair Deal nursing home support scheme is a cash limited scheme and the funding available may not be adequate to meet demand. There will be a 2.3% reduction in funding for elderly care services other than Fair Deal.

* The planned national bowel cancer screening programme, due to start in January 2012, has been delayed until October at least due to funding difficulties.

* 555 public beds for elderly care in community nursing units will close this year. A small number of these units will be closed completely.

* There will be a reduction of 4.5% nationally in the level of home help hours. No increase in home care packages.

* Reductions in day services, residential and respite services in the disability sector.

* Further reductions in spending on agency staff.

The HSE says the target this year is to have nobody waiting more than nine months for planned hospital procedures and a nine-hour target has been set for admission or discharge once a patent comes into an emergency department.

Hospitals, are likely, however, to find it difficult to meet these targets given the level of funding cuts.

There is little in the way of good news in the service plan.

However, it is confirmed that the plan to give long-term illness patients free GP care will go ahead. They will receive GP visit cards late this year - they already receive free drugs.

There will be an investment of €35 million in mental health and an additional 400 staff in line with 'Vision for Change'.

There will be an additional €20 million given to primary care, including GP care, which is supposed to be resourced properly to take the pressure off hospital services. However, the HSE admitted that this sum is to be spent merely on replacing posts that are already vacant.

An additional €5 million is to be spent if it can be established that there is scope for further savings at this level in demand-led schemes.

The plan makes provision for the development of the new children's hospital, but cost estimates have yet to be agreed with the Department of Health.

The HSE said the cut of 555 elderly care beds was due to staff reductions, the need to reduce agency staff spend, and the need to meets national quality and safety standards in relation to the physical structure of some community nursing units

Age Action's Eamon Timmins said the loss of so many public beds and the scale of the cuts in the home help service provided by the HSE will undoubtedly be felt by the sickest of older people.

"Without home help service frail older people will struggle, and those requiring round-the-clock nursing home care will end up being admitted to acute hospitals for their care if a nursing home bed is not available."

for this year.

This follows cuts of €1.75 billion over the past two years.

HSE CEO Cathal Magee, speaking at the launch of the executive's 2012 service plan today, warned that it will be a very challenging year for health and social care services.

The service plan warns that frontline care will be impacted directly to a greater level than ever before. Over the past two years, it says, savings largely did not directly impact frontline care as they were been largely achieved through pay and fee cuts, drug cost reductions, procurement savings, and increased charges.

However, this year, the service plan indicates, the scope for further efficiencies in these ares is limited and the plan says the savings will impact increasingly directly on frontline care. It says much efficiency has already been delivered and it is not possible to protect services from cuts in 2012.

The situation will be worsened by the fact that around 3,300 staff will have quit the service between September of last year and this March, to avail of the ending of favourable tax status on severance payments. Already, staff levels have reduced by over 8,700 since 2007.

More than half of the 3,300 additional staff due to retire before March are medical and nursing staff.

However, progress on implementing these alternative care programmes has been slow, and the programmes are only this year receiving finding of €24 million they were due to receive last year.

Acute hospitals alone face a reduction of 7.8% in their budgets this year, including the carry-over from deficits run up last year.

The service plan says hospital bed capacity must be reduced in line with the cut in funding but increased efficiencies should ensure that as many patients as possible will be seen.