Management and staff will be fully consulted on a plan to slash €920m from the health services budget next year, Taoiseach Brian Cowen has said. Unions want to bring forward alternative cost-cutting proposals which they said will not impact so heavily on patient care.
The HSE’s controversial National Service Plan for 2009 includes plans to review 11 accident and emergency units in Dublin and Cork in a bid to trim its annual €14 billion euro budget. The HSE’s approved service plan for 2009 envisages savings of at least €520m as part of a value for money programme. And the Executive has also identified a possible additional €400m of “cost reductions which may be required in light of the emerging situation.”
The Service Plan outlines how the HSE will invest the €14,791,000 allocation received for the coming year. It has been framed within the context of health service reform, a rapidly changing economic environment and a climate of reducing resources. However, despite this the HSE is seeking to deliver the same quantity and quality of services as delivered in 2008. As part of a value for money programme the HSE is delivering savings of at least €520m. The Service Plan 2009 is based upon maintaining and slightly increasing hospital and community services. Key areas for investment will include disabilities, an additional 715 public nursing home beds and targeted investment in hospitals.
The HSE has pointed to savings of over €280m already realised in 2008, in specific value for money initiatives. The Service Plan 2009 will take a similar approach in 2009, targeting an overall saving of €250m in value for money initiatives. Cost containment and management savings are expected to realise savings of €250m, while the HSE is also currently engaged in discussions with unions to address proposals aimed at saving in areas including; work practice reform (redeployment of staff, more flexible working arrangements), sick leave, absenteeism, overtime, use of agency workers and allowances. The HSE is further targeting a reduction of three per cent in management/administration staff through planned redundancies.
Government have identified that we are facing an increasingly challenging economic climate for 2009. The HSE accounts for in excess of 25 per cent of total government spend. The Service Plan 2009 was completed and submitted almost two months ago – following a process that was started in October based upon known information at that time. Health services are directly impacted by downturns – more people require medical cards, more people require hospital and mental health services. Mr Liam Woods, HSE Director of Finance said: “We had anticipated significant increases in demand in October – we may now be faced with revising this.” The HSE has identified that a possible additional €400m of cost reductions may be required in light of the emerging situation.
Mr Woods stressed that the HSE will continue to review the finances for 2009 based upon the wider economic position. “We will do everything we can to ensure we protect delivery of services but many of the developments we had included may be challenged. But we obviously cannot confirm any of this now.”
Expenditure on “Demand Led Schemes” (including the medical card, long term illness and drugs payments schemes) have been increasing at significant rates in recent years – expenditure has risen by 26 per cent over the past three years. Over €2.89bn was spent on these schemes in 2008, compared with €2.56bn last year and €2.56bn in 2006. Ireland has a very open system of reimbursement and as a result the cost of prescriptions has risen by 90 per cent over the past five years.
The HSE has already begun addressing the high costs incurred through these schemes and will continue to do so in 2009, focusing on efficiencies while ensuring continued equity of access.
Acknowledging the challenges facing the HSE over the coming 12 months, Prof Brendan Drumm stressed that, “Quite simply, we have to remain totally focused on doing more with what we have. Central to this is modernising how we do things, reducing the over reliance on high cost acute hospitals and providing more integrated community based care.”
The Service Plan does, however, outline how increases will be achieved in services provided. Among the targets set out is the proposed increase in overall hospital activity by three per cent over the target set out in 2008 (including inpatient and day case activity). The HSE also plans to ensure that more new patients are seen in outpatient clinics (by addressing the number of unnecessary follow up appointments).
Pointing to the need to change the way services are organised and delivered, Prof Drumm stressed however that, “There is no acceptable reason why people in Ireland should have to spend longer in an acute hospital than those in comparable countries for the same conditions and procedures. To address this we are continuing to reconfigure and transform many frontline services in keeping with our overall strategic direction.”
The HSE is also reflecting the international move towards greater use of day surgery and less dependence on in patient facilities. Advances in technology, drugs and techniques make this approach more available and it has the further benefit of reducing the level of hospital infections.
Nationally, the HSE plans to increase the number of patients who use day case rather than in patient services by 9.2 per cent. The target in this area for 2008 was 590,016; the target for 2009 is 644,777. It is appropriate therefore that this would decrease the need for in patient treatment – this is reflected in the target for 2009, with 573,360 people to be treated compared with the target for 2008, anticipating that 593,859 people to be treated.
The HSE expects that emergency presentations will remain at similar levels in 2009 as they reached this year. The HSE plans to continue to provide for the same numbers attending at Emergency Departments, while also ensuring the timely availability of inpatient beds for emergency admissions to reduce waiting times for admission.
Measures aimed at improving in patient services in hospitals for 2009 include:
• Minimising the number of days patients remain in hospital
• Ensuring patients are admitted on the day rather than the day before planned surgeries as appropriate
• Proactive discharge planning – ensuring the medical and nursing teams know the day when the patient is due to be discharged
• Better access to diagnostics and better use of day case facilities wherever possible
A detailed analysis of the provision of emergency services in a total of 41 hospitals across the country will take place over the coming months. This process will be initiated in January and the HSE would stress that there are no specific plans in place at present. However, there are no plans to make any changes to the current structure of ED services. The analysis to be undertaken will provide an overview of all services across the country and will be achieved in a consultative manner. It is designed to ensure greatest efficiency and patient safety. Having been directed to specifically focus on ED facilities in Dublin and Cork, the HSE will obviously include these as part of the overall analysis.
The target for outpatient attendances for 2009 is significantly higher than for 2008. However, hospitals will be directed to increase the number of new attendees within their overall numbers. The HSE anticipates that with planned improvements, there should be a reduction in the number of appointments that lead to “did not attend”, a reduction in the number of unnecessary follow up appointments and this will create capacity for an increase in the numbers of first appointments/new attendees.
Service Plan 2009 is also placing greater emphasis on community facilities and services to ensure those people whose stay in hospital is complete, can be transferred back to a more appropriate location – whether their own home or a community hospital.
In conclusion Prof Drumm noted: “During 2009 we will continue to make further progress with our Transformation Programme to build a health service that our children will be able to sustain. We need to be more flexible, modernise the way we do things, and encourage more effective team working across services. We need to be honest with each other about the contribution each of us needs to make and uncompromisingly challenge all pay and non pay costs.
“While we face many challenges in the year ahead, we are continuing to focus on improving the services we provide and changing the way we provide them – giving people better access to high quality, safety and fully integrated health and social services. We will continue with our programme of integrating hospital and community services so they operate as one seamless service, we will implement regional structures to enable use to make more timely decisions to bring decision making closer to patients and staff and will ensure we have doctors involved in both the planning and delivery of our services.”
Targeted Developments included in Service Plan 2009:
Services for Older Persons:
• 715 new public beds for older persons in HSE facilities including community hospitals and 432 replacement beds
• 245 additional contract beds to alleviate pressures of delayed discharge
Community Facilities:
• 300 additional posts to support the continuing development of Primary Care Teams – to be linked to the development of 200 new Primary Care Centres
Services for People with Disabilities:
• 200 additional day places for people with disabilities
Children’s Services/Mental Health
• 50 additional emergency residential placements within children’s services
• 8 new Child and Adolescent Mental Health Teams to be recruited
• 14 additional beds for children and adolescents to be opened in 2009 within the mental health area, with construction to begin on appropriate facilities in Cork and Galway
Suicide Prevention:
• €1m extra to be spent on programmes for young people
Cancer Services:
• Continuing implementation of the National Cancer Control Programme with €15m to be invested in the development of services – with a focus on the areas of lung and prostate cancer
About Gary Culliton
Loading ...
