Transport services to be restructured

Niamh Mullen writes that HSE spending on cabs for patients and staff last year cost more than three times the budget shortfall of Our Lady’s Children’s Hospital in Crumlin.
A review of patient transport services is under way at the HSE with a view to providing a more structured, efficient and effective service.

The review took place in 2008 and the HSE is working to implement a consistent national approach to make sure the service operates efficiently. Its work is due to be completed by the end of the year, or in early 2010. In the meantime, spending on taxis remains high with €28,623,328 spent on patients and staff last year alone.
h4. Unacceptably high
Fine Gael transport spokesperson, Fergus O’Dowd TD slammed the figure, calling it ‘unacceptably high’. Deputy O’Dowd said there was no doubt that savings could be made on the massive bill. “This is the kind of waste that must be cut out through more sensible spending. For example, each hospital could buy a people carrier and hire a driver for around €80,000 a year, leading to an annual bill for the State of €3.5 million.” He pointed out the taxi spend for 2007 (€31.6 million) and 2008 was six times the €9 million budget shortfall at Our Lady’s Children’s Hospital in Crumlin and it was equivalent to the budget needed to provide the cervical cancer vaccination programme for six years. The money could also provide an additional 36,527 medical cards this year or open almost 200 hospital beds, he said.
Figures obtained by Irish Medical Times, following a Freedom of Information request, showed €27,910,135 was spent on patient journeys and €713,193 was spent transporting staff. The HSE said it was not able to provide details of how many journeys were taken because its systems ‘do not capture the number of patient journeys just the monetary amount’. As a result, it was not possible to work out the average cost of a journey.
However, an eTender notice advertised in May by St James’s Hospital in Dublin for the provision of a taxi service gave an indication of the number of journeys taken. It said it expected that approximately 1,000 journeys would be made each month.
h4. Cost-effective solution
In a statement, the HSE said taxis provided an effective service for patients or clients who were not acutely ill, while HSE vehicles and staff were prioritised to do frontline, emergency work. “The use of taxis for patient transport represents a more cost-effective solution when compared to investment in a fleet of HSE-owned vehicles for this purpose. Additional costs relating to this would include the provision of 24/7 staffing, maintenance, fuel, insurance and tax. The use of taxis also allows the HSE flexibility in the face of variable demand,” it stated.
Deputy O’Dowd said he did not accept that it represented a cost-effective solution for patient transport. “I am calling on the Minister for Health and the HSE to review it urgently, so that scarce public money can be used to the best effect,” he said.
The Dublin Mid-Leinster region spent the most, with €8,590,058 going on patient journeys and €453, 300 for staff – that is a total of €9,043, 358. Around 1,140,000 people live in this area, according to Census figures.
Next highest was Dublin North East, which has a population of around 900,000 in Dublin North, Louth, Meath, Cavan and Monaghan. It spent a total of €5,978,663, of which €5,977,323 was for patient journeys. Just €1,340 was spent on staff. However, a breakdown of the amount spent on staff cabs for the northern area within this region was not provided. The HSE said they represented a small percentage of the total figure.
The HSE West region has a population of 1,000,000 in nine counties, stretching from Donegal to Limerick and spent €5,771, 690 on cabs for patients, with €190,685 accounting for staff journeys – a total of €5,962,375.
HSE South covers Kerry, Cork, South Tipperary, Waterford, Carlow, Kilkenny and Wexford and has a population of approximately 1,100,000 people. It spent a total of €3,317,657. Again, a breakdown of patient and staff journeys was not provided and the HSE said staff taxis represented a small percentage of the total figure.
That means HSE South spent €5,725,701 less on taxis and cabs than Dublin Mid-Leinster, despite having almost the same population. It also means HSE spending on taxis is worth an average €1,049 to every taxi driver in the country.
According to figures from the Taxi Regulator, there were 27,286 taxis registered in Ireland on June 1. Hypothetically, cab drivers in HSE West do best. There are around 4,300 cabs and €5,962,375 was spent – that is €1,386 for each taxi.
In Dublin Mid-Leinster, there are approximately 9,500 taxis registered — that is an average of €951 for every taxi driver there.
It is worth €656 to each driver in Dublin North East, because there are around 9,200 taxis and €5,978,663 was spent.
In HSE South, €3,317,657 was spent and there are around 4,400 taxis – that is an average of €754 for every driver in the area.
h4. Patient journeys
Staff at the corporate office, Shared Services (SS) and the Eastern Regional Health Authority (ERHA) spent €66,230 on cabs. Patient journeys cost €107,427. The HSE said the expenditure related to a contract between the National Cancer Control Programme and the Midland Transport Service. The Primary Care Reimbursement Service (PCRS) spent €1,157, while the Health Service Employers Agency (HSEA) spent €479.