Dr Mick Molloy wonders just where the savings are to be made by cutting back on elective surgery and if we are still in the business of healing the sick, at all. Nobody knows what effect the current budgetary scenario will have this year, let alone the next. Multi-annual budgeting, a concept we thought would be introduced years ago, is further away than ever now – at a point when many hospitals need it to plan their very existences.
How many large university or regional hospitals will have to become ‘hubs’ to accommodate ‘spoke’ minor-injury units in their referral areas in the next few years? What additional costs will they incur for this, and how will this be factored into their base funding?
Non-trauma ambulance calls to smaller hospitals at night are usually for chest pain, stroke or difficulty breathing. The majority of these will require admission. Even if the total number of patients seen in smaller emergency departments between 8pm and 8am is reduced, it will mean a consistent number of additional admissions to hospitals that do not seem to have any plans for additional capacity at present.
h4. Elective surgery
A recent article in the press suggested that Temple Street Hospital must cut back on elective surgery in an effort to control costs. This may seem a silly question: what costs exactly are they trying to contain?
The article from the Irish Mail on Sunday intimates that there were between €3 million and €6 million in potential savings identified, but for the life of me I can’t identify where they could find such savings in one of the smaller city hospitals.
Over 70 per cent of the costs of running our acute hospital services comes down to staff pay. Cutting back, or postponing, elective surgery will not cut down that cost.
Unless employment is cut, there will be relatively little change in staff costs except reductions in unnecessary overtime.
h4. No savings
Staff will continue to be paid in the medical division, nursing, household, administrative and security aspects of the hospital. So no savings there.
If elective surgery is postponed, then I suppose the actual equipment used during the procedure will not need to be sterilised, so there will be a minuscule saving on electricity related to heating the autoclaves; there will be an additional small saving on sterile paper to package the newly sterilised piece of equipment, but not if this has already been purchased.
The saving could only come from not restocking the dwindling supply cupboard… unless the operation is one that involves the use of disposable equipment, in which case the equipment should already have been paid for and is available in the equipment press ready to be used.
So no saving there… unless the hospital purchases one disposable piece of equipment at a time, which I seriously doubt. On that point, do we not now have some sort of bulk purchasing power in the HSE and centralised purchasing that hospitals can benefit from reducing their costs? Wasn’t that one of the reasons for having an all-encompassing agency in the first place?
If the surgery is postponed, there will be no need for discharge letters to be written to the GP. Potentially that could save a few stamps per week, the stationery would have already been purchased with the HSE logo in the requisite colours and size in the correct position on the paper.
The cost of stamps hardly seems a sufficient reason to cancel elective surgery for what may be a very treatable conditions.
h4. Surgery postponed
In the article, a consultant ophthalmologist explained that children needing corrective eye surgery would be postponed, and that potentially children with eye tumours would not be operated upon – risking their eyesight and, worse still, death. That is a horrendous prospect, if it is the case, and highly emotive.
How could it be countenanced to postpone such surgery? Is there no clinical governance at work here at all? Where are the newly appointed clinical directors, and what is their stance on this?
h4. Cost-cutting measure
The consultant in the article also outlines that this may cost more in the long run. These patients are added to the NTPF list and are now paid for in a private institution, despite the public institution being physically capable of performing the operation in the first place but prevented from doing so as a cost-cutting measure.
I am not sure if, looking at the bigger picture, there is any cost saving to be obtained in such manner if even one child were to lose their sight. What would be the cost to the State educating them and taking care of their medical and social needs into the future?
A HSE spokesperson allegedly confirmed in the article that there would be a reduction in surgeries but not that there would be cutbacks. This brings me back to the days of the readjustments and not budgetary cuts. Are we still in the business of healing the sick, or is that now ‘ameliorating the disturbance in their physical functioning’?
About Gary Culliton
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