Health cutbacks are already being felt, and will continue to impair the provision of care to the ill and the elderly, writes MUIRIS HOUSTON
ON BUDGET DAY last month, Minister for Health James Reilly told a press conference that cuts to frontline services were inevitable in 2012. This was an honest admission that some existing public healthcare facilities would not be available to patients this year.
Neither the Minister, his department nor the Health Service Executive have specified the exact places where the axe will fall. So how will patients and their families experience the health system in the year ahead?
In the acute hospitals, people will find that waiting times will begin to increase. This is because hospitals must limit the amount of work they do to try to stay in budget.
Even a small reduction in the number of procedures carried out on each surgeon’s operating list will cause a backflow. Fewer hip and knee operations means waiting lists will grow, with the back pressure eventually being felt in outpatient clinics as fewer people move through the system.
In some specialities whose waiting times were substantial even during the good times, such as neurology and ear, nose and throat, the situation will worsen.
And as planned care gets pared back, pressure on emergency departments will increase as complications arising from treatment delays force more urgent referrals into the system.
Acute hospital services face another challenge in the coming year. A national shortage of non-consultant hospital doctors will continue and may force the curtailment of services in some specialities in certain hospitals. In particular, patients needing emergency department care are likely to experience longer queues and prolonged waiting on hospital trolleys.
The not-so-subtle but under-the- radar cuts to health service provision in the community will continue. Take one of the 10,000 Irish people who will be admitted to hospital with an acute stroke in 2012. Ideally, having been cared for in a dedicated stroke unit, the time comes for them to be discharged home.
Because of a residual disability, they need some modifications to their home in order to continue living independently. This requires an assessment by an occupational therapist (OT) in order for specific aids and appliances to be identified and for the specification of home refurbishments for possible grant aid.
But because of a shortage of OTs in the community (at a time when we are educating many allied health professionals for export due to a public service recruitment ban), in some areas of the country these home assessments are not available.
And even when they are, patients may be approved for a specific grant only for the local authority to inform them they have run out of money and their application is put on hold.
At worst, this means the recovering stroke patient cannot go home; at best it means some cannot manage independently at home, develop a complication requiring an urgent hospital admission, placing them back in acute care some weeks after initial discharge.
As budgets have tightened in the past few years, this revolving door version of medical care is sadly becoming more common.
The hospital system is still good at dealing with emergencies and treating the acute symptoms; increasingly, however, patients are being discharged at short notice to clear a bed for the next urgent case.
It’s not uncommon for people to be listed for investigations over the coming days, only for families to receive a late afternoon phone call telling them their relative is ready for discharge that day. This means their planned tests must be cancelled and are often not rearranged until the patient is followed up in the outpatients department. Or if they are reorganised, the test that was available in days is now rescheduled for six months’ time.
In the meantime, no one has established the reason for the now settled acute symptoms so that no preventive treatments or procedures can be undertaken by either the hospital doctors or the patient’s GP.
In extreme cases, this can mean a patient being serially admitted to an acute bed for the same problem because the root cause of their symptoms has not been identified before the revolving hospital door sweeps the person back out again.
In a properly functioning health system, it should be possible to have most tests performed following direct referral from your family doctor. However, as hospitals try to control budgets, it is often these services that are cancelled or curtailed first.
So next year, where in the past you were able to have a cardiac monitor fitted on the request of your GP, in 2012 the facility may be restricted to those referred by a consultant cardiologist. Or the hours when blood tests are available may be restricted. And you may find that direct referral to physiotherapy has been withdrawn.
The planned closure of many community nursing units will impact heavily on older people in the year ahead. These units have always looked after people whose condition was too complex for private nursing home care. Neither the theory nor the practice of eliminating these beds make sense.
In the case of Abbeyleix, local GPs have been presented with a decision to close their community hospital as a way to save money in an overdrawn community services budget.
But, at the same time, the acute services wing of the HSE has written to these doctors asking them to reduce referrals to the local acute hospital because it is overcrowded with delayed discharge patients. The cost of looking after these people in the acute sector is about €1,000 per day. The cost of looking after them in the local community hospital would be about €1,300 per week. As well as not making financial sense, removing community facilities at a time when more primary care is seen as the way forward is puzzling.
On a positive note, the additional €35 million funding for the mental health sector is welcome. But it must be matched by action to improve services on the ground.
The non-recruitment of some 100 mental health professionals by the HSE in 2011, although specifically allowed for under a derogation from the public service jobs embargo, means that thousands of people with psychological health needs will not be cared for.
Those fortunate enough to be able to afford private health insurance will see a reduction in access to private beds in public hospitals, as the cost of these beds to insurers is set to double. And for those on medical cards, dental health services will continue to decay at an alarming rate.
Minister for Health James Reilly faces a difficult year ahead on a number of fronts including increased waiting times in emergency departments and for surgical procedures, the planned closure of community nursing units and a continued deterioration in free dental care services.
2012: THE MOST LIKELY CHANGES
Longer periods spent on hospital trolleys.
Longer waiting times for some specialist appointments.
Fewer directly accessible services in the community.
Paying for some facilities that have been free until now.
Fewer people able to afford private health insurance.
Free dental care service will continue to disintegrate.
