While the overall level of cutbacks facing the health services is known, it remains to be seen where the worst impact will be
IT WILL be a number of weeks yet before the full impact on the health service of the Government’s €750 million spending reductions for the HSE is known.
Ministers and HSE chiefs have argued that mitigation measures, such as the effects of the new clinical programmes in a number of specialities in hospitals, along with reforms and work practice changes, will take the sting out of many of the cuts.
However, it would probably be wise to wait and see how the various HSE regions and individual voluntary hospitals plan to structure their own services in the light of budget cuts before a definitive assessment can be made.
For while many of the headline figures about the resources available to the health services for 2012 are now known, a number of key elements are still outstanding.
It will probably be early February before the four HSE regions have produced their own service blueprints for this year and it remains to be seen what level of cuts will be put in place in local areas, particularly in hospitals west of the Shannon which will be carrying forward significant financial overruns from 2011.
Similarly, the allocations for voluntary hospitals such as the Mater, St Vincent’s, St James’s and Beaumont, have yet to be published.
It is known from the HSE’s national service plan that hospitals generally are facing a budget cut of 4.4 per cent on average (rising to 7.8 per cent when account is taken of deficits being carried forward).
However, how these cuts will manifest themselves in services provided by individual hospitals is unclear.
Apart from budget measures, services are also likely to be affected as a result of falling staffing levels and the impact of HSE plans to cut €100 million or more from the amount it spends on staff provided by agencies.
According to figures given to the Dáil last week by Minister for Health James Reilly, 1,500 HSE staff retired in the four months to the end of December. A further 2,000 personnel have indicated that they will leave by the end of February when new pension arrangements come into effect.
Almost 50 hospital consultants and a couple of hundred nurses at various levels are among those who have either left or are planning to leave the HSE.
However, it is unclear whether all 2,000 staff who have applied to leave will actually do so, as they can change their mind more or less up until the last minute.
It is also unknown at present how many health service personnel will be replaced, although the service plan allows for 400 to be taken on by the mental health services and “as many vacancies as possible” to be filled in primary care.
On top of this, the Government has announced that there will be limited recruitment in the public service this year and has mentioned an indicative figure of about 3,000.
However, this is based on about 9,000 staff leaving the public service overall and it will not be known until the end of February whether this target has been met.
Separately, even if the figure of 9,000 departures is achieved, the health service will have to compete with other parts of the public service for approval to recruit new staff, subject to the 3,000 limit.
Parts of the health service which have become reliant on using agency personnel as well as on overtime could also be hit by plans to significantly reduce spending in these areas.
The HSE national service plan says that the organisation had built up an unaffordable reliance on agency staff in recent years, in an attempt to maintain services “often at levels beyond that for which we had staff or budget”.
“This cannot continue, and a critical part of 2012 will be to substantially reduce agency expenditure and seek to use our own staff to keep priority services open.
“Agency spend in 2011 exceeded €200 million. This will have to reduce by up to 50 per cent. This reduction will impact primarily on hospitals, childcare services and community nursing units.
“Hospitals and childcare services must achieve these reductions in order to address their underlying deficits and community nursing units must do so in order to reduce their unit costs which are becoming increasingly unviable.”
It has already been widely reported that a minimum of 550 public beds in community nursing units will close next year.
However, the national service plan appears to suggest that, in addition, there will either have to be radical changes to the operation of some hospital and childcare services, which are largely reliant on agency staff, or else these may be curtailed or discontinued.
The health service will draw up a new action plan for implementing reforms under the Croke Park agreement by the end of the month.
This new document may give some indication of the thinking of management about changes they may want to put in place to live within the new budgetary and staffing realities.
However, any moves to change existing roster arrangements, demarcations or traditional working roles and responsibilities – perhaps through the greater use of advance nurse practitioners in place of agency doctors or the substitution of staff leaving by those taken on at lower costs – will undoubtedly test the agreement to the full.
