ANALYSIS:WITH A 3 per cent reduction in its budget this year compared to 2008, and an estimated €9.6 million deficit to make up, the one certainty is that Our Lady's Hospital for Sick Children, Crumlin, will not be able to deliver the full level of service it had planned for the year, writes DR MUIRIS HOUSTON
Therefore, the only question that remains to be answered is how the cuts will be applied.
Politicians speak of protecting frontline services, but in reality this is impossible to achieve.
It might be possible if the hospital applied the entire 3 per cent cut to administration, but even then it is likely that some patient services would suffer. In an attempt to be fair, and because it is administratively the easiest to achieve, hospitals facing a shortfall usually top slice their entire budget by a flat amount.
This is the crudest way to cut back on activity and inevitably leads to the cancellation of services. However, if a service has been underresourced for some time, or has recently become more efficient, the effect of a blunt, across the board cutback will be magnified.
This scenario applies to orthopaedics at Crumlin, which despite accounting for up to 15 per cent of hospital activity, has a proportionately smaller budget. Complex spinal surgery costs €40,000 – €60,000 per child. If a specified amount of money followed each patient operated on, then the kind of guesswork associated with percentage cuts in resources would not happen.
International experience shows that when the funding is attached to a patient rather than an institution, budget setting, transparency and accountability improve significantly.
It has been suggested that the National Treatment Purchase Fund money (NTPF) could solve the impasse. Apart from the fact that its own fund has been cut by 10 per cent this year, NTPF money cannot go to Crumlin hospital for it to treat its “own” patients. Instead, it follows the patient to the UK or to a private hospital in Ireland and does not contribute to the kind of volume savings that might be made if taxpayers’ money was channelled to one specialist centre here.
Crumlin hospital has already closed one 25-bed ward and it is closing its specialist operating theatres on a rolling basis. In practice, this means the spinal orthopaedic specialist cannot operate for one week in every five.
Some 7,000 fewer patients will be assessed in outpatients this year. With one of the youngest populations in Europe, it is not possible to institute cuts of this magnitude at our main paediatric hospital without hurting patients.
Cuts that affect cardiac surgery and other life-saving operations inevitably receive the most publicity. Images of Kilkenny girl Jamie Murphy, whose planned surgery at Crumlin was cancelled, in some distress due to the effect severe scoliosis has on her lung capacity, undermine parents’ confidence in our health service.
Guarantees of emergency surgery not being cancelled don’t help, although the hospital’s statement last evening that further planned cuts would not now take place may steady the ship.
With the steep economic downturn still upon us, and with severe cuts in public expenditure inevitable in the next budget, cuts in the health service are sure to worsen. And with the HSE effectively emasculated by a transformation programme that seems to have ground to a halt, the autumn is sure to see a focus on the rationing of resources amid further funding cuts.