A HEALTH cut of €1 billion is almost certain in the context of an even greater overall reduction in December’s budget than hitherto planned, signalling uncomfortable times ahead for patients and those who work in the public health system. With services already curtailed during this fiscal year, it is inevitable that many people right across the health spectrum will suffer in 2011.
Home help hours and rehabilitation services have already been reduced significantly to the point where those who suffer a stroke or develop other chronic neurological illness are provided with less community support. And strains are also beginning to show in acute services, with claims last week of reduced access to cancer surgery in the west. It appears inevitable that waiting times for joint replacement surgery will lengthen, with the public-private imbalance in hospital services growing even greater.
Because 70 per cent of health funding goes to staff salaries, which cannot be cut under the terms of the Croke Park deal, most savings will have to be achieved from just one-third of the budget. And while non-core pay such as allowances and overtime will be targeted in an “aggressive fashion”, according to the Minister for Health, it means we still face significant cuts in the availability of items such as drugs and medical appliances.
It is a worrying time also for the traditional “Cinderella” of the health system, mental health. Chronically under-funded, it will suffer disproportionately in any crude percentage-based cut to the health service. Unfortunately, as greater cuts are demanded in a tightening budgetary timeframe, an indiscriminate top-slicing across the system becomes more likely. This would represent the worst possible scenario, something highlighted recently by Frances Ruane of the ESRI when she said: “While the emphasis in the current discourse is on where to make cuts, and these are clearly very necessary, it is important that what is cut is viewed in the context of the total health system. If this is not done, crude cuts now may generate disproportionate losses in healthcare quality and the growth in hidden costs elsewhere”.
It could be said we are wasting money by not employing most of this year’s 1,600 nursing graduates. Having cost the taxpayer in the region of €90,000 each to train, their expertise will now benefit patients elsewhere. The same fate, and exchequer loss, applies to hundreds of speech and occupational therapists, many of whom trained in centres specifically set up and funded by a Government responding to a clearly researched need for additional healthcare staff.
The lack of integration in the planning of current and capital expenditure on health adds to the difficulties facing health service chiefs as they attempt to cut back on services. It is an indictment in particular of the Department of Health which, since it divested the running of the health service, largely has failed to deliver its planning brief. At a time when invasive surgery to the system should be minimised, this failure means a blunt fiscal scalpel may be the only treatment.