#Budget19: Hospital capacity deficits unresolved

Family doctors and hospital consultants are warning that Budget 2019 does not address capacity deficits and will lead to longer waiting times to see GPs and more widespread cancellation of surgery in public acute hospitals.

While the Irish College of General Practitioners (ICGP) welcomes a 10% increase in the weekly income thresholds for GP visit cards — potentially expanding access to a further 100,000 people — it said the extension will put further pressures on GPs.

“Already we have up to half of all practices saying they cannot take on any new patients because of the shortage of GPs,” said Dr John O’Brien, ICGP president.

We need to double the existing health spend of 2%-3% on general practice in the health budget to properly resource the development of community-based chronic illness management.

The Irish Hospital Consultants Association (IHCA) said the budget is “unlikely to address serious capacity deficits that are delaying the provision of public hospital care to patients”.

Donal O’Hanlon, IHCA president, said there is “now a dangerous situation in hospitals” where patient surgical appointments are being cancelled at short notice, much earlier than previous years. Cancellations this week occurred at University Hospital Limerick, with less than a day’s notice; at Galway University Hospital, capacity constraints resulted in more than half of patients planned for surgery in certain specialties not being operated on. In the Mater, all elective admissions except cancer patients were cancelled yesterday, Dr O’Hanlon said.

And 15 patients awaiting urgent neuro-surgical care could not be transferred to Beaumont Hospital due to the unavailability of beds, he said.

The Irish Medical Organisation (IMO) described the budget as “a missed opportunity”: that the funds allocated to Sláintecare (€200m) are so small “that no significant reform can take place”.

The IMO said it is “not sustainable to continue to increase spending on private services through the National Treatment Purchase Fund (NTPF) — up by €20m to €75m — while starving public health services.

The Private Hospitals Association argued the opposite, saying substantial elements of NTPF funding is “simply going back into the public system in the form of in-sourcing activity, which in turn is shoring up the financial deficits that exist within our public hospital system”.

The Irish Nurses and Midwives Organisation (INMO) welcomed “the extra investment in public health service” but questioned inaction on the recruitment and retention crisis in nursing.

INMO general secretary, Phil Ní Sheaghdha, said they will be seeking to meet with the HSE “to ensure that their service plan provides for additional nurses and midwives”.

The Irish Pharmacy Union (IPU) welcomed the decision to reduce the prescription levy to €1.50 per item for the over 70s, but said it needs “to be removed in its entirety especially for those in vulnerable patient groups”.

IPU president, Daragh Connolly, said the €10 reduction in the Drugs Payment Scheme threshold, from €134 to €124, is “clearly not enough to have a significant impact on hard-pressed families”.

Harris: Onus on all to get on with job of health reform

The health minister said there is an onus on the HSE, the Department of Health, and politicians to pull together and “get on with the job” of implementing health reform in light of a “record” €17bn health budget, of which €200m is earmarked for Sláintecare.

Marking a new spirit of co-operation between the department and the HSE following a deterioration in relations at the start of the year, Simon Harris said he wanted to work with the HSE to identify opportunities to progress Sláintecare as they frame their service plan for 2019. Sláintecare is the government blueprint for health reform, which has cross-party support.

The HSE responded to the health budget saying it would “greatly assist in dealing with the year-on-year rising demands on our healthcare system”.

The Government is to provide a further increase of €1.05bn in health funding for 2019, on top of an additional €700m, by way of a supplementary estimate, bringing the total additional 2018 investment to €1.2bn.

Mr Harris said a number of specific Sláintecare measures will be funded including:

  • €20m integration fund to move projects, identified as working well, from hospitals into the community, as well as supporting and growing local innovative approaches
  • €55m extra for mental health, with a strong focus on improving services in the community
  • Cutting prescription charges for over-70s from €2 to €1.50
  • €10 cut in the monthly income threshold for the Drug Payment Scheme to €124
  • €25 increase in GP visit card income threshold, potentially opening up access to 100,000 more people
  • funding for 100 additional therapists to address, inter alia, backlogs in assessment of need applications
  • 78 extra hospital beds at the start of 2019

Mr Harris said: “We are now firmly in the era of Sláintecare. In framing the 2019 National Service Plan, we will be charging the HSE with using the significantly increased resources to deliver on Sláintecare.”

Among other funding allocations are €12m earmarked for the introduction of Termination of Pregnancy (ToP) services, but how much would go to GPs providing services in the community and how much to hospitals was not yet decided. Talks with GPs are due to take place about costs in the community, the minister said.

However the National Association of General Practitioners described Budget 2019 as “Death by 100,000 cuts” and said extra GP visit cards were being issued “without consultation, negotiation or discussion” and would have “a devastating impact on the delivery of patient care”.

In relation to implementing the recommendations of the Scally Report into CervicalCheck, Mr Harris said €9m had been set aside. This money would include supporting the introduction of the HPV test as the primary screening test for cervical cancer and the extension of the existing HPV schools vaccination programme to boys. Mr Harris said it was his intention to introduce HPV screening “early in 2019”.

Mr Harris said he is meeting today with Gabriel Scally, the man who investigated failures in the CervicalCheck screening programme, and that Dr Scally has said he will remain in Ireland for another 12 months to help oversee implementation of his report recommendations.

The minister has also committed to publishing an action plan for women’s health by next summer.

National Women’s Council of Ireland director Órla O’Connor said she hoped the funding “represents a turning point for women’s health in Ireland”.

Other funding commitments include €75m for the National Treatment Purchase Fund, up €20m on last year, and €6.7m in funding for the National Children’s Hospital project.

The figures

  • €200m for Sláintecare
  • 50c cut in prescription charges for over-70s/phasing out of charge for those in emergency accommodation
  • €10 reduction in monthly threshold for Drugs Payment Scheme
  • 10% increase in weekly income thresholds for GP visit cards
  • Funding to implement recommendations of CervicalCheck Scally Report, including switch to HPV screening, and extend HPV vaccination to boys
  • Funding for termination of pregnancy services
  • €20m increase for NTPF
  • €55m extra for mental health
  • Funding for 100 therapy posts to address assessment of need waiting lists


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