Looking forward to tomorrow’s budget, Catherine Shanahan asks what is needed to improve the health service?
Bigger slice of the financial pie:
Since 2009, over €3.3bn has been taken out of the Health Service Executive (HSE) budget necessitating supplementary funding every year. From an all time high of €16bn in 2009, health got just over €13bn last year.
More acute hospital beds:
According to the Irish Medical Organisation (IMO) hospitals are now operating in the ‘death zone’ where occupancy levels are above 92.5%, the point at which mortality rates rise.
The number of acute hospital beds is down more than 1,600 since 2007, the equivalent of removing four acute beds a week from the system.
The HSE said it hopes to open 440 additional beds this winter against a backdrop of the Irish Nurses and Midwifery Organisation warning that the hospital system may not be able to cope with overcrowding this winter.
More community beds:
Fund additional beds in the community to deal with the ongoing problem of delayed discharges which has a knock-on affect on our emergency departments. In last year’s budget, funding of €25m was set aside to tackle the problem. A further €74m was provided late last year followed by €10m last week to support this year’s winter initiative. Trolley numbers are already looking ominous ahead of winter proper.
Invest in primary care:
Enable GPs to do what the Government has consistently says they are best placed to do — manage chronic disease in the community rather than the current hospital-based, more expensive approach.
As doctors point out, three quarters of people over 75 have at least one chronic condition and chronic diseases account for two thirds of emergency medical admissions to hospitals. Managing chronic disease in general practice is associated with a decrease in the likelihood of future hospitalisations as well as decreased premature mortality. Against a backdrop of a Department of Health prediction (2009) that if current trends continue, hospital bed requirements would rise 50%-60% over the next 15 years, investment seems a no-brainer.
More attractive working conditions:
Work to retain doctors and nurses with multiple benefits — more beds open, more patients treated, shorting waiting lists and waiting times, and inevitability, better outcomes and reduced mortality rates. According to the IMO, staffing levels in the HSE are down 12.9% — equivalent to 14,418 full time staff — since 2007 and 20% of all emigrants from Ireland are leaving from the Health and Social services
Invest in tackling outpatient waiting lists and waiting times. At the end of May, there were 414,778 people awaiting an outpatient appointment, 85,130 for more than a year and 11,609 for more than two years. There were also 67,359 adults and children waiting on elective procedures of which 9,180 were waiting over 12 months.
Prioritise mental health:
Boost spending from 6% of the HSE budget to the 8.5% envisioned in Vision for Change. And spend the money allocated.
Hike price of cigarettes.
The Irish Cancer Society and the Irish Heart Foundation want a new levy on cigarette sales to help pay the cost of helping smokers quit. And do as doctors suggest and tax foods that are high in sugar, salt and fat to deter consumption and tackle obesity.
Protect basic services:
Retain or reduce prescription charges (currently €2.50 per item), Emergency Department fees (€100 without GP referral) and hospital bed charges (upto €1,000 for overnight stay in single occupancy room for private patients).
Protect drug funding:
Either reduce or leave unchanged the threshold for the Drug Payment Scheme (€144 per month) and the income threshold for medical cards and GP visit cards.
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