Consultants call for more realistic budgets for patient care

Senior doctors have called for more realistic budgets to treat growing numbers of patients in acute public hospitals at a time when the sector is running a deficit of €28m.

As part of its pre-budget submission, the Irish Hospital Consultants Association (IHCA) says that pre-set targets by the HSE have consistently underestimated patient demand for hospital care, creating the kind of situation where an overrun of €28m was already in evidence by the end of the first quarter of 2013.

The pressure on hospitals is exacerbated by an ageing population and the numbers dropping out of private health insurance.

About 64,000 people cancelled their insurance last year.

The HSE’s own figures show that for 2012, inpatient figures were up 7.4%; day cases were 5% over target; and emergency admissions were 7.5% higher than anticipated.

However, the IHCA said that while the number of patients being treated continued to rise, the health budget was being cut.

Denis Evoy, IHCA president and consultant surgeon in St Vincent’s University Hospital, said consultants were treating 160,000 more patients per annum in public hospitals than three years ago, yet the Government may be proposing to cut the overall health budget by €300m, following on from €2bn in cuts since 2008.

This was at a time when up to 250,000 bed days were being lost in the system because of the delayed discharge of patients whose doctors had deemed them fit to be discharged.

“The delayed transfer of patients to appropriate aftercare facilities is preventing consultants from admitting new patients. The lost capacity created by these bottlenecks represents around 250,000 bed days — the equivalent capacity of a large hospital,” said Mr McEvoy.

The IHCA is also highlighting the fact that there are 9% fewer inpatient beds than in 2006; that the number of people awaiting elective care increased by 7% to 48,279 in the year to May 2013; that the number of day case patients treated by hospital consultants has risen 40% from 2007 to 2012; and that funding for mental healthcare has decreased 30% from 2009. Despite a rapid increase in demand for mental health services — the number of referrals for children and adolescents rose 15% in the 12 months to Apr 2013, and the number of admissions rose 77%.

The IHCA also points out that Ireland’s per capita expenditure on health has fallen 15% since 2009, and at €1,883 is 40% less than the spend in the Netherlands (€3,083, up 7% since 2009).

IHCA general secretary Martin Varley said despite the improvements arising from consultant-led clinical care programmes, budget pressures were restricting theatre access and bed use.

The IHCA was also critical of the number of staff employed in management and administration posts in the public health service — close to 16,000 — while there are just 2,530 consultants. This represents 6.2 administrators and managers for every consultant, compared with an estimated ratio of 3:1 in Britain.

Mr Varley said there were about 480 vacancies in consultant posts, both permanent and those temporarily filed by locums.


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