Health Minister Leo Varadkar has claimed the HSE’s budget plans for next year mean the "battered and bruised" system is finally being nursed back to health, despite fears it will not address chronic waiting list and emergency department problems.
The senior cabinet member made the claims at the launch of the major document, which outlines exactly how public money will be spent in the system next year, yesterday.
However, while interest groups welcomed the end to “a cycle of brutal cuts”, they warned the plan leaves “literally” no room for increased demand, has failed to address all service needs and means the system is a patient “where you’ve stopped the bleeding but they’re still critical”.
Under plans revealed yesterday:
-The HSE will have a €625m funding rise, falling to €115m when this year’s €510m overrun is removed;
-€35m will be ring-fenced for mental health services, down on the €50m previously promised;
-€25m will be provided for free GP care for under-sixes and €12m for free care for the over-70s;
-€20m will be given to disability services;
-Managers will be forced to sign new “performance” deals which could see them sacked if they fail to meet targets;
-Hospitals and individual services have also been promised a more flexible approach to filling posts.
In addition, the HSE will for the first time have a formal rule which allows for budget overruns to be the “first” cost accounted for in future budgets, while it will also be tasked with making €230m in savings which will be re-routed to other health areas.
Mr Varadkar — who suggested his job was similar to the “loaves and fishes” bible parable of feeding 5,000 people with “tight” resources — said the €115m budget increase is a “modest” but important rise, and shows the system is finally turning a corner after seven years of ever-deepening cutbacks.
However, he stressed funding remains limited and that it is “important to be upfront and honest” that “we do not have sufficient funds to solve all our problems”.
HSE director general Tony O’Brien said the budget increase is badly needed after the “nightmare” of the 2014 service plan when he was asked to announce “unrealistic” cuts of up to €1bn. However, he added the rise equates to just three days’ total health spending, stressing the system’s difficulties remain “challenging”.
Despite welcoming some reforms interest groups were more blunt, saying measures fall far short of what is required.
The Irish Medical Organisation said the plan outlines a “very difficult year”, with president Prof Trevor Duffy saying the system is now “like a patient where you may have stopped the bleeding but they are still critical”.
The Irish Nurses and Midwives Organisation was equally worried about what next year will bring, with its general secretary, Liam Doran, saying the plan cannot ignore the current reality of “7,000 people on trolleys during October, over 2,000 acute and continuing care beds closed and 5,000 less nurses compared to 2009”.
Disability Federation of Ireland said the €20m funding for services “doesn’t even start to plug the gaping hole that has been left by €159m in cuts since 2008”.
Meanwhile, Mental Health Reform noted the €35m in funds its services will receive is €15m short of what has been previously promised.
-HSE and hospital managers who fail to work within specific budgets will be forced to sign up to new “performance agreements” as part of accountability measures next year — and could be sacked in extreme scenarios.
HSE director general Tony O’Brien revealed the sanctions and disciplinary action move at the launch of the group’s service plan yesterday.
Speaking at the publication of the detailed document — which outlines how public money will be spent by the health system in 2015 — Mr O’Brien said managers will from now on be made to take responsibility for what happens on their watch.
He said a National Performance Oversight Group will be set up to enforce performance agreements and formally escalate measures if targets are being repeatedly missed — with the HSE report saying a “range of sanctions” will be available to address “under-performance”.
The agreements will focus on four specific areas, namely access to care, quality and safety of services, staying within set budgets, and ensuring staff absenteeism is addressed alongside excessive working hours.
Under the plans, all managers will also have to supply monthly and annual performance reports on their work.
Despite the positive measures — some of which are already in place — managers have privately raised concerns over whether they will be made to bear the brunt of under-staffing and budget problems outside of their control.
— Fiachra Ó Cionnaith
Extra staff hopes
-Hospitals have been given hope they can start filling positions which have been left empty for years, after a loosening of long-term restrictive staff recruitment rules.
The HSE service plan published yesterday has given individual services a greater say in what positions need to be filled, with attempts to reduce agency spending by €60m at the heart of the measures.
While no exact details on the new staff positions will be available until after local health service plans are published next month, HSE director general Tony O’Brien said the move is likely to focus on agency workers “migrating” to the roles.
However, medical unions have noted if the move is confined to this measure it will not result in a real increase in worker numbers, with any staff increases balanced out by agency worker declines.
Meanwhile, Health Minister Leo Varadkar has said he is “not trying to pull a fast one” after re-announcing a €25m fund for next year to address the delayed discharges “bed blocker” problem. Last month Mr Varadkar said the money would be available next year to address delays of up to four months in moving more than 2,000 elderly people into nursing homes — an issue which is adding to hospital waiting list delays.
Speaking yesterday, he clarified that while “€3m-€5m” of this fund has already been spent this year, an additional €25m will be available next year, with the current spend added to the 2014 overrun.
— Fiachra Ó Cionnaith
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