Niall Hunter, Editor – www.irishhealth.com]
Our health service currently comes in two versions – the official one that tells us that real reform and progress is being made in delivering better care.
And then there’s the harsh reality that many of us are only too aware of, and which poses a major question mark over the safety of care being delivered.
Much of the HSE’s latest annual report read more like a glossy company report than an account of how a ‘patient-centred’ health service is being delivered. You cannot help but get the impression that there is more emphasis on financial rather than patient outcomes.
We are told that the HSE had delivered services 3% ahead of targets, extra services were provided within budget, that staff numbers came in below projected levels and that savings were achieved through efficiencies and cost containment measures.
The HSE trumpeted the progress it was making in (slowly) setting up primary care teams, in cutting waiting lists (although numbers are starting to rise again, which didn’t get a mention), in opening some new hospital units and services, and in treating 3.4 million outpatients, although again it was not mentioned that there are over 175,000 people on outpatient waiting lists.
However, HSE CEO Prof Brendan Drumm, in one of his valedictory statements as he enters the final lap of his tenure, also told us that staff were going that extra mile to provide ‘more care with less funding’. At first glance this sounds like a good thing – getting better healthcare value for money for our tax dollars.
And it cannot be denied that the HSE under Prof Brendan Drumm has had to live recently in straitened budgetary times, but has managed to root out some waste and inefficiency, as well as recording some successes such as re-organising cancer care.
However, might ‘staff going that extra mile to provide more care with less funding’ also mean ‘staff struggling to maintain safe and quality care with ever diminishing resources?’
Read another report, the latest HSE financial performance report, for the year up to the end of April, and you’d be inclined to take the more pessimistic view.
The report showed us that the HSE, which has suffered a massive €1.2 billion budget cut this year, is finding it difficult to deliver a reasonable standard of service within the unprecedented budgetary restraints it is now labouring under.
The situation is exacerbated by the fact that the pay cuts and income gathering targets aimed at meeting most of the deficit are not being met. The fact that the job reduction target is not being met means that new posts may be denied to vital new services in areas such as cancer.
The HSE’s financial report expressed concern about the effects of the recruitment moratorium on service delivery, indicating that vital frontline staff were not being replaced. The HSE’s deficit for the year is already exceeding €100 million, and while that is small in the context of a €14 billion allocation, in terms of a tight budgetary situation it can mean a lot. And further cuts may have to be made to deal with it.
The HSE has been learning to live on diminishing resources over the past few years. The obvious challenge is how much further can the budget cuts go before the HSE holds up the white flag and says it cannot guarantee a safe service for the money it has at its disposal.
Recent events would indicate that the level of cuts being imposed on the HSE are starting to compromise the delivery of safe and good quality care. And at this stage the warnings being given are not merely industrial relations or vested interest rhetoric.
These worrying developments include:
* Extra beds moved onto wards/beds on corridors to cope with increasing pressure on emergency departments (EDs). Traditional summer decrease in trolley numbers not taking place to any great extent.
* Ambulances delayed at a major Dublin hospital while their trolleys were used for the ED.
* Patients dispersed from an Alzheimer’s unit at a Dublin hospital.
* Some patients requiring MRI scans having to wait three to four months to get a scan.
* Delays in developmental check-ups for infants.
* Continuing cuts in acute bed numbers with no real evidence of transfer of resources to boost primary and community care.
* Growth in numbers on inpatient and day case waiting lists.
* Institute of Obstetricians indicating that maternity units may currently be prevented from sticking to best practice guidelines due to a shortage of staffing and resources.
* Threatened scuppering of plans to hire staff for new cancer services.
* HSE itself admits that it is concerned about the recruitment moratorium’s effect on service delivery.
The crisis the HSE faces in terms of delivering adequate services with less and less money will be the most immediate challenge facing new CEO, Cathal Magee, when he takes over on September 1.
