A winter of discontent in health lies ahead..

Posted in Blog by saraburke on September 11, 2009

There is no question of whether the health budget will be cut, the question is by how much more, as it is already being cut. In my health slot on 10 September 2009, I looked at the intractable issues in the health system we have failed to solve during the decade we had most. I also outline the impact of the cuts to date, the potential damage of McCarthy’s proposals and who calls the shots in deciding the budget for health.  Here are the mains issues covered. All comments and feedback welcome… 

Despite a decade of mega health investment, we already have system under pressure. Efforts to address certain areas just have not worked.

  • There are still 18,000 public patients waiting over three months for in patient or day procedures. 
  • There are 870 delayed discharges in hospital beds. 
  •  In 2001, we were promised 600 state of the art primary care teams and eight years later, just 120 are in place and I’d doubt that figure. Drumm speaking on This Week on Sunday last said ‘we now have a fabulous primary care infrastructure going in across this country’. This is not credible to most people because to the vast majority of citizens no such ‘fabulous primary care infra structure is evident.
  • If we take A&E, on 9/9/9 (according to the HSE count) there were 84 people waiting over 6 hours or more, 44 of these were waiting over 12 hours and this is after a decision to admit has been made ie it is not a measurement of the time since they arrived in the Emergency department. The INO counted 273 people waiting. 

So in the decade we had most, the HSE has failed to address some of the most intractable issues facing them. 
There is no doubt impact that the cut backs are impacting on patient care.

The HSE’s mantra is that they are providing more and more services, year on year, with less money and fewer staff. And that is true.

They publish a monthly performance report which goes through in great detail on what services are being provided and how much money is being spent. The June report shows that there are 4,000 fewer staff in the HSE now than in December 2007, 1,600 of these are nurses.

The HSE see this as a real achievement, they are closer to living within budget than ever before and they are 740 people below their staff ceiling of 111,800. However those on the front line would say that the pressures are increasingly evident on day-to-day services.Wards are being closed, staff not replaced, they are letting go those on contracts less than 12 months, no replacements for maternity leave. There are fewer home help hours, fewer nursing homes subventions evident in numbers of older people in hospital beds – the 870 delayed discharges There are increased numbers of slips and trips of older people in public long term nursing units due to under staffing. Such under staffing is more expensive in long term.

 I heard yesterday of letter which went to the LHOs rationing the number of dental appointments for people in nursing homes to 15 a month.

Increasingly one hears from front line staff of delays in decision making over whether to give someone a particular test – what should be clinical decisions are being over-rided by financial ones – because its cheaper not to do the tests but it also results in people staying in hospital longer.

So what impact will the McCarthy proposals to cut 6,000 staff have? According to a leak in the Irish Times (10/9/09) the HSE has made it very clear what while they can potentially cut 2,000 additional staff on top of the 4,000 already made. (1,000 through natural attrition, 500 through temporary staff, 500 early retirement scheme), it is simply not possible to cull another 6,000 out of the system without “significant service implications”.

The unions and front line staff are very clear if staff cutting aspects of the McCarthy report introduced it will result in destruction of public health system. The unions are saying McCarthy cannot be done without withdrawing services, closing wards or hospitals, that it will result in a 10-15% downsize of the public health system.


The HSE say they could live within their current budget if they can change work practices, staff relocation, change in roles, getting rid of allowances, different working arrangements are put in place. Unions say they will not allow service closures, job cuts and pay cuts – action seems inevitable. Unions are already balloting for localised industrial action.

In the meantime, beds are blocked, wards are being closed and inevitably services will close.

Driving through the  planned ‘reconfiguration’ of hospitals has strong potential for savings. Closing A&Es in Dublin in Cork, closing smaller acute hospitals in South, North East and Mid West, getting the children’s hospitals to co-operate and have one A&E , all these measures can save money. But they will not be popular. 

And while it is our political leaders who decide the extent of the cuts at the cabinet table. Ultimately its Drumm and HSE who have to implement the cuts. And given that Drumm says he will be gone by this time next year, there’s a sense that he has nothing to loose and every intention to steam roll through the changes he wants made.

It certainly looks like a winter of discontent for Irish citizens…

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