Uphill struggle ahead as Reilly finishes first term in health
As the political season ends and James Reilly gives an upbeat speech to the MacGill summer school, immense challenges face him now and when the autumn season begins…Yesterday (28 July), at another meeting of the newly formed HSE board, many hard facts were tabled for discussion. Exactly three months ago, the old HSE board members offered their resignations, which had been sought by Minister Reilly so the old board went before they were fired.
The new board is made up of the most senior officials in the HSE and the Department of Health, its secretary general, Michael Scanlon, the Chief Medical Officer, Tony Hollohan, the HSE chief Cathal McGee and other HSE national directors. They have been meeting every two weeks since forming in May and some of the figures presented to them on 28 July give a very stark insight in to where we are now and the challenges ahead.
The HSE annual budget for 2011 is €12.35 billion, so you’d expect half of that spent by end of last month and figures presented to the board show a €208 million over spend of which €124 million is hospital budgets, senior sources say they is no reason to believe that the situation has improved since the end of June.
So over half of the over spend comes from hospital budgets and some hospitals such as Limerick regional have particularly high over spends – between 20-30%. Other hospitals in the west and northwest overspending by about 10% include Mallow, Letterkenny, Roscommon, Portunicla.
In the North East, Cavan and Drogheda have an over spend of about 10%, in Dublin, Tallaght and Blanchardstown have over spent by about 10%, while Monaghan hospital is the highest over spender at 36%.
The INMO released a statement on the day of the HSE board meeting (28 July 2011) about cuts to the budget for agency staff in Blanchardstown and Monaghan hospitals by 37%.
The overspend in hospitals and cuts to agency budgets are directly related. Agency budgets are one of the only aspects of hospital spend that can be cut without much notice. The use of agency nurses, doctors and other professionals is a direct result of the blunt instrument that is the HSE moratorium. In absence of being able to hire new people, frontline services use more expensive agency staff to plug the gaps.
And although there are over 2,500 fewer HSE staff now compared to December 2010, and the HSE is well below its staff ceiling, pay costs have not gone down, there are a few explanations for this
- those who left in redundancy programme in December 2010 were mostly lower paid administrative and support staff
- they are being replaced by muich needed but higher paid therapists and consultants
- while there has been a cut in rate paid to agencies and a cut in numbers of agency nurses, agency doctors are up by 33% and healthcare assistants by 17% compared to this time last year.
These budgetary overspends and staffing constraints provide a very real dilemma for the HSE board and the new minister, particularly as other figures presented to the board show increased waits for elective procedures in both adults and children, increased emergency department presentations and admissions, under 50% of those needing a hospital bed getting it within the six hours of arrival at an Emergency Department, increased use of out of hours GP services, more inpatients and day cases than expected, increased numbers of delayed discharges – back up to 800 in June.
And although it’s become the norm for wards to be closed and services restricted during summer months as a way of cost saving, people can expect to see more of that. There are plans for extended ‘seasonal closures’, inevitably this will result in more people waiting longer, which has more expensive costs both in human and financial terms.
There is also an issue with this in terms of priorities that minister Reilly set himself – ‘never again seeing 590 trolleys in Emergency Departments’, reducing waiting times, improving quality of care, not to mention free GP care by 2016 and the introduction of universal health insurance. As a central pillar to deliver these, Minister Reilly set up the new Special Delivery Unit (SDU) in the Department of Health, headed up by Dr Martin Connor.
But if the HSE is responsible for reining in the budget and it is and the SDU is responsible for getting rid of trolley and long waits – there are an inherent contradictions between these roles and it will be interesting to see who wins out. For much of that we will have to wait til Autumn/Winter 2011 to see but what can we tell from Reilly’s first term in office ?
If we take the high profile issues that have occupied much of his first four months – the decision to locate the children’s hospital on the Mater site has got the go ahead which might not have been expected and shows decisiveness; the suspension of the Fair Deal scheme seemed an unnecessary own goal early on in his tenure; the management and communication of Roscommon hospital was a real blunder and while Minister Reilly can provide real leadership in this area, he needs to do it with greater clarity and consistency and working with the HSE and other health professionals as well as local communities and politicians; Minister Reilly has spoken very publicly about renegotiating GP and consultants contract and paying them less and yet consultants were excluded for the 15% voluntary pay waiver announced by Minister Howlin on 22 June 2011 for all public servants earning over €150,000 – there needs to be more consistency and better results in areas such as these.
I still don’t understand how Minister Reilly and the government can commit to provide more and better services to more, older, sicker people, free at the point of delivery with fewer staff and less money particularly when we have no control over our overall finances…