Hospitals at the edge…

The CEOs of four Dublin hospitals made valid points about health cuts but went about it the wrong way. See column from 21 November 2013. So Minister for Health Dr James Reilly is in the soup again over Budget 2014. This time it is due to the unusual move of the CEOs of four Dublin voluntary hospitals coming out saying they just cannot afford to take any more budget cuts.

Of course some of this is a last ditch public attempt to prevent another cut to their budgets. And as voluntary hospital CEOs they have more scope that HSE hospital CEOs to write such a letter. However, the fact that RTE’s Prime Time had it before HSE Chief Tony O’Brien received it tells a lot.

What is much more significant is the letter’s content. They state how they have experienced a €206 million cut collectively, equivalent to 20.5 per cent of the budget between 2009 and 2013 and appropriately identify the “arbitrary” nature of Irish health budget cuts. Hospitals have been disproportionately cut since 2009. That being said, nationally hospitals received a 3.5 per cent increase between 2012 and 2013, however three of these four hospitals received budget cuts in 2013. And if one looks at the breakdown of the €666 million cuts proposed for 2014, just one of them is specific to hospitals.

The core point of the CEOs is that it is just not possible to continue to reduce budgets and staff, improve access and increase activity, while at the same time “guaranteeing safe services to patients”. The CEOs describe these competing demands as “inherently contradictory” and “undeliverable”. Most worryingly, they point out how cutbacks have already “begun to seriously threaten the quality and safety of patient services… reflected in… unacceptable delays in treatment access for certain cancer patients”.

This is a very serious statement to make, especially without substantiating it with specific examples. I put questions looking for specific examples to each of these hospitals. The response was that “the hospital will be pursing the issues raised in the letter directly with the HSE and not making public comment”. Why on earth then did they purposefully put such statements in the public domain?

Three of these four hospitals provide cancer care. Prof Owen Smith, Professor of Haematology, Our Lady’s Children’s Hospital, Crumlin spoke on RTE’s Morning Ireland the day after the letter was leaked and gave examples of children’s cancer treatment being delayed. Under the stewardship of Prof Tom Keane, and more recently Dr Susan O’Reilly, the Cancer Control Programme has capably overseen the ring fencing of cancer budgets and the building up of skilled staff operating specialised services. I put questions to the HSE’s Cancer Control Programme, which oversees cancer care. They had not heard anything from these hospitals about delayed cancer care. Again, one has to ask why go public before going to the Cancer Control Programme?

The second critical point the CEOs are making is that it is just not possible to prevent cases such as the death of Ms Savita Halappanvar if money is cut, as they will not have enough staff to ensure patient safety. Critically, they are making these points before the 2014 cuts are outlined.

Their statements reinforce the indicators collected by the Resilience Project (www.resilience4health.com) which show that from 2008 to 2012, the health system managed to provide more care to more people with a greater burden of chronic disease, to an ageing population also experiencing a baby boom. However, these indicators also show that since autumn 2012 there has been a reversal in this trend. For the first time, the health system is doing less with less. Some activity, such as emergency admissions which are beyond their control, have continued to rise, but others have levelled out (day cases and out-patient appointments) while in-patient admissions are down.

Similarly, while there was some progress on reducing waiting times for elective treatment in hospitals up to August 2012, in the last 15 months these figures have reversed with increases in all lengths and numbers waiting, except for the longest waiters. Quite simply, the system has reached breaking point and can no longer even try to do more with less.

They also point out that these cuts now cost more in the long run. They are right; deferring treatment and care means more people end up in hospital needing more expensive emergency treatment. That is not to mention the impact delayed and deferred treatment has on people’s quality of life and stress levels.

While the health budget continues to be haggled out between the powers that be in the HSE, the Department of Health, the Department of Public Expenditure and Reform, and the Department of Finance, it seems that the hospital CEOs’ very public letter might well backfire on them. However, the content, if substantiated, should not be ignored.

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