In response to Brendan Howlin’s ‘Good Health’ blog
Analysis from the Irish Independent on 26 July on challenges facing the new health minister.
It’s great to see Brendan Howlin taking an interest in the health budget. The money minister (or more likely one of his officials) took the time to pen a posting, entitled ‘Good Health’, for the blog part of the website of the Department of Public Expenditure and Reform (PER).
The sole point of his short statement was to reassure the public that the health budget has not been cut since 2011 – since this government came into being. Coincidently, the same year that the PER department was set up under the new coalition. And broadly speaking, Mr Howlin is right.
Using the same figures as the minister – the Revised Estimates for the ‘Health Group Gross Expenditure’ – Health was allocated €14.3bn in 2011 and €14bn in 2013, hardly a cut at all.
But behind these headline figures lies a more interesting, more complex picture. While the minister acknowledges the cutbacks to health before 2011, he fails to highlight how between 2008 and 2011 Ireland experienced the most severe cuts of all health budgets in the 53 WHO Europe countries, save Greece.
The Revised Estimates show €1.4bn cut from the health budget between 2009 and 2013. They conveniently left out the 2014 budget, which cut another €900m from Health. The carving out of the budget for the new Children’s Department meant €550m of this was a direct transfer to them but it still left Health €350m down and more than €1.7bn less than pre-2009 levels.
Critically, Mr Howlin failed to acknowledge the intent of Budgets 2012, 2013 and 2014, of which he had chief stewardship, which set out to cut another €900m from Health. This is blatantly evident from the required supplementary health budgets of €245m in 2012 and €199m in 2013. Health secretary general Ambrose McLoughlin is on record as saying another €500m supplementary budget will be needed this year.
Interestingly, all the supplementary budgets since 2008 add up to the same amount as the actual cuts from the health system – €1.7bn. Without the supplementary budgets, a whopping €3.4bn would have been taken out of health.
There is no question but that there were inefficiencies in the health system and many of these have been tackled in the drive for austerity – lower pay to workers and fees to professionals, a 12pc cut in actual staff numbers, better deals with pharmaceutical companies.
Research shows that the health system managed to provide more care to more people with significantly less resources from 2008 to 2012. But since 2012/3, it has reached a tipping point, most evident in hospital care, but true across the board, where it can no longer do more with less, it has no choice but to do less with less.
Ireland has a growing, ageing population with increasing prevalence of chronic diseases. That, combined with half a million more citizens covered by medical cards and fewer people with private health insurance, all places greater demands on a public health system with ever-diminishing resources.
The death of Savita Halappanavar in Galway and of the babies in Portlaoise hospital throw into sharp focus the issue of quality of care. We have no way of judging pre and post-crisis levels of quality of care due to the absence of measurements of quality. But it is reasonable to say that never-ending arbitrary cuts, such as those that have been imposed on the Irish health system, lead to unsafe staffing levels, which can have catastrophic effects on patient safety and quality of care.
Remarkably, in spite of the cutbacks, the HSE has managed to make parts of the system safer, evident in reduced hospital infections and in notable improvements in stroke and cancer care, to name but a few.
But all the indicators now are of a system at or beyond tipping point – a system that cannot maintain safe care and services as well as medical card coverage at current standards, without more staff and money, let alone trying to make it better.
Howlin’s blog can be seen as the first arrow shot from the Budget 2015 bow and a warning to halt Leo Varadkar’s ambition to secure a sufficient budget for health. Or it could be viewed as part of the new more social Cabinet who might be persuaded to see health spending as a worthwhile investment in people and society, not as a liability to nation’s financial stability.
For Howlin’s blog, see http://www.per.gov.ie/good-health/
For research mentioned above, see http://www.healthpolicyjrnl.com/article/S0168-8510(14)00166-3/fulltext.