Funding cuts not in patients’ interests, warns HSE director

The director general of the HSE, Tony O’Brien, warned the Government that a failure to provide funding for its proposed key developments for this year could be contrary to the best interests of patients.

Newly available official documents show that the HSE initially told the Government, in a formal submission last September, that it anticipated needing €545 million to provide all the services it considered necessary this year.

In a letter to the secretary general of the Department of Health Ambrose McLoughlin, dated October 14th, Mr O'Brien said that the submission was based on "delivery of a sustainable and safe level of service and in order to provide for known and unavoidable pressures, demographic requirements, critical care priorities, [commitments in the] Programme for Government and service developments and quality initiatives".

Mr O’Brien said that “some very significant areas of planned expenditure” had been edited from the list of proposed developments in a bid to reduce the level of funding it was seeking “in light of the emerging estimates picture”.

“However, we jointly cautioned that this may not be in the best interests of patient care.”

Priority areas
He said that some of the priority areas which were dropped included an investment of an additional €53 million in services for older people, €3.9 million for the planned colorectal screening programme and an investment of €500,000 in BreastCheck.

Mr O’Brien maintained that virtually on the eve of the Budget, which was announced on October 15th, the cost of the HSE’s revised list for developments to address demographic and critical service priorities submitted to the Department of Health was €166.5 million.

He said this involved €93 million to address demographic issues and €73 million for critical service priorities.

“Following conclusion of discussions last night [October 13th], it seems clear that additional funding will not be forthcoming to address these requirements.”

The HSE service plan for 2014, which was published in December, shows that just €62.42 million is to be made available this year for demographic requirements and €58.58 million will be invested in critical service priorities.

The official documents show that the Minister for Health, Dr James Reilly, specifically requested that investments in certain areas be included in the HSE's service plan.

On October 31st he wrote to Mr O’Brien stating that his over-riding priority in the service plan was patient safety. “My next priority is treating patients in as timely a fashion as possible given the constraints the service is under. Other specific priority service areas to be addressed are:

Diabetic retinopathy screening and treatment;

Bilateral cochlear implants, with particular emphasis on five

and six year olds in 2014;

Disability services, 0-18 and additional school leaver, emergency and residential needs placement;

Organ donation and transplantation (to address additional needs in this area);

Care in the community for special care children who have had to undergo tracheotomies, to allow such children to grow up at home and not in hospital;

On the capital side, an investment programme of the order of €5 million to award (sic) good practice in hospital units achieving special delivery unit targets.”

The Irish Times reported in December that the HSE had identified to Government in its draft service plan that there were about 50 projects identified as being "service requirements" for this year but for which there was no funding. These projects would have cost €315 million in total.

Mr O'Brien confirmed to the Oireachtas Committee on Health and Children earlier this month that there were "things that will not be done as part of the current service plan that might otherwise have been done".

As examples, he said: “We would have liked to develop a national perinatal pathology service this year, at a cost of €420,000, but we are not in a position to do that.

“We would also have liked to go to phase two of our intermediate care service as part of the NAS, at an estimated cost of €4.4 million, but will not be doing that this year.

“The HSE would have liked to do more in the area of health and wellbeing initiatives, at an estimated cost of €1.5 million, but will not do so. We would also have liked to roll out an extension of BreastCheck, at a cost of another €0.5 million, in this current year but that is not proceeding.

“We also wanted to put considerable resources into revamping the dental treatment services scheme but we cannot do so this year. There is a list of things such as those I have just mentioned which, while being important developments, are not ones that can be afforded within the envelope that is available to us this year. Therefore, they stand as priorities that we will seek to address in the 2015 service plan”.

The Irish Times today publishes a comprehensive list of the health service developments which the HSE had considered should be funded but for which no money was available.

One of the most expensive developments on the list was a €40 million proposal to review homecare and community support services “to develop a new model of service delivery, maintain home-help hours at 2013 levels, provide homecare packages and support for early discharge from hospital, while reducing level of entry to long-term residential care”.

The unfunded projects also included a €25 million plan to meet increased demand for dental treatment services.