The Western Health Board can only achieve savings sought by the Department of Health and Children if it cuts existing jobs and services, a detailed analysis prepared for the board suggests.
The Minister, Mr Martin, has argued that the savings sought can be achieved by not filling 85 proposed new jobs.
But an analysis of the WHB's financial position, prepared by its chief executive officer, Dr Sheelah Ryan, shows that unfilled jobs had already been put on hold before a demand for more cuts came from the Department.
That demand, made in July, was part of a package of measures designed to reduce Government spending across the economy. Among the measures designed to save money in the health services was a directive to health boards not to fill 800 proposed new jobs.
However, documentation prepared by Dr Ryan before the Government measures were announced shows that "continuing to delay the filling of all but essential front-line clinical posts" was already in place as a measure to reduce a threatened overrun of €13 million on its €652 million budget to €6.5 million by the end of this year.
Even that cost-cutting plan depended on the Department allowing the board to divert money earmarked for developing new services to dealing instead with the current financial crisis.
Dr Ryan's analysis suggests that when the demand for an extra €1.15 million in cuts arrived from Dublin there was no scope left for saving money except by cutting services or jobs.
A whole range of other cost-saving measures had also been decided on, again before the demand for extra savings came. These included closing some wards while staff took leave, reviewing all temporary contracts and postponing the purchase of office equipment, furnishings and supplies. Also under threat were the provision of aids and appliances to people living at home.
Even the provision of funding for incontinence wear appears to depend on the provision of extra funding by the Department of Health and Children which, according to Dr Ryan, gave a "positive indication" in that regard.
She makes no secret of her frustrations with the way the WHB is funded. These include:
Funding for hospitals is based on outdated measures of the treatments being provided for patients. If this was corrected, the WHB would have got an extra €13 million from the Department this year and would not have a funding crisis.
Of the significant amount of new money which the Department has provided to the WHB in recent years, two-thirds has gone to fund pay increases for existing staff. Of the remainder, the board is told what to spend it on and is given virtually no discretion.
The Department is not prepared to pay for some measures which it wants implemented. "For example, a directive from the Department of Health and Children to use disposable equipment in one type of orthopaedic procedure this year (instead of resterilising) is adding €10,000 per week to the work of one speciality," Dr Ryan writes. "No account is taken of this in funding."
Virtually no capital funding has been given to the board for replacing equipment or plant. "So, when a boiler breaks down, or a piece of equipment is faulty, we have to provide from within or do without."
The board has also had to reduce its contingency fund - for dealing with unexpected events - at the request of the Department.