Cuts pose additional threat to delivery of safe patient care

Finally, the HSE service plan for 2014 has been published. What does the detail in the much delayed document predict for those who will be using our public health service next year?

Those with medical cards will be spared the worst of the ominous “probity exercise”, as the savings target for this area has been cut significantly from €113 million to €23 million. But even before the Orwellian plan was mooted in the budget, it was clear the medical card scheme was coming under extraordinary scrutiny.

As a result, children with serious congenital illnesses had their cards cancelled or their parents experienced difficulty in accessing free care on initial application. Examples of arbitrary decision -making were highlighted in The Irish Times and other media. Whether this inconsistency will be tackled by the HSE remains to be seen.

Specifics
Some of the plan's specifics are timely: it addresses the recent controversy whereby children who had undergone tracheotomy were unable to be discharged from Crumlin and other hospitals by ring-fencing funding of €1.2 million to strengthen home services to allow their safe return home; and it earmarks almost €1.5 million for the partial implementation of recommendations arising out of the inquiries into the tragic death of Savita Halappanavar at University Hospital Galway's maternity unit.

One of the lessons for the health service in 2013 was the exposure of real risk to patient safety. While the Halappanavar case identified some 13 significant errors in her care, the extent of the system-wide risk to the safety of patients was laid bare in a letter from the chief executives of four Dublin teaching hospitals to the HSE. Among other concerns, they predicted delays in the timely administration of cancer treatments to patients.

Yesterday's plan promises a dedicated Patient Safety Agency in 2014; however, the small print suggests little more than a skeleton will be in place by year-end. And it is an unfortunate reality that serial budget-cutting while simultaneously pursuing a major system transformation has exposed faultlines in the ability of the health service to ensure acceptable levels of safe patient care.

Further cuts for next year pose an additional threat.

Those requiring surgical operations and other procedures face some additional waiting due to the plan’s confirmation of a 3 per cent reduction in elective hospital activity for 2014.

While the new HSE directorate deserves praise for offering a level of detail in the service plan not seen before, there are many potential funding holes that will threaten its successful delivery.