Patients to be pursued more actively for A&E charges

The Health Service Executive (HSE) will pursue patients who fail to pay inpatient and emergency department charges more actively as part of efforts to save money, according to its director general, Tony O’Brien. Mr O’Brien said the HSE needed to maximise collection of hospital charges, “whether in the corporate sector or individuals”, in order to ease the funding pressures on its budget.

Those without a medical card are subject to a variety of charges, such as the €100 fee for using hospital emergency department when not referred by a GP. However, collection rates vary across different hospitals.

After the publication of the HSE service plan for 2015, he said the budget for the health service for next year was realistic but not without its challenges. He welcomed provisions which give the HSE greater freedom to recruit staff within allocated budgets. This was “an opportunity for a fresh start” which would greatly improve morale within the health service.

He warned that any pay rises agreed by the Government with health service unions would have to be funded separately. “Up to now, cuts in pay have been taken out of our budget. We’d expect therefore that any pay rises, should they occur, would be reflected in our budget. We don’t have the capacity to pay that bill.”

The issue of consultant pay could not be allowed to drift, he said, as the HSE would be unable to sustain some services or plug gaps unless it was resolved. A recent pay offer, which has been rejected by the Irish Medical Organisation, “substantially” restored the 30 per cent pay cut imposed on consultants in 2012.

Mr O’Brien said he was open to discussing the issue with the IMO. “We need to get to the point where we begin to pay those higher rates,” he said.

He criticised some pharmaceutical companies for seeking “unrealistic and unjustifiable” prices for new drugs. In some cases, the cost of treating one person with these new drugs was more than €400,000 a year, he said.

“If we paid this price, it would encourage other companies to try to hike their prices, and that would mean one fewer primary care centre, or fewer early years interventions. It’s all about choices.”

On patient safety, Mr O’Brien said “an irreducible level of adverse outcome” was inevitable at times in any health service. “We must ensure when this happens, we respond with humane compassion and focus not on protecting the system but the individual’s interest.”

Citing the closure of smaller breast cancer services that were not fit for purpose as a reason the service had improved, he said political considerations in the past had delayed the taking of actions to achieve “optimum quality”.