HSE remains miserly with details of cuts as spin appears to be primary obsession

ANALYSIS: The nuggets of information in the HSE's service plans are buried deep

Health service budgets are such a work of fantasy that it is tempting to dismiss instantly the latest sheaf of documents to come from the Health Service Executive outlining its spending plans for this year throughout the State.

Yet these service plans – covering four regions and two groups of hospitals – are the only way local communities can glean information about the health services they are to get this year.

Ideally, the documents should set out in precise detail the services they will get and, more importantly, the services that are being axed. You should be able to tell from your local plan which wards will be closed and where staff cuts are being made as part of efforts to make saving of more than €720 million nationally this year.

Accentuate the positive

Sad to report that while regional managers have been instructed to accentuate the positive, much of this news is missing from the documents, while the nuggets of information contained in the plans are buried deep.

So it is that we read in small print on page 41 of the HSE South plan that Mallow Regional Hospital’s emergency department is to be transferred to Cork later this year. A similar fate for acute surgery in Bantry General Hospital is adverted to briefly a page later.

Yet there is no mention of these cuts in the upbeat three-page press release sent out with the plan. It says only that the two hospitals now have “a defined role delivering less complex care” which will guarantee a “sustainable and central” role for them.

“In line with the principles of the Department of Health’s policy on small hospitals, Mallow and Bantry will continue to provide services that are appropriate for the hospitals and for the local population, delivering non-complex care as close as possible to patients’ homes.”

More complex care such as surgery, however, will entail a 45-mile journey for the townspeople of Bantry to Cork from later this year.

There are good, arguable reasons for centralising acute hospital services in high-volume centres of excellence with a wide range of medical specialties; but there are no good reasons for pulling the wool over people’s eyes.

Despite all the structural and personnel changes at the top of the HSE, the impression remains that spin is still one of its primary obsessions. These plans should have been published at the start of the year, when all that was released was an emaciated national service plan with little detail.

Hope the public won’t notice

Rather than state clearly where the axe is to fall, the approach seems to be to say nothing, in the hope that the public won’t notice, and when they do, to make light of the cutback. If the fuss grows too big, as in the case of the cuts to personal assistants last year, the HSE (fronting for the Department of Health) rows back a little to defuse the controversy.

Despite the official news blackout for the first two months of the year, it is clear that budgets are being cut across the board. Every day brings new examples on the ground – the closure of wards, cuts in budget support for voluntary bodies and delays in opening new facilities or appointing staff.

This is the reality of the hairshirt imposed on the health service by the Government at the behest of the troika. Some of our health services are improving – reduced waiting lists, improved quality of care in some areas, etc – but given the overall scale of cutbacks in recent years the overall picture is unavoidably negative.

The budgets announced yesterday are predicated on a wide range of factors that may yet unravel – agreement on Croke Park II, for example, or the promised introduction of legislation to charge all private patients using public beds. There are already signs that some hospitals are struggling once again to stay within their budgets, making a repeat of last year’s huge budget overrun inevitable.