Hospital A&E departments could be downgraded under plan

The existing operation of some emergency departments could be downgraded under a hospital reconfiguration programme to come into effect next year, the HSE’s service plan for 2014 has indicated.

Speaking at the publication of the service plan yesterday, the director general of the HSE, Tony O'Brien said €7.5 million had been earmarked for the reconfiguration of hospitals in the last quarter of next year, adding that "the issue of emergency departments is one of those things that will have to be examined", a process that would not be limited to Dublin.

Mr O’Brien said next year’s service plan was “probably one of the most difficult service planning years that the health service has faced”.

It sets out overall savings of €619 million; however, this figure excludes a €419 million underlying deficit carried over from 2013.

The €619 million in savings will come from a number of sources, including savings of up to €140 million under the Haddington Road agreement.

However, the HSE also pointed to “unspecified pay savings” of €108 million.

Asked where these savings would come from Mr O’Brien said he was not in a position to say at this time.

Mr O’Brien confirmed that planned medical card probity measures of €113 million that were announced on budget day were now “definitively off the table”, having been reduced to €23 million, partly due to €47 million in additional funding from the Government.

He said the decision followed concerns that the original target was “not achievable and that the consequences of achieving it were not desirable”.

Medical card cut
However, although €35 million is set out under the plan for the provision of 60,000 new medical cards next year, it also signals a cut of up to 75,000 cards, leading to a net reduction of 15,000 cards.

The HSE said the 75,000 reduction would be made up of a combination of the impact of a change in income thresholds for over-70s, probity, deaths, emigration and changes in people’s circumstances.

Other details contained in the service plan include:

A reduction in inpatient and outpatient numbers, with over 3,000 fewer elective inpatient admissions and over 175,000 fewer outpatient attendances;

An overall cut of 3,600 whole-time equivalent posts to reduce the HSE’s workforce to approximately 98,000 next year;

The movement of €23 million from the Fair Deal scheme into home-based care for older people, in addition to current home-based services;

The BreastCheck screening programme will not be extended to women aged between 65 and 69 next year;

€3.1 million to be provided to address issues around working hours for non-consultant hospital doctors to bring Ireland into compliance with the EU working time directive;

€1.48 million to be provided for the implementation of recommendations to upgrade maternity services following the death of Savita Halappanavar;

€37 million to be allocated for a free GP care scheme for under-sixes.Mr O’Brien said the HSE was committed to the delivery of safe, high-quality healthcare, adding that the focus of the service plan was “very much to maintain sustainable levels of service, with quality and patient care at the heart of everything we do.”

Small spending increase
The revised spending estimates for next year, published yesterday by the Department of Public Expenditure and Reform, show a small increase in planned spending since October's budget, mainly due to the aforementioned €47 million allocated to the HSE and the allocation of an extra €24 million to the Department of Justice, almost all of which will go to former residents of the Magdalene laundries.

Total gross spending will come to €52.9 billion next year, which amounts to a reduction of almost €2 billion on the amount spent by the State this year.