The director general of the HSE Tony O’Brien has told the Government that deep cuts that are to be implemented in spending on medical card services next year are being taken “against the advice of the HSE and the Department of Health”.
The comments are contained in a confidential letter sent Minister for Health James Reilly last Monday that accompanied the HSE's service plan for 2014.
Highly-placed sources said that in the seven-page covering letter, Mr O’Brien maintained that the plan provided for cuts in spending of €133 million on medical cards – higher than the €113 million in cuts which had previously been suggested.
However the tone of the letter has been interpreted by some in Government as Mr O’Brien signalling that he did not agree with the scale of the proposed cuts and that the responsibility for any fallout from the measures would lie elsewhere, other than in the HSE.
The HSE has been asked to make overall savings of €666 million next year.
There has already been considerable controversy this year over medical cards with the opposition claiming that thousands of people have had these withdrawn. The Government has argued that there has been no change in policy on medical cards.
In the budget the Government set a target for the HSE to generate savings of €113 million on medical cards next year.
Elsewhere Mr O’Brien indicated that while the Haddington Road agreement would deliver savings on payroll costs next year, a plan would need to be developed to realise significant amounts of the €248 million which the Government had sought to be generated.
Pensions
The letter has raised eyebrows in some quarters of the Government, where it is considered as an attempt to refight the recent rows over the spending estimates for 2014.
The Irish Times has learned the service plan also proposes that health staff should be excluded from measures agreed by the Government that personnel across the public service who retire before next August can do so with their pensions calculated on the pre-pay cut salaries that applied before the Haddington Road agreement.
The plan proposes that HSE management should be permitted to assign a specific date for staff who want to retire rather than having potentially large numbers departing at the same time next summer.
The move is aimed at generating savings on the payment of lump sums for retiring personnel.
Sources said the HSE also indicated in the plan that it would not be in a position to provide planned follow-up care for women who received faulty breast implants.
The Department of Health said a review of the plan was ongoing.
