William Darcy is a full-time carer and an unlikely victim of health service cutbacks. For the past 10 years, the 64-year-old has done everything possible to save the State money by insisting on caring for his seriously ill wife at their home in Lusk, Co Dublin.
Now, with the axing of the Hospital In The Home programme, which kept Mairead (65) out of hospital over the past year, William fears that the next time she gets ill she will have to go into hospital and risk getting an infection that could kill her. He can't understand how it makes financial sense to cut the scheme. Over the past year they have only availed of it on two occasions when Mairead, who has MS, required intravenous antibiotics.
The decision to cut the Hospital In The Home programme is just one of a wide range of cost-cutting measures being implemented by health services in an effort to address budget overruns. While very radical money-saving options proposed by the HSE to the Department of Health, including restrictions on the issuing of medical cards, cuts in drug reimbursement schemes and the closure of wards have not yet been decided on, cutbacks are already being enforced.
So called 'Breakeven Plans' are being drawn up, which basically mean cutting costs and reducing services. For example, the breakeven plan for Connolly Hospital in Blanchardstown in west Dublin details proposed cutbacks under 13 headings. The measures planned include "phased closure of beds at strategic intervals during the year", "closure of the outpatients department for two weeks during summer months and at year-end" and closing the surgical ward for two weeks each during consultants' leave and at the end of December.
Local Labour TD Joan Burton noted that the catchment population in west Dublin was increasing rapidly and patients would inevitably suffer. She also said a factor contributing to the hospital's difficulties was a €5 million bill for agency workers - largely the result of the recruitment embargo. She argued that it would make more sense to recruit and pay staff directly.
A consultant rheumatologist at Connolly Hospital, Dr Trevor Duffy, warned at this year's IMO conference in March that plans to reduce services at the hospital to the levels of two years ago would undo gains made in extra recruitment - the number of consultant physicians had doubled towards the end of 2006. "So basically, that staffing increase has now almost become redundant," Dr Duffy said.
At Leopardstown Park Hospital in Dublin, chief executive Patrick Smyth has issued a statement saying it was necessary to close a ward of 21 beds and that this process had started from April 9th. He said the cuts were necessary "due to reduced funding from the Health Service Executive in 2008". The statement added: "Regrettably, it is also necessary to suspend respite care services, as part of this process, from the beginning of May 2008, for the foreseeable future." Families affected by the suspension of respite services have been invited to a meeting at the hospital on May 12th.
The hospital statement added that the board and management "are very aware of the adverse impact this will have on acute hospital services resulting in delayed discharges".
Similar cutbacks planned for Cherry Orchard Hospital in Dublin, which would have seen the closure of 12 of 24 respite beds, have been dropped, after a campaign by affected families and local representatives. The Carers Association had pointed out that it made no sense to close respite services as it would only result in families "out of desperation and exhaustion" being forced to place their relatives into full-time care.
Other hospitals where details have emerged of planned cutbacks are in the north-east. There, the breakeven plan provides for closing beds at Monaghan General Hospital, reducing outpatient clinics at four hospitals, taking Monaghan hospital off call for medical and other emergencies and reducing elective surgery to four days a week.
While the HSE may argue that most of these cutbacks - and other publicised proposals including one for a major reduction of services at University College Hospital Galway during August - have not been finalised, there is no doubt that a very different approach to health finances is being taken this year than last year, when the HSE ran up a €244 million deficit. Plans to cut services to reduce costs emerged even before the end of January, as it seemed HSE managers were intent on preventing budget overruns.
Then in March, plans to cut costs stepped up a gear when it emerged that the health service had an €82.6 million deficit over the first two months of the year. And just as hospitals argue that their 2008 allocation is not enough to maintain existing service levels, let alone allow for increased demand, the HSE is pointing out to the Department of Health that more people are using the services and rising unemployment levels mean more are eligible for medical cards and drug payment schemes.
However, Minister for Health Mary Harney has been insisting over recent weeks that the HSE must stay within its budget this year. Speaking in the Dáil she said the €14.2 billion allocated represented an increase of 8 per cent over 2007. She said that, at the end of April, the HSE was reporting an overspend of €95 million, adding that she had had discussions with the chairman and chief executive of the HSE about "emerging budget pressures". She said the "imperative for efficiency gains and more effective practices is all the greater".
Fine Gael's health spokesman Dr James Reilly said he believed more cutbacks will emerge in June. He said he found it "extraordinary" that every time the HSE tried to improve efficiency, it did so at the cost of patient care. "It never seems to look to itself, to its own bureaucracy, to save money," he added. He said some ideas being proposed were bizarre and that people would really suffer.
Back in Lusk, William Darcy says he may consider taking his wife out of the country for care. He is angry that a scheme that was meeting their needs has been axed and they have not been informed of an alternative. The HSE has said that, after terminating the contract with the private company which provided the Hospital in the Home programme, it intends to provide the service itself, but patients have not been given any details.
Because Mairead is particularly susceptible to infection, William is afraid of allowing her to go into hospital. "I feel that if I can't give her my full care and attention she would slip through the net, that they would let her die."