Dublin's five major acute hospitals have warned they will be forced to cut services if they do not get increased allocations, Maev-Ann Wren reports
Representatives of Dublin's five major acute hospitals, of the Eastern Regional Health Authority and the Department of Health are to meet in the next two weeks to discuss the hospitals' budgetary concerns.
The ERHA, which funds the hospitals, has issued a statement emphasising that it has sufficient funds "to purchase acute hospital services to the same level as it purchased in 2001" and "to purchase service developments".
The ERHA's budget for acute hospitals has increased by over 15 per cent to €1.2 billion this year. However, allocations to the five hospitals have increased by only 2 per cent. The hospitals understand that the ERHA may allocate a further €30 million, which would give them an overall increase of under 6 per cent. Inflation in the public sector is forecast by the Central Bank to exceed 9 per cent this year and medical inflation would typically be higher still. The hospitals estimate that they would need a further €37 million to maintain services at existing levels.
In a letter written in February to the ERHA and the Department of Health, the hospitals' umbrella group, the Dublin Academic Teaching Hospitals, warned that failure to address its budgetary concerns "satisfactorily in the coming weeks will render it necessary for the hospitals to plan and bring into effect downward adjustment in service levels".
A number of sources in the hospitals have expressed great disquiet at this budgetary impasse. Following the revelation in the Exchequer returns last week of serious shortfalls in Government revenue, members of hospital boards fear that after the general election, a Government which was committed to fiscal rectitude and unwilling to raise taxes might force real cuts in their services. The hospitals went substantially over budget last year but were encouraged by the ERHA to respond to the demand for their services and were eventually given extra funds, which increased their original allocation for the year by nearly 28 per cent.
However, despite the ERHA's statement that it has sufficient funds to maintain services at existing levels, the hospitals have been instructed by the authority that they must plan to provide services within the agreed budgets, which they consider insufficient to achieve that. The hospitals are by no means reassured that they will be given further funds this year to meet demands on their services, particularly given the uncertain economic outlook and undecided political complexion of the next government.
The ERHA is statutorily required to agree provider plans with agencies including the hospitals from which it purchases services for the population of over 1.4 million in the eastern region. Up to two years ago the five hospitals - the Mater, Beaumont, St Vincent's, Tallaght and St James's - had been under the more relaxed administration of the Department of Health.
A large part of the rationale for the establishment of the ERHA was to make these very independent voluntary hospitals more answerable to the State for the public funds on which they depend. It is undoubtedly an element in the current impasse that the hospitals and the ERHA are finding their feet in this new dispensation.
Whereas formerly hospital budgets tended to be increased incrementally without detailed overview, the ERHA has been having very precise negotiations with the hospitals about the services they will provide and the cost of those services, a role which has provoked resentment.
There are, nonetheless, grounds for the hospitals' current concern. The Value for Money audit of the health service conducted by management consultants Deloitte and Touche for the Government pointed out last year that "work carried out by the Dublin Academic Teaching Hospitals indicates that the financing of core activities in the hospitals (i.e. excluding funding associated with service developments) has in fact been decreasing".
The acute hospital sector in the ERHA area is to provide 330 of the 700 new beds promised by the Government this year.
The population of the area has increased by an estimated 14 per cent over the last 10 years without any increase in bed numbers, having borne the brunt of the cutbacks in the late 1980s.
Once these beds are provided, the hospitals will require extra funds to treat the patients they accommodate - a sum which is not included in the ERHA's budget for the year but which, according to the ERHA, the Department of Health is committed to providing.