ANALYSIS:MINISTER FOR Health James Reilly has warned over recent weeks that 2012 will be a very challenging year and that there will be cuts to services.
However the extent of the cuts being envisaged by the HSE to generate savings of more than €560 million next year are of a scale not seen since the 1980s, if then even.
Under the HSE proposals possibly up to 900 beds in publicly run community nursing units would close, including potentially 10 full units.
Separately, activity levels in hospitals would fall by about 5 per cent, affecting thousands of patients awaiting elective admission while there would also be significant cuts in mental health and primary care budgets.
The proposals are set out in a draft service plan for 2012 drawn up by senior HSE management.
The service plan is the agreement between the Government and the HSE on how it spends its €13 billion budget.
The draft plan has been discussed at a number of high-level meetings between senior HSE and Department of Health personnel over the last week or so – the senior management figures in the HSE and the department effectively comprise the board of the HSE.
The service plan has to be formally presented to the Minister before December 28th and he then has 21 days to consider it.
However Mr Reilly has already briefed the Cabinet in recent days on the outline of the plan.
The Minster has said that the plan will be evaluated when submitted and it remains to be seen what his position will be on it.
However it would be unprecedented in the seven-year life of the HSE for the plan to be rejected fully by a Minister. On the other hand cuts on the scale envisaged have never had to be put forward previously.
Over the last two years the health service has already experienced total budget cuts of €1.75 billion. However the draft plan says that a substantial component of this reduction came from pay cuts and staff reductions – down 8,000 from peak employment level in 2007 – as well as from savings on drug costs and procurement.
“This year the bulk of the reductions that the HSE is required to deliver are impacting more directly on frontline services,” the draft plan states.
This is due to a combination of the effect of the Government cuts to the overall health budget and the sizeable number of staff who are expected to leave before Government changes to pension arrangements come into effect at the end of February.
“It is clear that there will be significant service reductions and that the targeted staff reductions and the lack of funding will mean real service cuts.”
While the proposed cuts are spread across the board most attention will probably focus on plans for services for older people, primary care and the acute hospital sectors.
The draft plan says a minimum of 555 and a maximum of 898 residential beds in publicly run community nursing units will close next year.
There are currently 121 such long-term residential facilities with over 7,000 beds in total between them.
The draft plan says that of the minimum 555 to be rationalised or closed, 111 would be in Dublin/Mid Leinster, 105 in Dublin/North East, 180 in the South and 159 in the West. It says that these include a potential 10 units for closure.
The plan also says that the numbers covered by the Fair Deal nursing home scheme would be capped at 23, 272 next year, an increase of 931.
With a number of local communities already engaged in protest actions at moves by the HSE to shut down community nursing units in their areas, any proposals for further widespread closures could prove a major flashpoint next year.
