Primary care takes major hit in HSE plan

The medical card and other primary care and community schemes will face the brunt of the cuts in the 2013 HSE service plan, in order to ease the budgetary problems of cash-strapped hospitals.

Details of measures announced today as part of the plan include 40,000 people losing full medical cards, more drugs being removed from the free medical card list, further staff cuts, a waiting list for the Fair Deal nursing home scheme, which is getting no additional funding this year, and an effective cut in home help hours.

The HSE will face an overall reduction in its budget of €721 million this year, with an net increase of €71.5 million. Almost 4,000 wholetime equivalent staff will be cut from the health service this year through retirements and a new voluntary redundancy scheme.

The health executive pointed out that the health budget has now been cut by 22% since 2008.

Announcing the 2013 service plan today, HSE Director General Designate Tony O'Brien said there had been a rebalancing of the plan this year to avoid the type of unexpected deficits which led to a fresh round of cutbacks in August of last year.

This rebalancing means that in order to spare hospitals from the major budget problems this year, the HSE has concentrated the savings on community/demand led scheme such as the medical card scheme. It is also more closely aligning budgets to activity levels.

However, hospitals, while they are effectively getting their accumulated €271 million deficits of recent years 'written off', are still expected to be challenged to keep within their allocations for 2013, which show an overall 3.5% increase.

According to the HSE, budgets for 2013 are based on actual activity levels rather than historic budget provisions, which should empower budget-holders to resopond to financial issues as they arise and reduce the likelihood of a financial csisis as the year progresses.

However, the balancing of the HSE's budget this year, as was the case last year, is heavily dependent on achieving savings in areas which have yet to be 'nailed down'.

This year the HSE is banking on delivering a balanced budget as a result of expected legislation on charging private patients for public hospital bed accommodation, achieving more pay savings under Croke Park, managing the expected staff reductions, implemnenting measures such as cutting GP fees in time to generate the necessary savings, and hoping that medical card numbers and hospital activity levels do not exceed targets.

Speaking at the launch of the plan, Mr O'Brien said the HSE was not planning for a supplementary budget this year, and the 'rebalancing' process in this year's service plan was designed to avoid such a scenario.

Last year, the HSE had to be 'bailed out' by the Department of Health to the tune of €360 million.

He said the approach adopted in this year's service plan placed a priority on stabilising hospital budgets, maintaining community services, while delivering further cost efficiencies in the primary care schemes and drug costs.

The HSE has piled on a further €60 million in cuts to these areas above that which was targeted in the recent Government estimates, bringing the total cuts to €383 million.

This means that in addition to already announced measures such as cuts in medical cards for over 70s and other patients, mere drugs are to be taken off the free medical card list, there are to be savings on high-tech drugs and new 'probity' review measures for medical cards.

In the service plan document, the HSE warns of a number of risks to the successful delivery of the plan, including dealing with increased demand for services beyond planned levels, achievement of targeted savings in primary care, potential insufficient capacity in the Fair Deal scheme, and delivery of regulations and legislation to support savings.

Further details on how the service plan will be implemented for hospitals and other services will be revealed by the HSE later this month.

The main measures announced today include:

* 40,000 people will lose medical cards; 'delisting' of more free medical card drugs; savings on high tech drugs (although there is specific provision for expected cancer drug costs); new 'probity measures' on medical card and other schemes; provision for 60,000 new full medical cards and 130,000 GP visit cards this year.

* Same level of home helps and home care packages to be provided in 2013 as in 2012. With likely increased demand, this is effectively a cutback.

* No additional funding for the Fair Deal nursing home scheme. The HSE says this will lead to challenges in responding to need for residential care, and a 'placement list' will be in operation.

* Overall 3.5% increase in hospital allocations. Accumulated hospital deficits of €271 million are to be covered by but hospitals still have to make savings measures. The HSE hopes the hospital budgets will cope with demands. It says their 2013 budgets will support 2012 activity levels while allowing for projected cost increases due to demographics, technology and clinical advancements. However, there are 'confoundables' such as the cost of drug treatments for cancer and other expensive technologies going over budget.

* HSE to lose 4,000 staff this year through retirements and a new voluntary redundancy scheme.

* HSE projects a saving of €150 million in pay costs (on top of other pay savings) as a result of the revision of the Croke Park deal.

* There are to be cuts to the palliative care and disability budgets.

* Maximum waiting time of eight months set for 2013 for inpatient/day case hospital procedures and 20 weeks for children. Target of maximum one year wait for an outpatient appointment.

*Funding provided for more mental health posts, for primary care posts postponed from last year, and for first phase of free GP scheme.

HSE's delicate balancing act on finances



[Posted: Thu 10/01/2013]


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