PRIMARY CARE SERVICES WILL BE STRENGTHENED

Posted on February 2, 2012 3:19 PM   |   Permanent Link   

I spoke today in the Dáil on the Health Plan for 2012. Obviously, this is a hugely difficult year for the health services. Yet again, this government has to face up to economic planning under the thumb of the Troika, a lack of national sovereignty and all that goes with it. The challenge for this government is to mitigate the impact on front line health care services. In The Plan, there are things which are to be welcomed - the development of proposals to protect the viability of community nursing units; increases in intermediate and community care capacity; a significant strengthening of primary care services; the enhancement of community mental health teams; progression of the clinical care programmes and a more tailored approach to disability services.

Legislation requires The Plan to outline the type and volume of services to be provided. What it also has to do is to manage the health services in a manner which will mitigate as best we can the impact which the budget and staff cuts would otherwise have on services, cuts that, as I said, were as a result from the economic situation that this country finds itself.

It is essential, therefore, that the focus should now switch to implementing the many reforms which are outlined in the Plan and to managing the risks facing the health services. In doing this, I call on the HSE and the Minister together with his Department to work collaboratively on this challenging agenda.

In terms of staff numbers and pay savings, HSE target numbers were, I am told, at 105,300 at the end of 2011 and the HSE estimates that the numbers employed at the end of 2011 end were actually about 104,500, some 800 under the ceiling. The end-2012 ceiling is about 102,100 - a reduction of 3,200 compared to the 2011 target and 2,400 relative to the forecast outturn. These figures are still being finalised and are subject to revision.

The scale of the financial challenges facing the HSE, and the resulting staffing challenges facing the HSE means there will be an inevitable and unavoidable reduction in services but it will not be a "straight line reduction". The Plan commits the HSE to minimising this impact by fast tracking new, innovative and more efficient ways of using the reducing resources. It reflects the need to move to models of care across all services/care groups which treat patients at the lowest level of complexity and provide services at the least possible unit cost. It also includes a commitment to addressing staffing levels, skill mix and staff attendance patterns/rosters within the context of the Public Service Agreement.

In 2012, hospital budgets will drop on average by 4% on last year's allocation but will face an expenditure reduction of 7.8% when account is taken of incoming deficits. The further roll-out of the clinical care programmes and other measures to improve the efficiency of clinical care delivery will limit the reduction in patient activity to an average 3% against 2011 outturn. Activity reductions will vary from hospital to hospital depending on incoming deficits. The need for emergency admissions will be reduced as a result of the Clinical Programmes, as will ED wait times which are a critical priority. Decreased hospital activity will impact particularly on non-urgent elective care but hospitals will work closely with the Special Delivery Unit to ensure that, notwithstanding this reduction, nobody waits longer than 9 months for an elective procedure, thus ensuring equitable access for all. All of this is what the HSE tell me. I certainly hope that their projections are accurate - I do not want to hear a repeat of the A&E trolley disaster reported to me by constituents late last year, where old people lay on trolleys in Beaumont A&E for several days before being moved.

In line with the commitment in the Programme for Government to a significant strengthening of primary care services, additional funding of €20m is being allocated to fill as many vacancies as possible. This will be increased to €25m if it can be established that there is scope for further savings of €5m in demand-led schemes. Funds have also been prioritised for the HPV vaccine programme and the catch up measles vaccination campaign. GP Visit Cards will be issued to Long Term Illness claimants in line with the Programme for Government. It is also intended to roll out a national chronic disease management programme for diabetes during 2012. Preparations will also be progressed for the roll out of similar initiatives for other chronic diseases including stroke, asthma and heart failure. Based on the projected 2012 outturn, a growth of 105,000 medical cards is anticipated.

In terms of older Persons, outside of the Fair Deal scheme, home care packages which support the most dependent to remain in their own homes will not be reduced in 2012. A reduction of 4.5% will be applied to home help hours but service efficiencies in this area will mean that despite this reduction, the number of people in receipt of home help services will only be reduced by 1.2%.

An additional estimated 1,270 clients (above the closing position for 2011) will be supported under the Fair Deal scheme. The HSE will also work with the Department increase intermediate care capacity by reallocating funding from long-term residential care and potential other sources such as acute hospitals.

In the context of mental health an additional €35m will be allocated to mental health services in 2012 targeted at improving child, adolescent and adult community mental health teams as well as suicide prevention and counselling services. In addition, a number of in-patient child and adolescent units will open during 2012. However, like all care areas, the budget allocation will be reduced as a result of general efficiency, procurement and moratorium savings. When offset by the additional allocation, the overall average cost reduction is just less than 1%.

This country faces stark choices. We can either make savings or see our deficit increase to even bigger size than it is at present. Those guiding our economic destiny do not wish to see this, and would take negative steps if they did see it. And so this government must face up to that, in the knowledge that it was the actions of the previous administration that led us to this point. Despite all of that, this government is investing as much as it can, where it can. Adjustments made are not straight cuts down the middle. They are adjustments in some areas, lined with investments in other areas, in order to improve on services and increase provision of services. This government is, I believe, trying its very best in trying to weather this very difficult storm.