€50 million HSE West cuts...

How is it after six years of Mary Harney as health minister and so called 'reform',  the HSE West is scrambling around for €50 million of cuts? By Sara Burke. 

Mary Harney came into the Department of Health in September 2004 just as the health boards were abolished and the HSE was set up. The rationale for establishing the HSE was to remove political influence and provide unified, quality health and social care across the country.

Yet in Galway on 25 September the protest against HSE West cuts was led by a trail of local councillors and TDs and ex-PD Noel Grealish who has withdrawn his support for government until the cuts are undone. Local councillors and TDs have never let go of the ownership they feel over their local health services – this clientelist role of politicians is very specific to Ireland.

The HSE was set up to remove that local interest in running health services, and it has been pretty successful in that, as long as government/HSE stand firm on the issue. But it is a failure to really reform health services that is the problem.

Since Health Act 2004, the HSE is required to live within budget. Prior to that, year in year out the Dept of Health bailed out health boards and hospitals for overspending each year-end. Now, the HSE must live within its budget and has got better at it.  

This year, the HSE West like all other regions have provided more services to more people with a smaller budget and therefore have a budget overrun for the first 6-7 months of the year. In order to finish the year within budget, they must now save or cut €50m.

This is the real evidence of the failure to reform. The Irish health budget is allocated on a historical basis – usually adding a bit year on year but more recently getting a bit less year on year.

There is no matching age, demographics and health need of the population to how services are provided which should, of course, be how it is done. So there is no logic to health allocation in Ireland which is also why the HSE have overspent as they are meeting local need but going over and above their budget.

What was tabled at the HSE West Regional Forum meeting on Tuesday last is that €12 million would be saved by cutting temporary staff by 7,000 hours a week. Also by reigning in absenteeism and overtime spend and redeploying corporate staff to hospitals.

Cutting temporary staff is very problematic, as temporary staff have been used to fill the gaps in services of the very blunt moratorium. They are nurses, porters, and homehelps – frontline staff.

There are other ways of finding €50 million than cutting frontline staff. One of the issues that came up at the regional forum on Tuesday is that HSE West is owed €40 million from private health insurers, €10 million of which is included in the overrun. So one fifth of it could be dealt with if senior managers were busy getting that money from PHI companies.

The failure to do this and to live within budget is a failure of our public administration system – a simple failure of management.

Also on Tuesday the clinical director for Galway and Mayo David O'Keefe admitted that money continues to be lost in the public system as private patients in public hospitals are not being charged the full cost of their care. Again this is symptomatic of the failure to reform our public health system.

The unions have tabled a range of proposals on how to find €50 million other than in frontline cuts. Even HSE HR manager Sean McGrath has said in an interview with irishhealth.com this week that "there is a lot of innovation coming from the trade unions at local level" in terms of reforms and cost reductions at local level, and he cites progress being made on reducing the deficit in HSE West services. Unions have proposed flexibility on unpaid leave, holidays, savings on drug duplications, standardised practices etc... the very things the HSE was set up to achieve.

Sean McGrath also admits there too many managers in HSE. And, in my opinion, there are not enough good ones. There are no consequences for performing badly plus the unions recommended six years ago a targeted redundancy scheme and this was out rightly rejected by government in 2004 and we are still paying the consequences of it now.

Where to from here? It is hard to see the Minister Harney getting to a 7th anniversary in health given the broader political scene but what lies ahead is not pretty – Croke Park commits to 6,000 fewer staff in the health system and if the softening up leaks are anything to go by another €7-800,000 has to be taken out of the health system. Isn't it ironic that on today, black Thursday, we are talking about € 50 million in health service cuts on the same day that €50 billion is being given to the banks.