Potential cuts of up to €833 million in the health budget are outlined in the Department of Health’s submission to the Government’s comprehensive review of expenditure.
The department says it would have to cut health spending by €213 million next year to comply with the ceiling set by the Department of Public Expenditure and Reform for the review.
This figure includes cuts of €74 million in acute hospital spending, €56 million on primary care and €24 million on disability.
To meet this target, the department proposes a “targeted reduction in high-cost procedures”, especially in orthopaedics (saving €24 million), closing 290 inpatient beds in hospitals with high agency nurse spending (saving €27.8 million) and reducing consultant and junior doctor usage (saving €25 million).
A further €620 million in savings would be needed to meet the instruction to identify another 5 per cent cut in the CRE (drug-resistant bacteria) ceiling, the department says.
In this scenario, the cuts to the hospital budget would be €216 million, primary care would lose €161 million and disability would be cut by €69 million.
To achieve this target, the document proposes a long list of possible cuts.
These include the closure of 24-hour service at five emergency departments – Portiuncula (Ballinasloe), south Tipperary (Clonmel), Naas, Portlaoise and Mercy hospital (Cork) – and a €25 increase (to €125) in the charge to non-medical card holders for attending an emergency department.
A new €15 levy for outpatient appointments is proposed, reduced to €5 for return appointments and €1.50 for medical card patients.
A €15 levy would also be applied when non-medical card patients are referred by a GP for an X-ray.
Drug spending
Other cuts mooted include strict controls on drug spending and the cessation of planned new developments in paediatrics and cardiology.
Consultants would be charged for the administrative work done by hospitals to collect private fee income and the fees paid to third-level colleges for medical and nursing training would be cut.
However, the department warns the requirements of the spending review cannot be achieved without “serious and adverse effects on patient safety, health and wellbeing”.
Illustrating its point, the department says cutting €74 million out of the hospital budget is the equivalent of taking a hospital the size of Tullamore out of the system and not replacing it.
Cuts to budget
The bigger target of €216 million in cuts to the budget is equivalent to taking a hospital the size of St Vincent’s out of the system.
According to the document, 10,000 patients are waiting over the “upper acceptable wait time” for their procedures, and 33,762 are waiting more than a year for an outpatient appointment.
“These delays represent very significant risks to quality and safety.”
The department says it does not believe the vast bulk of savings measures listed in the document are achievable “and should not be interpreted as recommendations or proposals for this purpose”.
It cites a number of factors which should be considered in assessing the health budget over the coming years.
These include spending reductions of more than €3 billion since 2008, the ageing of the population and a big increase in the number of adults with chronic diseases.
The requirement to cut staff by a further 2,400 this year, down to 94,200, will lead to increases in the cost of pay because of a greater reliance on overtime and agency staffing, the department says.
