Cash-starved hospitals have been set the near impossible task of slashing budgets over the next three months while at the same time processing thousands of extra outpatient appointments in order to meet Government targets.
The Health Service Executive, in a letter to all hospitals, has told health managers to ensure they "bring back" their deficits, which currently stand at a cumulative €75 million. In previous years this has involved cutting services in the final months of the year.
At the same time, the HSE says hospitals have developed and in some cases begun action plans designed to ensure that no patient is waiting more than 12 months for an outpatient appointment.
At the end of August almost 85,000 patients were on the outpatient waiting list for more than a year, yet the target for year-end is zero.
One way the waiting lists will be cut is through the implementation of a “one-strike” policy for the average 15,000 patients a month who fail to turn up for appointments.
The HSE has instructed hospitals to use text messages and phone calls to remind patients of appointments and to warn them they will be removed from the list if they fail to attend.
However, further reducing the list will require additional investment. Minister for Health James Reilly promised earlier in the year that a €19 million "intervention fund" would be created to reduce waiting lists. His spokesman said yesterday some of this money was still available.
The HSE recorded a deficit of €93.7 million for the year to the end of August, according to its latest monthly report.
It is now forecasting an end-of-year deficit of €105 million on direct services, including a shortfall of €25 million on primary care reimbursement services, including medical cards.
St James’s Hospital is €10.4 million over-budget, St Vincent’s hospital has a deficit of €8.6 million and University Hospital Galway has overspent by €7.2 million.
The overall deficit is likely to be far higher when account is taken of a failure to make projected savings under the Haddington Road agreement and the deferment of payments due from private health insurers until next year.
Projected savings from fee cuts for doctors and other health professionals are also behind target to the tune of €70 million in the first eight months of the year.
The HSE has calculated a figure for the projected deficit by year’s end, but declined to release it yesterday because discussions are ongoing in relation to health insurance and other issues.
Some 45,155 adults and children were on waiting lists for elective procedures in August, while a further 76,617 were waiting for gastrointestinal procedures, the month’s national performance assurance report states. Some 374,104 people were on the outpatient waiting list, of whom 2,236 patients are waiting four years or more.
The report shows there is little likelihood of the HSE meeting a range of performance targets by the end of the year. There were, for example, 2,087 adults waiting more than eight months for an inpatient elective procedure in August; the target is to clear this list by the end of December.
