The Cabinet has rejected a key element of the Health Service Executive’s spending plans for next year, following fears it would create an election storm about cuts in the numbers of medical cards.
On Monday, The Irish Times reported that the HSE's budget partly depends on assumptions that 125,000 people would not need medical cards because they will get work during the course of the year.
Fearing, however, that it would be accused of having a secret plan to decimate the medical card system, Ministers on Tuesday said that the predicted fall should be set at 50,000, not 125,000.
“The Cabinet did not think that the projection of 125,000 was credible and was concerned that this would look like a plan to reduce the card numbers, which is not the case,” a source said.
Speaking at the Cabinet, Minister for Public Expenditure Brendan Howlin strongly criticised the HSE and the underlying figures presented by Minister for Health Leo Varadkar.
Target
Mr Howlin is understood to have said the HSE numbers kept changing and he expressed concern the medical cards figure could be seen as a target that will have to be met.
Separately in the service plan, the HSE has suggested it could withhold incremental pay rises due to be paid next year to about 30,000 healthcare staff as an alternative to cuts to patient services.
The HSE has forecast a funding shortfall of €100 million in hospitals and has drawn up options for addressing this in a manner which which would not involve cutting services.
It says “aligning activity levels to the funding available” would be considered as a last resort.
The service plan suggests that not meeting approved but unfunded pay rate increases and increments could generate savings of up to €21.9 million.
It says the HSE had received no funding to pay for increments which could cost it €30 million.
The proposal is highly unlikely to be accepted by Government as increments could not just be frozen for healthcare staff and any such move would breach the Lansdowne Road pay agreement.
Reduction
Sources said Ministers on Tuesday felt the projected 125,000 reduction in medical card numbers was “too big a drop to be credible” and the Opposition would “make out that we have a secret plan to cull medical cards after the election”.
"Which we very definitely don't," added the source. Alternative funding was found by moving money from the State Claims Agency. There will be no change in eligibility for medical cards, and there will be no review of existing card holders.
Another Coalition figure said both parties were conscious of previous efforts to reduce the number of medical cards in 2014, a factor that contributed to poor showings from Fine Gael and Labour in the local and European elections.
The 125,000 figure proposed by the HSE was seen as too “risky”, although one source stressed that it was a “projection for financial purposes”, rather than a target.
New waiting lists, possible cuts in services and up to €110 million in savings are proposed in the 2016 plan as ways of containing rising costs.
The plan to be published on Wednesday says there are specific financial pressures and challenges in the areas of hospital spending, medical cards and drugs, disability and older people. It acknowledges “it will not be possible to address all the challenges identified”.
