HEALTH CUTS:SAVINGS CALLED for in the health sector total almost €1,230 million.
Almost one-third of this results from staff costs. In all, 6,168 jobs are to go – 168 in the Department of Health and 6,000 in the Health Service Executive (HSE), producing a total saving of more than €400 million.
Of this, €11 million would come from the Department of Health through a 10 per cent reduction in staff every year for the next three years. The elimination of 6,000 HSE staff would result in a €300 million saving.
The HSE staff reduction has already been put in motion through the 2009 Employment Control Framework, which imposes a general moratorium on recruitment and promotion. However the report recommends this be boosted by compulsory redeployment and, if necessary, redundancy to achieve the full 6,000.
But the cut most likely to anger unions representing administrative and frontline staff is the €90 million a year to be saved in health sector “efficiencies”.
This will involve cuts to overtime, premium payments and allowances for qualifications, which would effectively mean that agreements between unions and the HSE would be scrapped.
The report blames unions for blocking the HSE’s attempts at making savings and accuses them of obstructing patient care: “. . . Restrictive agreements and work practices, involving trade unions and professional staff organisations, have been a major inhibitor to staffing and pay efficiencies in the health sector, and a block to good quality patient-focused care”.
The report particularly highlights restrictive agreements with Impact and the Psychiatric Nurses Association.
The primary-care sector faces the most austere cuts, with planned savings of €577 million. The most controversial of these cuts is likely to be the €100 million reduction in medical card costs to be achieved through further restricting access to the card.
The report states that increasing unemployment is resulting in unsustainable growth in medical card holders. Income eligibility needs to be restricted to the basic rate of social welfare, ie jobseekers allowance, and other non-criteria such as childcare costs, rent or mortgage payments should be scrapped. HSE discretion in allocating cards should be removed so applicants who did not meet clearly defined criteria would not get cards.
Free prescriptions for medical card holders are also to be eliminated with all card holders paying €5 towards prescriptions to achieve a €70 million saving. The Drugs Payment Scheme threshold, for non-medical card holders, is being increased from €100 a month to €125 to save €37 million.
However, the largest saving in the primary-care area would come through scrapping the contracts with GPs and pharmacists to provide care or medicines to medical card holders and allowing competitive tenders to provide the services instead.
This move, likely to be strenuously fought by the representative bodies, would result in savings of €370 million, notes the report.
The elderly are being hit through an increase in their contribution to nursing-home care. Under the Fair Deal agreement, which was due to come into force later this year, an individual would have contributed up to 15 per cent of the value of their home to their care. This would be increased to 22.5 per cent, to save €50 million.
Homecare packages for the elderly would be means-tested to realise savings of €24 million.
In acute hospitals, annual savings of €96 million are sought. This would be achieved through a 20 per cent increase in charges for private facilities in public hospitals to save €50 million and an increase in hospital charges to save €6 million. Hospitals would be required to use generic medicine to save €30 million, and money spent on non-emergency patient transport costs would be reduced to save €10 million.
