That the Health Service Executive (HSE) had, on a number of occasions, to postpone the submission of its service plan for 2014 is the most obvious signal that the public health system faces enormous challenges in the year ahead. Minister for Health James Reilly finally approved the plan prior to Christmas. However, doubts remain as to the its viability.
Even if viable it poses daunting budgetary targets for a health service already under extreme pressure. Demand-led schemes such as medical cards and drug repayments are once again likely to exceed expenditure targets and threaten funding earmarked for treatments in hospitals and the community. General practitioner services are already deteriorating due to a sharp cut in funding and rising demand.
Last night the Oireachtas Health Committee was told some €108 million in budgeted savings remain “unspecified”, with an acknowledgment that mechanisms to achieve this target have yet to be determined. While the disconcerting medical card “probity exercise” has sensibly been pared back, there are a number of other savings targets in the plan of an equally nebulous nature.
The ultimate test of the service plan will be its ability to ensure patient safety. However, even at last year’s funding levels, the warning by chief executives of some Dublin teaching hospitals that cuts have already threatened the quality and safety of patient services means the question must be asked: has the reduction in funding outlined in the 2014 plan been stress tested for the risk it may pose to patient safety?
The creation of a dedicated Patient Safety Agency is a step forward; however the small print in the service plan makes it clear it will, at best, be a skeleton structure in 2014. Bland assurances about quality and safety from the Taoiseach and Minister for Health are not enough. Health consumers must be told in some detail what measures have been taken to ensure their safety in the face of significant budgetary uncertainty.