THERE was a simple, stark and, in many ways, terrible reality in Health Minister James Reilly admission on Friday last that the only way to bring the HSE's budget back into line is by cutting services because staff pay and conditions are cosseted behind the protective wall of the Croke Park agreement.
The nation's health service is running seriously over budget. This would hardly be acceptable at the best of times but with the Troika breathing down our necks there is an absolute imperative to reign in the HSE's over-spending and to make enough savings to balance the books. With the HSE €259 million over budget so far this year that is no small task and, thus far, Dr. Reilly's efforts at reform have fallen well short of what is required.
The Minister might have pointed to his failure to live up to his pre-election commitment to tackle the very thorny issue of consultants' pay. For reasons no ordinary taxpayer will ever be able to understand, however, consultants' pay is apparently untouchable. Savings that Dr. O'Reilly hoped to make in the enormous cost of medicines have also not materialised. We don't really know why this is - perhaps because the big drug companies are too much of a handful for our little country.
So, caught between a rock and a hard place Dr O'Reilly has to make savings where he can. It is now proposed to shave €22 million off the HSE's spending by cutting back on personal assistant hours for people with disabilities, cutting home helps for those who need assistance so they can live in their own homes and cutting back on home care packages.
Cuts like this are an affront to any sense of decency in a nation that purports to care for the weak and vulnerable. It might be said that desperate situations require desperate actions - and there's no question but the state of the nation is indeed desperate. But what makes these health cuts utterly repugnant is that, in the same week that the HSE announced the latest round of cuts, Minister for Public Expenditure and Reform Brendan Howlin blithely informed the Government that expected savings of €75 million could not be made from the massive €1.5billion paid out in various - sometimes bizarre - allowances paid to public servants.
These allowances include paying civil servants extra for eating at their desks and paying meat factory inspectors for having to put up with the smell of meat.
Unions won't accept cuts to such allowances as they are considered part of civil servants' overall pay. That pay is protected by the Croke Park Agreement, to which the Government is committed so it's a simple case of hands off - just like with medical consultants' whopping pay packages. Meanwhile, elderly people will go without home help visits that give them security, reassurance and essential care; some will be found dead and alone when the home help eventually gets to call.
What all this amounts to is really very simple: given a choice between preserving life and preserving lifestyles, we opt for lifestyles. In a health service, that has to be seen as a pretty sick choice.