Fair Deal shortfall will trap elderly in hospitals
But shortfall in nursing home scheme to be revised monthly to 'ensure a balanced position is attained'
Elderly patients face being ‘trapped’ in hospitals because of a shortage of funding for nursing home beds.
A senior HSE manager has warned that a Fair Deal shortfall of up to €30m by the end of the year is set to delay the release of elderly patients from hospitals.
Internal HSE documents have also set out concerns that spending on homecare is “reaching funding limits”.
And fears have been raised about funding deficits for cancer care as the HSE documents shed more light on Ireland’s broken health system.
The issues are among numerous stark warnings contained in the briefings prepared for new HSE director general Paul Reid.
The Irish Independent has already revealed senior HSE management concerns about patient safety and funding with staffing levels said to be “too low for safe care in some areas”.
Further documents lift the lid on issues in the Nursing Homes Support Scheme (NHSS) and cancer care.
Among concerns raised are:
:: A budget deficit of up to €30m for the Fair Deal scheme;
:: Targets for the number of hospital beds occupied by healthy patients are already being missed;
:: An “inconsistent approach” to the allocation of home support packages;
:: Funding deficits for cancer care affecting areas such as radiotherapy.
Last night, Mr Reid vowed that he would "deal with these challenges in the coming months and over the course of my term".
The warning about a deficit in the NHSS - also known as Fair Deal - is contained in a briefing from David Walsh, the national director for community operations.
Fair Deal is the scheme where residents make a contribution towards the cost of nursing home care and the State pays the balance.
In relation to care for older persons, Mr Walsh warns of a "budget deficit for NHSS scheme (€30m) - impacting on patient flow and discharge".
The briefing also says there is an "inconsistent approach" to the allocation of home support packages across the country.
Another senior manager - then-interim deputy director general Liam Woods - also references these issues in his briefing for Mr Reid.
Among the "key current issues" he identifies is a note saying: "reaching funding limits on Fair Deal and homecare expenditure".
Angela Fitzgerald, a senior manager overseeing acute hospitals, highlights a growth in delays releasing healthy patients from hospitals.
She says a National Service Plan 2019 target of having fewer than 550 beds subject to so-called "delayed discharges" is being missed. The number recorded in her briefing from April stood at 639.
She said that "further deterioration" was expected due to a "funding limit", but added that there was a "strong management focus on patient flow".
Last night, the HSE said that the Fair Deal scheme had a budget of €985.8m.
A statement said an "initial analysis" for the first quarter of the year suggested a shortfall of €30m against potential applications by the end of 2019.
It said this had been revised to a potential shortfall of €17m after a further analysis of "applications, leavers and costs".
The figure would be further revised monthly "in line with performance to ensure that a balanced position is attained".
The HSE said it was not stopping new applications to the Fair Deal scheme.
"However, it is required to carefully monitor and manage expenditure to remain within budgetary targets to year end," the statement added.
Elsewhere, issues relating to cancer care are raised in two of the briefings for Mr Reid.
John Hennessy, the national director for acute strategy whose section has responsibility for planning for 49 acute hospitals, including cancer services and strategy implementation, warns of "funding deficits for cancer care to match referral demands in areas such as radiotherapy, rapid access cancer clinics and diagnostics".
The briefing does not provide a sum for the funding deficits.
Dr Jerome Coffey, the head of the National Cancer Control Programme (NCCP), which is responsible for the development of cancer services including workforce planning and capital projects, highlights the issue of "service development with, for the first time, no new development funding in the National Service Plan for the current year".
A HSE statement said the briefing note "relates to challenges and emerging pressures mainly in the areas of new high-cost cancer medicines and cancer therapies.
"Access to current cancer services is monitored closely on a month-by-month basis to ensure that delay is minimised and dealt with as an absolute priority," it added.
The details of briefings provided to Mr Reid by 20 senior HSE managers are contained in documents obtained by this newspaper.
Other concerns raised included infection control issues and how emergency department attendance is said to be rising above the funded level and displacing elective care.
Last night, Mr Reid said: "Many of the challenges outlined come as no surprise as they have already been well discussed in various fora - including Oireachtas committees."
He added: "Similar to other jurisdictions, there is no doubt that the health service in Ireland faces a range of challenges.
"It is my intention to work through and deal with these challenges in the coming months and over the course of my term."
He said he would do this along with the newly established HSE board, his HSE colleagues and "in close collaboration with the Department of Health".