Eilish O'Regan: 'Coming in 'on budget' must not compromise any patient's safety'
The briefing dossier given by experienced senior HSE managers to their new boss Paul Reid has several alarm bells that should worry us all.
Coming in on budget and avoiding another end-of-year financial bailout for the HSE is very much the mantra of the present time.
But if it does happen, it may come at a price - not just in prolonged patient suffering, but also safety.
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The message to the HSE director general from these insider veterans is that staffing is already too low in several parts of the service, including hospitals and the community, to ensure safe care.
However, keeping a rein on the pay bill has already been triggered in recent weeks.
And managers have been told to stay within their hiring limits in the coming months while keeping overtime and agency staff to a minimum.
The knock-on effect of this is that some services will simply be curtailed - procedures and clinics will not go ahead because of a lack of staff.
In other cases, too few workers will be looking after patients which increases the risk of something serious being missed.
What is clear is that the HSE, for all its record funding of recent years, is still in recovery after the recession.
Public spending on health fell by 12pc between 2009 and 2015 and staff numbers dropped by 14,000.
For much of that time we were sold the utopian fantasy of a version of universal healthcare as well as the abolition of the HSE, which turned to dust.
The HSE is still playing catch-up but time has been lost.
Opportunities to tackle inefficient work practices and risk a union backlash were not fully grasped. But all the time, patient demand is rising faster than increased budgets.
Nurses report today that the trolley crisis this summer is at the same level it was in the winter of five years ago.
Waiting lists are the open wound that is not healing.
A lack of specialists, beds and the intrusion of private practice in public hospitals are fuelling the backlog.
Then there is the emigration of home-grown doctors who received a costly, mostly taxpayer-funded education, and an inability to attract them back to full-time posts in hospitals around the country .
The €75m outsourcing of mainly surgical patients is providing some relief - but it's just a sticking plaster.
The whole area of delays in social care services used to be under the radar but increasingly as people live longer with more complex needs, the demand for home care and respite services is becoming a deepening crisis.
The executive notes warn of overlap and confusion in parts of our community care services as well as an inconsistent approach in allocating home care packages across the country.
The contradiction in rationing home care, while there is also an expected increase in patients who cannot be discharged from an expensive hospital bed due to lack of this support, is also highlighted in the briefing.
There is little enough reference to Sláintecare, the plan to switch more services out of hospital. It is making slow progress, although there has been a deal done with GPs and nurses that should shift more care to the community.
But it's still shrouded in uncertainty, not just because of under-funding.
It proposes to remove private practice from public hospitals although it generates €600m in income.
This will require taking on the powerful consultant corps, renegotiating their contracts and paying compensation for loss of private income.
If we are finding it hard to hire consultants now, who will work here should that scenario happen?