Eilish O'Regan: 'Time to come clean over back-door rigid funding and its effects'
Rationing is a fact of life in the health service, although it's usually clouded in spin.
The latest internal memo from the HSE's Services for Older Persons section, instructing officials across the country there is a "strict" weekly quota of long-term nursing home and convalescence places, is stark.
This allowance cannot be breached. It is more proof of financial restriction in the face of growing demand.
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The cap was taken from the €1bn Fair Deal nursing home support in recent years.
It is now supposed to be demand-led. This allows the HSE the freedom to spend more to meet growing numbers of patients, mostly elderly and in hospital beds who need to move into a nursing home permanently.
But now there is no flexibility to be shown in the weekly allocation of nursing home places.
According to Nursing Homes Ireland, which represents private nursing homes, more than half the patients awaiting discharge from hospitals need long-term nursing care.
CEO Tadhg Daly said the feedback was that there was a definite slowing down in the transfer of many older patients who were having to lie in hospital when they should be enjoying the comfort and independence of a nursing home.
It comes as recently installed HSE director general Paul Reid vowed to come in on budget this year and not end up seeking a top up to its €16bn at the end of the year.
The main concern has to be for older people who are assessed as being suitable for nursing home care who now risk facing delays.
However, the domino effect of this policy - as well as the tightening up of homecare supports - is also becoming increasingly clear.
Hospital A&Es have endured a torrid week of overcrowding.
Patients in University Hospital Limerick, Cork University Hospital and University Hospital Waterford have been caught in the hold up for hours for a bed.
University Hospital Limerick has twice the normal number of patients occupying beds who could be discharged if they had a suitable step down.
Yesterday the hospital apologised to patients for the delays caused by overcrowding. It said that access to transitional care and homecare package funding had been reduced over the past two weeks, which had led to an increase in delayed discharges.
Transitional care beds in nursing homes can act as a bridge for a patient who is ready to leave hospital but has not yet finalised their Fair Deal scheme application.
Although the latest hospital waiting lists, which are on the rise again, need further analysis, the squeeze on hospital beds is undoubtedly contributing to the increase.
Fewer beds mean more waiting list patients who need an overnight stay for surgery and cannot be admitted.
This is traditionally the time of year when surgeons try to make inroads into waiting lists by doing more operations.
But this window is getting narrower as the trolley crisis refuses to wane in summer.
It's true to say there are no budget cuts as such. But it's time to come clean on back-door rigid control of funding. And the question must also be asked about the full knock-on impact and how much of it can amount to a false economy.