Health plan is best one we've had in six years, but it's still not enough
The sense of relief was palpable at yesterday's launch of the HSE's 2015 Service Plan. HSE chief Tony O'Brien was flanked by ministers Leo Varadkar and Kathleen Lynch.
There was no smugness or back slapping, instead a sober acknowledgement of the "welcome but modest" increase to the health budget for the year ahead.
Ministers Varadkar, Lynch and Mr O'Brien each outlined how the figures for 2015 were "realistic", "challenging but not impossible". When all the pluses and minuses are taken into account - including the €510m supplementary budget that has yet to be allocated to health for this year - the health system budget will be pretty much the same next year, as it was in 2014.
But very significantly, for the first time since 2009, the health service budget is not being cut and the HSE is planning to deliver "existing levels of services in 2015", to implement some long overdue Programme for Government commitments and some new service priorities.
Minister Varadkar was keen to emphasise that our health services are under-funded to meet demand and population need, that they cannot eliminate waiting lists, or overcrowded Emergency Departments, or get rid of delayed discharges in the year ahead, but they are in a better position now than they have been for a long time. And they reinforced how they have entered a multi-year reform programme for the health system, which is now going in the right direction.
Speaking at the launch, Tony O'Brien said: "When you owe a lot of money, it is the bank's problem, when you owe a little, it is yours." He explained that owing a little is the welcome position the HSE will be in next year. O'Brien was quite clear that if they provide the services as outlined in the 2015 Plan, they will be €100m short this time next year.
There are a few differences between this year and next. For the first time since the HSE was established, the Department of Health, not the HSE, will be responsible for the health budget. Under this new regime, if the HSE overspends in 2015, it will start 2016 with that deficit. Also new is the fact that if the HSE achieves savings, it can keep them rather than having to hand them over to the central exchequer.
Another significant development for 2015 is that the HSE will be able to hire additional staff. For eight years, the health services have been stymied by the crude public sector-wide employment control framework. However, next year, in a move agreed in the 2015 budget negotiations, the HSE will be allowed to hire extra staff instead of spending more money on agency staff. This is good for patient care and for overall budget management.
The HSE Service Plan details similar or modest increases in services to be provided in 2015. For example, while last year's plan predicted fewer hospital inpatients, day cases and emergency admissions, next year's plan allows for increased hospital activity in each of these areas.
The plan estimates 60,000 fewer people with medical cards at the end of 2015 than there currently is. Presumably, this is based on the declining numbers of unemployed, but it may well be hard to implement in the run up to the next election and in light of the fall-out from discretionary medical cards.
There is more detail on the €25m announced in Budget 2015 to address delayed discharges - the 800 people stuck unnecessarily in hospital beds. Some €10m of this will be allocated to 300 additional nursing home beds, the rest will be spread across increased numbers of short stay and transitional beds as well as more home care packages and community intervention teams. If this works, it will also help relieve long waits in Emergency Departments and for planned elective care. But as Minister Varadkar and Mr O'Brien emphasised, it is not nearly enough to solve these intractable problems.
There are some small amounts of extra money for disability services (€20m), mental health (€35m), and the long neglected area of ICT (€55m), where investment is much needed.
The illusive area of free GP care is also in there, with commitments to free GP care for under six-year-olds and over-70s restated again for next year with an additional €37m earmarked for them. The ministers were very cautious not to set another deadline they would not meet on free GP care, but Minister Lynch was confident that talks with GPs were going in the right direction, mentioning April 2015 as a possible date for this to be realised.
Throughout the HSE plan, there is a renewed emphasis on patient safety and quality of care, with Mr O'Brien emphasising the importance of care and compassion as well as quality services. A 'Quality and Patient Safety Programme' is published in an the appendix and quality indicators are set for the first time.
Also new is an 'accountability framework' which Mr O'Brien said was essential for the HSE deliver within their 'very tight budgetary' arrangement. Under this senior HSE managers, hospital group and the new Community Health Organisation managers will be held to account.
Having had six years of arbitrary and unrealistic cuts, the fact that the health budget is not being cut in 2015 is positive. Years of slashing services combined with our growing, ageing population means there undoubtedly will continue to be unmet need and more demand on the system than the resources allow for.
That said, the 2015 HSE Service Plan is a significant turning point in the right direction. How it is managed and delivered upon will be a real test to the health chiefs in the run up to next general election.
Sara Burke is a health policy analyst and a research fellow in Trinity College Dublin