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Reality check needed on health spending

28 Sep 2016

IHCA Research and Policy Executive Daniel Costigan, reviews the Association’s recent pre-Budget Submission, which has called for health spending to be based on more realistic, verifiable projections

In our Pre-Budget Submission, the IHCA has stressed that patient safety has been jeopardised by eight years of cumulative cuts to the acute hospital and mental health budgets.

The 2016 acute hospital budget is 11.4 per cent below the 2008 budget.

Acute hospital deficit
Based on the most recent reports available, the acute hospital deficit was €112.1 million (8.28% over budget) in the first four months of 2016.

It is clear that this year’s acute hospital budget is not adequate to care for the number of patients requiring care. The Association has recommended in its submission that future budgets be based on more realistic, verifiable projections which take account of the ageing population and the increased numbers of patients awaiting care.

The number of inpatients and day case patients treated in acute hospitals, for example, has increased by 282,434 (22%) in the seven-year period to 2015. By 2021, there will have been a 53 per cent increase in the population aged 65 and over – from 462,400 in 2006 to 713,600 in 2021. This cohort of patients accounts for 91 per cent of delayed discharges and more than half of all inpatient bed days.

Pic: Getty Images

The IHCA submission strongly recommends that after years of austerity the Government must now address these overwhelming constraints that are severely restricting and undermining the delivery of care to patients.

Cumulative cuts
Yet simply restoring the budget to 2008 levels will not address the effects of these cumulative cuts. Between 2008 and 2016 the cuts to the annual capital public health budget and the acute hospital capital budget accumulated to €1,700m and €530m respectively.

In the next Budget, the Government must significantly increase funding that targets the front line in acute hospitals to provide the resources needed to care for the growing number of patients presenting in hospital and mental health services.

Bed stock
Also, the number of acute beds has been cut by 1,643 (14%) from 12,123 to 10,480 in the past decade, when the population increased significantly. Recommendations in a HSE commissioned Prospectus report for an immediate 45 per cent increase — from 289 to 418 – in ICU beds in 2010 alone and a doubling by 2020 were ignored and the number of ICU beds has actually declined. Ireland now has one of the lowest numbers of acute hospital beds across the OECD at 2.4 compared the OECD average of 3.6.

In the year to July 2016, the numbers of patients waiting on the inpatient and day case waiting lists increased from 68,786 to 77,810 (13%).

The Association’s pre-Budget submission has recommended an urgent increase in the number of acute, ICU and rehabilitation beds in order to treat patients awaiting care on time, relieve emergency department overcrowding, reduce bed occupancy levels and address growing waiting lists.

2008 Contract
In its submission to Government, the IHCA also recommends that the 2008 contract terms be honoured and the discrimination against new entrant consultants ended in order to restore the trust of the medical profession in the State. This is essential to improve the country’s international competitiveness in recruiting consultants.

Mental health
The submission also recommends that the additional €35 million provided in the Mental Health Service budgets must be expended on a timely basis to recruit additional staff and ensure the delivery of timely care to an increasing number of mental health patients.

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Click here to view the full article which appeared in Irish Medical Times: Opinion