Friday, 17 July 2009

An Bord Snip - An attack on the health of the nation

Sara Burke: The Bord Snip Nua report has the potential to undermine the health of the Irish people and specifically those who already have the poorest health.

Proposing a cut in social welfare rates of 5% shows no understanding of the day to day realities of living on €200 a week. Already the vast majority of the 1.2 million social welfare recipients have received a 2% cut in their annual income when their Christmas bonus was taken away from them in the April budget.

Over 90,000 households who receive rent supplement have also received a further cut through the changes introduced in the October and April budgets which mean they have to contribute about €11 more per week, this is in effect an 8% cut. Basic social welfare rates are already below the poverty line of €228 per week.

Does this government really want to push more people on social welfare further and deeper into poverty and poor health? It is well established that the most important contributory factors to poor health are one's income, housing, education and work opportunities. Cutting social welfare rates will not just impact on people's day to day lives and pockets, but also on their health.

The proposals for the health sector are also an attack on the public health service which has been built up over the last ten years. McCarthy et al outline €1.2 billion in cuts in the health area.

The three biggest contributory factors to achieving this massive sum are:

1. Reducing HSE staff in by 6,000 (€300 million) plus additional efficiencies in the HSE (€90 million)
2. Opening up contracts with GPs, opticians, pharmacists and dentists to tender and presumably negotiating better deals for those covered by medical cards (€370 million)
3. Revising down income eligibility for medical cards (€100 million) and introducing a range of new co-payments or increasing extra payments which will hit the pockets of patients (e.g. €5 charge for a prescription for all medical card holders (€70 m); making the 70% of the population who pay for their own drugs pay €125 a month not €100 a month as is currently the care (€37 m); increasing admission charges to A&E from €100 to €125 (€6)).

These measures, if introduced, will hit the people who depend on the public health services the most - the sick, the disabled, the young, the old, the poor.

Cutting 6,000 staff from the HSE is bound to impact upon patient care. The HSE by its own estimations is already trying to cut about 3,000 staff, so what impact will 6,000 fewer staff have on front line services?

The report does suggest that these job losses be achieved in the administration and support areas. However, finding 6,000 of such posts is hardly possible. We are already seeing ward closures, difficulties in getting home care packages, longer waits for some treatments: cuts such as these will only exacerbate pressure on a health system already under pressure.

There is no doubt that there is waste in the system, and the report clearly states that without union co-operation such measures must be introduced with 'compulsory redeployment and if necessary, redundancy'. Given the stand off already in place between HSE management and the unions on a previously announced redundancy programme and paid leave, achieving such cuts in staff will inevitably result in industrial relations turmoil, unless a very different strategy is embarked upon.

Similarly, the report is very critical of deals done with the unions and professional bodies which have hampered so-called 'reform' to date. Both the minister and the HSE management have an enormous capacity to alienate every group they are seeking to 'reform'. Achieving better use of public money and new contracts with professionals is essential if the delivery of health and social care is to be sustainable but, once again, the track record in achieving this to date is non-existent. Remember the consultants' contract deal that was heralded by the minister, which took five years to agree and is a very bad deal for the public purse?

Revising the income guidelines downwards for medical cards and introducing charges on prescriptions for medical card holders is a sure way of hitting the people who need, and are entitled to, these services most.

We know from research carried out by the ESRI that the medical card is an effective pro-poor measure. We know from an international body of evidence that introducing charges for health care and services dissuades people who need those services from accessing and utilising them. We also know that cutting essential health and social care services now can be more costly, both economically and health-wise, in the long term.

Many of the measures detailed in the health section of An Bord Snip may save money in the short term, but are sure to cost more in the not too distant future.

On a more positive note, there are some good ideas on the health section. Getting rid of senior managers and administrators that were duplicated rather than rationalised when the HSE was established is welcome, but nothing new. Reducing the staff in the Dept. of Health by 10% a year for three years also seems to make sense. Restricting the National Treatment Purchase Fund to private facilities is a step in the right direction (however, if I were on An Bord Snip I would shift that €100 million into the public health system). Eliminating all bonuses to HSE managers is also welcome, but again nothing new in that idea. Unfortunately, none of these measures add up to a significant amount of savings.

Other political and economic choices could be made in the health area which could save hundreds of millions of euros, without hitting those who need and are entitled to quality public health services, e.g. more use of generic drugs, revisiting the consultants' contract, spending all public money on public health services, really targeting waste in the system identified in a myriad of reports already out there.
More on this anon....

Sara Burke is the author of Irish Apartheid: Healthcare Inequality in Ireland, which has just been published by New Island.

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