THE HSE is facing a “challenge of €21.7 million” for acute hospitals in the region to break even this year in spite of a 10% increase in budget on 2012, politicians were told this week.
At a briefing on the HSE Mid-West service plan for 2013, hospitals group CEO Ann Doherty expressed confidence a combination of cost reductions and extra income would mean the six hospitals would stay within budget.
Historical imbalances in the funding of hospitals in Limerick and the Mid-West were addressed with an increase in the allocation from €217 last year million to over €238 million this year. But the group - Limerick Regional, the Regional Maternity, Croom Orthopaedic, St John’s, Ennis and Nenagh hospitals - had ended up spending over €250 million last year.
Fianna Fail’s Deputy Timmy Dooley challenged Ms Doherty on the financials.
“The cost of running your operation last year was €250 million and you have €238 million to run the same operation this year,” he said.
“If you are to deliver for the same number of patients the same level of activity as last year, you are going to have to do it with €12 million less, notwithstanding the increased costs that brings you to a total of €21 million of a pressure. It is somewhat of a spin to suggest the Mid-West region has benefited by a 10% increase in funding,” Deputy Dooley asserted.
Increased costs facing the hospitals group this year include the payment of increments to staff and the cost of running new services at the €37.5 million critical care unit in Dooradoyle, which started accepting patients in January.
“We got a significant uplift on our budget, that is a statement of fact,” Ms Doherty replied, although she conceded that “that uplift did not meet our out-turn for 2012 in its entirety”.
Savings in the hospitals would be made through the recruitment moratorium, cutting procurement costs and better control of stock. This year’s plan provided for an overall reduction in staffing of 70 whole-time equivalents, Ms Doherty said. Any further efficiencies that could arise from Croke Park 2 were not factored into the budgets, Ms Doherty said, which were based on the earlier public service agreement. Management aims to further reduce reliance on overtime and agency staff and do more to tackle absenteeism.
On the income side, Ms Doherty said €4.3 million could come in this year once the government introduces promised legislation to levy insurers for private patients occupying public beds. Regional management was also seeking a €1.7 million cash boost from the HSE for historic development at St John’s Hospital.
The HSE has set a number of targets for waiting times and waiting lists across the emergency, elective and outpatients departments. It is hoped that nobody will be waiting longer than six hours in an emergency department to be either admitted or discharged and Dr Con Cronin, clinical director of medicine, told Deputy Kieran O’Donnell that the ambition was that nobody would be left waiting on a trolley in casualty by the end of this year. “We would feel we have failed ourselves if we have not achieved that target,” Dr Cronin said.
Expansion of services at medical assessment units in Limerick, Ennis and Nenagh would help in this regard and three acute medicine physicians had been appointed this year to help ensure patients are treated in the most appropriate setting.
“We won’t resolve the issues in our emergency department if we continue to work in the way we have been, which was people going to their GP and coming into the acute hospital,” Ms Doherty said.
“That is not the way to address our emergency department challenges. What is the way to address it is the development of our acute medical programme which involves our acute medical assessment unit in Limerick working with medical assessment units at Ennis, Nenagh and St John’s so that patients can be streamed to the right centres for their care needs. So if somebody needs access to critical care or are at risk of deteriorating, they need to come to Dooradoyle, they don’t need to go to the other centres.
“But for the majority of people there are very good services that they can avail of in Ennis, Nenagh and St John’s.”
Ms Doherty said that by the end of this year, no adult would have to wait longer than eight months for an elective procedure while children would be seen within 20 weeks. And nobody would have to wait longer than 12 months for an outpatients appointment by the end of 2013.
On the capital side, the HSE would start work on a new €7.5 million emergency department that would take up the ground floor of the newly built critical care block and a space as big again in a second block to be built adjoining it. The long-term plan was to replace much of the 1950s-vintage ward accommodation in Dooradoyle with “four floors of 20-bed wards” in this new development.
More immediately, the HSE anticipates that the new high dependency and intensive care units will open by the summer once commissioning and calibration of equipment was concluded. Over €3 million had been allocated by the HSE to run these expanded units and management was currently recruiting additional specialist staff, including ICU nurses.