As always around this time of year, the nation suffers an acute shortage of hospital beds.
Minister Reilly, who loves pulling, stokes, and hates being accused of dodgy deals, has for once come up with a jaw dropping solution, which will insure hospital beds are readily available.
A program of replacing hospital beds with hammocks will begin early next year and will more than double their capacity for patients despite the crippling effects this will have on overstretched staff.
Reilly was disappointed that the HSE were themselves unable to come up with this simple initiative. He did thank the consultancy firm known as the friends of Reilly for their work in this area.
The first thousand hammocks are to be installed in January.
Reilly does not expect fallout from the scheme.
Taoiseach Enda Kenny was warned the decision could have implications for 25,000 jobs and future investment.
Early this year, the HSE decided not to reimburse new drugs that had passed all regulatory stages and were becoming available for use in patients. They included drugs for treating skin cancer and cost up to €85,000.
In correspondence with Mr Kenny, up to 20 multinational drug firms claimed that the HSE move was portraying Ireland negatively and could have “unintended consequences” for Ireland.
The details have emerged against a backdrop of continuing controversy over the price of medicines and Government efforts to curb costs, including the cost of drugs. A recent survey found that the cost of some medicines here is among the highest in the world.
It has also emerged that the price paid for drugs in Ireland is of critical importance for pharmaceutical companies as it influences the price in many other countries, both within and outside the EU, as part of an international price-referencing effect.
Earlier this year the HSE argued that no specific budget had been provided to it to pay for the cost of new drugs and medicines coming on the market after approval.
However, the multinational drug companies argued that a ban on reimbursing new drugs by the HSE represented a breach of a supply agreement with the State.
In June Minister for Health James Reilly reached an interim deal with the pharmaceutical industry that involved reductions in the price of certain off-patent medicines. He claimed this could save up to €20 million in a full year.
As a condition of the agreement the HSE was obliged to add to its list of items for reimbursement “drugs which in the normal course of events would have been approved under its schemes”.
In effect, this meant that the HSE could not refuse to pay for drugs for financial reasons.
In October the Government secured a full agreement with the pharmaceutical industry which it said could generate €400 million in savings over three years. In return for making price concessions, the pharmaceutical companies reinforced the principle that new medicines will be approved under the HSE’s drug schemes once they have been proven to be cost effective.
However, new documents released by the Government show that Mr Kenny received strong representations on the cuts by leading pharmaceutical companies. The letters had been written in February and March and many struck a similar tone.
In one, the president of Eli Lilly, John C Lechleiter, was concerned that “your Government’s recent decision not to reimburse new medicines puts at risk this aspiration and portrays Ireland negatively to inward investors such as Lilly”.
Mr Lechleiter pointed out that Lilly employed more than 700 people in Ireland in two manufacturing sites. “I believe further price cuts and a blanket ban on reimbursement of new medicines could have a number of unintended consequences for the wider Irish economy.”
The chairman of Johnson and Johnson, William C Weldon, told Mr Kenny in a letter: “When new medicines are scientifically and independently judged to be of value and improve health outcomes, it is imperative that they are made available to Irish patients.”
More medical card cuts on the way
However, further as yet unspecified cuts to medical card entitlements for other age groups are also due to take place next year and are to be revealed in the HSE‘s forthcoming 2013 service plan.
The Department of Health old irishhealth.com are to be changes to the medical card means test next year, but so far no precise details of this have emerged. The Government had been under pressure from the Troika to tighten up on medical card eligibility.
Minister, Reilly, having promised on coming to office last year that he would abolish the 50 cent medical card prescription charge, has now trebled it to €1.50 per prescription item, subject to a monthly maximum charge of €19.50 per family. This increase has been ‘due to the current financial climate’.
Under the over 70s medical card changes, the Minister said 92% of over 70s will still have medical cards, while 5% will no longer have a full card but will qualify for a GP visit card, while the wealthiest 3% will have neither card, which is the same percentage as at present.
Dr Reilly said single over 70s earning €600 to €700 per week will lose their entitlement to a full medical card, while those earning over €700 per week already do not qualify for a card, following the last review of eligibility in 2009. The new thresholds are double for elderly couples.
Elderly people who will be downgraded to a GP visit card will now have to pay drug costs up to €144 per month, following a new rise in the drug payment scheme threshold.
GPs and other professionals providing services under the medical card and other State schemes are to have their fees cut further.
Dr Reilly told a press conference on the health measures in the Budget that €781 million will have to extracted from the health service in savings next year.
By the end of 2013, this will bring the amount cut from the health service in the previous four years to around €3.3 billion. The service is to get €13.626 billion for everyday expenditure next year.
According to the Department of Public Expenditure, this will be reduced to €13.420 billion in 2014, when further health cuts will be required.
However, Dr Reilly said the lesson over the past year had been that by reforming services, more had been done with fewer resources, with inpatient waiting lists and trolley numbers reduced. He admitted, however, that next year would pose great difficulties.
Dr Reilly stressed the need to promote a greater level of generic prescribing. He said there were some drugs that were of the same class that were one-third the price of the other drugs in that class.
There would be legislation and initiatives to promote more generic prescribing.
The bulk of the €781 million in savings will come from €323 million in primary care scheme savings – this includes the medical card scheme.
The projected savings of €323 million in primary care schemes will come from:
* A projected €120 million from agreements with the pharmaceutical industry on drug cost cuts.
* A projected €70m from reductions in fees to primary care health professionals.
* €50m from the increase in prescription charges.
* €20m from changes to medical card means test.
* €12m from replacement of medical cards with GP visit cards for persons over 70 in excess of certain income limits.
* €10m from increasing the threshold in the Drugs Payment Scheme.
* €15m from ‘delisting’ certain products from the medical card scheme.
* €20m from promotion of more cost-effective prescribing practices by GPs and consultants.
* €5m from a reduction in reimbursement prices of oral nutritional supplements.
The remainder of the total €781 million in health service savings will come mainly from ‘pay related savings’, as yet unspecified; increased generation of private income from public hospitals – a measure that was promised for 2012; a net saving on the Department’s vote, and savings in procurement.
Dr Reilly declined to be drawn specifically on what pay savings in health might arise from an extension to the Croke Park Agreement. However, areas such as rostering were being looked at.
Asked what level of cuts in their allocation hospitals might face next year, Minister Reilly said there would be details of hospital allocations in the HSE’s service plan when published.
Minister of State at the Department of Health Alex White indicated that the €20 million planned to be spent on primary care staffing this year but which was reallocated to cover the HSE’s deficit would be spent next year. However, there is no specific provision for this expenditure in 2013 in the Book of Estimates.
Funding is to be allocated for the initial phase of the planned free GP care scheme for people with certain long-term conditions, Mr White said.
Minister of State Kathleen Lynch said a further €35 million would be spent on mental health services next year. She said all of the €35 million allocated for development of these services in 2012 was not spent.
[Posted: Wed 05/12/2012]
Nearly 12,000 patients have had their admission to hospital for treatments such as surgery cancelled between March and September this year.
Although there is a range of reasons for this, the most common problem is that the bed the patient due admission was going to be placed in had to be given to a patient who came through the hospital emergency department.
A lack of intensive care beds can also lead to cancellations because they are already occupied, leaving patients who will need to be admitted after surgery, waiting longer for their operation.
The cancellation can cause major upset and inconvenience as well as being very disruptive for someone who badly needs to have an operation or test.
In an interview to Ireland’s RTE TV channel, Praveen Halappanavar said he would not meet the chairman of the Health Service Executive (HSE) inquiry into his wife’s death. The family, he said, wants a public inquiry funded by the government.
“I had to answer the family back home… They couldn’t believe it. It was such a simple case,” Mr Halappanavar said on the channel’s Prime Time programme.
Click on the link below to view
Hopefully this programme will get to be seen worldwide
His comment came in response to the continued calls of Praveen Halappanavar, via his legal team, that the investigation into his wife’s death should be a public one and that he would not cooperate with any HSE inquiry.
Making reference to this (audio below), Reilly said:
There may come a point where, obviously, we won’t have the completeness of information without Mr Halappanavar’s input and to me that will be regrettable but I want to get the investigation to that point at least before we have any further public discourse on this.
I would appeal directly to Praveen Halappanavar, who is a decent man, to meet with the chairperson of investigation team without prejudice because it is very necessary that the truth of these circumstances be found out.
SPENDING IN Sligo Regional Hospital continues to be €800,000-plus per month over its approved budget, according to the latest figures released by the HSE last night (Tuesday).
However, finances in the hospital improved marginally — by a fifth of one percent — during September.
Sligo Regional is now listed 13th in Ireland — from 119 centres — for rates of absenteeism. General support staff, nursing and management/admin are the grades identified.
St Johns Hospital is also showing a budget overrun in excess of 10% for the year.
The ‘shave back’ and savings in Sligo Regional Hospital helped contribute to a national picture which saw the HSE’s overall deficit for 2012 drop back to €399 million — it’s first drop.
Sligo Regional Hospital has spent €7.4 million more than its allocated budget in the first nine months of 2012, last night’s official statistics confirm.
The Hospital has now exceeded its annual budget by 10.5%, states the HSE Performance Report for September.
Statistics for Sligo Regional Hospital reveal that by September 30th it had spent €78.4 million of its entire 2012 budget of €92.3 million.
The budget allocated by the Department of Health for 2012 suggested that Sligo Regional Hospital should have been able to get by with €70.9 million between January 1st and September 30th.
In St John’s Hospital, the accumulated budget overrun for the year now stands at €1.3 million — a 10.2% overrun.
St Johns show heavy spending on agency costs for staff in medical/dental; it accounted for 23% of payroll costs in September.
The Minister for Health, Dr Reilly, has iterated all year that there will be no bail-out for HSE or hospitals running over budget.
The Government has been under some pressure from The Troika, which oversees Ireland’s bailout. It has criticised spending on health.
The Irish Times reports this morning that the Government has agreed “to comply by the end of the month with a request from the EU-IMF troika for a detailed plan to tackle the spending overrun in the health service.”
RTE has, however, offered a glimmer of hope; unexpended capital budgets in 2012 may be considered for reallocation to current-side budgets, the station’s Health Correspondent Fergal Bowers indicated last night on television.
Fianna Fáil’s Health spokesman Billy Kelleher separately predicted the Minister “will move to ‘shore up’ his budget failings by moving unspent money from his Department’s capital allocation to current spending.”
A nursing union leader, Liam Doran of the INMO, said that talk of budget overruns was ”an accountants exercise.” The original budget was wholly inadequate, he said.
Criticism of budget overrun was “unfair, misguided and unwarranted,” added Mr Doran, who praised staff for “heroic” efforts.
The leading Labour Party councillor in Sligo, Cllr Jim McGarry, has also queried in past fortnight whether Sligo Regional Hospital has been under funded by the Government. See SligoToday.ie 5/11/2012
No Specific Reference
There is no specific reference to Cregg House in the Performance Report released last night.
Page 40 deals with an update assessment titled: ”Service Arrangements and Grant Aid Agreements.”
It remains unclear if this section — unlikely — includes any reference to the ongoing impasse between the HSE and the Daughters of Wisdom at Cregg House.
The Performance Report states: ”….Of the 27 Non Acute Agencies in receipt of over €10 million in the non acute sector, 14 have completed, with the remainder all indicating that they will sign with the exception of a single provider.”
This single provider, adds the Report, ”is in negotiations on whether they will continue to provide services.”
The Report speaks of “cost containment issues,” in particular in HSE dealings with disability agencies.
The Daughters six months ago publicly highlighted an issue of under funding in a proposed renewal of its Service Level Agreement (SLA) and said they could not continue.
In the past two months the Daughters again re-stated their commitment to leave after 57 years but offered an extension to January to the HSE.
The Performance Reports provides the most up-to-date picture of what is happening at all levels inside Irish hospitals, community services and the HSE itself.
In comparison, the report released Monday by the Economic, Social and Research Institute (ESRI) — which assessed hospitals including Sligo Regional Hospital — refers only to 2011 and an historical analysis of data.
They Reports are released online each month after all data and commentary for the relevant month has first been sent to the Minister for Health.
Sligo Regional is highlighted in the Performance Report for high levels of absenteeism. It is 13th in the country on a rolling assessment over three months up to August.
Cregg House is placed 112th in a list of 119 named centres, while Roscommon County Hospital is 7th in Irish health settings for absenteeism.
The absenteeism issue in Sligo is once again ‘flagged’ in the summary comment to the Minister.
General support staff (9.75%), nursing staff (7.39%) and and management/admin (6.48%) absenteeism rates in Sligo Regional Hospital all far exceed the national average of 4.7% for the three month rolling period under review.
No reasons are offered in the Performance Report, or elsewhere, as to why absenteeism — and across several grades — remains high in Sligo Regional Hospital.
The Performance Report indicates that nine in every ten incidents of absenteeism is certified — 89.8%
Finally, 1.8 million medical cards had been issued by October 1st — almost 40,000 more than were planned in budgets for 2012, says the Performance Report.
Detailed plans for the future of the health service, which will see free GP care for all introduced in 2015 to be followed by the promised universal health insurance scheme, were announced yesterday. The plans set out target times for implementing 48 reforms, culminating in the introduction of universal health insurance in 2016.
While many of the elements of the Future Health document published Miniser Reilly yesterday are in the programme for government, he pointed out concrete timeframes were being provided for the first time.
The plans will see a new patient safety agency next year and a health and wellbeing agency in 2015. BreastCheck cancer screening will be extended to 65-69 year-old women in 2014, while the first round of the colorectal cancer screening programme for men/women of this age group will have been completed by the end of 2015.
The document anticipates the controversial reorganisation of services by hospital groups, although the Minister indicated this would be done on a trial basis at first.
A series of financial reforms will see control of health spending return from the HSE to the Department of Health in 2014 and the introduction of new financial management systems aimed at controlling costs. The HSE is currently €400 million over budget. Dr Reilly said he wanted to see “aggressive” cost control in the health insurance market with payments being made per medical procedure rather than based on the number of nights a patient spends in hospital.
The hospital has introduced a number of cost-saving measures and is in talks with the Health Service Executive (HSE) about reimbursements which, if obtained, could see the overrun reduced to €8 million or €9 million, according to informed sources.
A confidential briefing note given to consultants in recent weeks said the Mater was facing a “serious deficit” for 2012. It said about half of the deficit “pertains to items which should be addressed through HSE reimbursements”.
It is understood that the largest element of the “reimbursements” referred to in the note relate to reductions made to the hospital’s budget earlier this year on the basis that the Government would introduce legislation to allow it charge for all private patients treated in public beds. This legislation was not put in place.
The note pointed out that the hospital’s annual allocation from the HSE had been cut by nearly €50 million over the past four years – down from about €250 million to €197 million.
Sources said that at the same time the number of patients increased by about 10 per cent.
The note said that as part of the cuts to be introduced, unrostered overtime for nonconsultant doctors would be restricted to one hour per day or five hours per week.
The note said it was agreed that such cutbacks in unrostered overtime would have an implication for service.
“It was agreed that the first area of cutbacks should be the number of patients attending outpatient clinics,” it said.
It also said a reduction in drug spending was required.