HSE Scandal - Never Mind, We Have To Balance Our Budget

national | anti-capitalism | news report Wednesday June 13, 2007 13:05 by Red and Black

(So what will change now the Greens might be in power?)

Confidential letter shows 'belt tightening' ordered in Cork hospital.

The full extent of Government duplicity with regard to hospital waiting lists is revealed in a new ‘confidential’ letter sent out by the CEO of a leading Cork hospital to its consultant heads. The letter – in full below – was circulated to all the hospital’s specialties with a view to reducing ‘activity’ at the hospital in order to meet stringent financial targets set by the HSE and the Government. The consequence to this ‘reduced activity’ at the hospital will be longer waiting lists and a reduced service to public patients. Once again it will be the working class that will have to pay the price.
The letter begins, initially setting out the financial situation at the hospital, stating that:

“One of the features of our finances in the first 4 months of 2007 is the level of activity which is 6% above the 2006 level. This is equivalent to one additional month’s activity for which we are not funded.”

The letter then continues with the announcement that the Executive Management Board at the hospital has taken the decision to

“commence the implementation of objective 6 of the Cost Containment Plan relating to the imposition of activity targets on all specialties to achieve a pull back to the hospital’s 2006 (financial) level.”

In pursuit of this, it directs consultants at the hospital to

"Utilising holidays and other leave [in] that no consultant should make use of any spare theatre, Daycase or OPD session when another is on leave"

In effect the hospital management is directing consultants not to undertake any work over and above that which is normally scheduled. Given that, in a whole range of specialties in this hospital (and in the Cork area) there are, at present, long waiting lists for treatment, this directive is a command to reduce activity levels and exacerbation this unacceptable situation.

To take the example of urology – kidney, bladder and prostate surgery have year long waiting lists in the Cork city area as a consultant who resigned has not been replaced. The hospital is saving money as it is by now having filled the vacant position. But on top of this urology is now being told to do nothing that would increase its workload. Moreover, the facilities and resources normally used by urology –underutilised due to the non-replacement of the vacant consultant position – is being put out of the reach of other specialties which could utilise the unused beds and resources. All in the name of ‘belt tightening’.

Last week the HSE was involved in a confrontation with the Crumlin Children’s Hospital regarding instruction received by the hospital indicating that Crumlin should reduced its vital services. See http://www.irishhealth.com/index.html?level=4&id=11666&...umlin. The HSE responded to the outcry by saying ‘it is in ongoing communication with Crumlin in relation to its budget.’

But it is clear from the above Cork letter (and from what happened at Crumlin) that for the HSE the key issue is meeting the commands of its financial masters in the Government. Long waiting lists and the suffering of public patients is simply not as important. What is worth bearing in mind also however is how these decisions are taken – behind closed doors and by functionaries.

As with much that happens in the Irish health service, it is clear that decision are being taken for many of us by ‘administrators’ and ‘managers’ none of whom are either elected or accountable. Rather many of the those who are taking these vital decisions are ‘yes’ men and women who have got into the higher echelons of management primarily because of their willingness and ability – if you can call it that – to follow orders. Hierarchy and capitalist economics have always got on well together
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Full Text Of Letter Sent To Consultants

Dear XXXXXXXXX

Current Financial Situation

In view of the current financial difficulties being experienced, I am writing to you to request your co-operation with a number of proposals that will assist the hospital in the management of the finances. It is essential that all efforts are maintained to stabilise the expenditure levels which are increasing well beyond the amount of funding the hospital has to run the services.

A Cost Containment Plan has been agreed by the Executive Management Board and many of the actions are being implemented. However, this plan has been designed to achieve savings of€1 .5m while the present level of expenditure indicates a need for a pull back of between €4 to €5m! The HSE is assisting the hospital with a cash management facility beyond the level of allocation. This is an arrangement which cannot be sustained into the future. Various efforts are being made to achieve an increase from the HSE in the baseline funding to the Hospital but it is clear at this stage that all Hospitals are in financial difficulty and there is not sufficient contingency available to achieve a breakeven situation. The percentage level of over expenditure by Mercy University Hospital is greater than many of the other hospitals and has put a spotlight on us that is not helpful.

One of the features of our finances in the first 4 months of 2007 is the level of activity which is 6% above the 2006 level. This is equivalent to one additional month’s activity for which we are not funded.

You will be aware that the financial problems have been discussed in great detail at EMB meetings. We have decided to commence the implementation of objective 6 of the Cost Containment Plan relating to the imposition of activity targets on all specialties to achieve a pull back to the hospital’s 2006 level.
Your co-operation in this regard will require the management of your elective workload. I am proposing that this can be achieved by:
• Utilising holidays and other leave in that no consultant should make use of any spare theatre, Daycase or OPD session when another is on leave;
• That you do take your leave and your support staff would perhaps arrange for leave at
the same time; -
• By arranging that locum consultants would only cover emergency cases.

There is urgency to achieving reduced theatre opening hours to achieve payroll savings in overtime etc.

We are also examining the possibility of a 2 week holiday OPD, Endoscopy & theatre closures except for genuine emergencies (those who cannot wait 2 weeks) this will leave us with one Operating theatre, one endo session and one staffed clinic room daily (Mon-Fri for OPD and endo) for emergencies. This could link with some ward refurbishment plans resulting in some bed closures during this period.

I attach a schedule showing the activity versus targets for your specialty so you can see the implications of this.