Update: Health Department Budget – Health 30th September, 2014

 
  *  466.  To ask the Minister for Health the areas throughout the health service currently experiencing the greatest pressure/demand in the public health sector; the measures/steps required to address any such issues; and if he will make a statement on the matter.

                                                                                          – Bernard J. Durkan T.D.

For WRITTEN answer on Tuesday, 30th September, 2014.

*  468.  To ask the Minister for Health the extent to which budgetary provisions for his Department have been adequate to meet requirements to date; the extent to which such requirements and resources are likely to be compatible in the coming year without loss or reduction in services.

                                                                                          – Bernard J. Durkan T.D.

For WRITTEN answer on Tuesday, 30th September, 2014.

*  469.  To ask the Minister for Health the extent to which on a monthly basis his Department has monitored expenditure and costs throughout the health service; the areas which have shown to have difficulties staying within budget; the action taken or needed in such circumstances; and if he will make a statement on the matter.

                                                                                          – Bernard J. Durkan T.D.

For WRITTEN answer on Tuesday, 30th September, 2014.
 
   
REPLY.
Officials from my Department continuously monitor expenditure and costs throughout the health service and meet on a monthly basis with officials from the Health Service Executive (HSE) to discuss the monthly Performance Assurance Reports and Management Data Reports produced by the HSE.  These monthly reports detail activity and financial performance in the HSE under each of its Divisional Areas and provide an assessment of the key expenditure trends across the health services.

This year is, undoubtedly, proving to be a particularly challenging year for the health services and this is reflected in the overrun to end July of €286 million.  The Department of Health has already signalled that the health service is facing a possible financial overrun of around €500 million this year.  Areas which are showing particular difficulty staying within budget include the Acute Hospital sector (57% of the overall deficit) and the Primary Care sector (19%).

Much comment has been made about waiting lists following the publication of the latest Performance Assurance Report.  The success of the Outpatient waiting list initiative, facilitated in part through appointments during additional working hours, made available through the Haddington Road Agreement, has had the consequence of increasing in-patient and day-case waiting lists, as people who have been seen as out-patients are referred on to such lists for further treatment as required.

Hospitals have endeavoured to respond to these developments, in addition to managing service demands arising from admissions through Emergency Departments; this is evident in higher in-patient and day case discharge activity to date in 2014.  Measures to make use of all available capacity and to drive evidence-based best practice health-care for optimum outcomes are being developed by the HSE, in collaboration with acute hospitals, the SDU and the NTPF.  These include:

· Strict observation of the National Waiting List Protocol (2014), including strict adherence to chronological scheduling and bi-annual validation of lists for all patients waiting more than 3 months

· Adherence to relevant HSE National Clinical Programme guidelines

· Flexible usage of theatre capacity within specialties

· Prioritising Day-of-surgery admission where clinically appropriate

· Implementation of pre-admission clinics to ensure that patients are fit for surgery

In addition, the availability of acute hospital beds is significantly constrained in that a significant number of patients who are deemed medically fit for discharge are awaiting alternative care arrangements in the community in the form of long term nursing home care, respite care or transitional care.  A co-ordinated approach to delayed discharges between Acute and Social Care Divisions of the HSE is underway to reduce the number of people awaiting placements to nursing homes or home, depending on their personal requirements.  Despite this initiative, the HSE indicates that the numbers of patients awaiting discharge will continue to increase over the next number of months thus reducing in-patient capacity for winter months.

The funding pressures in primary care are mainly related to local demand led schemes, PCRS and legacy child-care expenditure.  However, positive developments include the fact that waiting times for physiotherapists and occupational therapists have decreased and there has also been improvement in end of life care and childhood health surveillance.

There has been understandable focus recently on the challenging resource constraints within which the health services are operating.  While the budgetary targets this year are particularly constrained, it is important to recognise that financial and resource constraints have applied in each of the last number of years as a direct consequence of the emergency financial situation the Government has had to address during its period in office.  These challenges come at a time when the demand for health services is increasing each year which, in turn, is driving costs upwards.  However, despite these resource reductions and increasing service demands the HSE has managed to support growing demand for its services arising from such factors as population growth, increased levels of chronic disease, the ageing of the population, increased demand for prescription drugs, and new cost intensive medical technologies and treatments.  The HSE and its staff are to be commended for their ongoing efforts to meet these increased demands on its services since 2008.

I have already stated that I am hopeful that next year things will be improving in regards to HSE waiting times and budget overruns.  Any improvements will of course be contingent on getting a realistic budget in place for next year.  I will continue to engage with the HSE and the Department of Public Expenditure with a view to putting in place a budget for 2015 which will stabilise the health service.