Preparing a feasible service plan with less money and fewer staff is undeniably a trying task.
Yet that is the challenge facing the four HSE regions in 2012.
First out of the traps is HSE South, who recently published its service plan complete with a €208 million overall budget reduction compared to 2011.
Some €80 million cost reductions along with a €35 million deficit carried over from 2011, minus cost reductions in areas not impacting services, means that the total resource challenge the year is €115 million, according to the plan.
In addition to the immense financial challenge, the issue of retirements from the health service is also addressed. Mr Pat Healy, Regional Director of Operations, HSE South, in outlining the plan, revealed that since 2007, staff numbers have fallen by almost 2,300.
At the end of 2011, the region had 1,400 less staff than at the start of 2010. Some 1,000 staff left the service in 2011 and 400 more will have departed by the end of February.
In an attempt to mitigate the impact of staff losses, the plan proposes the implementation of many roster alterations, among other measures, as part of the Public Service Agreement.
Greater productivity through the clinical programmes along with “limited and targeted recruitment” will also be adopted, Mr Healy told members of the HSE South Regional Health Forum.
The success of the plan is also contingent on the reorganisation of hospital services, workforce planning, the delivery of care at the lowest level of complexity and how quickly change can be delivered.
Mr Healy said that every effort had been made to protect patient services.
Following initial plans to reduce residential care beds for the elderly by up to 250, the HSE had managed to reduce this to 128 beds, 101 of which are vacant, he stressed.
Yet home help hours are decreasing by 4.5 per cent in the region, a move that could increase demand for residential care in the future.
Inpatient and paediatric beds will fall by 93, according to the plan.
The greatest reduction occurred at Cork University Hospital (CUH), where some 35 surgical beds are to close along with 35 day beds.
Seasonal bed closures will occur at the maternity unit at CUH while 20 beds, two theatre beds, 12 surgical beds and six paediatric beds have closed at Mercy University Hospital.
All other acute hospitals in the region will be subject to either permanent or seasonal bed closures.
In the area of disability, “a minimum of two per cent will be sought from cost efficiencies and 1.7 per cent will be found from service reductions,” Mr Healy stated.
He added that some 60 acute inpatient beds in mental health services would close and that roster levels would be reduced and reviewed.
The region hopes to mitigate the volume reduction to three per cent “through the implementation of National Clinical Programmes”.
Under the programmes, 50 posts, including 20 consultants, are to be hired (some of whom have already been recruited) in 2012.
The inescapable fact of the matter, however, is that limited recruitment, service rearrangements and changes in work practices cannot prevent service reductions when less funding is available.
Fewer beds in the South will ultimately result in less access.
And less access will lead to longer waiting times for patients, even if the impact can be limited to a three per cent volume reduction.
