The countdown to the much-feared Budget 2012 begins.
Minister for Social Expenditure Joan Burton was last week given the nigh-impossible task of cutting her Department’s budget by an enormous €700 million in 2012. This will essentially mean complete reform of Ireland’s complex welfare system, with Burton herself admitting that she was “staggered” by the number of schemes and conditions within the area of social welfare. The health system is also going to suffer debilitating cuts, following a year in which its budget is expected to overrun by more than €300 million. Frontline services will no doubt be affected as those involved in primary and secondary care struggle to maintain care with no funding.
With the National Centre for Pharmacoeconomics (NCPE) already beginning to play a bigger role in which drugs doctors are allowed prescribe, talk is turning to a version of healthcare rationing – a dire situation we cannot imagine but elements of which are already apparent. The infamous National Centre for Clinical Excellence (NICE) in the UK has been assessing drugs on the basis of cost as well as effectiveness for years, and many key players in the Irish health service expressed concern that the same could happen here. Yet that was before the recession hit in 2008, and now the grim economic reality is that we cannot afford to give every patient the care they need, whether it be prompt diagnostics or advanced medical therapies. The National Centre for Pharmacoeconomics has already made some very unpopular decisions. It is a fact that all healthcare systems spend the vast majority of their budgets on staff costs.
When established in 2005, the amalgamation of the regional health boards meant that the Executive started life with a disproportionate number of people in upper management roles, with many receiving large Grade 8 salaries. The HSE has tried to address this in various ways including the voluntary redundancy and early retirement schemes, but this was nowhere near as successful as former health minister Mary Harney expected it to be, with just over 2,000 people availing of the schemes, far short of a projected 5,000 administration, managerial, and clerical staff. Earlier this year, Minister Reilly indicated more than once that he would like to see another voluntary redundancy scheme for the health service, even suggesting at one stage this could take place in the autumn.
The leaves are now off the trees but there have been no murmurings of this happening, even though the Minister appeared to have clear plans when he said that any new scheme would be very focused in comparison to last year when many essential staff took early retirement. The failure to preserve all frontline services and the difficulties associated with the international recruitment campaign for NCHDs means that the Minister’s PR recently has probably not been to his satisfaction. Facing the spectre of a further reduction in an already insufficient budget means that his task will be as difficult if not more so than Minister Burton’s, bearing in mind the savage cuts the Department of Health has already experienced in recent years.
The health service was a source of controversy even when the going was good. As Budget 2012 approaches, we may have to ready ourselves for radical change in the manner in which healthcare is provided in this country.
