The HSE Service plan is out today, and you can read it here. I’ve just finished reviewing it for the Pat Kenny show on Newstalk.
Some key points
- Some money to reduce waiting lists in acute hospitals
- Some money to support moving patients out of hospitals in to home care or long term care
- Hospital groups to happen
- Palliative care service in the Midlands for the first time
- Better access to diagnostics for GPs – ultrasound now, more services in 2016
- Some increase in spending on disability services and mental health
- 0.7% increase in spending from 2014 outcome
- New use of balanced scorecard methods to hold managers to account
- More investment in ICT
All in all the new service plan represents some progress, and a lot of stabilisation. Over the last few years HSE has made much more systematic use of information to monitor activity and track progress toward its objectives. This is elementary good business practise. They now publish monthly performance reports, which provide a great resource for seeing what HSE are up to, and what they had planned.
From my perspective, 2014 was a really hard year for everyone in the services. It started with what I believe were fantasy savings of €666 million, later reduced to a less obviously sarcastic €619 million. Over the year, many measures deteriorated. Trolley counts, which had fallen quite steadily since 2011, began to rise, waiting times for admission began to rise, and even the newly available waiting times for outpatients began to rise. The number of medically discharged patients, often cruelly and unfairly called ‘bedblockers’ rose – and is now nearly 800, the size of a very big teaching hospital.
There were some more positive signs. A pressure sore initiative reduced sores by 70% in the North-East, a great result. There were 13 people waiting over four weeks for urgent colonoscopy at the end of September, but all were seen by the end of October. In the past, these people would have been left waiting.
Looking at the service plan for 2015, it looks realistic. The savings figure, of €140 million will be tough, but can be reached. There is an acknowledgement that both waiting lists and people on trolleys will continue. Having spent several nights myself on trolley in A/E I do not take this lightly, but at least the problem is known, it is being measured, and they will try to manage it. There is more money for mental health and disability services – not enough more money, but perhaps enough to hold things stable, and make some people’s lives better in 2015. There is some extra money for home care packages, and some for nursing home packages (Fair deal), mostly aimed at frail elderly people, too many of whom are sitting in acute hospital beds.
There are some interesting straws in the wind – there is money for new services in general practise, with better access to diagnostics, a new service for managing people on warfarin, and a move to do more minor surgery in primary care. The Medicine’s Management Program are getting more resources, presumably to improve the quality and reduce the costs of prescribing. If this can be made to work, it could be a very big win. Ireland does very poorly on measures of prescribing cost, and generic prescribing, and we spend a lot of money on drugs. This could be the very modest start of a serious shift of resources into GPs and primary care. It’s not big enough, and not fast enough for my taste, but it looks realistic, and achievable.
This is a credible plan. If cost containment, especially in the acute sector, works, and this is a big if, it can be delivered, and will modestly improve the situation for quite a few people.