HSE’s 2016 Service plan has just been published. I was on RTE’s Drivetime talking to Mary Wilson about it on Thursday night. It’s a long document, at 178 pages, with more detail and more useful information than previous plans. If you work in health, it’s worth looking at the pieces directly relevant to yourself and your patients.
The high level message is an 0.8% increase on the (expected) 2015 spend, or 6.7% on the 2015 budget. The good part is that talk from DPER about bringing the 2015 deficit forward into 2016, which would have led to a 5% cut in expenditure, has gone away. The bad news is that HSE probably needs a minimum of €300 million extra (that is above the 2015 spend, not the 2015 budget) in 2016, just to stand still, and it’s not getting it. The 2015 service plan took a similar approach to the budget, and 2015 was definitely easier than 2014. The acute hospital sector may have the greatest difficulty with a budget €83m less than they have spent in 2015. There is a lot of language about ‘significant financial challenges’ and ‘financial risk’, which is likely to be prophetic.
None of this was unexpected. HSE had suggested an extra €2 billion in budget, or about €1.4 billion in health service spend this year, which was never going to happen. The Irish budget is still very constrained by our commitments to the EU. These commitments may, or may not, be sensible (see a report from Brookings), but Ireland can do little to change them unilaterally.
What is more optimistic, from my perspective, is some of the content. The new service service plan is longer, more detailed, and better structured than the previous plan. There is a clear statement of a vision, mission, and values for HSE, and these are much more credible than those I have seen from other services. There is an emerging strategy, and it’s now easier to follow than in 2015, or
2014, which in turn were vastly better than earlier years.
The new vision is of ‘A healthier Ireland with a high quality health service valued by all’, to be delivered on the values of Care, Compassion, Trust and Learning. This gives a mission :-
- People in Ireland are supported by health and social care services to achieve their full potential
- People in Ireland can access safe, compassionate and quality care when they need it
- People in Ireland can be confident that we will deliver the best health outcomes and value through optimising our resources
There is always the cynical view that such mission and value statements are just corporate window dressing, as indeed they too often are. My own view is that the key challenge for HSE is to transform a notably toxic corporate culture into something that can work, and this is a necessary step in that process. The vision is attractive, the values seem sound, and the mission is, at least, measurable, and probably achievable.
What of the steps involved – what will actually happen on the ground? There’s quite a bit of extra money for mental health – €35m, and there is money for expanding free GP care to the under 12’s – €13.5m. There is €25m for care services for the elderly, but most of this is going to nursing home beds. There are plans to expand GP access to diagnostic services in hospitals, and speech and language therapy for children. Disability services are to move towards person centred care – but no mention of personal care budgets – which is probably a necessary change, albeit one that will not be popular with many service providers. There is little enough attention paid to general practice as a whole, and there is no sign, as yet, that the very large investments needed to make general practice and primary care work better will be made. The main source of savings is expected to be PCRS, and over half of these savings are likely to come solely from the expected reduction in medical card numbers. There is no word, that I can see, on some significant items for GPs, notably the rural practice payments. These may be in the operational plans to be published in early 2016, or part of the ongoing negotiations with the IMO.
The two other interesting features are a 40 page appendix on the HSE accountability framework which has been greatly beefed up, and looks much more credible, and the long set of key performance indicators (KPIs) preceding this (Appendix 3). For the first time, a broad set of KPIs are published, giving last years target, last years outcome, and this years target. The accountability framework also includes as details on actions to be taken when these are not met.
All in all, this is a good service plan, within excessively tight, and probably unrealistic financial constraints. If there are to be big changes in health care delivery, a lot more money will be needed to support the changes. The model here, with the department holding on to just under €60m, for new developments, which will be released as plans become more solid, is interesting, and may be a very useful model for the future. At the least it will build some trust between HSE and the department.
I agree 100%, without a single tier health service few other changes can be made. It’s harder to figure out how to get their. No-one that I can see has really effectively tied private and public services together. There are some basic conflicts of incentives which keep coming up. These lead to cost-shifting, and other adverse outcomes for the public sector.
I respect your expertise and input on the health services in Ireland. But, if there are to be big changes in health care delivery there needs to be an end to the two tier system of health services – talking about the public system without considering and mention of the private system makes no sense – the HSE is working in a vacuum which is widening by the day and will continue to do so until the election, then who knows. Let’s put health and re imagining the health service and health system in Ireland on the election agenda