An Bord Snip: The HSE

The HSE gets 10 pages to itself in the report, on top of the 6 pages given to the department of health.

The report in general recommends that citizens pay for services they are currently entitled to – this comes on top of a reduction in the number of people who are entitled to these services. The medical gets hit heavily, given it’s proven political toxicity, it’ll be interesting to see to what degree the Government considers implementing the proposals.

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There are two agreements between the trade union IMPACT and the HSE that are now affecting very significantly the HSE’s capacity to reconfigure services and redeploy its workforce in line with best practice in integrated healthcare. The Group recommends that these arrangements be ended and replaced with new arrangements which allow for optimum deployment of resources in the best interests of patients and which take account of the budgetary realities.

It also recommends:

Removal of premium pay for work done between 8am and 8pm for any employee on a contract which currently pays this premium.

Overtime rates be reviewed

The agreement with IMPACT that limited open recruitment competitions be scrapped

Unnecessary demarcation that prevents nurses doing certain duties they are trained to do be abolished

Allowances that are the result of “custom” or “practice” be withdrawn

Compulsory deployment of staff and, if necessary, redundancy.

Non-routine services should be out-sourced if available at lower cost

6,000 jobs should be removed from the system which would result in savings of €300m

No expenditure reductions in the Children’s and Families Program – this would be a false economy in the long-term.

Generic medicenes be used if available at lower cost.

Medical Cards and Long-term Illness Schemes

Reduce the income guideline levels to basic rate of social welfare. This would mean the low-paid wouldn’t be entitled to a medical card, only those on social welfare. However, this would be supplemented by a variable allowance based on medical needs. All current allowances that are based on the entitlement to holding a medical card would be removed. This would mean medical card holders would no longer be exempt from paying State exam fees or eligible for the Early Childcare Subvention Scheme or eligibile to receive free transport to school or eligible for the Student Assistance Fund for third-level attendee or for assistance with the purchase of school books.

Threshold for Drug Payment Scheme to be increased. People will have to pay €125 rather than €100 for drugs before the remainder is covered by the scheme. This would save €37m annually.

People who are on the Long-term Illness Scheme would have to pay €5 per prescription for drugs they currently get for free.

Restructure contracts with GPs and pharmacists to increase competition for contracts.

People presenting to A&E without a letter from their GP would have to pay €125 while inpatient charges will increase by 20% – savings of €6m.

Private facilities in public hospitals to cost 20% more.

The report hints at making patients availing on non-emergency transport could be made pay 20% of the cost.

Medical Card holders will have to pay €5 per perscription.

Introduce measures that achieve greater efficiencies in non-government agencies in receipt of State funding.

Homecare packages for older people may become means tested, savings would hope to total €24m

Increase the maximum percentage contribution for an individual under the Fair Deal agreement to a maximum of 22.5%