What the Budget means to You:
HEALTH consumers were particularly hit in the austerity years with out of-pocket expenses. They faced higher medical card prescription charges after they were promised they would be abolished. And for a long time there was little reprieve in the limit private patients had to pay for their medicine bills every month.
So after all the hardship most people will be glad to hear they have to shell out a little less cash – even if they have to wait until next summer and autumn for it to come through. It’s still modest, of course. Yesterday’s Budget cut of 50c in the prescription charge for all medical card holders goes further than expected as it was forecasted to be confined to the over-70s.
Private patients who use the Drug Payment Scheme and reach the current limit of €124 a month will be €10 a month better off from July.
It will create a “feel-good” factor which the Fine Gael Government hopes will carry it through when it promotes itself to the electorate in the run-up to the next general election.
The same “family friendly” theme sees the promise of free GP care for children under eight and free dental care for the under-sixes.
There are many hurdles to be crossed yet, including agreeing fees with GPs and dentists, and it is not surprising their respective unions were talking tough, as usual, yesterday.
Beyond the giveaway highlights of the Budget for the health service yesterday lurk the ongoing bottlenecks that continue to haunt it daily.
The health budget has been setting new records annually in recent years but the increases in funding have continued to be outpaced by demands.
This was seen starkly this year in the escalating numbers of people on outpatient waiting lists, the growing queues of people needing homecare and the failure to meet the four-week deadline for older people who are approved for nursing home support under the Fair Deal scheme.
There is also the hidden impact of what the HSE does not want to call an employment “embargo” but is leading to hospital groups and community services being told they cannot breach their hiring budget.
Health service unions issued predictable reactions to the Budget yesterday about the failure to attract staff, including consultants, due to pay and conditions.
But although they make valid points, at some stage they may also have to take some of the responsibility for adding to the negativity that may be driving workers away and contributing to vacancies.
The next round of pay talks is expected to be around closing the gap which sees consultants hired since 2012 earn €50,000 less than those recruited before that date.
It will be a test of the Government to see if the pay deal comes with reform.
It is also up to the new board and higher management in the HSE to stop looking for easy targets – like homecare and nursing home funding – to manage its budget.
The board has sat several times since early summer, but it has little to boast about yet, except a reduced deficit.
For the 560,000 public patients on outpatient lists and scores of others needing surgery there is some hope that the €100m to pay for some of their care privately will finally rescue some from deteriorating health. Some €75m was allocated this year but the target to stabilise outpatient waiting lists will not be met.
There is €20m towards a Sláintecare integration fund and €12m for care redesign to build up community services.
It is the way to go but, so far, the progress has been extremely slow.
PUBLIC and private patients who have the highest medicine bills are among the winners in this year’s Budget.
The monthly threshold for the Drugs Payment Scheme – which covers 1.3 million people of all ages – will be cut by €10, reducing it to €114.
The prescription item charge for all medical card holders is coming down by 50c.
It will be €1 per item for the over-70s and €1.50 for other age groups from July.
The medical card income limit for the over-70s is also being changed and will be increased to €550 a week for a single person, allowing around 56,000 more people, who already have free GP care, to also have free medicines.
Currently 357,385 of the 426,331 people over 70 in the country have a medical card.
The promise is also to extend free GP visits to children under eight and free dental care to the under-sixes.
However, most of the these measures will not kick in until next summer or autumn.
Overall, the health service is getting €17.4bn in 2020 in current spending, a 6.3pc increase.
This amounts to an extra €1bn of which €335m is already spoken for to pay for this year’s HSE overrun.
The Department of Health will get €854m in capital funding next year, €112m above the revised 2019 allocation.
The additional capital funding will have to pay for the ongoing construction costs of the €1.7bn new national children’s hospital, primary care centres, updating of public nursing homes as well as hospital ward extensions and additional beds.
Hospital waiting lists, which include around 556,000 in the queue to see a specialist, are to get a cash injection of €100m.
The funding – which is €25m higher than 2019 – will go to the National Treatment Purchase Fund to pay for private care for public patients.
Although waiting lists for surgery have fallen this year, the numbers on outpatient lists have continued to escalate.
The Budget promises an extra one million homecare hours next year. It should mean around 19 million hours of care are available at a cost of some €481m.
But it comes against a background of a waiting list of more than 6,000 and a growing and ageing population.
The Fair Deal scheme, which subsidises nursing home care, is getting an extra €45m next year to cope with the increasing demand, with more than 24,000 people now being supported.
It was necessary to pump in more money in order to avoid the waiting time exceeding a month for a place in a nursing home.
Around €80m will go to GPs to provide more structured care to medical card patients with long-term conditions, including diabetes.
Mental health services will receive €1.03bn, an increase of €36m.
This is expected to see more investment in the new Vision for Change policy for the future of mental health services.
It remains to be seen how far this will go with inspectors’ reports still showing a lack of proper therapies and services for many inpatients.
Next year the replacement for the Central Mental Hospital will open in Portrane in north Dublin.
The National Forensic Mental Health Service will provide care for up to 170 patients as well as referrals from the courts.
About 1,600 18-year-old school leavers who have disabilities are to be supported next year.
In line with Sláintecare, which aims to move more care out of hospitals, the Budget pledges to hire 1,000 more therapists, nurses and other professionals in the community over 2020 and 2021, at a full-year cost of €60m.
There is no particular reference to funding for hospital consultants’ pay demands. They want an end to the €50,000 gap between new recruits and longer-serving colleagues.
It will be a matter for the Health Service Executive to draw up a service plan for 2020, which it will publish later this year, and this will have more detail on where the money will be spent as well as allocations to various services which it funds.
THE health service is getting an extra cash injection of €1bn – bringing its day-to-day spending budget in 2020 to a record €17.4bn.
Some €335m of this will have to go to pay off this year’s deficit.
And it faces the challenge of demographic demands as the population ages and increases.
It means the Health Service Executive (HSE) may be running fast to stand still yet again.
Although Finance Minister Paschal Donohoe paid tribute to HSE management for lowering the deficit this year, it has come at a price.
The number of patients who are stuck in hospitals reached an all-time high this summer as spending on homecare and the Fair Deal nursing home scheme were rationed.
The HSE will have €100m, through the National Treatment Purchase Fund, to tackle hospital waiting lists next year but much of this funding will go to private hospitals rather than the public sector.
The HSE also has to suffer the fall in income from medical card prescription charges which are being reduced by 50c.
It is unclear whether this will be made up by funding from the Department of Health or whether it will have to be found in “savings”.
How these savings are achieved is always vague – and targets tend to never be met.
It means that the money will have to be found from cutting services or else the HSE will be asking for another bailout at the end of 2020.