It’s been a busy week in health this week with the announcement of changes to the medical card system and the publication of the 2015 HSE Service Plan, both coming within days of each other.
On Tuesday, Ministers Leo Varadkar and Kathleen Lynch announced the long awaited changes to the medical card system. They also published two major reports on the issue– that of the Expert Panel on Medical Need for Medical Card Eligibility; also known as the Keane Report, and the external review of the Medical Card Process, by Prospectus and Deloitte.The main finding of the Keane Report was that that it was not feasible to come up with a comprehensive list of medical conditions that would automatically qualify a patient for a medical card was not surprising. The expert group concluded that
“In the absence of international objective and reproducible methods of measuring burden of disease and illness, it is neither feasible nor desirable to list conditions in priority order for Medical Card eligibility. A listing approach risks inequity by diagnosis and a further fragmentation of services”.
It also said
“in the context of an ethical approach to the allocation of finite resources, the current system as it stands is not without its merits for the great majority”.
Therefore a person’s income remains as the main qualifying criterion for a medical card in Ireland, however the group made a number of practical recommendations with the aim of making the medical card process easier for the public.
In response to the Keane and Prospectus/Deloitte Reports the Government announced ten actions aimed to improve the operation of the medical card system, particularly for people with significant medical needs.
These included the promise of an enhanced assessment process which takes into account the burden of an illness or a condition; a greater exchange of information between the medical card central assessment office and the local health offices; giving GPs more power to extend medical cards in difficult circumstances; plans to establish a clinical advisory group to develop guidance on assessing applications involving significant medical conditions; the commitment that medical cards given to people with terminal illnesses will no longer be reviewed; and the HSE will be empowered to provide people with therapies or appliances, in the absence of a medical card.
The Department and the HSE will also consider the best way to make medical aids and appliances available to people who do not hold a medical card, the provision of services to children with severe disabilities, and to enable people with particular needs to have these met on an individual basis rather than awarding a medical card to all family members. Commenting on the changes Minister Varadkar said,
“The medical card controversy of last summer required the Government to reconsider how the whole system works. Having done so, with the help of the Expert Group, we have concluded that a financial means-test remains the fairest way to assess eligibility. But we also need an enhanced assessment process, which takes into account the burden of an illness or a condition. From now on, wider discretion and greater humanity will be exercised in such cases.”
These provisions are all welcome. However it will not be until applications are made for new medical cards, particularly discretionary cards, under this new process, that we will see if they have made any real difference to patients.
HSE Service Plan 2015
The HSE Service Plan for 2015 was published on Thursday and as Tony O’Brien, the Director General of the HSE, told journalists at the press briefing, this was the earliest that the Service Plan has ever been published. It usually comes in the middle of December when most people are turning their thoughts to Christmas presents.
Unfortunately the HSE Service Plan for 2015 didn’t deliver too many early Christmas presents for the health service although the fact that the health budget has been increased for the first time in seven years is to be welcomed.
The total budget for the HSE in 2015 will be €12.131bn, plus an additional €35m for mental health services. This funding includes an additional €625m. However as the HSE has a deficit of €510 million in 2014 the net increase in funding for 2015 is €115m.
An additional €115 million is approximately 1 per cent of the total health budget which the HSE described as a “modest but welcome increase in funding available for health services in 2015”.
Of this €25 million has been allocated to address the increasing difficulties of delayed discharges.
The Irish Times reported yesterday that the number of delayed discharges currently stands at 850 which to be best of my knowledge is one of the highest numbers on record.
This €25 million will provide for the provision of home care packages, long term care beds and intermediate care beds.
€10 million of this will provide an additional 300 places and €8 million for 115 additional short stay beds across the Dublin area. This includes 65 beds that will come on stream in 2015 in the former Mount Carmel Hospital, as a dedicated community hospital for Dublin.
An additional €20m funding has been provided for disability services, €25m for free GP care for children under 6, €35m for mental health services, €55m for ICT capital investment, an increase of 37.5 per cent and €366.159 in capital funding.
While this modest increase in funding is to be welcomed, that welcome is extended against the backdrop of the past seven years where a massive €4 billion has been taken out of the health service.
Speaking at the launch of the Service Plan the Minister for Health warned:
“We do not have sufficient funds or the right systems in place to solve all of our problems or meet all of our priorities. Moreover, any increase in demand for services next year will inevitably impact adversely on waiting lists.”