By J. P. Anderson

Health Service austerity cuts to a range of services to the old, young and disabled has raised tensions between the two government parties. It is understood that the severity of the cuts has provoked much anger amongst the membership the trade union movement and the grass roots of the Labour Party.
Such a division especially at cabinet level may lead to a general election within the next six months.

Among the most contentious of issues involving the proposed austerity cuts in the area of health is the proposal to change the rules and requirements related to eligibility criteria for medical cards.

That issue caused the ‘grey revolt’ in 2008 when over 400 elderly people attended a rally organised by the charity ’Age Action Ireland’ in Saint Andrew’s Church in Dublin’s Westland Row and two Government Ministers (of the previous government) were shouted down (in a spontaneous reaction to their presence) and prevented them from addressing the rally from the alter of the church.

Minister for Health James Reilly has signalled the Government should look at the issue of public service pay – which is guaranteed under the Croke Park agreement - in tackling its financial difficulties.
Speaking this afternoon, Dr Reilly said the Croke Park agreement had to be expanded to deal with the financial problems facing the health service.

Dr Reilly suggested that those who were among the best paid in the public service should have to shoulder some of the burden.
Pay was the “elephant in the room”, he said.
“If 70 per cent of my budget is pay and up to 90 per cent in some of the NGOS, the point comes when you have to look at pay or start cutting patient services,” he said.
“As a doctor or as a Minister, I want to see patients and patient services protected.”

Asked whether he believed the Croke Park agreement - which guarantees there will be no further pay cuts in the public service in return for agreement on reforms - should be renegotiated, he said: “I want all the elements outside of core pay explored first, like I said, overtime rates, agency staff use -- which both relate to absenteeism it has to be addressed.”

He said there was “absolutely no doubt” the agreement had to be expanded to address the issues faced by the health service.
“You can’t make savings without addressing that issue. But that is a broader issue than health,” he said. “It is an issue…that the Government has to consider and it is not for me to decide. It has to be done in conjunction with the Department of Public Expenditure and Reform.”

In his first public comments on the €130 million cuts to be implemented by the HSE, the Minister said he wanted to give a categorical assurance that everything would be done to ensure patient services were maintained.

He said he had asked the HSE director general designate Tony O’Brien for all non- clinical areas to be examined and “squeezed as hard as possible” in relation to making savings.
“The last thing that should suffer is patient services,” Dr Reilly said.
Dr Reilly said he wanted the “glaring problem” of absenteeism tackled.

He said the average absenteeism rate in private sector was 2.58 per cent, compared to double that figure in the public sector. In some hospitals, he said, it is three times that level in some hospitals, rising to 10 per cent in specific grades in some hospitals.
“I want that addressed. I do not see why patients should suffer because of mismanagement of absenteeism.”
He said he was going to publish details of the rate of absenteeism by grade and by profession in each area on the internet.

Minister for Education Ruairí Quinn has said he does not yet know the reasons behind the cuts imposed in health services announced by the HSE yesterday, while Tanaiste Eamon Gilmore has called the move "regrettable".

Cuts affecting the elderly and the disabled feature strongly in a €130 million cost-reduction package announced by the executive yesterday. The cuts to home help services in particular have provoked a furious reaction from groups working with older people and the disabled and disagreement between the Government parties.
Speaking in Dublin this morning, Mr Quinn said Minister for Health James Reilly would brief the Cabinet on Tuesday “as to the raison d’être that’s behind it”.

He added: “We will wait to hear what he has to say."
Cuts had to be made “because we have lost our economic sovereignty, we are no longer in control of our cheque book”, he said.
“We don’t want to do theses things.
We inherited a situation where we simply had no choice but to reduce expenditure and in those circumstances there is nothing sacrosanct unfortunately,” he said.
Tánaiste Eamon Gilmore today said it was “regrettable’’ that the Health Service Executive had announced cuts in services.

“Every organisation, every department and every service has to obviously work within budget,’’ he added. “My priority, and the priority of the Government, will be to ensure that services needed by people who need care and assistance continue to be provided.’’
Elsewhere, the HSE said that proposed cuts to home-help and homecare services will be considered on an individual basis, a move welcomed by Mr Gilmore.

Speaking on RTÉ's Morning Ireland earlier today, Laverne McGuinness, national director of integrated services with the HSE. said that while the cuts were necessary, the first aim of the health service "was always to protect front-line services."

Ms McGuinness said that while €26 million would be cut from home-help and homecare services, there would still be 10.1 million home-help hours available for those looking after people at home.
She also said that home-help cuts were being constantly reviewed and would be considered on an individual basis.

However, groups working with older people and the disabled continued to voice their opposition to the cuts announced yesterday.
The Carers Association said the cuts would likely discourage people from offering to care for family members being discharged from hospital.

"It's going to put pressure on members of the family who are looking after somebody who is ill at home. It will also lead to earlier admissions to nursing homes as people at home with reduced support will not be able to cope. It is going to lead to longer stays in acute hospitals for people whose families simply aren't able to take them out earlier...and it's going to lead to an explosion in queues in emergency departments," said John Dunne, acting chief executive of the Carers Association.
Mr Dunne said that the cuts would completely undermine the Government's strategy in relation to healthcare.

"The Government has a coherent strategy in theory which is to encourage people out of expensive acute hospitals by providing greater community and home support services (but) if you start cutting those services then you're completely undermining the rationale of shifting personnel out of hospitals."

Dr John Ball, a spokesman for the Irish College of General Practitioners (ICGP), also criticised the Government's decision to cut home-help and homecare services.
"It really is staggering because it is in everyone's interest that patients stay at home. It obviously preserves the dignity of the patients themselves (and) the family carers involved.
It also seems economically not to make sense because if patients don't get this back-up care, the risks of falls increases and they end up in A&E."
The chief executive of Alone, Seán Moynihan, called for an immediate reversal of the proposals.

“These cuts affect the basic needs of the one in ten older people who are in dire need of support which includes daily activities such as washing and cleaning. This is totally unacceptable," he said. "Home care services are low-cost yet high value. The cost of home care provision is significantly less than that of nursing home care provision, or long term hospital stay and to propose cuts in this area is short-sighted in the extreme."
The strength of the reaction appeared to take Government by surprise and caused dismay among Labour politicians.

Labour Party chairman and Galway East TD Colm Keaveney said last night he was “very uncomfortable” with the cuts affecting older people and the disabled. While accepting the need to deal with the HSE’s €260 million deficit, cutbacks should be targeted on “trophy areas that appear to be protected” instead of vulnerable groups.

“In the context of political stability, this can’t happen again. If I were minister instead of James Reilly, I’d be tackling consultant salaries and drug costs instead of the areas of greatest dependency.”
Another senior Labour source warned that the Government risked a re-run of the 2008 revolt by older people over changes to medical card eligibility.
He claimed the cutbacks wouldn’t have been necessary if Dr Reilly had achieved savings in drug costs and secured a deal to charge more for the use of public hospital beds by private patients.
Siptu said its members working as home helps “will not stand idly by and allow this attack on the sick and vulnerable to proceed”.
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