Medical associations respond to the Budget 2018 which was overseen by the Finance Minister Paschal Donohoe and released on Tuesday (October 10th).
NAGP warns that GPs are considering industrial action: The National Association of General Practitioners (NAGP) has warned that the GP union is considering some form of industrial action in response to the budget.
In relation to industrial action, the association told IMN: “GPs cannot strike so any action taken would be within the parameters of the law, we are taking legal advice. NAGP is currently running a nationwide meeting roadshow and we are engaging with our grassroots membership at these regional meetings”.
The association claimed that the level of funding currently invested in General Practice is unsustainable, cautioning that the hospital system will suffer should general practice fail this winter.
The association has said that the budget indicated no progress towards achieving a GP-led primary care.
“Vulnerable cohorts including the frail elderly would benefit most from this rationalisation of healthcare delivery. Once again, community based care has suffered in favour of the more expensive hospital-based system”
Dr Andrew Jordan, NAGP Chairman, has called for a transformational fund of €500 million to initiate a shift to GP-led primary care.
“The Government have stuck their heads in the sand and ignored our calls for reversal of FEMPI (Financial Emergency Measures in the Public Interest) in General Practice. The service is beyond capacity and requires urgent investment.
“All stakeholders agree that a cornerstone of healthcare reform in Ireland must be a move to more community-based care. This requires resourcing”.
€25 million funding for General Practice was announced in the Budget for 2018 which the NAGP claimed will not be sufficient to address the current capacity issues.
Patients with medical and GP Visit cards have increased to almost half the population in recent years with the introduction of the under sixes and over 70s free GP care.
Dr Jordan said, “In our pre-budget submission we called for funding for additional practice nurses in order to resource more care for patients in the community. This would enable general practice to provide more preventive, predictive and anticipatory care to patients in the community.
“Vulnerable cohorts including the frail elderly would benefit most from this rationalisation of healthcare delivery. Once again, community based care has suffered in favour of the more expensive hospital-based system”.
Funding in General Practice was cut by up to 38 per cent under FEMPI, which the government has not considered reversing, despite similar programmes being in place for public sector workers.
The GP union has claimed that FEMPI is a key factor in the high emigration of GPs as the profession is now “unviable” in Ireland.
Dr. Jordan, said, “GPs have suffered disproportionate cuts under FEMPI and continue to work under a contract that is no longer fit-for-purpose.
“The impact of these cuts is being felt by patients as pressure on GPs increase waiting times for an appointment. We can no longer accept the inaction of Government and must take a stand on behalf of our patients”.
ICGP criticises failure to build capacity in General Practice: The Irish College of General Practitioners (ICGP) has predicted that the failure to provide resources for a new GP contract in Budget 2018 will have a detrimental impact on those on lower incomes, in addition to increasing pressure on the acute hospital sector.
“GPs are acutely concerned at an absence of substantial provision for a new contract for General Practice in the budget, or specific reference to reversal of FEMPI cuts, which reduced practice income by over 30 per cent in many areas,” said Dr Mark Murphy, Chair of Communications with the ICGP.
“Much has been done to ameliorate cuts to public sector wages and staffing as the Irish economy works its way out of recession, but GPs and their practice teams operate in the private independent contractor sector, and have had absolutely no reversals of cuts”, Dr Murphy added.
“A national manpower crisis looms, and to attract more doctors to become GPs, the government must offer greater financial security and a new contract with flexible conditions and an expanded role in managing chronic diseases”.
The college has welcomed the small reduction in Prescription Charges, and the use of progressive taxation on tobacco and alcohol.
IMO “deeply disappointed” in Budget 2018: The Irish Medical Organisation (IMO) has described next year’s budget as “deeply disappointing and regressive from a health perspective”.
Responding to claims that the health budget was the biggest in the history of the State, Dr Ann Hogan said: “That is nothing but spin and fake news. The reality is that our spending on public health services has not kept pace with either rising demands or the increase in population of our patients over 65.
“Everyone knows that the health budget for the coming year will not even keep pace with health demands and the various crises afflicting the health services will worsen over the coming year.
“What we now know as a crisis in our health services will become the new norm and we still wait for our Government to make meaningful investment”.
The IMO president warned that the result of the budget would be lengthening waiting lists above the level of almost 700,000, in addition to overcrowded hospitals.
She also cautioned that there would be a rise in the trolley count to over 500 on a regular basis, that overwhelmed GP services would only be able to deliver the most acute of services due to lack of resources and unsustainable costs, and that the emigration of doctors would continue.
Dr Hogan criticised the lack of ambition towards a transformation of our health services and the move to GP-led primary care.
“The funding allocated is so woefully inadequate as to make it impossible for any significant development in terms of a new GP Contract or new services for patients.
“An opportunity has been missed, again it is inevitable that General Practice will see waiting lists and greater referrals to the secondary care system as GPs are unable to cope with the demand and the complexity of care without adequate resources”.
The IMO disagreed with the increased allocation of resources towards the National Treatment Purchase Fund (NTPF), describing it as a “private sector fund at the expense of increasing resources for public hospitals” and as a “sticking plaster solution”.
Dr Hogan drew attention to the absence of allocation for an increase in bed capacity in acute hospitals, highlighting the fact that 1,500 beds have been taken out of the system, while the elderly population over 65 has grown by 33 per cent since 2008.
The IMO noted that the SláinteCare report has failed to translate into meaningful investment, claiming that politicians are high on aspirations for Irish health services but failing in terms of funding.
The organisation concluded by stating: “There is no doubt that our politicians must protect the economy, however it is reckless in the extreme to put the health of the nation at risk in this way. Investment in health services is a good thing not a burden”.
“The funding allocated is so woefully inadequate as to make it impossible for any significant development in terms of a new GP Contract or new services for patients”
Private Hospitals Association welcomes additional NTPF funding: The PHA has welcomed the commitment to spend €50 million in an effort to tackle waiting lists through the National Treatment Purchase Fund (NTPF).
CEO Simon Nugent commented: “While acknowledging the €50m NTPF commitment for 2018 came in last year’s budget, it is regrettable that the Government has not committed to a further increase to at least €100M in 2019 and 2020 as we had called for in our pre-budget submission.
“Forward planning and multi-year funding is essential if we are to make a real impact on waiting list numbers which now stand at 679,000”.
He described the reduction in prescription charges, recommended by the Sláintecare committee, as a “sensible move” but criticised the absence of any plan to phase out private care in public hospitals.
“Public Hospitals are once again expected to bring in the same amount of private income in 2018 as in 2017 (€600 million). This will add to delays and waiting times and is an opportunity missed”, he stated.
Mr Nugent continued: “If Government wants to get new beds opened in the short and medium term, they should come and talk to the Private Hospital sector. We can move quickly to make beds available and to tackle the growing needs of an ageing population”.
The association expressed their disappointment that no move had been made on tax relief for private health insurance and they have called for the ceiling on premiums eligible for relief to be raised from €1,000 to €1,200.
The PHA concluded by stating that, while some positive measures had been taken in the Budget, they felt the government has failed to grasp the fundamental bottlenecks that continue to affect the health service.
“While the reduction out-of-pocket charges for medicines is welcome, the problem remains that patients in Ireland are not getting access to the latest new medicines as fast as patients in Western Europe”
IPHA welcomes reduction in prescription charges: The Irish Pharmaceutical Healthcare Association (IPHA) has welcomed the reduction of prescription charges and the lowering of the Drugs Payment Scheme threshold in Budget 2018.
However, the IPHA claimed that the budget offered no solution to Ireland placing last in Western Europe regarding the adoption of new medicines.
Oliver O’Connor said: “While the reduction out-of-pocket charges for medicines is welcome, the problem remains that patients in Ireland are not getting access to the latest new medicines as fast as patients in Western Europe”.
The IPHA chief executive commented that, although prices and spending levels now sit at the average of 14 comparable EU countries, Ireland continues to lag behind Germany, the UK, Austria, Sweden, Denmark, France, Finland, the Netherlands, Portugal, Italy, Belgium and Spain in bringing new medicines to patients.
Mr O’Connor continued: “…the absence of any clear additional Exchequer funding for medicines over and above the savings provided by the industry has led to serious delays in patients having access to medicines that are routinely available in most Western countries”.
He claimed that there needs to be a sustained and reasonable level of growth in Exchequer funding for new medicines, planned on a multi-annual basis, if Ireland is to deliver medicines to patients as efficiently as the best in Europe.
With regard to new medicines, he stated: “Budget 2018 provides a 4.6 per cent growth in health current expenditure but as of yet, no indication of any new funding for new medicines.
“Any idea of zero or close to zero growth in funding for medicines will undermine the achievement of best outcomes for patients”.
IHCA consider budget a step in the right direction but insufficient to tackle bed shortages: President of the IHCA, Dr Tom Ryan, stated: “While the announced increases to the health budget are a step in the right direction, the reality is that there are huge shortages of beds and staff in our acute hospital and mental health services.
“What is in the budget is not sufficient to address these shortages, which are the root cause of patients being treated on trolleys and escalating waiting lists’’.
In addition, Dr Ryan said that the increase of €470 million in health capital funding over the 2018 to 2021 period must be assessed in the context that 1,400 in-patient beds have been closed in the past decade.
He claimed that increased funding must be directed towards replacing those beds, highlighting the need for additional capacity to provide care to a population that has grown by 500,000 in the past decade, including the 35 per cent increase in the cohort that is 65 years and over.
Commenting on recruitment shortages, Dr Ryan continued: “It is essential that the planned increase of 1,800 health service staff are appointed to front line acute hospital and mental health services”.
The latest employment census indicated that just thirteen additional nursing staff were recruited in the first nine months of this year, confirming what the INMO have described as “a nursing/midwifery recruitment/retention crisis”
INMO welcomes increased funding for health services: The Irish Nurses and Midwives Organisation (INMO) has welcomed the increased allocation for public health services of €685 million.
While the organisation acknowledged the stated commitment to increase the number of frontline posts by 1,800 in 2018, they noted that an agreement was reached in the 2017 budget that there would be 1,000 additional nursing/midwifery posts for the public health service which has not been met.
The latest employment census indicated that just thirteen additional nursing staff were recruited in the first nine months of this year, confirming what the INMO have described as “a nursing/midwifery recruitment/retention crisis”.
Meanwhile, a record number of patients (over 73,000) who were admitted for care in Irish hospitals during the first nine months of this year were treated on trolleys.
The INMO has called for additional nursing staff which must, in turn, provide for additional acute and long-term care beds so that these admitted patients can be cared for appropriately.
INMO General Secretary Designate Phil Ní Sheaghdha said: “The increase in the health allocation should be welcomed. However, the challenges facing our health system, in terms of meeting demand, recruiting/retaining the nursing and midwifery workforce and expanding services, particularly in primary care, make it essential that all of this additional money is channelled into the frontline where the patient must come first”.
Ms Ní Sheaghdha concluded by expressing her disappointment that there also appears to be no provision, in the form of a protected budget, to begin implementing the SláinteCare Report.