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Legal question as HSE commits to hospital activity with €39m shortfall

The budget for hospitals is estimated to be €39 million below that required to fund activity levels currently set out in the HSE National Service Plan 2020, which would be in breach of a legislative requirement on the Executive.

According to the service plan, published on 17 December, it is a legislative requirement for the HSE to set out a plan that shows the type and volume of service activity that can be delivered for the funding provided.

The document outlined that the HSE would in the following eight weeks collaborate with acute hospitals and other “internal and external stakeholders” to work-up a range of “deliverable options”.

These would be consistent with mitigating clinical risks, including in relation to consultant manpower risks in certain hospitals; aligning with existing policy, regulatory and legislative requirements, including Sláintecare, European Working Time Directive (EWTD) and the small hospitals framework; advancing overall efforts to better integrate care between the hospital and the community; and enabling €39 million worth of “cost reduction above and beyond the other efficiency and related savings measures already assumed within the plan”.

“The intent is to have these options agreed before the end of 2019 for implementation in 2020,” according to the document. “In the event that it does not prove possible to agree and implement options to the full value of the €39 million then, as a last resort, and in line with the legislative requirement, acute hospital activity will be adjusted downwards as necessary, while maximising opportunities to reduce low-value/no-value care and to shift care to more appropriate settings.

“By way of context, €39 million represents some 0.6 per cent of expected total acute hospital gross expenditure in 2020. It should be noted that, as more detailed work is completed on the various savings efforts above, it may, in certain instances, become necessary to adjust budgets internally to reflect same.”

Overall, the plan said additional cost pressures on the health service were €32 million above the total additional funding of just over €1 billion and this generally excluded costs of additional service activity to deal with demographic, technology, unmet need and other pressures on the system, which was estimated at €420 million.

The HSE had not commented by press time.

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