24TH MAY, 2010




“That the Forum Members receive detailed information on the plans in each
of the Hospital in Dublin and the North East to tailor their services to
the budget allocation for 2010.”

Cllr. Bill Tormey

Breakeven Plans 2010
The HSE acknowledges that 2010 is proving to be an extremely challenging

In line with Government policy to reduce gross current expenditure, the HSE needs to reduce its costs by €400m. The DNE Hospitals’ share of the
government measures in 2010 is an actual expenditure reduction of
approximately €65.2 million. This represents an average of a 5% reduction,
in real terms, for each hospital/hospital group on their 2009 allocation.
However, the challenge may be more significant for individual agencies,
depending on such factors as their prior level of expenditure or case-mix
adjustments. The hospitals must also reduce staff numbers by 240, but
this headcount reduction only represents a proportion of reduction in pay
expenditure that must be made.

All management teams within DNE were briefed on a potential challenge of
this scale in November and December last year. Sample budget scenarios were presented, including a scenario of an expenditure reduction of €100m across the entire DNE Region. Management teams were asked to commence preparing cost containment plans. 2010 allocations were subsequently issued in early February. Since then, every hospital/group has engaged with the hospitals network office in the development of breakeven plan measures to address their potential deficit. Given that the majority of health
expenditure is pay related, the areas where agencies can act to save
significant monies is restricted. A key priority is to minimise the impact
on front line services. Appendix 1 is a summary of 2010 allocations to
hospitals. There is no doubt that the scale of fiscal challenge is
daunting; opportunities to reduce expenditure continue to be identified and

Detailed activity reports are not available as a result of the industrial
action, but the indications are that hospitals to date are meeting the
commitments outlined in the service plan.

The HSE 2010 service plan commits to a 5.6% reduction in in-patient
admission and a commensurate 6.5% increase in day cases. A reduction in bed numbers is therefore to be expected as in-patient admission avoidance
measures, such as higher day case provision and enhanced access to
diagnostic services, become operational. Hospitals have included bed
closures as part of their breakeven plans.

The reduction of beds must also be seen in the context of the reduction of
delayed discharges. It does not follow that bed closures will
automatically result in a reduction in acute care services. Since the
introduction of Fair Deal the HSE has been actively working with hospitals
to reduce the number of acute bed days lost to patients who require long
term care placements. In 2009, Beaumont Hospital used approximately 46,000 bed-days for the care of delayed discharges patients. This was equivalent to 126 hospital beds being unavailable for acute care for an entire year. The number of delayed discharge patients in Beaumont has now decreased to 111 from a peak of 176 in November 09, a reduction of 65. Beaumont has now closed 62 in-patient beds and plan further bed closures as more long term care patients are discharged. This will be facilitated by the commissioning of 32 step-down beds in Clontarf from end of May this year, as well as the provision of an additional 100 long term care beds in St.
Joseph’s, Raheny. The St. Joseph beds will be commissioned from the end of
third quarter, providing the HIQA registration process has been completed.
We met with HIQA to seek priority for this development and HIQA agreed to
facilitate this, as far as their legislation permits.

It should also be noted that although Beaumont has now closed beds, their
Emergency Department performance has shown improvement since last year in terms of the 2pm wait time for admission targets. Beaumont has only
breached the 24 hour wait time twice since April and has significantly
reduced the numbers waiting in the 12-24 hour wait time, compared to the
same period last year. Work continues to improve ED performance further,
but it is acknowledged that it will be extremely difficult to maintain the
gains made in ED performance whilst the bed closures take effect.

The Mater hospital lost approx. 36,000 bed-days, which equates to 101 beds being unavailable for acute care for a full year. The total number of
delayed discharges in Mater hospital has now dropped from a peak of 121 in
June 09 to the current level of 72, a decease of 49. The Mater has also
commenced bed closures. Five beds were closed on Friday, 21st May, and
further closures will be phased in, bring the total to 60 by the start of
July. A further 20 beds may be closed later in the year.

For both hospitals, a number of these closed in-patient beds will be used
as day-case beds, to achieve the planned increases in activity. With
continued focus on ‘Fair Deal’ discharges, the hospitals should therefore
be on target to provide the acute care services, as outlined in the service

The aspect of the ongoing industrial dispute which targeted the
non-submission of financial data to corporate and regionally has recently
been lifted. Detailed expenditure trends will be available to management
in the next two weeks. Expenditure trends for the first quarter indicate
an excess of €16m over budget allocation for acute services for the region.
It is not expected that this level of over-expenditure will persist, as
future quarters will reflect the cost-saving measures that have been
implemented by the hospitals.

Non-Consultant Hospital Doctor Recruitment
A separate area of emerging concern relates to the filling of
non-consultant hospital doctor positions for their next appointment period,
commencing in July. Early indications are that the larger hospitals are
attracting the majority of applicants, whereas smaller hospitals, with
fewer recognised training positions, are finding it difficult to attract
suitable candidates. The specialities particularly affected are
Anaesthetics, Surgery and Accident and Emergency. Should this trend
persist there may be a significant impact on the provision of services at
smaller centres. The situation is being monitored and contingency plans
are being developed.

Appendix 1 2010: Hospital Allocations

Hospital 2010 Notified Budget Allocation Total
Measures required to
adhere to budget allocation

Mater 213,026                                                        17,300
Beaumont 241,179                                                19,095
Rotunda 47,289                                                        2,158
Cappagh 26,245                                                        1,623
Connolly 90,044                                                       3,659
Dublin North Group 617,783                             43,835

Louth Meath Group 160,085                                9,857
Cavan Monaghan Group 77,361                         7,990
NE Group 237,446                                                   17,847

Total DNE Hospitals 855,229                                61,682*
% 7.2*

* Note: The figure of 7.2% (€61,682m) represents the savings that must be
found to achieve breakeven as a percentage of the 2010 budget. The 5%
reduction referred to in the 2nd paragraph of this report is based on the
reduction from the 2009 budget, and is not therefore directly comparable.