HSE West overspend could be €100 million by December

Fears that services at Mayo General will suffer

The HSE West has overspent by €34.6 million in the first four months of the year and this debt could reach €100 million by December, a meeting of the HSE West Forum was warned this week.

At a meeting of the forum on Tuesday in Merlin Park members heard most of that debt (€31.3 million ) was incurred by hospitals.

This led Galway county councillor Mary Hoade to warn the executive that the debt could rise to €100 million by the year end. She said it was very worrying that the authority had exceeded its €684 million budget by 7.7 per cent so early in the year.

However, Mayo General Hospital is one of the best performing hospitals in the region, having only overspent by €1.8 million. Mayo General’s budget for the first four months of 2011 was €76.3 million and has run to €78 million.

Overall the main areas for expenditure are in pay. The meeting heard that the main categories where overspending had occurred were in drugs and medicines, medical and surgical supplies, professional services, heat, power and light. There were savings, however, on office expenses, miscellaneous and grants.

Liam Minihan, assistant national director of finance for the HSE West, said the service was facing “a challenging remaining period”. He said the staff moratorium will contribute to more savings, as well as a national agency contract which is now in place and a new laboratory on-call rota. He said private health insurers owed the HSE West in the region of €12 million.

According to Mr Minihan a major income collection project is under way in acute hospitals focused on the backlog of claims not yet submitted to insurance companies. The biggest problem he said was getting consultants’ signatures on claim forms. The HSE is also looking at claims pended by the insurance companies for various reasons and making better use of private bed resources. Local cost containment plans are also currently being implemented.

Mayo county councillor Seamus Weir expressed his fear that services in the Castlebar hospital were suffering because management were working within the confines of their budget. He made the point that other hospitals who had overrun their budgets by millions could provide better services than the likes of Mayo General which was almost working within budget.

He pointed out that Mayo General Hospital was under “major pressure” with a lot of patients on waiting lists. “People with cancer can’t get treatment right away,” he pointed out. According to Cllr Weir some hospitals are overspending and Castlebar, which is doing well financially, is suffering in terms of services. “Good management can create weaker services,” he added.

Cllr Austin Francis O’Malley asked if progress was being made in relation to the claims backlog. He queried whether Castlebar would be “tarred with the rest who haven’t pulled up their socks” or rewarded for sticking within budget.

Forum chairman Cllr Padraig Conneelly was critical of the delay in getting consultants’ signatures on claims forms that would enable the HSE to claim money owed to them from private health insurers.

Mr Minihan said the situation was serious and there was no provision for an overspend in 2011. He highlighted the pattern in 2010 and what was emerging in 2011 with high expenditure in the first quarter reflecting a busy winter period. He said this was a period of “extreme pressure” on services. But the tendency was for that to recover during the summer months with more pressure coming on around October. He said there are control and containment plans in place for each of the management teams, with gains to be made by wiping out absenteeism and overtime. There is also an opportunity to improve income collection. According to Mr Minihan they were dealing with the situation in a “balanced way” that protects frontline services.

He said Castlebar wouldn’t be penalised for performing well financially. “We are being very deliberate in 2011 that hospitals that perform well in budgets are rewarded,” he added.

In relation to private health insurers he said there was “ample evidence” of consultant support for the process of claiming money.

Dr David O’Keefe, clinical director for acute and continuing care, pointed out that if hospitals weren’t being paid then consultants were not being paid either. “It’s a bundled form,” he explained but added it was also a complicated clinical form. He said HSE management was using its “persuasive powers” to encourage consultants to speed up the process.

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