Disparity in health resources’ allocation?

CLARE health services are not getting their fair allocation of resources per capita, compared to other counties in the west, a county councillor has claimed.

 

Councillor Brian Meaney has queried why the allocation for all non-acute services in the Primary, Continuing and Community Care (PCCC) budget in Clare is the lowest in the HSE West area.
With a population of 117,196, Clare received an allocation of €73.7 million under this budget heading, which Councillor Meaney believes is a fair way of assessing spend by county, as there is a disparity in the acute budget post-reconfiguration.

The division reveals a spend per capita of €629.55 in Clare. This is in contrast with €1,390.36 in Tipperary North, with a population of 70,322. The per-capita allocations are Donegal, €785; Sligo/Leitrim, €1,128; Mayo, €952; Galway, €786; Roscommon, €754 and Limerick, €696.

He alleged at a recent HSE Forum meeting that there was conflict in the explanation provided to him in a written answer to a forum question and a Dáil response offered to Deputy Timmy Dooley.
Deputy Dooley was told the current HSE budget allocation process is based on a “historic” methodology, which allocates funding on a historic basis to the care centres from where the services are provided. This system funds hospital, primary and community care in the various Integrated Service Areas (ISA), irrespective of whether the patient lives within the boundary of the ISA.

However, it also noted a new document published last year recognised that a fundamental reform of this model is required to introduce a money-follows-the-patient model.

In a forum reply to Councillor Meaney, regional director of operations John Hennessy stated the distribution of per-capita funding across the PCCC does not take into account the adjustments required for acute hospitals, private hospitals or the distribution of services from regional centres like Limerick.

Mr Hennessy noted the issue of cross-boundary patient flows is not provided for in this table and added that under a new model, the system would be more transparent, as providers will be paid for the quality care they deliver to clients within newly designated ISA areas.

He told the meeting the HSE did engage in negotiations with voluntary agencies and other groups providing services before the budget estimates were approved and did their utmost to deal with any particular inequities subject to resources.

Under the new model, he believes the HSE would be better placed to address any inequity that may exist and pledged to look at the two replies to see if the alleged conflict could be explained.

At the meeting, Councillor Tom McNamara queried the allocation of home-help hours and elderly care funding to Clare.
Official figures reveal the county has an allocation of 1.46 hours per head of population, the lowest in the west last year. This compares to 2.71 hours in Limerick/North Tipperary/East Limerick; 2.56 in Galway; 2.92 in Galway City; 3.59 in Roscommon; 4.09 in Sligo/Leitrim and 3.78 in Donegal.
The total number of home-help hours allocated to Clare in 2012 was 169,122, compared to 677,658 in Limerick and North Tipperary.

Councillor McNamara also queried the disparity in elderly care funding in the region.
The total combined budgets, including public unit Fair Deal income and a share of the regional resources based on a notional 40/30/30 split used for regional services, is Limerick, €34.286m; North Tipperary/East Limerick, €20.848m and Clare, €24.51m.

Under this allocation, Limerick gets €220 per head of population, compared to €211 for Clare, which translates into a shortfall of €1.04m.
Mid-West PCCC area manager, Bernard Gloster, stated at a previous forum meeting that reductions in 2012 for the last quarter resulted in Clare being under its targeted hours by 750, which was restored this year. He pointed out the home-help budget in Clare is protected from the 2.6% reduction applying to all older persons services and noted Clare has more access to elderly care beds than North Tipperary and had more investment in day services.
The HSE has provided €100,000 for a new day centre at Carrigoran and an additional €50,000 in Clarecastle, with no such expansion in North Tipperary.