Health managers have urged the new Health Minister, Dr. Leo Varadkar to end the dilemma where they can only fund newly approved expensive treatments at the expense of equally badly needed existing treatments and services. They also say the Government should take this opportunity to define the kind of health service it wishes to have and not allow it to develop haphazardly at the whim of local political and populist demands. Maureen Browne reports.
Health managers have urged Dr. Leo Varadkar to provide ring fenced funding for new approved treatments, which they say they can only provide at present by cutting very badly needed services to other patients.
“The current situation is that when new treatments become available and are approved, consultants naturally want to provide them, patients equally naturally expect them but there is absolutely no mechanism to fund them,” said one disillusioned manager. “Patients who would benefit from these drugs and treatments are understandably delighted but some of these medications can cost €80,000 to €100,000 a year and we just do not have the money for them. We can only find the money by cutting what some consider less glamorous but equally vital services.
“Yet these new treatments could be expected to dramatically improve a patient’s quality of life and of course save the economy money in the long run as they may, for example, result in patients requiring less care, less expensive care, becoming mobile, going back to work.”
Consultants naturally want to provide them, patients equally naturally expect them but there is absolutely no mechanism to fund them.
A colleague in an acute hospital agreed saying she was sick and tired of managers being asked to decide whether they would provide life-giving treatments and medication for some patients at the expense of what were in effect social services for others and being pilloried by both sides.
“We can’t be throwing our hands up every time we hear a new and expensive drug which is and should be part of a modern health service has come on the market and received HTA approval. Our dilemma is that we want to give these to our patients who need them, but we know it will push us into the red and jeopardise our ability to treat other patients.”
The big problem is that once a decision is taken to approve a new medication or treatment there is no process or mechanism to discuss how it is to be funded or the repercussions on other services.
“Patients quite understandably think that once a product has been approved it will be easily available. They don’t realise that there is no ring fenced funding or special grants available for it. This leads to what I can only term clinical injustice – do we give the patients these new drugs which may be life saving at the expense of other patients,” said a manager who is deeply concerned about the present situation.
Another colleague said that he was deeply concerned that people could miss out on really good treatments because money was being spent in areas where it should not.
“The trouble is that what some see as less glamorous services can suffer. We are in the situation where we are faced with either telling a patient who has just heard of a new life extending or life saving treatment that we cannot afford it or telling patient with a chronic disease that we cannot afford to treat him or her. Patients do not understand that we have to make decisions like this and they should not be asked to do so.”
Managers are in general agreement with the difficulties that something must be done about the situation where a new and effective drug could cost €70,000 – €100,000 a year but although it has been authorised, no financial provision has been made for it.
They say that it must be looked at on a national basis. “If a GMS drug is approved it will be provided and paid for,” said one manager “But on the hospital side there is no mechanism. It is up to us to try and argue for money and I can only see this getting worse with the silo approach to hospital and community budgets. If a hospital drug is approved and consultants believe it is valuable there has to be a mechanism for funding it.”
A number of managers believe that Dr. Varadkar and the Government should take the opportunity when making this much needed reform to define the kind of health service they wish to have and not allow it to develop haphazardly at the whim of local politics and populist demands.
They say that decisions need to be taken on whether we will have a modern health service with the latest treatment or continue to squander money on hospitals which are not fit for purpose and outdated models of care.
“New treatments will be coming on line as part of a modern health service and we need to make financial provision for them, but we are spending a lot on services and hospitals which are not fit for purpose and they are just devouring money. We might be better off closing them down and implementing modern treatments which do not require the kind of stays in hospitals which have been a feature of the past,” said one senior manager
Another colleague said that he was very worried that people could miss out on really good treatments because money was being spent in areas where it should not. “We cannot keep on adding on costs even if the economy was doing well which it is not,” he said. “Every industry is constantly improving and modernising its operation and the health services have to do the same. But we are not – we are still bringing people in on Saturday for surgery on Monday to ensure they have a bed, we have hundreds of patients in our acute hospitals whose acute treatment has long been completed, and we are treating patients in hospitals who should be treated at less complex levels.”