The Government announced its National Recovery Plan on 24/11/10. The main elements of the plan as they effect public services and in particular health services are outlined hereunder:
• The gap between income and spending for 2010 will be €18.5billion.
• This gap has to be bridged by borrowing
• Tax receipts for 2010 will be 35% lower than in 2007, loss mainly due to the collapse in revenue from property and construction related business.
• To remedy this a €15b adjustment is required to bring the deficit below 3% of GDP by 2014. This is in addition to the €15b adjustment that has already been implemented over the last 2 years.
• €6b of these cuts will be implemented in 2011 of which 2/3rds will be on expenditure and 1/3 on revenue measures.
• Key measures on current expenditure:
• Savings of €7b by 2014
• 40% implemented in 2011
• Public Service pay bill will reduce by €1.2b
• Reduction in Public Service numbers by 24750, this is an 8% reduction in numbers in employment at end of 2008.
• Health budget will be cut by €1.4b by 2014 with €746m cut in 2011
• HSE numbers will return to 100800 (2005 level) a further cut of 6000 on end of 2010 figures.
• Redeployment within/across grades as the terms of the Croke Park Agreement on reform are vigourously implemented.
• Reduction of 10% in pay for new entrants and introduction of a new pension scheme for the new entrants
• Pension reduction for Public Service pensioners to yield €100m (about 4%) in accordance with the following bands, first €12000 - 0%, €12001-€24000 - 6%, €24501 - €60000 - 9%, balance 12%
• Grace period for calculation of pensions on pre cut salary is extended to end of February 2012. For those retiring after this the pension reductions outlined above will not apply as their pension will be based on the actual salary that they are in receipt of which already had a reduction of 7% on average applied.
• The use of consumer price index (CPI)for post retirement increases for existing pensioners and serving staff will be considered in discussions in Spring 2011 but outlines that the "current pay parity" will remain unchanged up to 2014 which means that no increase whatsoever will apply under the Term of the Croke Park Deal.
Revenue Measures
• On aggregate 16.5% reduction in the value of income tax bands and credits - 10% in 2011, 2.5% in 2012, 2% in 2013 and 2% in 2014.
• This will reduce the entry point to income tax for a single PAYE person to €15,300 approx by 2014 down from €18,300 in 2010.
• By 2014 net pay for a single person on €55,000 will be reduced by €1860 or 4.8%. For a married one income family on €55,000 net pay will be reduced by €2310 or 5.4%.
• Income tax relief on pension contributions will reduce from 41% to 34% in 2012, 27% in 2013 and 20% in 2014.
• Removal of PRSI and Health Levy relief on pension contributions in 2011
• Included in the measures to be abolished in 2011 is Income Tax relief for Trade Union subscriptions
The exact details of the above will be outlined in the budget on December 7th and in subsequent budgets.
For full Report please go to http://www.budget.gov.ie/RecoveryPlan.aspx
In a Statement the PNA said that it is inevitable that this 4 year plan will result in further cuts to psychiatric services.
We have long experience of the Mental Health Services bearing the brunt of cutbacks in times of scarce resources. At a time when there was never a greater need for Mental Health Services for a society in deep trauma, Mental Health Services are being allowed to disintegrate with no regard for the need not alone to maintain existing services but to enhance services.
Within the last two years the Psychiatric Services have had:
• Spending on Mental Health reduced annuallly from 7.9% to 5.3% currently as a percentage of the Health Budget.
• Vision for change declared that it would require a minimum of 8.4% to deliver an adequate service. Spending in the U.K. stands at 12% of Health spending.
• Suicide rates are on the increase. In 2008 there were 424 recorded suicides and 527 in 2009, an increase of almost 20%.
• 1500 Nurses have left the service in the past three years, almost none of whom have been replaced because of the Government Moratorium. Despite having fewer than 9% of the total HSE workforce, Mental Health Services have contributed up to 60% of the total reduction in HSE numbers required under the moratorium.
• Failure to deal with the Mental Health problem will lead to a greater problems, e.g. a report by the Mental Health Commission (2008) stated that Mental Health problems cost this country over €3billion, less than €1billion was to provide health care, the remainder was due to lost economic output.
• Almost one quarter of the 77,665 persons in receipt of illness benefit last year cited Mental Health problems. What will it be this year?
• Negative social determinants such as poverty and/or economic insecurity increase the risk of Mental Health problems. The highest rates of admission to Psychiatric hospitals in this country are those from the unskilled occupational class, while common mental illnesses are twice as frequent among the lowest income groups. What does this say about our ability to provide services in line with the challenges affecting individuals, families and those most vulnerable in today's turbulent climate.
• Proposals to discontinue rehabilitation services which is so important to recovery. Those of us at the coal face of providing a "Mental Health Service" do so in knowledge that treatment is not designed just to "manage" patients, but to bring about their recovery, this is at the heart of modern thinking on mental health services and government policy Vision for Change 2006. Lack of rehabilitation services will seriously undermine the ability of patients to recover.
Mental Health Services are being destroyed with plans to close acute admission units, e.g. 50 acute admission beds are targeted for total closure in Clonmel. There are also proposals to close acute beds in Monaghan and Enniscorthy.
The Government must act to protect the most vulnerable in our society. Rather than further cuts the 5.3% spend must be increased and the Government moratorium on employment must be set aside in respect of the Mental Health Services otherwise:
• Suicides will continue to rise
• The 40% incarcerated by the penal system suffering from Mental ill health will increase
• Homelessness will increase
• Social isolation and family disharmony will increase
• Children requiring psychological/psychiatric assessment and treatment will have no service. Currently there are 2800 children or adolescents on waiting lists, some for over 12 months.
