EIGHTEEN hospitals -- several of which were already under financial pressure -- have been hit with "fines" totalling €13.8m for being inefficient.

The biggest penalty was imposed on Tallaght Hospital in Dublin, which had some €2.6m deducted from its budget.

Under the controversial 'casemix' system, hospitals are measured under various efficiency headings, such as the costs involved in treating people for similar illnesses and the throughput of patients.

The €13.8m taken from the 18 hospitals is then re-distributed among another 21 hospitals.

The biggest winner this time round was Mullingar General, in Co Westmeath, which received an additional €2.3m.

But among the losers were Our Lady of Lourdes, Drogheda (fined €1.7m); Tullamore General, Co Offaly (€1.7m); Limerick Regional (€1.3m); St Colmcille's Hospital, Loughlinstown, Co Dublin (€1.3m); and Sligo General (€1.3m).

Others fined include the Coombe Women's Hospital in Dublin (€409,448) and the National Maternity Hospital in Holles St, Dublin (€227,411), both of which are under pressure because of soaring births.

Criteria

High-performing hospitals include Wexford General (given €1.4m), St James's Hospital, Dublin (€1.2m); St Luke's Hospital, Kilkenny (€1.1m); and Mayo General (€1.09m).

The Health Service Executive (HSE) yesterday defended the system, which has been in place since 1993. It said standard criteria were used to measure the hospitals' performance.

The HSE rewarded efficiency by re-directing funds to hospitals which had demonstrated that "additional funding will result in real benefits", a spokesman for the HSE said.

"The system is designed to take account of each hospital's unique issues and unique patients.

"Hospitals are not penalised for long-stay patients; neither are they rewarded for discharging patients too early," the spokesman said.

He added that since the HSE based its budgetary decisions on evidence-based data about a particular hospital's performance, the casemix system should play a more central role in acute hospital funding and management practices.

However, the system has been criticised over the years because it only takes into account in-patient and day-case activity, while it excludes a hospital's accident and emergency performance.

Targets

The latest annual round of performance-related fines comes as hospitals brace themselves for cuts to stay within budget targets.

The Mater Hospital is planning to cut outpatient clinics and close beds, while Temple Street Children's Hospital is closing its respiratory clinic to new referrals because it has a waiting list some two years long.

A spokesman for Tallaght Hospital said the casemix was calculated on a 'previous year' basis so the figures for one year reflected performance in the previous year.

"Since 2008, the hospital has conducted a review and implemented a number of changes, which should lead to a better performance rating," the spokesman said.

"Changes include initiatives on length of stay, admission on the day of surgery and protection of day-ward beds.

"The hospital's performance has been severely hampered in terms of reduction in elective surgery due to prioritising patients requiring admittance from our A&E department.

"However, the changes outlined should improve the hospital's performance," he added.

Irish Independent