A taste of cuts to come?

Ireland

To get a glimpse of the potential consequences of the £20 billion in NHS "efficiency savings" which the Con-Dem government is determined to make by 2014, just look across the sea to Ireland, where protests are growing against cuts of an equivalent scale.

The Dublin government has been pressing since last year for 1.23bn euro cuts in spending on health and children's services to combat a massive deficit triggered, like Britain's "public-sector" deficit, by huge bail-outs for the banks.

In January the Irish Times reported that Health Service Executive (HSE) planned to close up to 1,100 beds from April, on top of 900 closed in 2009 - and cut numbers of patients admitted to hospital by up to 54,000.

Cuts have even included the scrapping of services in Galway to provide prosthetic limbs for amputees, and cuts in orthotic services which provide special supportive footwear that allows disabled children to walk and helps avert the danger of amputation for diabetics.

This is part of a succession of heavy cuts in the west of Ireland, seeking to avert the prospect of a 90m euros overspend this year.

A children's residential service, health centres and some home help services will close. Hospitals in Mayo and Galway will be downsized, hundreds of temporary nursing and medical posts will be axed and there will be cuts in mental health services.

But there have been protests - 8,000 people joined a street protest in Roscommon on August 14 in response to warnings that the hospital was under threat of closure.

It had been identified as a target for closure in a secret report commissioned by the HSE, the existence of which has been revealed by the Irish Independent newspaper.

Some of the campaigns have forced retreats by ministers, notably the thousands of pensioners who marched last year against plans to axe free medical care for the over-70s, and managed to secure a substantial climbdown by the government, even though it has refused to rule out a cut in pensions.

Nonetheless beds closed last year in hospitals across the country, including Dublin, Galway, Cork, Ballinasloe, Kilkenny, Naas, Navan, Louth, Dundalk and Letterkenny. Waiting times for hospital treatment have gone up and elderly people are being left longer in hospital for lack of home care funding.

On June 12, 4,000 people took to the streets in Mullingar, County Westmeath, to protest at cutbacks in services at the local Midland Regional Hospital and rumours of further cuts to come.

In Kilkenny hundreds of nurses and campaigners marched on June 25 against the closure of 20 of the 51 beds and the "redeployment" of nursing staff at Kilkreene Orthopaedic Hospital, with numbers of operations halved - to save €1m.

Plans to axe a quarter of the training places for junior doctors were withdrawn at the beginning of June as it became clear that the unfilled vacancies would lead to drastic cuts in services. But the decision came just a couple of weeks before a new rotation of junior staff on July 1 and by mid-June some 300 jobs were still vacant.

South Africa

As NHS unions in Britain ponder their response to a two-year pay freeze, South Africa's public-sector workers have been taking strike action, which has seen striking health workers defy army detachments, police batons, rubber bullets and court edicts to maintain their picket lines.

The strike is to support a demand for an 8.6 per cent pay increase and a 1,000 rand (£90) housing allowance. The government initially offered 7 per cent and 700 rand, which it then revised to 7.5 per cent and 800 rand.

But ministers were quick to invoke the courts against the strikers and an injunction on Saturday August 21 ordered thousands of health workers and others deemed to be providing "essential services" to return to work.

In Durban two groups of hospital workers defied the ban and blocked the entrance to their hospitals.

However there was defiance from health union leader Sizwe Pamla, who declared that staff should not return to work, insisting the union would challenge the court order.

A solid eight-day strike by car workers had earlier won a 10 per cent increase in pay as employers' resistance crumbled.

This seems to have fuelled greater resistance by health workers.

United States

In the US, too, the grim consequences are starting to emerge of the cutbacks driven by the recession which has left public-sector budgets drained even as it has made more low-paid and unemployed US citizens dependent on public support.

In California, Sacramento County has axed its mental health crisis stabilisation unit and halved the number of beds in its mental health treatment centre.

As a result people with severe mental illness were diverted inappropriately to nine local emergency rooms, bringing a 28 per cent leap in numbers of patients whose main problem is a mental health disorder, despite the fact that the hospitals are not resourced or staffed to deal with them.

Many mental health patients also lack health insurance.

Further cuts in mental health budgets have only been averted through the intervention of the courts, which had to instruct county administrators not to axe successful treatment programmes run by non-profit organisations and divert 4,000 patients to new, cut-price county-run clinics.

Mental health services have also suffered in other states, according to a round-up in August by the Centre on Budget and Policy Priorities. It found that at least 46 states had imposed "cuts that hurt vulnerable residents and the economy," with the loss of 226,000 jobs, health cuts in 31 states and more to come.

Some 31 states have imposed cuts that will limit health insurance for low-income children and families. Some 29 states have cut or increased charges for medical, rehabilitation, home care or other services needed by low income elderly people or those with disabilities.

Maine is cutting the range of hospital diagnostic, outpatient and inpatient services for low-income people on Medicaid.

New Mexico is expected to eliminate a number of Medicaid services that are not stipulated by federal law - including dental services, spectacles, emergency hospital services and inpatient psychiatric care.

Arizona has axed provision of insulin pumps, California has cut nearly all funding for services to support HIV/Aids patients, Massachusetts too is cutting HIV/Aids prevention by 6 per cent, and Washington state is increasing by 70 per cent the premium for a health plan serving low income residents, with payments for the very poorest set to double.

The list goes on - state after state has been picking off the elderly, chronic sick, children, the disabled and people with mental health problems or learning disabilities as soft targets for cuts.

Who wants to bet that a similar pattern of cuts will not prevail here as ministers crack the whip for their £20bn "savings" target?

Eastern Europe

Health services in Bulgaria and Romania have been castigated in new EU reports.

Desperate shortages of staff and resources mean that patients are often required to supply the own syringes, bandages and other equipment for their own operations, while low pay and poor morale among nurses and medical staff mean that bribery is common to secure access to health care.

Thousands of Romanian doctors have left to work for higher pay and in better conditions in other countries and both countries are well below European average staffing levels.

In Bulgaria, it is common for patients to be two-to-a-bed while cockroaches scuttle past.

What was that again they said about the superiority of the market system?