HSE budget revelations likely to prompt further questions

Revelations the Health Service Executive sought more than double the amount of additional money it received this year is likely to reopen the debate on what is the appropriate level of health spending.

The newly emerged official correspondence is also likely to raise questions on what exactly went on in the budgetary discussions last autumn.

The HSE, Department of Health and Department of Public Expenditure and Reform have all refused to release the papers prepared for the financial estimates process that preceded the Budget last October.

The Government allocated an additional €625 million to the health service, with a further €10 million targeted from projected once-off increases in revenue.

However, when account is taken of the €510 million overrun recorded last year, the net increase in funding for the health service is about €115 million, or 1 per cent.

Budget increase

As a result of the emergence of the new correspondence, it is now confirmed the HSE on September 9th last year wrote to the Department of Health seeking a budget increase of €1.4 billion. In net terms this represented an increase of about €900 million.

However, on September 30th, Minister for Health Leo Varadkar told the Dáil he could categorically deny media reports he was looking for either €1.2 billion or €900 million.

“I am seeking to achieve a neutral health budget to enable the department to spend more or less that what was spent this year.”

While HSE director general Tony O’Brien in his letter to the Department of Health acknowledges it was unlikely he would receive the full €1.4 billion he had sought, it is likely the Opposition will seek to determine what transpired between the HSE making its pitch for funding on September 9th and the Minister saying at the end of that month he was only looking for more or less the same health budget as was in place last year.

Precise services

It is also likely the HSE will come under pressure to elaborate on the precise services it is unable to fund as a result of not getting the budget it sought, and how this might affect patients.

In his letter to the Department of Health's secretary general Jim Breslin on November 18th, Mr O'Brien said it had "not been possible to provide funding to address the substantial majority of the demographic and critical service cost pressures, some of which carry risks from a clinical perspective".

The demographic challenges facing the health service are well known: the over-65 population is growing by about 20,000 each year and the number of people over 80 is increasing by 4 per cent a year. The older the patient, the more complex and expensive their treatment tends to be.

Last week, Mr Varadkar told the Oireachtas health committee the health service clearly did "not have sufficient funds to address all areas of concern across the health sector immediately".

This is broadly saying the same thing as Mr O’Brien stated in his letter.

However, by suggesting the HSE did not have sufficient funding to address some issues which presented clinical risks, Mr O’Brien’s correspondence will raise further questions.