Cost of running HSE services over next year to ‘exceed’ available funding

The cost of running HSE services over the next 12 months will “exceed the total funding available to it” despite planned cuts to spending on agency staff and overtime, according to the health authority’s national service plan for 2024.

The HSE published the plan on Wednesday following a year in which it faced significant criticism for budget overruns. It implemented a recruitment freeze for the vast majority of staff roles as a result of the financial deficit it ran up last year.

The Government allocated a record €23.5 billion to the HSE for this year in Budget 2024, an increase of some 4.6 per cent on last year’s budget. Of this, €2.8 billion has been provided by the Department of Children, Equality, Disability, Integration and Youth in respect of specialist disability services.

A total €162.8 million has been provided for investment in new developments, including enhancing mental health and disability services. This year will also see the establishment of six new HSE health regions, resulting in a change to the size, purpose and function of the organisation at a national level.

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However, the service plan warns it will be a “significant challenge” to run existing services within the allocated budget and it is “likely” that a supplementary budget would be needed.

“The cost of running our existing services at current levels over the next twelve months will exceed the total funding available to the health service in 2024,” the service plan states. “Therefore, in addition to developing more effective service delivery approaches to enable greater activity to meet rising demand, we will also seek other opportunities to minimise the level of financial deficit that will arise.”

There will be “affordable” limits on whole-time equivalent staff (WTEs) for various sectors, which “may mean a reduction for some services, compared to 2023″, the plan says.

Some of the other ways the HSE intends to reduce spending is by reducing agency staff hours by one third, which would equate to some €250 million in savings for the year. Replacing these with directly employed staff and reducing overtime will yield savings of €80 million, bringing the total pay-related reductions to €330 million for the year. There is also a target to reduce expenditure on consultancy by €34 million.

“This reduction in agency staff hours, which currently contribute directly to service provision, means that we will need to increase productivity to be able to maintain current service levels, and grow them where this has been specifically funded,” the plan notes.

The HSE delivers more care to more patients every year, but services remain “under pressure almost all year round and are operating in challenging environments”, according to the document.

Over the period from 2017 to 2022, unscheduled care presentations increased by 27 per cent from 1.25 million to 1.59 million. The number of presentations is projected to increase almost threefold between 2022 and 2042.

“The continued growth in patient demand presents ongoing challenges, both in terms of staffing and delivery of healthcare in this setting, and in the financing of this growing level of activity,” the service plan says.

HSE chief executive Bernard Gloster said the investment in services is welcome and “has allowed the HSE to respond to sustained pressures, but not yet to overcome all of them”.

“In 2023, we improved access in both scheduled and unscheduled care but with, many challenges remaining, these must be our priorities again in 2024. Delivering high-quality, safe, effective, responsive and person-centred healthcare service is our paramount focus,” he said.

“We will continue to meet the changing healthcare needs of the population, which includes a growing and ageing population and an increasing number of people living with complex care needs.”

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