Confidential report shows HSE sought extra €1.4bn in funding

The HSE told the Government last September that it needed more than €1.4 billion in extra funding this year.

This included nearly €600 million for specific new projects and developments that it wanted to put in place.

It also warned the Department of Health in a submission that achieving any additional significant levels of efficiency was "no longer possible".

It said the potential for securing material savings in the health sector had been “maximised” and there was now a requirement to stabilise the funding position in terms of correcting its financial base, addressing demographic needs and securing investment in critical service priorities.

Once-off increases

Ultimately, the HSE received an additional €625 million for the health service, with a further €10 million targeted from projected once-off increases in revenue. However, when account was taken of the overrun of €510 million last year, the net increase in funding for the health service was about €115 million, or 1 per cent.

The HSE was also given a target of generating €130 million in additional savings.

The official submission – which the department and the HSE had refused to publish but which has been obtained by The Irish Times following an intervention by the Information Commissioner – said that on top of the €510 million for the 2014 overrun, the health service needed an additional €300 million this year to provide existing levels of service.

It said a further €33 million was required to deal with unavoidable new cost growth.

The HSE submission also argued that nearly €598 million in additional funding should be earmarked for necessary investments “to tackle the backlog and [to deal] with new demographic and other critical service pressures as well as programme for Government commitments”.

It said each of the initiatives set out for development – the plan runs to more than 40 pages – had been through a process involving senior clinician input and assessment against quality and service priorities. “Each initiative is necessary and will have impacts if not progressed in 2015.”

Waiting lists

The HSE submission called for an investment of €40 million to tackle surgical in-patient and day case waiting lists. It also proposed more than €4 million to pay for more maternity nursing staff.

It said the “birthrate-plus” project – an internationally recognised midwife-to-birth ratio – would identify staffing deficits that would need to be addressed this year.

The HSE also looked for more than €2 million extra in funding for orthopaedics. The submission said, for example, there was a two-year waiting list for scoliosis surgery. It also looked for funding for an acute forensic service to deal with child sexual assault.

In addition it sought more than €400,000 to meet targets for dealing with diabetics who presented with urgent foot problems. It warned without the investment there could be a “continuing increase in amputations” and said each amputation cost an average of €70,000.

The HSE also proposed that more than €4 million in additional funding should be earmarked for therapy and assessment services for children with disabilities in pre-school and school settings. It said there was an inability to meet the statutory requirements of the assessment of need process under the Disability Act. It said only 29.6 per cent of assessments were completed within the statutory timelines.