Varadkar’s officials deeply unhappy with HSE’s draft service plan

The Department of Health was deeply concerned and unhappy with elements of the draft spending plan for this year drawn up by the HSE last autumn, official documents reveal.

The papers show the HSE had, in its draft service plan, initially proposed a 35 per cent reduction in inpatient activity in public hospitals despite what the department said was a funding increase of nearly €800 million.

In a letter to HSE chief executive Tony O'Brien on November 19th, the department's secretary general Jim Breslin said the proposed cut of 34,568 in inpatient elective procedures seemed to entail an unjustifiable increase in unit costs. He said the draft plan argued elsewhere that the capacity to reduce elective work was limited, given already lengthy waiting lists and clinical requirements.

‘Credibility’

“For these and other reasons it seems unlikely that the approach is capable of being implemented in the manner proposed,” Mr Breslin said. “Therefore, the necessity for, and the credibility of, the management strategy being considered by the [HSE] directorate in this area is not one that is likely to be capable of being recommended to the Minister for his approval.”

Mr Breslin said that if the plan were proceeded with, “there would be an enormous waste of skilled resources and facilities, the cost of which would still be incurred throughout next year while the unmet needs of patients go unmanaged. It is difficult to conceive of how this would represent the most beneficial, effective and efficient use of the resources available to the HSE,” he added.

In the letter, released to Fianna Fáil health spokesman Billy Kelleher under the Freedom of Information Act, Mr Breslin also took issue with comments in the draft plan that it had to be read in conjunction with the HSE's submission for the pre-budget financial estimates. In this process, the HSE had sought nearly €2 billion extra.

“The HSE estimates submission has no standing at this stage after the Government has finalised the official estimates and the Minister has made his expenditure determination,” Mr Breslin said. He said that while the draft plan provided analysis and commentary, it was “well short on well-developed programmes of action to more effectively manage budgets in key spending areas across the €13 billion available to the HSE”.

Mr Kelleher said he was concerned about what seemed from the documents to be a “highly dysfunctional” relationship between the department and the HSE.

Asked about the letter, the department said the HSE was granted two extensions to give it more time to formulate a service plan in line with Government policy and to allow for feedback from the department to be taken on board.