HSE heading for ‘mindblowing’ €1.5bn deficit by end of year

TD tells committee of his shock at scenes of violence in hospitals, including one incident where ‘one man wrapped a crutch around the head of another’

The HSE is heading for a “mindblowing” deficit of up to €1.5 billion by the end of this year, TDs have been told.

With a projected cash shortfall of €1.1 billion, the organisation is expected to incur an income and expenditure deficit of €1.4 billion to €1.5 billion by December, HSE chief executive Bernard Gloster told the Oireachtas health committee.

This means the health service will need an additional €2.4 billion in funding next year to maintain its existing level of service before any new measures are contemplated, Department of Health secretary general Robert Watt confirmed.

About half of the total is due to health cost inflation, a quarter relates to increased demand from patients and the rest is down to control issues, Mr Gloster said.


Of the €700 million overspend to the end of July, the committee heard, some €68 million is a “hangover” from the Covid-19 pandemic and the rest is a core deficit.

Sinn Féin health spokesman David Cullinane described the overspend as “mindblowing” and pointed out that this figure will have to go to the base for next year’s budget, leaving less money from Government for other areas.

Mr Cullinane quoted from ministerial briefing documents from last March, which cited a HSE estimate of its cost overrun for the year at more than €1 billion, while the Department of Health estimated the figure at €400 million to €500 million. The HSE was told to remove all references to this financial risk from its annual service plan.

Mr Cullinance said this showed the HSE’s estimate had been right, the department’s was “grossly inaccurate” and it was a mistake to tell the HSE to remove references to the shortfall from the plan.

Mr Watt acknowledged there were issues with financial management in health. He said the system was under “enormous pressure” and there was “definitely” underfunding for the existing level of service.

“We accept this way of doing business needs to change,” he said. “This year has been exceptional, with demand way above what was expected, and also inflationary pressures.”

Fine Gael TD Bernard Durkan said he was shocked by the scenes he witnessed during recent visits to hospital emergency departments.

He said he saw patients in urgent need of attention who were “intimidated” into sitting in the back row while other patients with drug or alcohol related issues were “dominating” the front of the waiting area.

“The people dominating demand are getting the attention,” the Kildare North TD said, adding that patients with such issues should be seen in drug treatment centres rather than hospitals.

Highlighting the “appalling amount of abuse” meted out to doctors, nurses and other hospital staff, Mr Durkan described seeing a fight break out in one emergency department in which “one man wrapped a crutch around the head of another”.

“This is a public hospital system. This is not supposed to be going on there. This is a waste of taxpayers’ money, to be entertaining people in that condition at the entrance of a public hospital. I want to register my abhorrence of the use of public money in that fashion.”

Mr Gloster said he shared Mr Durkan’s abhorrence of violence towards staff, but that all patients have to be triaged. If the HSE failed to care for any patients requiring treatment, he said, it would find itself the subject of an inquiry.

The committee also heard that more than 600 hospital consultants have signed up to the new public-only contract. About two-thirds are existing consultants moving over to the contract and the rest are new appointments.

The process of recruiting heads of the six new HSE health regions started last week with the advertisement of the posts, TDs heard. Mr Gloster said he hoped to have the six people selected by the end of the year and in post by February. The RHAs will start operating in autumn next year.

Mr Gloster said he has drafted a plan for a “radical redefinition” at the top of the organisation, which is to take effect next year. This will be “the most significant delayering” of the HSE since it was established, he added.

Paul Cullen

Paul Cullen

Paul Cullen is Health Editor of The Irish Times