No cuts to health services next year despite ‘guaranteed deficit’, HSE chief says

The health service will run a large deficit next year but there will be no cuts to services, HSE chief executive Bernard Gloster has told TDs.

Clinical strategies will grow more slowly next year than they have in recent years, Mr Gloster told the Oireachtas health committee.

“We will consolidate what we have, we will do the best we can with that. There’s lots of work we can do, this is not all doom and gloom, but we won’t grow all of our development strategies as fast as we would have liked to,” he said.

Recruitment of additional staff is being capped, not cut, he emphasised, so existing levels of service provision will continue.

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Mr Gloster repeated his view that the health service has not been adequately funded for next year under its allocation in Budget 2024. His best estimate for the deficit this year remains at €1.4 to €1.5 billion, he told the committee.

[ Stephen Donnelly promises ‘in-depth report’ on future costs of healthcare after budget row ]

The majority of this is beyond his control, he stressed, as it is being driven by rising inflation and increased patient demand.

Asked how much extra his department had sought in pre-budget discussions, Department of Health secretary general Robert Watt said an additional allocation of about €2 billion was sought, along with some once-off funding.

Ultimately, health was given an additional €708 million to provide the existing level of service next year, along with €100 million for new developments.

As a result of this shortfall, the HSE’s service plan for 2024 will include a guaranteed deficit, Mr Gloster acknowledged.

There will be a large budget deficit in 2024 as “the only alternative to that would be to cut services and, to be fair, I haven’t been asked to do that”, he said.

Fianna Fáil TD John Lahart expressed his admiration for Mr Gloster for standing by his “ballsy” insistence that the health service is inadequately funded for next year.

However, the issues of universal payments and universal eligibility for services will have to be scrutinised, Mr Lahart said. “I know it’s Government policy, but I also know GPs have issues with this – of clogging up surgeries, there’s a shortage of GPs, that kids with runny noses are coming in continually and clogging up GPs’ waiting-rooms, and kids and adults with real needs are being prevented access.”

While there are some control issues, Mr Gloster said, he wanted to “absolutely reject” the notion that “we’re just a bunch of wasters with public money” or that the health services is “some sort of flesh-eating thing on the public finances”.

He said 99 per cent of people working in the service “give their best”, often in inadequate infrastructure. When the HSE’s energy contract changed, the cost went up 85 per cent, he pointed out: “That’s not my being a waster”.

[ Q&A: What’s the problem with the health service budget? ]

Asked if he should have been more “upfront” about the HSE’s spending deficit earlier this year, Mr Watt said he had not hidden the deficit. At the time, there were different view on the financial risk faced by the HSE, he said, and as the year progressed things got worse as demand and inflation increased.

“We got much greater demand than we expected and prices went up more than we factored in,” he said.

On the €3.2 billion drugs budget in the health services, Mr Watt said this was “incredible and not sustainable”.

Many more people are accessing high-tech drugs, whose prices are also increasing, he said. “Everyone want to fund them but the challenge for society is to generate the space to fund them.”

Asked about 1,500 rapid-build beds promised by Minister for Health Stephen Donnelly, Mr Watt was unable to say how many will be provided next year.

In relation to Letterkenny University Hospital, which local doctors say is at risk of “collapse”, Mr Gloster said he has asked for the HSE’s performance management improvement team to be deployed to assist the hospital.