Health spend analysis: Is this throwing good money after bad?

The biggest health budget in the history of the State was announced on a day when figures published outside the Dáil starkly illustrated how poorly much of the sector is performing.

Minister for Finance Paschal Donohoe’s €17 billion bonanza for health in 2019 will do little to relieve the plight of the 525 sick patients who were on a hospital trolley on budget morning for want of a proper bed. For most of the 700,000 patients on official waiting lists, as the latest figures to be published this week will show, it will offer no more than a glimmer of hope.

In the State’s largest hospital, St James’s in Dublin, four of the 13 operating theatres are closed at present due to a lack of beds and staff, according to hospital consultants. And 15 patients requiring urgent neurosurgical care cannot be transferred to Beaumont Hospital because no beds are available.

It’s a familiar refrain, indicative of the need for a radical cure. Yet if Mr Donohoe had reservations about giving an extra €700 million to health (or €1.2 billion in total this year) – and his officials certainly have – he didn’t take the opportunity of his budget speech to ventilate them.

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A sector that has overspent by €2 billion in the past four years gets an additional €1.05 billion next year without so much as a sigh of disappointment over past behaviour. Ireland, the Minister noted, already ranks fifth for per capita health spending in international rankings; by next year, we should be medal contenders.

Perhaps it is curmudgeonly to criticise the allocation of extra money to health when the needs are so great? Surely we should be welcoming the increased budget allocation as an opportunity to fix things?

The problem is that previous hikes in spending have not resulted in service improvements. We risk throwing good money after bad. We need more beds and, in some areas, more specialised staff. But we also need a new way of doing things. Much of the extra budget money will go towards helping the health service keep running to stand still, by covering the cost of overruns or employing extra staff to plug gaping holes.

An extra €20 million is being provided for the National Treatment Purchase Fund with the aim of cutting waiting lists. The fund has made a small dent in inpatient lists over the past year and might just work in the long term, but in its previous iteration the impact of throwing money at the problem effected only a temporary improvement. Once that tap was turned off, the lists grew again.

Overall, the increased budget allocation should make it easier for Minister for Health Simon Harris to weather the inevitable strains on the service this winter – a not insignificant political consideration in the run-up to the next general election.

Economic downturn

Of course, there is a big plan, in the form of Sláintecare, which carries a five-year price tag of more than €4 billion. Mr Harris says he is allocating €200 million to an implementation strategy to get the plan under way, but it is unclear how much of this money would have been spent anyway. With Brexit and possibly a cyclical economic downturn on the way, it may be that the funds available for Sláintecare have already been used up.

The extra 100,000 GP visit cards available for those on lower incomes will be widely welcomed, except by overworked GPs. The Irish Medical Organisation said it was difficult to see how the extra card holders could be safely managed given the cuts of recent years; its view may soften if talks on new funding for general practice, set to resume on Wednesday, are successful.

The 50 cent reduction in prescription charges (for over 70s only) is a move in the right direction. The levy was intended only to disincentivise overprescribing of expensive drugs and not as a source of revenue for the cash-strapped health budget. Reducing the monthly threshold for the drug payment schemes by €10 is also a modest move in the direction of fairness.