Health service efforts to manage budgets have ‘consistently failed’

Patients are not seeing the full benefit of major financial investments in hospital services over recent years, a review carried out by the Department of Public Expenditure and Reform has suggested.

The review argues that hospital expenditure continues to grow year-on-year “while outputs and waiting list numbers stagnate or deteriorate”. It also contends that “the ability of the health service to manage the hospital budget appears to have consistently failed”.

It says “targeted initiatives” aimed at reducing waiting lists as having effectively failed to produce long term results.

The review says that between 2014 and last year, investment in the acute hospital sector increased substantially by 17 per cent to €4.7billion. It says expenditure on pay increased by 14 per cent while non-pay spend increased by 30 per cent. It says staffing levels increased by about 8,400.

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“While spend has increased dramatically and consistently over the last three years, outputs and activity metrics have not mirrored this trend,” the report says. “The increases observed in terms of day case activity and emergency department attendances cannot explain the increase in spend that has been witnessed.

Patient numbers

“Despite the efficiencies and cost savings associated with moving away from in-patient treatment where possible, day cases have increased by just 4 per cent over the three year period with inpatient numbers remaining relatively flat, falling by 1 per cent over the period.”

The review says that between 2014 and last year the number of people waiting on an inpatient procedure increased by 46 per cent while those waiting on a day case procedures increased by 59 per cent.

It says the proportion of those waiting more than 15 months increased by 10 percentage points for day cases and 14 percentage points for inpatient procedures over the same period.

“This is despite ongoing investment to tackle waiting list numbers which, as is shown in the data, serves to have a short term effect on reducing the waiting list numbers before returning to and exceeding peak levels,” it says.

“The ability of the health service to manage the hospital budget appears to have consistently failed. This is most clearly demonstrated in the performance of hospitals against budget.”