Health funding hikes 'have not improved services'

Spending review advises reducing legal aid payments and garda overtime rates

Minister for Finance and Public Expenditure Paschal Donohoe  warned that health spending would have to be controlled. Photograph: Nick Bradshaw

Minister for Finance and Public Expenditure Paschal Donohoe warned that health spending would have to be controlled. Photograph: Nick Bradshaw

 

An almost €700 million increase in funding hospitals over the past four years has resulted in only “marginal” improvement in their performance, a review of public expenditure states.

Amid growing concern among Ministers over escalating expenditure in the health service, the review finds that efforts to manage hospital budgets have “consistently failed”.

Minister for Finance and Public Expenditure Paschal Donohoe yesterday warned that health spending would have to be controlled and the rate of recruitment of new staff, running at between 350-400 a month, could not be sustained indefinitely.

Senior Government sources privately confirmed that concerns about health overspending have scuppered requests from the Minister for Health Simon Harris for extra funding for the proposed Sláintecare plan, a 10-year reform programme for the health service proposed by an all-party Oireachtas committee.

A series of expenditure reviews drawn up by the Department of Public Expenditure were published yesterday.

Legal aid spending

Elsewhere, the spending review warns that policing operations and the justice system will come under significant pressure in the years ahead unless the Government moves to reduce legal aid payments and garda overtime rates. It suggests that those accused of criminal offences should make a contribution to their own legal aid for the first time.

The review includes a draft Criminal Justice (Legal Aid) Bill which would introduce a sliding scale to legal aid contributions, meaning those who have some assets but can’t meet the full cost of a case will have to make a contribution to their costs. The contribution would be decided by the courts.

A spending review of the education sector maintains that hundreds of primary teachers will be surplus to requirements over the coming years due to falling numbers of projected pupils. While the enrolment at primary level has been growing for almost two decades, the department says primary enrolments are projected to peak this year and will gradually reduce until at least 2025.

The most likely scenario is that up to 696 fewer primary teachers will be required between next year and 2021 as a result.

Office rentals

The spending review also says the State’s rental bill for office accommodation has increased by 10 per cent in three years, with further hikes expected if Dublin becomes a destination of choice for multinational firms post-Brexit.

The cost of public service pensions will rise sharply in the coming years, jumping by almost €2 billion by 2025, while the level of pension contribution from public servants will remain steady.

The review has found that the cost of public sector pensions to the exchequer will rise from €3.4 billion last year to €5.3 billion by 2025, while the contributions from public servants will remain static at about €1.6 billion a year. The cost of public sector pensions will rise to €7.3 billion by 2040.

On health, the report argues that while spending on acute hospitals increased by €680 million (17 per cent) between 2014 and last year, improvements in outputs were “marginal”.

Official data “demonstrates a clear disconnect between the increased investment made over the three years and the subsequent improvement in terms of output levels”, the spending review says.

While staff numbers increased by 17 per cent over the period and pay increased by 14 per cent, waiting lists continued to grow, it says.

During the period, day case procedure numbers and emergency department presentations increased by 4 per cent and 5 per cent respectively while inpatient numbers fell by 1 per cent.