Health service overruns follow familiar pattern

Good morning.

This morning's lead tells a story that has become familiar in recent years - spending in the health service is once again running way ahead of budgeted levels and if left unchecked will require another bailout of several hundred million euros before the end of the year. Fiach Kelly is on the job.

The same pattern has been repeated every year since the Government came to office. It goes like this: health spending tears ahead of where it’s budgeted to be by mid-year. The Government first denies it. Then it says that every department has to stick to its own budget, that there’ll be no extra money, no bailouts, no supplementary estimates.

Then it becomes clear that if this is applied to the health service, swingeing cuts in services would have to be implemented in the second half of the year. The Government has a think about that and the political consequences that would inevitably spring from it. So it backs off. The health service stutters on. The requisite several hundred million euros are found before the end of the year.

Citizens’ Assembly to discuss structure of Dublin councils

---

Construction delays could see children’s hospital cost rise further

---

Miriam Lord: the doorsteps have taken to shouting about home-care supports

---

Irish air was polluted over Easter weekend, Minister confirms

---

There is another part of the familiar sequences outlined above, however. It happens in October when the budget for the next year is set. Because of the way the budgeting works, the extra several hundred million euros goes into the “base” for next year - that is to say, the health service’s starting budget for the next year is the amount of money it actually cost to run the service during the year, rather than the amount of money that was budgeted at the beginning of the year. So that’s one increase.

Then an annual increase - to account for new services, the cost of demographics, pay rises, etc - is added to that figure. That’s another increase. All of which means that health budgets have been increasing at somewhere near a billion euros a year, but the health service still busts its budget every year.

And, finally, all this is accompanied by annual pledges that this is the last bailout for the health service, that it must stick to its budget next year, that any budget overruns must be met from within its own resources, etc. If you were a betting man or woman you’d hardly put money against the same happening again this year.

Three things may be said in addition and qualification to this rather gloomy outlook. The first is that health budgets will not keep expanding at this rate forever. At some stage, they will have to be controlled because otherwise they will cannibalise everyone else’s budget. There is already a high degree of resentment among non-health Ministers.

The second is that it’s not as if nurses and doctors are spending the cash on trips to Las Vegas. Health is a demand-led service. Most of the money is spent on treating patients - albeit in structures that are woefully inefficient - and if the money is turned off, patients will go untreated, and waiting lists will get longer. International comparisons suggest Ireland spends an awful lot of money on health for outcomes that are middling at best, but transition to a better designed and more efficient service will take time and effort, patience and political will.

The third is that this is another political problem for the Fine Gael-led Government. One of its great problems right now is the erosion of its claim to fiscal responsibility and economic competence. Today’s revelations will only further damage it on that front.

The Government's fiscal woes are discussed on this week's politics podcast and on the business podcast with the chairman of the Fiscal Council, Prof Seamus Coffey. You'll find them here.

Brexit and Boris show rumbles on

You might think the UK would be paying a bit more attention to the prospect of a conflict with ourselves over Rockall, but, no, they're still consumed with this blasted Brexit business and the, ahem, parade of all the talents that is the Conservative leadership election. Denis Staunton has a page one story as the Conservatives go to vote today in the first round of the contest.

Yesterday it was the turn of front runner Boris Johnson to launch his campaign, which he did with typical brio. Also rather typically, he avoided all but a handful of questions from journalists present, and even some of those questions he dodged shamelessly. Boris is trying to win the election without ever campaigning in public, which is a novel approach, though one that so far seems to be working. This doesn’t say much for the other candidates.

The Daily Telegraph is continuing to campaign fiercely for him; while most other media outlets are doing the opposite. Here's a scathing assessment from the New Statesman. Denis Staunton's analysis of yesterday's launch is here.

In the House of Commons, meanwhile, a Labour attempt to seize control of parliamentary business as a means of preventing a no-deal Brexit failed. The motion lost narrowly - but it won't be the last attempt.

As it stands, Britain is poised to select a prime minister pledging a no-deal Brexit if necessary with a parliament determined to prevent it - the recipe for a full-blown constitutional crisis.

Abortion issue returns to Dáil

Abortion was back on the floor of the Dáil yesterday, when Aontu leader Peadar Tóibín sought answers from the Taoiseach about the circumstances of an abortion carried out at Holles Street hospital on - it appears - the mistaken premise the foetus had a fatal condition. Subsequent tests showed no fatal condition, making the abortion a mistake and, perhaps, illegal.

Allegations are flying about; inquiries are promised. Marie O'Halloran's Dáil report is here.

Best reads

Stephen Collins on the warning signs for Fine Gael about how Fianna Fáil might beat it in putting together a coalition after the next election.

The future of the four separate local authorities in Dublin, as well as having a single, executive, US-style mayor for the capital, will be up for discussion at the proposed Citizens Assembly, Fiach Kelly reports.

Patrick Smyth on the legal realities of the dispute over Rockall.

Always essential reading: Newton Emerson on the Tory leadership contest and the DUP.

Ronan McGreevy tells the story of when Charles De Gaulle left France suddenly - and reappeared in Sneem, Co Kerry.

Miriam Lord has an insight into those talks between the Irish and Scottish governments about Rockall: "Both sides will slap each other over the heads with dead fish until they bond over Brexit."

Playbook

The king and queen of the Netherlands are here, and the king will drop in on Taoiseach Leo Varadkar at Government Buildings in the afternoon. They dropped into President Higgins yesterday. This follows the recent visit from the king and queen of Sweden. Michael D is becoming quite the chum of European royalty.

Over in Leinster House, there's defence questions, Leaders' Questions, the weekly votes and a busy day at the committees. Full details, including the Seanad programme, are here.

EU finance ministers are meeting in Luxembourg where the next EU budget is on the agenda. In Brussels, meanwhile, the jockeying over filling the EU’s big jobs for the next five years is intensifying ahead of next week’s summit. As noted above, at Westminster, Tory MPs vote in the first round of the leadership contest.

Today is the 13th anniversary of the death of Charles Haughey – taoiseach, bon viveur, statesman, kept man, liar, cad and political colossus who dominated Irish politics for nearly two decades.

It’s also the feast day of St Anthony, patron saint of lost things. Fianna Fáil might search for all those votes that the party has lost since the days when CJH was in his pomp. Fine Gael might search for the fiscal credibility it has misplaced in recent months. For the rest of you, do have a very jolly, utterly fruity day.