Paschal Donohoe links Government funding to HSE reforms

Minister suggests top HSE chiefs will have to have more personal accountability for spending

Minister for Finance Paschal Donohoe: he said he was committed to tax reform. Photograph: Julien Warnard/EPA

Senior health service managers will have to be more personally accountable for how money is spent if the Government is to agree to increasing investment, Minister for Finance Paschal Donohoe has said.

Speaking at the National Economic Dialogue at Dublin Castle, Mr Donohoe said there had been a “massive amount” of political debate regarding what was the most appropriate governance model for the health service.

He said there was an opportunity for change at the top of the health service – following the departure of former HSE director general Tony O'Brien – as well as through the creation of a stronger board structure.

“I am clear that if we are going to be putting in place a framework like Sláintecare it has to be accompanied by a higher level of personal accountability in relation to health expenditure.”


Sláintecare is a plan published by an all-party Oireachtas committee which advocates for a universal single-tier health and social care system for the State.

Mr Donohoe said he had already put in place increased levels of investment for the health service in order to deliver better outcomes for patients.

“What we have seen accompanying that over the last two years in particular is the HSE in the course of the year moving ahead of that budget.

“What I am indicating now is as we work on how we deal with the health service now and into the future coming years, that as we put new people in place to run the HSE and a strengthened board, a key element of the conditions they have will be how they manage their budget.”

The HSE has recorded a deficit of €101.5 million in the first two months of the year, and the overrun by the end of June could be between €200 million and €300 million.

Biggest challenge

On Wednesday, Taoiseach Leo Varadkar also criticised the health service in his address to the National Economic Dialogue, and said it was not working well. He said healthcare reform was the biggest challenge in the public service.

Mr Varadkar suggested the €15 billion health budget – one of the highest levels of expenditure per head anywhere in the world – was “hard to justify” given Ireland’s relatively youthful population.

The National Economic Dialogue provides a forum for various groups such as trade unions, employer representatives, farming interests, environmentalists, social justice campaigners and others to set out their view on how available resources should be utilised in the budget for 2019.

Mr Donohoe also said he was committed to tax reform and getting to a place where “if you’re earning an average wage in our country you’re not on the higher rate of income tax”.

The Minister also said the budget deficit next year would be no larger than 0.1 per cent, and that all resources available would not be spent.

“The artist formally known as fiscal space will not be making a return. What we have to do now is look at what is the right stance for our economy.”

Martin Wall

Martin Wall

Martin Wall is the former Washington Correspondent of The Irish Times. He was previously industry correspondent