Health funding: internal tensions on view

Our two-tier health system has serious problems but not all are money-related

Serious financial difficulties are likely to affect the health service during the coming year, according to Health Service Executive director general Tony O'Brien. For the past decade, shortfalls in funding have impacted mental and other services, with money going to politically sensitive areas. But the HSE's decision to concentrate criticisms on Government funding reflects its unwillingness to accept blame for the expected consequences. Unlike other administrative areas, the independence of the HSE allows it discretion in that regard.

Having announced an additional €600 million for the health budget in 2018, Minister for Health Simon Harris spoke confidently of providing thousands of additional hospital beds during the coming years. But HSE documents suggest a different story.It had sought an extra €900 million but, to make the figures add up, savings targets were added - and it is now questionable whether they will be reached. That money will have to be found and concerns about the exercise were conveyed to the Minister. It didn't stop there. The HSE took out further insurance by warning it had virtually no capacity to deal with mass casualties caused by chemical accidents, nuclear incidents or terrorist attacks and wanted additional funding. It also needed to upgrade its computer systems.

Competition for funding at budget time can become intense. But it does not usually involve criticisms of a lead department by a related agency. Breaking with that unsatisfactory tradition, the HSE itemised areas of critical need and necessary expenditure. It noted that thousands of women were being left with a poor quality of life because of inadequate gynaecological treatment; people were going blind because ophthalmology theatres had closed; community services were undeveloped because the promised GPs had not been employed and there was a shortage of hospital beds in Drogheda, Galway and Mayo.

Our two-tier health system has serious long-standing problems. But they are not all money-related. Structures and management are in need of urgent reform. The HSE is not blameless.