The Irish Times view on Government spending on health: a better return is needed for the public

An explanation for why the additional money spent to date has not had a greater impact on services is needed

The budget for the State’s 25 acute hospitals rose from €4.4 billion to €6.37 billion between 2016 and 2022, after adjusting for inflation. Staffing at the hospitals – which offer a full range of services including accident and emergency – rose from 53,819 to 69,262 over the same period. However, bed occupancy rates fell from 94.6 per cent to 92.3 per cent against a background of rising waiting lists.

Even when adjustments are made for variables such as the complexity of treatments carried out and rising costs, a new report estimates that there was an increase in productivity of 3.8 per cent in return for a 45 per cent increase in expenditure and a 29 per cent increase in staff numbers.

The figures – published yesterday by the Department of Health – are something of an open goal for those who like to portray the health service as some sort of fiscal black hole where the only winners are insiders. Countering this misperception is made harder by the fact that the Government – by its own admission – has no simple explanation for how so much taxpayer money can be spent for apparently so little gain.

Instead, the report proffers a mix of factors and caveats which together may or may not have led to this outcome, plus a promise to get to the bottom of the issue. These include the reality that a lot of necessary expenditure in areas such as infection control, safe staffing levels and training that contribute to better care do not automatically result in the capacity to treat more patients. They also note that one in three of the staff hired during the period were in administrative roles. Longer hospital stays, meanwhile, may be due in part to Covid and an ageing population.


However, the inescapable and concerning reality is that the Department does not really know why the return on its investment has been so low. A productivity taskforce established in January may shed some light. In the meantime, the money will continue to flow, as it must. Savings of €424 million have been targeted but a better explanation for why the money spent to date has had such little impact is needed.