Accounting for health spending


Sir, – You report (News, July 28th) that the ESRI believes that additional expenditure of up to €12 billion may be needed to fund primary, community and long-term health services over the next 14 years. I suspect one could add the usual zero to that.

Leo Varadkar wants the additional €4 billion committed to health expenditure in last October’s budget to be made permanent (“Varadkar to call for huge boost in health spend”, News, June 19th). Pat Leahy pointed out that this would represent a step-change for spending on a health service which is already one of the most expensive in the world (Analysis, June 22nd).

Why would we give yet more billions of euro to a health bureaucracy which consistently produces mediocre results with a world-class budget? If yet more money could solve the well-flagged problems in our health service, we wouldn’t have a problem. We have tried that approach year after year.

We don’t have far to look to identify a key obstacle. Martin Wall reported that the HSE is to introduce significant rationalisation of its central corporate structures (News, June 15th). This follows a review commissioned in late 2019 by Paul Reid, the HSE’s chief executive. Paul Reid is reported as saying that the HSE’s governance structures “had become quite complex with some areas of overlap within and across various corporate functions”.

The HSE’s Health Service Employment Report shows the growth in employment numbers over the period between October 2013 and January 2021. The increase in headcount in the most senior “executive management” roles was from 172 to 364, an increase of 112 per cent.The corresponding increases were 82 per cent in senior management, 62 per cent in middle management and 17 per cent in clerical.

The leaders of any large organisation, assuming that they feel a sense of responsibility for spending money wisely, might reasonably be expected to review its central corporate structures before doubling up on senior management roles. But the HSE is a law unto itself. It puts the boots on the ground and then carries out a review which finds that there are areas of overlap within and across corporate functions. I think most of us in this other world would not have needed 18 months to reach that conclusion.

But, despite the planned rationalisation and the elimination of overlap within and across functions, the HSE is able to tell those who are overlapping and the rest of us who pay for it that no voluntary redundancy scheme to reduce staffing levels is seen as required at this point.

Many years ago I was studying business at the onset of the computer age. One of the textbooks gave warning that computers would not be a panacea for the problems of business – “if you computerise a bad system you just speed up the mess”. For computers and business read money and the HSE. Throw more money at the HSE and we will still have a mediocre health system. It will just cost more. – Yours, etc,



Dublin 6.