Health spending: a ritual drama

Sir, – Your lead story on political concerns over the rise in health spending contains an interesting phrase, to the effect that pressure arises because of "larger hospitals seeking more money than had been anticipated" ("Fears of more overspending as health spending accelerates", June 13th). I assume that this is from Government sources, rather than the reporter's own words, because it is a fiction.

Each year, the HSE prepares a budget based on need, and each year the amount is cut back on orders from the Departments of Health and Finance. The amount of shortfall is referred to in annual HSE service plans as the “financial challenge”, although this phrase has been dropped since the departure of Tony O’Brien as director general.

So there’s nothing unanticipated about it, and this year the health service plan includes at least €400 million of “savings” that are unlikely to materialise.

Every year the pantomime replays: by summer, reports of overspending appear, followed by government promises that there will be no extra money. Then in winter, a supplementary budget is voted through, and the charade begins again. Readers interested in the detail of previous health budgets can find it at under the health category.


So either the extra funding will be found again this year, or the Government will face the political consequences of actual service cuts. In fact, it has already started: in the same edition, Miriam Lord reports that the Taoiseach has had two days of Dáil questions about the recent HSE decision to stop allocating new home-help support until November ("The doorsteps have taken to shouting about home-care supports", Dáil Sketch", June 13th).

It’s way past time that the Government moved to a HSE funding system based not on artificial budgets, but on payment for services provided. – Yours, etc,


Dublin 6.