The health service is heading once again for choppy waters, despite record funding in Budget 2024.
A partial recruitment freeze and an empty drugs budget were just two of the pieces of bad news delivered by Minister for Health Stephen Donnelly at a briefing on Wednesday, but they are unlikely to be the last.
The numbers don’t add up. Mr Donnelly himself highlights the multiple factors driving up spending in health, notably health inflation running at up to 20 per cent and a substantial increase in demand for services, particularly among older patients.
Yet the amount allocated to deal with these pressures seems inadequate. Further, much of it is being provided in the form of noncore, or once-off, funding, when the requirement for extra money is a recurring one. That amounts to storing up problems for the future.
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Half of the €2 billion increase for next year is noncore funding. And of the €808 million in core funding, just €100 million is for new measures.
Most of the €1 billion-plus deficit forecast for the end of this year relates to recurrent costs, which need to be covered again next year – and that is before the impacts of inflation and further increases in demand are taken into account.
HSE chief executive Bernard Gloster has already acknowledged that up to €2.5 billion extra will be required to maintain an existing level of service next year – about three-times the amount provided in Budget 2024.
Barring a new approach, it is hard to argue with the forecast of Sinn Féin’s health spokesman David Cullinane: “The deficit will get even bigger next year. We have a black hole in health financing and it will be even greater in 12 months’ time.”
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Behind the blizzard of figures are patient stories. The first to feel the impact of the health funding squeeze will be patients waiting for new medicines to be approved, because there is no budget for newly approved drugs next year.
“The budget decision appears to mean that the availability of these new medicines depends on other new savings being realised in-year by the HSE over and above the savings being delivered by our members,” said the Irish Pharmaceutical Healthcare Association.
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“This is not a good basis to plan for new treatments. It will lead to delays, uncertainty and backlogs, as before. In short, it risks avoidable deterioration in the conditions of many patients, adults and children included.”
In 2024, we are told, 162 new hospital beds are being provided, when the Government’s own reports say 1,000 new beds a year are needed. There was no talk from the Minister on Wednesday about his earlier plans of rapid-building 1,500 beds across the country.
Mr Donnelly has promised a new focus on “productivity”, or making savings. The usual suspects are being lined up – agency workers, overtime, the drugs budget.
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Too little, too late, some might say. The agency budget this year is €300 million, but spending is expected to hit €1 billion.
The last time Government tried to make savings on the drugs bill, four budgets ago, the result was a backlog of applications and angry demonstrations by frustrated patients.
While there is always a case for saving money, a stop-start approach to funding is in no one’s interest.
Asked why savings were only now under consideration, the Minister replied: “We were not thinking about productivity while we were in the throes of a pandemic, but now that Covid has receded we are most definitely thinking about productivity.”