So, what's going on? Last weekend, the Business Post reported on a leaked tape containing the unvarnished opinions of civil servants in the Department of Health, on January 27th, discussing the Health Service Executive and healthcare budgets generally.
What did it tell us that we didn't know? Well, it outlined how the officials felt that recruitment targets of 10,000 for the year were essentially "fake" and how they feared an accounting error was going to fall due in the HSE, potentially adding up to more than €200 million. It showed they were concerned about "sloppiness" in financial reporting, and claimed a junior Minister sought more money for mental health services than the HSE felt it could spend.
And is that it? Not quite. More documents emerged during the week, which had been submitted to the Public Accounts Committee. They claimed to depict more interactions between civil servants. Some of this stuff was more of the same – suggestions that recruitment targets were "bats**t" – some was new, suggesting budgets for nursing homes supports had been spent on One4All gift vouchers for staff, or that the budget for public nursing homes was about to be blown for a second year in a row.
What has the HSE and department had to say about this? First, not much, but at a fractious meeting of the Oireachtas health committee during the week, some information was confirmed – such as the near-impossibility of meeting healthcare recruitment targets. Some was knocked back, for example, the accounting error looks more like being in the region of €50million -€100 million. This is still a lot of money, but it seems to be more in line with what the department had expected, and the State's spending watchdog believes there is unlikely to have been a "material loss of funds". Minister of State for Mental Health and Older People Mary Butler, the Minister who was cited as pushing for more money to be given to the HSE than it could spend, said it was "misleading".
What's all this about a whistleblower? One man, Shane Corr, is the source for a dossier of documents containing many of the disclosures which has been given to both the public accounts and the health committees. Included in the dossier is a note of the January 27th meeting, and what are generally described as "careful verbatim notes" of other meetings. Corr is the same man whose protected disclosure led to a RTÉ Investigates programme which reported that the Department of Health was keeping dossiers of information on children with autism suing the State.
What does it all mean? Some have dismissed the disclosures as evidence of little more than the daily tensions between the HSE and the Department of Health which are the stock in trade of the pair's relationship. However, that ignores the substantial issues raised, which bear general examination.
Briefly, they include the nature of budgetary planning in the health service, and political influence over targets. Outlining the precise nature of the relationship between the HSE and the department, which covers a budget of €22 billion, is also of course in the public interest. One senior mandarin confided during the week that, “When it comes to the crunch, what you saw on the tape was ‘what tools do we have to hold these guys to account’. And the answer is there aren’t [any tools].”
Then, there’s the specific issues about financial errors, blown budgets and so on.
There’s also fallout to manage internally in the department, where officials are feeling bruised. “People aren’t robots. They have to be able to have conversations, blow off steam,” the same source said.
What happens next? It looks like the Public Accounts Committee (PAC), the most powerful Dáil committee which sits alongside the Comptroller and Auditor General, is likely to take on the task of investigating the issue. The C&AG said on Friday that the HSE will have to explain errors in its financial statements, but simultaneously cast doubt on the possibility of a material loss of funds. The committee has also written to the HSE and the Department of Health to seek a response to the claims reported this week, and to hold a meeting with both bodies. Watch this space.
