It was a subdued James Reilly who chaired the traditional post-budget press conference on health yesterday, so subdued that at times it was hard to make out what the Minister for Health was saying.
Maybe it was the long hours of haggling with Minister for Public Expenditure Brendan Howlin and his officials over yet another health overrun and more cutbacks that had the Minister in less than ebullient form.
It was clear from the body language that Hawkins House won’t be rushing to invite civil service counterparts in Public Expenditure to their Christmas party, and the feeling is probably mutual over in Mr Howlin’s HQ on Merrion Street.
Distaste
The distaste of health officials for the €113 million figure they are supposed to save through a "probity" drive on medical cards, pushed by Public Expenditure as a way of slashing costs, was almost palpable. That their work will be pored over by a committee including officials from Public Expenditure and the Department of the Taoiseach may not have helped, though Dr Reilly's officials emphasised that this committee is being convened at his request.
Or course it could be that the Minister’s mien was influenced by the prospect of what he himself predicted will be “the most challenging year yet” next year.
HSE boss Tony O’Brien didn’t lighten the mood by saying 2014 will be the hardest in the history of his organisation.
While the gloom may be starting to lift in other areas of Irish life, the health service will be expected to cut costs by another €666 million next year. This is on top of €2-3 billion taken out of the system in recent years, and at a point when many of the easier cuts have been made and staff unrest is increasing.
Daunting
It's a daunting task, not made easier by the recent memory of the HSE's failure to achieve budget targets in each of the last six years. Dr Reilly said this year's overrun would be in the range of €150-200 million, but that could change by the year end.
Most of the main health items in the Budget were leaked beforehand, not least free GP care for under-fives, which was first reported in this newspaper back in early August. Dr Reilly did clarify that free GP care “at the point of use” means “free – full stop” with no hidden charges.
The Coalition missed an opportunity to socially engineer some changes that would benefit the health of the population – no tax on sugary drinks and just 10 cent on cigarettes.