Minister for Health James Reilly is facing warnings from the Labour wing of Government to ensure health managers realise major cost savings next year.
Although Dr Reilly has been under political pressure since before budget day to make certain that big savings are achieved, health managers continue to question the validity of the assumptions set out on October 15th.
This has served to prolong tension over the 2014 fiscal plan between Dr Reilly and Minister for Public Expenditure Brendan Howlin, whose officials are overseeing health expenditure.
Labour is backing Dr Reilly but there is frustration in the junior Coalition party that the wrangling over the health budget continues, a fortnight after the plan was unveiled.
This follows a long and difficult budget negotiation in which Dr Reilly's estimate was not settled until the very last minute, and only then at a special meeting with Taoiseach Enda Kenny and Tánaiste Eamon Gilmore.
“We will provide whatever political support is required for Dr Reilly to get on with the business, but he does have to get on with it,” said a senior Labour source.
No reworking
Although health chiefs are warning that cuts might have to rise next year to €1 billion from the €666 million set out on budget day, the senior Labour source said there was no scope to rework the fiscal plan.
“The department and the Minister should simply get on with implementing budgetary decisions.”
The attitude on the Fine Gael side is that Dr Reilly is doing a challenging job and that reform is urgently required in the health service.
The health managers’ concerns centre on targeted pay-related savings from the Haddington Road agreement and projected savings from a “probity” review of the medical card scheme.
Doubt as to whether the required savings can be made have, in turn, led to questions over funding for a planned maternity services upgrade in the wake of the Savita Halappanavar case and the execution of a new deal on doctors' working time rules.
Such concerns have come to the fore as work continues on a statutory health service plan for 2014, which much be produced about three weeks after the budget.
They are made all the worse by the fact that a supplementary health estimate is likely to be needed this year to make up for an ongoing deficit.
Although serious questions have been raised as to whether promised but unfunded new services can be delivered next year without making a new round of unbudgeted health cutbacks elsewhere, the Government continues to insist on the validity of the budget as cast.
“The service plan will be delivered as is required. It is designed to put patients at the centre of the health service,” the Government spokesman said.
