Editorial shoring up health spending

ONE of the features of last week’s Budget 2016 announcement that took even the Irish Fiscal Advisory Council by surprise was the adoption of hefty supplementary budgets for a number of departments this year that are rolling over into allocations for the coming one. The higher-than-flagged levels of government spending remain a concern for the IFAC, which seems not to have been kept fully informed about budgetary intentions and this should also be a matter of wider concern given that the advisory body is meant to function as a watchdog to try to ensure that the mistakes that brought the country from boom to bust are not repeated.

For several years, not inconsiderable supplementary funding has had to be found to shore up the money-devouring health service just to stop it from going any further backwards, what with its current shambolic state of long waiting lists of patients to be seen by specialists, and then for the necessary treatment, not to mention the plight of hundreds forced to wait on hospital trolleys in accident and emergency units countrywide because there are not enough hospital beds for them. We have been promised so many times over the years that this would be addressed, but the problems remain unsolved as we head for another winter of possible discontent.

It is encouraging to note HSE boss Tony O’Brien taking a hands-on approach to the problems at A&E units by personally leading the Emergency Department Taskforce in a bid to avoid a repeat of the catastrophe that they had earlier this year when the number of patients on trolleys topped the 600 mark for the first time ever last January. This was a big blow to a government whose initial health minister, Dr James Reilly, on taking office in 2011, promised that numbers on trolleys would never again exceed the record at that time of 569.

His successor as minister, Dr Leo Varadkar, has inherited this problem and, even though he is more pragmatic in admitting to the problems his department faces, the rate of progress in solving them during the 15 months he has been in office so far has been painfully slow, which is of little consolation to those waiting to access our public health service where the care is second to none, but the obstacles to availing of it in a timely fashion remain in place.

The public health service continues to lurch from one financial crisis to the next as successive ministers have failed to come up with a long-term sustainable model to make it work more efficiently and within budget. Under new EU fiscal rules, from next year onwards, the option of shoring up health spending with a supplementary budget will cease to exist, so if there is an over-run, the amount needed will have to be taken out of some other area of expenditure. 

Given governments’ historic inability to provide enough to adequately cover annual health spending, there is a very real danger that the service could run short of money before the end of next year with all the extra demands such as the extension of free GP services to children up to their 12th birthday, the higher payroll costs of necessary new recruitment and agreed public service pay restoration and that’s before even thinking about the extra costs of looking after our increasing older population. This is not helped by confusion over exactly how much extra is being allocated to the health service for next year, as Minister for Public Expenditure and Reform Brendan Howlin’s claim that resourcing has been restored to ‘its pre-crisis level’ has been disputed by some commentators, which is not surprising given how convoluted the budgeting structure is.

Even if health spending is being restored to ‘pre-crisis level,’ as claimed, it was not enough then, so how can it be so now? At a post-Budget interview, the most optimistic spin that Minister Varadkar was able to put on it was that the money provided would allow the existing levels of service ‘with some improvements or enhancements.’  

This hardly inspires confidence that the health service is going to improve significantly any time soon; it may even get worse in the coming year. While nobody expects the problems to be fixed overnight, there needs to be a realistically-costed and targeted plan that can be effected over a number of years.

The public wants more money to be spent on making the health service fit for purpose and, as it looks like this is not going to be done by the current administration, it must be a priority of the next government – whoever that will comprise – to find that money and spend it wisely.