Peter Fitzpatrick (Louth, Independent) | Oireachtas source

The Department of Health is already facing an overspend of around €1.5 billion this year and €1 billion next year, which is an overrun that will require a Supplementary Estimate allocation. However, only €22.5 billion - current and capital - was allocated for the public health system as part of budget 2024. Despite this being an increase of €1.1 billion in current expenditure on last year’s budget, the budget 2024 allocation has been roundly criticised as insufficient to meet rising demands in the health sector. Notwithstanding this, the question of a bailout for the Department of Health will only be considered later in the year. This seems paradoxical considering the official policy of the Government is to expand access to healthcare under the Sláintecare programme.

When Sláintecare was published in 2017, demand projections were based on population projections to 2026 and carried out within the health service capacity review. However, the projected population for 2026 was surpassed last year. We are therefore working from out-of-date projections. As in all other sectors, medical inflation is resulting in price increases for contemporary, effective drugs and devices. Bernard Gloster, who runs the HSE, is in a difficult position. The HSE must either put forward a service plan that has an inbuilt deficit or make a series of cuts that are undoable.

The current recruitment freeze is an inevitable consequence of underfunding. Last Friday, Mr. Gloster extended the recruitment freeze beyond clerical and management grades to include patient and client care roles. Many plans in place to improve services were in the process of recruiting. Mr. Gloster also announced an immediate pause on 7,000 posts, previously approved in principle, which cannot now be funded.

Let us assume the cost of the existing level of health service, which means keeping the health service running with no expansion, is €2 billion for the current year. If it receives less than €1 billion investment, the health service is on track for a deficit that does not account for demographic expansion or medical inflation, let alone any increase in services. The Government is calling this deficit an overspend. Many in the healthcare field are calling it lack of funding. Regardless of opinion, when it comes to healthcare, we need to focus on meeting the needs of our growing and ageing population. According to a former director general of the HSE, Tony O’Brien, “dodgy maths and dark politics are putting Irish patients in danger.” The Government is putting surplus moneys into the creation of two new funds, which are needed. However, health services are demand led and will only increase in the coming year.

If the Government wants to avoid a healthcare disaster, especially considering the common winter crisis, the only way to do that is to properly fund the health service. If it does not invest now, this will have consequences, including a negative impact on patient safety. Services across healthcare, from disability and mental health services to hospital and primary and community care services will be affected. We need to invest in beds, personnel, innovation and medication. Not a single euro was invested in new medications in this budget. We are going to fall behind because of lack of funding.

There is also a growing sense of apprehension about the future of mental health funding. Mental Health Reform estimated that an additional €115 million to mental health funding in budget 2024 was essential to improve access to timely and effective mental health care. What percentage of the health budget will go to mental health?

Supplementary funding needs to be recurring in next year's budget, but also needs to address the problem that not enough funding has been allocated for this year. However, the details of Supplementary Estimates will not be considered until more financial information is available towards the end of the year. Reactive governing, a lack of foresight and funding and an absence of negotiation will affect every service going forward. We need to act now.

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