David Cullinane (Waterford, Sinn Fein) | Oireachtas source

I move:

That Dáil Éireann: notes that: — it is widely accepted that the Government has chosen to underfund the Health Service in Budget 2024;

— comments made by the Minister for Health, Stephen Donnelly TD, recorded in the Irish Times on Thursday, 12th October, 2023, stating "it is entirely likely that a supplementary budget will be required next year";

— comments made by the Chief Executive Officer of the Health Service Executive (HSE) to the Oireachtas Joint Committee on Health on 27th September, 2023, stating that there will likely be a Health Service income and expenditure deficit of "somewhere in the region of about €1.4 billion or €1.5 billion" in 2023; and

— comments made by the Secretary General of the Department of Health to the Oireachtas Joint Committee on Health on 27th September, 2023, stating that "there has definitely been underfunding of Existing Levels of Service (ELS), absolutely. That is a problem"; further notes that: — the Government have allocated only €708 million for ELS funding in 2024 for the Health Service, which is less than half of the shortfall identified for 2023 before even covering other cost pressures in 2024, such as carryover, demographics, and pay;

— the Government has not allocated additional capital funding to the HSE to deliver the promised and needed 1,500 acute inpatient hospital beds, which are not included in the National Development Plan funding; and

— the new children's hospital will require a significant additional allocation of funding due to the Government's mismanagement of the project, which will add further cost pressures on the HSE's budget; condemns the Taoiseach, the Tánaiste, the Leader of the Green Party, and the Government as a whole for: — their reckless decision to underfund the Health Service in Budget 2024;

— embedding an overreliance on outsourcing, agency staffing, management consultancy, and overtime, which has increased costs, hollowed out the Health Service, and burned out the workforce;

— their failure to reform the healthcare system and deliver a single integrated financial management system in the HSE, to invest in digital transformation and to put in place more effective management of waiting lists;

— ignoring warnings from the HSE and the Department of Health that the budget for 2023 and 2024 does not cover the true cost of running the HSE; and

— ignoring warnings from healthcare trade unions and patient advocacy organisations of the potentially catastrophic consequences of dramatically underfunding the HSE for workers and patients; considers that the Government's budgetary decisions for 2024: — will have a severe impact on frontline services, clinical programmes, national strategies, access to new medicines, tackling waiting lists, and dealing with manifold crises across Emergency Departments, Child and Adolescent Mental Health Services, and Children's Disability Services;

— have already led to cuts in frontline services with 7,000 unfunded approved posts in the HSE being cut, and a recruitment freeze being put in place on vital frontline Health Service roles, such as non-training scheme doctors, healthcare assistants, and home help workers;

— will have serious consequences for the HSE's ability to meet the already weak targets set out in the Minister for Health's Waiting List Action Plan, which is behind profile and unlikely to hit targets by year-end for a second year in a row; and

— will result in hospital managers and doctors making tough decisions on what services to provide, what services to cut, and which patients will not receive the care they need; and calls on the Government to: — immediately increase the funding allocation for the Department of Health for 2024 to:

— adequately cover existing levels of service and cost pressures such as inflation, demographic changes, demand increases, and pay increases; and

— provide for new developments funding to advance vital projects across hospital bed capacity, community care reform, and taking further steps towards universal healthcare and reducing the cost of healthcare such as raising the medical card threshold and reducing the Drugs Payment Scheme threshold;

— urgently bring forward a supplementary budget for 2023 to reverse the recruitment freeze on essential frontline posts as the HSE faces into an extremely tough winter without adequate resources to deliver the quality and quantity of care to avoid thousands of patients languishing on trolleys and exposed to unnecessary risk of delayed care and hospital-acquired infections; and

— put in place a time-bound plan for ending the HSE's reliance on expensive outsourcing, agency staffing, management consultancy, and private healthcare.

It is hard to take seriously the Minister’s amendment to the motion I have just proposed. It is blatantly wrong to claim in the second line of the amendment that "the health additional allocation for Budget 2024 is nearly €2 billion". That is not correct. There was some €808 million of additional core expenditure. There was then one-off funding of €1.032 billion which the Minister knows includes Covid-19 expenditure, Ukraine money, waiting list initiatives and so on. Almost all of that was there last year as non-recurring expenditure, with €750 million for Covid-19 alone. When the Minister says there is an additional €2 billion of spending on health in this budget, it is more spin coming from a Government which has deliberately underfunded the health service for next year.

The head of the HSE, Bernard Gloster, and the head of the Department of Health, Robert Watt, appeared before the Joint Committee on Health today. They confirmed that they sought €2 billion of additional core current expenditure, at a minimum, and they received €707 million. They both accepted that the shortfall is in the region of €1.3 billion. The CEO of the HSE reiterated clearly and publicly today that the health service is not properly funded for next year and that he was given inadequate funding. He went on, astoundingly, to repeat what he had said previously, which is that he has been asked to write up a national service plan within which he has to build in a deficit of potentially up to €1.3 billion. Essentially, we will have a national service plan which is a work of fiction. All of that is because of a very deliberate decision that the Minister and his colleagues have made, essentially not to fund the health service properly.

The Minister in his countermotion fails to address any of the consequences of the decision he and his colleagues have taken. The Minister was very quick over the course of this year to talk of 1,500 new beds coming on stream. These are rapid-build beds and we are hearing that hundreds of those will be coming on stream in 2024. Let us see what happens but I would be astounded if any of those beds are delivered in 2024, and still no funding has been allocated for them.

We also know that for the first time in many years the head of the HSE was forced to put in place a recruitment embargo in many areas of the health service, including the front line. That was not even done during the darkest days of the troika. This recruitment freeze includes non-training junior doctors, some home helps and healthcare assistants, clerical staff and so on.

I have spoken to many hospital managers over the course of the past couple of days. Already the consequences of this decision are being laid bare. In my own constituency and that of the Minister of State, Deputy Butler, I spoke to the manager of University Hospital Waterford. The Minister and I, and the Minister of State, Deputy Butler, have praised the work done by the hospital to ensure there are no patients on trolleys. One of the reasons there are no patients on trolleys in that hospital is because a medical ward was opened: medical ward 6, which has 35 beds. The Minister might be surprised to learn that most of the staff who are there to keep that ward open are agency staff in are what are called "unfunded posts" which they were hoping to have funded as part, perhaps, of those 7,000 posts which have now been scrapped. This manager now tells me that he has to make a tough decision on whether to close that ward, with the consequence of having patients on trolleys again, or to take staff from elsewhere, including cardiac care services and other services. We are seeing across many hospitals that managers are being asked to make very tough decisions.

The reality is that one cannot have a recruitment freeze and say that it does not bite. One cannot shelve plans to build beds and say that it does not bite. We had 130 patients on hospital trolleys in Limerick yesterday, which shows the madness of the Government's position. It is clear from what we have heard again today from the heads of the HSE and the Department that the health service is not adequately funded. The question the Minister has to answer is whether the HSE will cut more to deal with that deficit or if the Government write the cheque in any event at the end of next year.

If the latter is the case, he has made an absolute farce of himself, the budgetary process, the Department of Health and the HSE. I ask the Minister to answer the question he has not yet answered. Where are those 1,500 beds and when will they be funded? I will make one final point. The Minister has still not answered questions that have been put to him by advocate organisations. He put in place a national stroke strategy. How much additional funding, or any funding, has it got for next year? Zero. It has got zero funding because of the decision he and his colleagues made not to properly fund the health service. If he does not think that will have consequences, he should not be in the job he is in.

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