Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

I welcome the opportunity to contribute to this debate and to highlight the Social Democrats concerns about the Government's funding of key public services. While I will refer to some of the amounts provided for in the Bill, I begin my contribution by raising the most pressing spending issue of the day, which is what would appear to be the deliberate decision by the Minister for public expenditure to underfund the health service. A €2 billion shortfall in the health budget is indefensible. It seems the Government is in complete denial about the impact of this decision.

The Minister, Deputy Donohoe, seems to believe he is punishing the Department of Health and the HSE but, in effect, it is patients who are being punished. Since budget day, I and others have been raising significant concerns about the hole in the health budget but the Government has buried its head in the sand. In fact, it is not just about what is likely to happen next year. We knew from the start of this year there was a €2 billion hole in this year's budget allocation. A senior member of the HSE board resigned over that matter. We know there was a significant amount of argument between the Department of the Minister, Deputy Donohoe, and the Department of Health, but they and the Government still proceeded with it. The Government knew starting 2023 that there was a significant deficit, and it looks like it will do the same for 2024. With this reckless decision, it has stymied future spending and recruitment in key clinical programmes such as cancer and stroke care. It has also forced the HSE to lose significant momentum in improving health services under Sláintecare, with a swingeing and wide-ranging recruitment freeze.

Even the State's fiscal watchdog, the Irish Fiscal Advisory Council, has issued a scathing assessment of this year's budget on several fronts and specifically called out the underfunding of the health service. In its fiscal assessment report, IFAC directly challenges the argument that the growing demand on the health service is a surprise to anyone. The report states, "The increase in demand over the last four years has been predictable based on demographics." It is predictable and should come as no surprise to anybody. If the Department of public expenditure had done the future planning work and looked at the census figures and a lot of other data that is available, it would have understood the demographic changes were entirely predictable. Likewise, IFAC states the increase in demand expected through the next four years is also predictable. In a briefing video on the report, Professor Michael McMahon, the acting chair of IFAC, was even more forthright in his analysis, stating that overruns in health obvious before budget day were not catered for sufficiently in the budget.

Many of us on this side of the House have been raising these points with the Minister, Deputy Donohoe, since budget day, but he has dismissed our arguments completely. I do not think he can do so in respect of IFAC, the Government's own watchdog. The projections put forward by IFAC show that, based on existing service levels over the period between 2025 and 2030, demographic costs will add approximately €1 billion per annum to health spending. When wages and inflation are included, the annual standstill costs average at €1.6 billion. That is before one looks at new services, innovation or drugs or any of the reform programme that is currently under way. There can be no denying that the Government is knowingly underfunding the health service this year and next year. It is not just the Opposition calling the Minister out on this; it is the Government's own watchdog.

Furthermore, we now know that dire warnings from the CEO of the HSE were given scant attention by the Department of public expenditure. In fact, the Department denied even receiving the letter from Mr. Gloster. The letter was forwarded by the Secretary General of the Department of Health to the Department of public expenditure. It outlined "significant and punitive risks to the public" if the health allocation was not increased. It later emerged the letter had been received by the Department of public expenditure even though its receipt had been denied. This matter is indicative of the dysfunctionality of the relationship between the Departments of health and public expenditure, as well as the dysfunctionality in terms of the basis on which funding is allocated. It is so serious that the Oireachtas health and finance committees will have a joint session early in the new year. The Department of public expenditure has been invited to appear at the meeting. The committees will go through chapter and verse of how this important letter with those dire warnings from Bernard Gloster was not acted upon within the Department. It is not good enough to brush things aside and say there is always a deficit in health. There were clear warnings. In the past three, four or five months, including in the lead-up to the budget, the Minister for Health and his officials were clear in respect of the need to maintain that momentum for reform, but also to ensure we took account of the growing and ageing population.

Of course, on several occasions recently the supplementary allocation to the Department of Health - there tends to be a supplementary allocation every year - has gone into the base for the following year. At some point, one must call a halt to this pretence, where an inadequate budget is provided at the start of the year and then, inevitably, there has to be a supplementary allocation at the end of the year. We have to recognise the actual cost of meeting the health needs of the population, particularly in the context of a reform programme that is aiming to bring about a fully functioning public health service, given that we are so out of line with the rest of Europe. Doing so is the political imperative, yet there has not been the required follow-through on it from the Department of public expenditure or, it seems, the Minister. When I raised this with the Taoiseach last week, he said it happens sometimes, but the Government was not going to agree to put the supplementary allocation into the base for 2024. That would be one way of doing it. It is clear that serious errors were made in the build-up to the budget. Given all the commentary since then, including from IFAC, as well as the fact that services are now seriously compromised due to the recruitment freeze, which has also given rise to industrial action, we should be taking that step and availing of that mechanism to push the additional allocation into the base. Again, it is not only me saying that; IFAC has stated that there needs to be a recognition of the increased demand for funding and that the additional funding from this year should be going into the base for next year. At what point will people get real about the need to fund the health service adequately and stop this charade of underfunding every year and then requiring a supplementary allocation at the end of the year?

I have concentrated my time on this area because it is critical. Another point is there was tremendous momentum achieved in the implementation of Sláintecare in the past two years . There is now a major question mark over that, however. At the end of the day, the Government must accept that reform costs money. Unless it is prepared to fund that up front, we will never see the kind of reform to which the Irish people are entitled.

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