Ken O'Flynn (Cork North-Central, Independent Ireland Party)
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883. To ask the Minister for Health the main cost drivers behind the need for a supplementary estimate for the health budget in 2025, by acute hospitals, primary care, agency staffing, and temporary schemes; the specific management or efficiency measures introduced to control these costs; and the means by which the Department will ensure that further overspends in 2026 do not lead to new charges or indirect increases in costs for patients and health insurance customers. [65737/25]

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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The 2025 Supplementary Estimate is mainly driven by:

Acute hospitals – driven by overspends on pay costs, particularly the higher usage of agency and overtime, combined with the impact of reductions in private income arising from Public Only Consultant Contract; also includes additional funding to cover higher costs and accounting deficits in voluntary hospitals.

Primary Care Reimbursement Service (PCRS) – driven by overspends on non-payroll costs (drugs and medicines), particularly due to higher numbers of medical cards, reimbursements under the drug payments scheme costs, and HSE direct expenditure on high-tech drugs.

The forecasted deficit for Primary Care of €15m is primarily driven by non-pay pressures, arising from an increase in demand plus inflationary price increases (the non-pay inflation rate in Primary Care is estimated at 4.6%, based on year-on-year growth from 2024 to 2025).

Agency spend in 2025 is forecast to be approximately €800 million, up 9% on 2024. Approximately 3.3% of this increase is due to wage inflation under public sector pay agreements, with the remainder related to combination of increases in volume (more hours worked) and mix (higher proportion of agency worked by higher paid agency staff, such as doctors, IT specialists and lower proportion on clerical staff).

By staff category, most of the agency cost of €609.4 million incurred to date to September 2025 is for Support staff €197.8 million (33%) and Nurses €151.9 million (25%).

By Service Area, agency is used most frequently in Acute Services €314.9 million (52%), Older Persons €104.3 million (17%) and Mental Health €92.6 million (15%).

The overspends in agency costs were offset by lower expenditure on National/Corporate primarily driven by under-recruitment as budget for new posts has historically been held centrally until the posts are in place, as well as lower expenditure on the State Claims Agency arising from a lower volume of high-cost claims.

There are no temporary schemes in 2025.

The Productivity and Savings Taskforce was set up to drive savings and productivity efficiency measures across the HSE. It is chaired by the Secretary General and CEO of the HSE. The Taskforce is a key reform initiative for the Health service, which focuses on implementation of existing and new additional reforms with a particular emphasis on value for money and better services within our existing resources. There are no plans for new charges or indirect increases for patients in 2026.