The Department of Health has advised the Cabinet that day-today spending on health needs to rise from £5 billion this year to £7 billion annually. Senior officials have also estimated that the health service requires a further £6 billion in capital investment, on top of the £2 billion already allocated in the National Development Plan.
The Department's secretary general, Mr Michael Kelly, has told ministers "under-investment has been endemic" in our health system and "despite recent increases, serious capacity deficits remain".
Mr Kelly was one of seven civil servants from the Department who were asked to give a detailed assessment of the state of the health service to a special Cabinet meeting in the Ballymascanlon Hotel in Co Louth last week. The Irish Times has seen details of their presentation to Ministers. It is understood that after making the presentation, the civil servants waited in the hotel expecting to be recalled later to answer ministers' questions, but this did not happen.
The Cabinet was told by Mr Kelly's team that although Ireland's health status was continuing to improve, "we lag behind the EU and the gap is widening".
The Department officials explained that while day-to-day spending on health went up from £2.4 billion in 1996, to more than £5 billion in 2001, 65 per cent of the increase went on pay. Employment in the health service rose from under 70,000 to 80,000 in that period.
Of the £914 million remaining for development of the health service, over 50 per cent went to community services. Primary care received 20 per cent, and the acute hospitals - where the health crisis is most widely perceived - received only 26 per cent, amounting to £240 million.
Dealing with why investment was needed in the health service, Mr Kelly cited:
"underinvestment in previous years";
"serious deficiencies" in health facilities;
"very serious shortfalls in capital investment" identified in the value-for-money audit conducted by consultants for the Department;
the expectations of users;
"an estimated £1.2 billion shortfall to renew and replace equipment".
In addition, construction inflation meant that the money allocated to health investment under the National Development Plan would fall short by £1 billion. Mr Kelly cited "evidence of serious deficiencies" regarding waiting lists.
"Lengthy waiting times remain nationally: 43 per cent of adults [on waiting lists] are waiting more than 12 months; 74 per cent of children are waiting more than six months."
To eliminate waiting lists and cope with the expected population increase and ageing, an additional 4,800 beds would be needed over the next 10 years in acute hospitals and a further 4,700 beds in units for the elderly, officials said.
They said primary care supplied by general practitioners, public health nurses and other paramedics also needed investment.
Recent increases in health spending followed years of under-investment, Ministers were told. In 1998, the latest year for which comparisons were available, Irish health spending per capita and as a percentage of GDP, fell well below the EU and OECD averages.
Figures presented to the meeting show that Irish people die younger than people in the EU as a whole - and that the situation is worsening. In 1970, men in Ireland could expect to live a few months longer than EU average life expectancy. But by 1997, although life expectancy had increased in Ireland, it had increased by a longer period in the EU as a whole, and Irish men were now dying over a year earlier than men in the EU generally. Irish women, who were already dying over a year earlier than the EU average age in 1970, were by 1997 dying over two years earlier.