If spending trends experienced in the first four months are not curbed, there will be significant problems later this year, reports Martin Wall
In themselves, it is not the financial overruns recorded by almost all the main hospitals in the first part of the year that most worry senior health service management.
Rather there is concern that the expenditure trends experienced in the first four months could, if not curbed, lead to significant problems later in the year.
Figures produced by management of the Health Service Executive (HSE) for its governing board reveal an almost nationwide picture of hospitals overspending in the first four months of 2006.
In a commentary accompanying the financial report, health service management warned the board that the expenditure levels witnessed in this period would be "unsustainable" if they continued for the rest of the year.
For the first time this year, the monthly health service financial report for April - the most recent released - features three of the main acute Dublin hospitals, Tallaght, St Vincent's and the Mater, on the list of institutions with the most significant financial variances.
In monetary terms, the worst overrun for the first four months of 2006 was recorded at Tallaght hospital, which exceeded its budget by more than €6.5 million, or just over 10 per cent.
The Mater hospital overspent its budget by about €5 million or just over 7 per cent. St Vincent's hospital exceeded its budget by more than €4.7 million, or some 8 per cent.
Spending at Letterkenny General Hospital overran the budget by more than 22 per cent. However, in monetary terms this amounted to €5.8 million, less than the figure for Tallaght. Among the HSE hospital networks, the largest over-spending took place in the northeast; hospitals there overran their budget by €15 million overall, or 22.5 per cent. Hospitals in the west and the northwest overspent their budgets for the first four months by more than €22.5 million, or 12.8 per cent.
The report also reveals that among general hospitals, St Columcille's in Dublin recorded the largest financial overspend, at more than 46 per cent of its budget.
One of the few hospitals to come in on target - actually €35,000 under budget - was the National Maternity Hospital at Holles Street, Dublin. St John's hospital in Limerick also came in virtually on target for the first four months of the year.
It is unclear how hospitals will claw back the financial overspending in the remainder of the year.
In a statement last week, the HSE insisted that no cutbacks were being planned in any part of the State. It said all current services, as well as new developments set out within the official service plan for the year, would go ahead.
In a report to the Department of Health several weeks ago, HSE chief executive Prof Brendan Drumm said early indications suggested that the National Hospitals Office "in its own right cannot deliver sufficient cost-saving measures to achieve a balanced budget".
Prof Drumm said there were significant "legacy issues" in some hospitals which had crystallised when the various sectors or pillars of the HSE were formed, and that some hospitals were left short of core ongoing funding.
"It is vital to re-establish the relevant funding to these hospitals in order to focus on financial control in 2006," he wrote.
The HSE chief said the director of the National Hospitals Office, John O'Brien, had put together a team which was developing a plan to deliver financial break-even for the remainder of the year.
"The management team is examining the implications of the legacy issues and the current expenditure rates in the context of the global resource and the vote management responsibilities of the chief executive officer," he said.