For a Government that wanted to provide more transparency to the budgetary process, an awful lot remained hidden about what went on in the run-up to the preparation of key spending plans for the health service for this year.
After the debacle of the 2014 budget – when from day one there was a hole of more than €100 million in the Health Service Executive service plan earmarked for additional pay savings that everyone at senior level knew were highly unlikely to materialise – the new Minster for Health, Leo Varadkar, said he wanted a "realistic budget" for this year.
When the official funding levels were announced last October, the Minister said he had achieved this ambition.
Reverse some of the harm
He said funding for 2015 would still be tight, but maintained the additional €635 million provided was realistic and would “reverse some of the harm of recent times”.
However, the Department of Health refused to release details of what the HSE had sought in the budget negotiations and the services it believed were necessary to put in place. The HSE also declined to release this data.
However, the official HSE submission, which has been obtained by The Irish Times following the intervention of the Office of the Information Commissioner, confirms reports at the time published by this newspaper that the HSE sought €1.4 billion in funding for 2015, more than double the amount provided.
The HSE document, which was sent to the then secretary general of the department in early September, also sets out the services it believed should be developed if funding was allocated. It also reveals the HSE’s internal view of the existing state of some services.
The HSE recognised in the submission there was unlikely to be sufficient funding in a single year to meet all the requirements it set out.
However, it said “the submission is framed within the context of what we believe has been an ultimately unsustainable trajectory of budget reductions for health services over the last number of years which has steadily eroded the funding base necessary to deliver the current level of service”.
“This has resulted in key service-level shortcomings and in an unfunded deficit which has grown substantially over the past three years.”
The submission, signed by HSE director general Tony O'Brien, said the health service had "an overriding requirement to deliver safe services while addressing risks to service users and to the general population, including the very real risks associated with delayed access to services".
Implications
“In this context we are obligated to clearly set out the requirements for 2015 so that the implications of not being able to fund any of these necessary measures can be fully understood by all of the relevant stakeholders and an agreed approach to dealing with same put in place.”
However, since the “realistic” health budget was announced last October, the department has had to go back to Government and seek additional funding. More than €70 million extra was secured a number of weeks ago to tackle the crisis in emergency departments and with the Fair Deal nursing-home scheme.
The submission shows that in September the HSE warned the department the number of patients who had finished acute treatment in hospital but were unable to be discharged had risen to more than 700. The HSE sought €106.5 million to deal with this issue and related problems with Fair Deal.
Ultimately, €25 million was allocated in October but within weeks the number on trolleys in emergency departments had exceeded 600 and the numbers waiting for Fair Deal had risen to about 2,000.
