State spending and value for money

A high-spend, low-service health system

Sir, – The Commission on Taxation and Welfare has reported. Notably, it has not called for a reduction in any taxation measures, but focuses instead on finding ongoing ways to levy additional and increasing taxes on capital, wealth, consumption and social insurance for self-employed people, so that ever-increasing demands for more public spending and welfare can be funded. It is now past time to have an independent commission formed to report on the efficiency and effectiveness of Irish public spending. Particular emphasis should be put on health and welfare expenditure. Strong evidence suggests that we have well-funded public services that underdeliver, continuously, on both quality of service and value for money assessments. While it is tempting to ignore value for public spending analysis, it is a big ask to ignore the quality of service outcomes of ever-increasing public spending. Each year we hear calls for more and more spending on the public health system while OECD and other data show we are a top public health spender compared to all other developed world countries. We also face an annual budget overspend on health, despite the reality that Irish public health expenditure, correctly measured as a percentage of modified gross national income, shows dramatic increases in spending every year. This indicates the desire on the part of successive governments to deliver strong public health services for citizens, but the health system has failed to enable the provision of even adequate quality of service. It is long past time for public sector unions and management to look at their role in this high-spend, low-service system. This year, the State has spent over €11 billion on health in the first six months and is well on track to burst through its 2022 budget of €21 billion for the year. The State is also in the process of adding 10,000 additional full-time staff in this calendar year alone, while waiting lists grow longer, despite the favourable demographics of a relatively young population. We desperately need public sector management and unions to embrace a spirit of change, which can begin with a new independent commission on public spending setting out proposals on how to go about it. – Yours, etc,

MARK MOHAN,

Castleknock,

Dublin 15.