Health budget no longer based on evidence, consultants’ conference told

The health budget for next year is “unrealistically low”, creating a high likelihood of further financial overruns in 2027, the State’s fiscal watchdog has said.The health service was allocated €25.8 billion in current expenditure this year, but a significant deficit has developed which could reach up to €1 billion by the end of the year.Budget 2027 allocated €27.4 billion for current services, however Niall Conroy, acting chief economist at the Irish Fiscal Advisory Council (IFAC), said that in reality this was only a “modest” uplift.Speaking at the Irish Hospital Consultants’ Association (IHCA) annual conference in Kilkenny on Saturday, Conroy said the way in which the health budget is calculated was no longer “evidence-based”.READ MOREThe health service requires a standstill cost of €1.7 billion for next year, Conroy said, but he argued that when the estimated €1 billion overrun this year is factored in, next year’s increase equates to €600 million. “It’ll be about 2 per cent. That is well below the cost to maintain the existing level of service,” he said.“If I was giving this talk again next year, I think I’ll be talking about substantial overruns next year as well.”Conroy said the sector was being budgeted just to “stand still”. [ How can runaway spending in the health service be reined in?Opens in new window ]He criticised the recruitment-freeze cycle, describing a pattern in which the health service recruits in the first half of the year, expenditure exceeds allocation, and then tighter controls or a moratorium is introduced.“That’s a very poor way of doing workforce planning.” Speaking at the same conference, Jennifer Kearney, chief executive of Cork University Hospital (CUH), said when she returned to the HSE “it felt, in some respects, like stepping back in time, nearly 10 or 15 years”.Kearney worked in the UK’s NHS for 22 years, and took the top job in the Cork hospital 15 months ago.Outlining various difficulties the hospital was contending with, she cited to delegates “the infrastructure, the constraints, the funding arrangements, the complexity of pay and number strategy, the limited autonomy available to those responsible for delivering services”. Kearney came under public scrutiny in August when she wrote to the HSE, stating the hospital was facing increasing patient safety risks due to a shortage of 1,000 staff.[ Half of HSE regions have ‘eaten into’ next year’s budget due to overruns, Minister saysOpens in new window ]Minister for Health Jennifer Carroll MacNeill argued against Kearney’s statements, adding that the hospital had hired a significant number of staff this year and had exceeded its pay budget.Kearney said she “absolutely stands” behind the patient safety concerns she highlighted, adding the situation “is getting worse”.She told IHCA members that only seven posts have been approved for CUH since letters she wrote to August emerged in the media, adding that the “gap is getting wider” between what the hospital needs and has.“We lost €15 million [from our budget] at the start of the year due to supplementary budget. We started already in the red,” she said.“I want to switch on the CAT scanners that are currently gathering dust because I don’t have the radiographers to open them. Diagnostic capacity, 50 per cent of it is switched off.”The surgical hub at CUH is open but she said it was not operating at full capacity due to employment restrictions in the region.She acknowledged the hospital was “overspending” but said this was because of inflation associated with the public-only consultant contract as well as increased overtime due to staff shortages.Carroll MacNeill has been critical of HSE regions overrecruiting. Last week, she described the practice as “unsustainable” and warned that those areas had “eaten into next year’s allocation”.