Crisis over: so do we want to go back to investing in health or just complain about the services?
Published 31/08/2015 | 02:30
Towards the back of the 'HSE's Budgeting and Service Planning 2016 Estimates Submission', there's a figure of €29.788m for "System Reform".
The heading is broken down across a range of governance, structural, IT and financial initiatives, which are planned for the health service.
The net effect is supposed to be a more efficient health service, delivering more for patients and in as cost effective a manner as possible.
In the context of an estimate of €14.047bn, seeking a little under €30m seems like a small enough ask. Yet here's the HSE coming along with the begging bowl for fundamental system reform.
When the HSE inevitably gets turned down for its demand of an extra €1.867bn, then funding will be needed elsewhere and the system reform will drop down the pecking order.
The HSE will spend the year trying to manage a budget that's lower than its requirements and the vicious circle will be complete once more. About a quarter of the way into next year, it will become apparent the HSE is on track with its perennial overrun and the rest of the year will be spent playing catch-up.
The lesson is never learned. The Coalition pays scant regard to the independent economic watchdog it appointed when the Fiscal Advisory Council warns against excessive budgets. But perhaps it will take note of its report last week entitled 'Controlling the health budget'.
The council said health spending had exceeded planned levels in recent years and these overruns could undermine the ability to plan ahead.
It said there was evidence of difficulties in budgeting and financial management and governance in hospitals, which "create a tendency towards budget overruns".
"Given known future challenges to the public health system, such as demographic change, existing financial planning and governance structures must be improved to ensure delivery of targets," it concluded.
In other words, if you don't get the budget planning right in the first place, then how can you expect to stick to it?
After seven years of austerity, the HSE is aiming to improve frontline services or even "move towards acceptable levels" as its director general Tony O'Brien put it.
The demand for an extra €2bn is a real budget buster and won't be met. But it will pose questions about the Government - and public - commitment to the health service. Are middle-income voters willing to take a pass on their tax cut to see more nurses, doctors and ambulance staff hired?
The HSE has got in earlier with its demands this year. Gone is the naivety of Dr James Reilly demanding an extra billion on the closing weekend of budget talks two years ago. Likewise, the gung-ho attitude of his successor Leo Varadkar in predicting he would put manners on spending and bring it in on target.
The overrun this year will be €500m. The HSE says it needs an extra €2bn in 2016.
Surely it's time for honest debate about health spending, rather than just complaining about the service.