Eilish O'Regan: €50m fund to tackle waiting lists won't go far
Continuing our series examining the upcoming Budget 2018 and its fault lines, Eilish O'Regan looks at the health service
The health service faces the upcoming Budget with its reputation intact as an extravagant spender that is permanently in some form of crisis.
Last year the Government trumpeted that the €14.6bn allocation marked the "highest ever health budget".
Yet there are now a record 690,000-plus public patients on waiting lists. And the numbers on trolleys in August hit new heights when compared to the same month over the past decade.
It is once again in the red with a projected deficit of €300m, due in part to meeting pay rises and compensation claims, but also regular housekeeping over-runs.
It is impossible not to be moved by the pleas from so many deserving people, be they pensioners struggling to pay a prescription charge, or a carer who is denied any respite.
What can patients and the public who depend on the services of the HSE expect in the Budget?
Funding for health will increase, but a lot is already spoken for. The HSE's bill for pay rises from the latest public service agreement will run to around €90m. This payout is always at the expense of services.
One of the headline giveaways in the Budget will be a special fund of €50m to tackle hospital waiting lists.
This is on top of the regular funding hospitals get.
Much of this will be likely spent on outsourcing to private hospitals, with another concentration on the longest waiters. Some €20m was allocated this year.
But it has made no major dent in the figures for various reasons and nobody on an outpatient list had their appointment paid for.
The outsourcing seems to be moving very slowly, and the Health Minister, Simon Harris, says there is an issue with the inaccuracy of lists - although all the money will be spent by the end of the year.
While €50m is a vast sum, the expectations of what it can deliver must remain modest. A hip operation alone costs €15,000 and there are more than 11,600 waiting.
Hospitals are still struggling with a shortage of key specialists and nurses. A classic example is lack of urologists, particularly outside Dublin, despite recruitment campaigns. Men with prostate cancer in Limerick and Waterford are particularly affected.
The Budget is also expected to have special funding for a form of "winter initiative" to keep the trolley crisis under some control. The €40m last year had a positive impact - buying more homecare hours, community beds and other supports to transfer many older patients who no longer had to occupy a bed. But it was not enough to stem unrelenting overcrowding in many hospitals.
The minister is shortly to get a report reviewing where beds are needed inside and outside hospital. This will command a slice of funding to start the roll-out plan.
The problem with once-off funding for winter pressures is that once it is spent, the underlying problems re-emerge.
There has also been much discussion about changes to the Fair Deal scheme.
Out-of-pocket expenses remain a hardship for many. Hopes are rising for a cut in the unpopular €2.50 prescription charge.
It was supposed to be abolished by now, and only pressure from Fianna Fáil led to a reduction for the over-70s last year.
It is one of the austerity charges that were hiked in the recession, with medical card holders paying out €117m in the levy last year.
The last Government also hiked the monthly Drugs Payment Scheme threshold from €120 to €132 at the start of 2012 and to €144 in 2013. But it is unlikely this will be changed.
The shortage of homecare supports, with a waiting list of 5,000 for home help, is expected to see a rise in funding this year. In 2017 it is still 23pc less than it was in 2009, despite an increased number of older people.