Thursday 26 April 2018

HSE seeks extra €1.9bn in Budget 2016 talks

HSE Acute hospital projects
HSE Acute hospital projects

Fionnán Sheahan

The HSE is looking for a whopping €1.9bn more in funding next year, adding to the pressures on the Coalition.

In a detailed submission to the Government, health service managers say the funding is needed to meet the overrun this year, match the same level of services next year and bring a range of hospital and elderly care services up to standard.

The HSE wants to take on an additional 5,000 staff over the coming year and also has to meet the cost of the reversal of the pay cuts imposed during the financial crisis.

The aggressive demands are contained in the confidential 'HSE Budgeting and Service Planning 2016 Estimates Submission', obtained by the Irish Independent.

But the demands will swallow up all of the Government's leeway in the Budget.

The chances of the HSE getting all the funding is non-existent, but the move will add to the pressure on the Government to match expectations in October's Budget.

The estimates show there will be an overrun of nearly €500m this year in the HSE budget - €497m up from the previous estimate of €418m.

On top of that, there's another €125m the Government will have to provide for historic items.

Just to provide the same services in 2016 will cost another €650m.

And demographic pressures add another €160m to the bill for the health service next year.

The cost of standing still without any additional policy changes is a staggering €1.45bn.

The HSE then says it needs another €420m for new improvements to the health service.

HSE director general Tony O'Brien outlined the costs three weeks ago in a submission to the Department of Health, which was also circulated to all Hospital Groups and Community Healthcare Organisations.

"If we simply stand still we will not be in a position to address the needs of our population as it grows and ages in the years ahead," he says.

The additional funding is needed for areas such as care of the elderly population, and improvements in facilities to bring them up to the standards of health watchdog Hiqa are also in the mix.

Giving the funding would mean the investment in health and social services would be €14bn - €1.7bn or 14pc more than it was 10 years ago.

"However over the same period the population over 85 years of age, ie those with the most complex and costly health and social care needs, has risen by over 40pc while the overall population has risen by 11pc," Mr O'Brien says.

Staff

The extra 5,000 staff will bring the total numbers in the health service up to 106,400 - still below the 111,505 in December 2007. And the total would still be 2,300 below what it was 10 years ago, despite the growth in the population.

"The vast bulk of this investment in staff relates to the direct provision of and support of clinical and other frontline services, for example midwives, doctors, nurses, porters, ward clerks, therapists, social care workers, cleaners, risk managers, clinical auditors, ambulance staff, health care assistants, patient records staff, dentists, catering staff, social workers, security staff, lab staff and cardiac and other specialist technicians," Mr O'Brien's letter says.

The director general says the HSE is aware the investment in health must fit in with the overall financial parameters for the State.

"At the same time we have a formal obligation to set out clearly what is necessary to address the deficiencies in our services and provide a safe environment for those that use our services and work in them," Mr O'Brien says.

The country's financial watchdog warned last week that there was a problem with the management in some hospitals when it came to ensuring certain budgetary targets were maintained.

The Fiscal Advisory Council report warned that the issue of "continued health spending overruns" was a looming crisis.

"There is evidence that difficulties in budgeting, and in financial management and governance arrangements in the hospitals area, create a tendency towards budget overruns."

The HSE estimates contain funding for reforms within the system. Mr O'Brien said the investment was particularly important given the HSE needed to make very substantial improvements while continuing to deliver day-to-day services.

How the extra funding the HSE wants all adds up...

HSE Budgeting and Service Planning 2016

n Revised estimated minimum deficit for 2015: €497m

- plus additional funding and minus once-off items: €125m

Opening position 2016: €625m

n Additional Existing Level of Service (ELS) for 2016: €663m

Recurring ELS requirement for 2016: €1.288bn

n Pure demographic funding for 2016: €160m

Cost of standing still - no policy change: €1.488bn

n New monies for 2016: €419m

Total funding requirement for 2016: €1.867bn

Irish Independent

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