Juggling of finances makes the HSE 'black hole' hard to critique
Spending in the HSE can be difficult to examine because of the way it juggles its finances - moving funding from one area to another during the year, according to a new paper.
It is the latest bid to throw some light on what has been called the "black hole" of health spending as the HSE faces a deficit of €600m this year.
The analysis by the Oireachtas Parliamentary Budget Office looked at the HSE's National Plan that is published every January, setting out how it will carve out its allocation from the Exchequer in various areas of the health service.
The analysis shows that funding can be shifted around during the year from one service to another.
Annette Connolly, director of the Parliamentary Budget Office, said: "Given the excess of expenditure over profile of some €300m on the health vote so far in 2018, understanding the relationship between this vote and the HSE's budget is essential for Oireachtas oversight.
"Our analysis highlights that the link between the monies voted by the Dáil and HSE expenditure is difficult to navigate. It also illustrates that the budgetary documents produced by the HSE at the start of the year cannot be taken as a complete statement of the financial needs of divisions within the HSE.
"Expenditure is frequently transferred between service areas throughout the year, so that the end-of-year allocations differ significantly from those at the start of the year."
Hospitals got the greatest portion of extra money in 2016, while some funding for health and well-being and the national cancer control programme was used elsewhere.
The paper analyses how the make-up of the HSE's annual service plan changed between 2011 and 2018. During this period, the net annual current spending allocation of the health service increased from €12.9bn to €14.6bn.
The significance of the net allocation in the annual plan is that this is the figure that must be met from the Exchequer.
But HSE gross current spending rose to €16.1bn in the same period.
Centralising the processing of financial and procurement data onto a single system, rather than the range of systems used today, should allow for much more detailed and accurate presentation of data to the Dáil, the Parliamentary Budget Office said.