CASH-strapped hospitals have been told by the HSE that they won't be getting any budget bailout this year.
A confidential government report shows that the health service is heading for a €530m over-run this year, with many hospitals running over budget already.
The HSE document suggests overspends this year at all the major hospitals in Dublin, with St James' the highest at €24.3m.
The other overspends outlined in the capital are:
* Mater Hospital, €7m.
* Crumlin Children's Hospital, €6.8m.
* Beaumont Hospital, €4.3m.
* Tallaght Hospital, €3.2m.
The positions in the hospitals around the rest of the country are not specified, but over-runs are predicted in every region including €22.3m in the Northern Health Area, the Midland Health Area (€22m) and Western Health Area (€20.3m).
The over-spend is being caused by a spill-over of payments from last year, hospital admissions being up and demographic pressures.
But the health budget is also bloated due to the well-publicised problems with savings from medical card probity, and implementing the Haddington Road agreement.
The HSE report predicts "a full-year 2014 potential cash shortfall of €532m".
Department of Health and HSE sources say the startling projection is on the basis of nothing happening to address the over-run and there is action being taken to fix the budget.
The figures are based on spending in the first few months of the year, which is always higher due to bills hanging over.
These sources say the shortfall will ultimately be in the region of €150m to €200m.
But the HSE has written to hospital managements informing them they must manage spending within their budget allocation and there will be no bailout.
The letter, from HSE chief financial officer Tom Byrne to hospital bosses, was sent in the past week.
The latest black hole in health is now threatening the Coalition's ability to deliver tax cuts in next year's Budget.
Tensions are mounting within the Government over Health Minister James Reilly's failure once again to get spending under control and achieve savings under the Haddington Road agreement.
Mr Byrne said the €530m figure was simply based on the level of cash spent in the first two months, known as the "burn rate", which would not reflect the year as a whole.
Mr Byrne also said there would be measures taken to contain spending throughout the rest of the year.