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Departmental Funding

Dáil Éireann Debate, Thursday - 26 October 2023

Thursday, 26 October 2023

Questions (4)

Róisín Shortall

Question:

4. Deputy Róisín Shortall asked the Minister for Public Expenditure, National Development Plan Delivery and Reform his response to a media report (details supplied), the engagements he has had with the Minister for Health and the chief executive officer of the HSE since budget 2024 was announced on 10 October last; his views on whether the health service budget for 2024 is sufficient to meet patient need and progress Sláintecare reforms; and if he will make a statement on the matter. [47189/23]

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Oral answers (13 contributions)

Does the Minister accept that the deficit in this year's health funding was identified in the early months of this year by a number of people in the HSE and the Department? We have seen that those concerns about the risk were very well founded. Does the Minister accept the fact that there was a problem with the allocation made this year and that this will have a clear knock-on effect in 2024?

The operation of the health service budget for 2024 is, as is the case with every departmental budget, a matter for the Minister for Health and his Department. It is the responsibility of that Department to decide how it allocates funding of €22.5 billion to respond to the many legitimate demands and needs our health service faces at the moment. It is important to note that since 2019, this Government has prioritised very significant and unprecedented investment in the health service. As a result, Ireland continues to spend more of its national income on health than the majority of European countries.

This investment has delivered an increase in staff of over 22,000, which will bring the total numbers employed in the health service to approximately 143,745 by the end of this year with, as I have noted, funding of €22.5 billion.

Overall, a strong level of funding is in place for our health service. Funding has increased by €7.4 billion from 2019 to 2024. With regard to Sláintecare, which is referenced in the written question the Deputy put to me, my understanding from the Minister for Health is that the programme board is making good progress towards the next implementation framework. I also understand that the board and the Sláintecare programme management office are working together to identify further measures that can be taken from 2024 to 2027. My officials will engage with the Department of Health on future Estimates processes to consider the phases of reform under Sláintecare.

With regard to budget preparations, there was extensive engagement with the Department of Health in determining the budget 2024 allocation. I have had continuous contact with the Minister, Deputy Donnelly, in the run-up to the budget and in its aftermath. The Deputy asked me whether I have had engagement with the HSE's chief executive. I have not had such engagement since the budget was announced.

The Minister says that control of the budget is a matter for the Minister for Health, which is true, but the issue is the size of the allocation which is, in effect, determined by the Department of Public Expenditure, National Development Plan Delivery and Reform. It is the quantum of the allocation that we are talking about and it is the Department of Public Expenditure, National Development Plan Delivery and Reform which decides that. Just in the past week, Mr. Bernard Gloster made it very clear that two significant elements of increased spending within the Department refer to areas over which nobody has any control. The first is inflation, including inflation in the cost of cleaning, energy and food. For example, the new contract for energy represents an increase of 85% on last year. The second element is unforeseen demand because of delays during the Covid years. Does the Minister accept those two reasons for increased spending and that nobody had any control over those elements?

The question the Deputy put in written format is a little different from the questions she is putting to me now. I want to answer them all in the interests of transparency for the Dáil. I will first deal with the questions the Deputy has just put to me. Do I accept that it is very difficult for our hospitals and the HSE to influence the level of demand for health services in the short term? Yes, I do. Across the medium term, it is possible to influence that level of demand through measures we take to improve the health of our country, through the use of medicines and through decisions on where our patients are treated. Do I accept that the impact of inflation on the delivery of services cannot be controlled? It is possible to have a degree of control over that through decisions made in respect of procurement and how we manage the impact of rising costs. All other Government Departments are experiencing the impact of inflation in the decisions they have to make and in the funding of their services. While the challenge of inflation has some particular health dimensions, it is also something that all elements of our public service face at the moment.

Over the past couple of years, a major reform programme, Sláintecare, has been under way in the Department of Health. That involves a movement to a new, lower cost model of care. We have heard from the chief executive of the HSE, the Minister for Health and the Secretary General of the Department of Health that there is real progress being made. We would all agree that progress is being made on moving to that new model of care, which is a lower cost model. That does not happen without incurring a cost. You do not click your fingers and then, next week, there is a new model of care.

There is an element of parallel models while you are moving to the new one. However, there was clearly momentum with the progress being made. That is now going to be slowed down. Can the Minister stand over this badly needed reform of the health service being slowed down as a result of the allocation from his Department, because that is what all of the senior people in health claim is happening?

We will continue to find ways to make progress on Sláintecare.

Did the Minister used the term "find ways"?

It is important to acknowledge that progress on Sláintecare falls under four different pillars, namely. affordability, accessibility, better outcomes for patients and reforming our health service. With regard to affordability, I thank the Deputy for acknowledging the progress that has been made in respect of inpatient hospital charges, the expansion of free GP care, what we have done in the drugs payment scheme, what we are doing regarding diagnostic scans for patients, free contraception for women up to the age of 31 and-----

My question was on the need to continue that reform.

Excuse me. We are now also making progress on assisted human reproduction. These are measures that are going to continue across this year. We will ensure the commitments we have made in these areas are delivered upon. We will find ways to continue the momentum on Sláintecare, for example, through the opening up of new hospital beds and the delivery of medical care professionals where they are needed, in line with what is funded. That will continue. Sláintecare is about more than just affordability. It is also about three other strands.

Absolutely but they need to be funded.

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