Tuesday, 2 July 2019

Questions (43)

Stephen Donnelly


43. Deputy Stephen Donnelly asked the Minister for Health the amount by which the HSE budget is overspent as of the end of quarter 2 of 2019; the projection for the full year overspend; the additional spending commitments he has made to date during 2019; his plans to seek a supplementary budget or bring full year healthcare expenditure in on budget; and if he will make a statement on the matter. [28086/19]

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Oral answers (6 contributions) (Question to Health)

My question is about the HSE budget for this year. My understanding is that we have quarter 1 figures showing an overspend. I would like to know how much the overspend is for the first three months of the year and also for the second three months, to the end of June. I imagine the Minister's officials and-or the HSE are projecting out what the full-year overspend is likely to be. What is the projection at this stage? Is the Minister in line with the new director general of the HSE saying that the budget will be brought in or does he foresee himself coming back to the House to seek a supplementary budget later this year?

The management of health services finances is always challenging, as we have seen since the HSE was set up. There is a range of supplementary figures going right back to the start of the HSE that I could put on the record of the House. The indications are that performance so far this year is better than last year and, as the Deputy has acknowledged, significant efforts are under way on the part of the HSE and the new CEO, Paul Reid, to manage available resources effectively. The HSE’s latest income and expenditure position at 30 April 2019 shows a revenue deficit of €116.2 million, which represents 2.3% of the available budget. The main drivers of the deficit are acute hospitals; the primary care reimbursement service, PCRS, in other words, the medical card and demand-led schemes; disability services; and the treatment abroad scheme. Current gross expenditure on the Health Vote, year to date, is 6.8% higher than the same period in 2018. This compares with an overall increase in the Health Estimate compared to the 2018 outturn of 5.8%. This House budgeted for the health service to spend roughly 5.8% more this year than last year and the health service bill is, I think, so far 6.8% more. It is within a percentage point of what this House has budgeted.

Encouragingly and importantly, significant savings are profiled later in the year in line with the targets set out in the national service plan.

I have heard this misrepresented on many occasions in recent weeks. When the service plan was being drawn up, the HSE was asked - and instructed - as is the norm in most health services, including the UK's NHS, to put a saving's plan in place. On the basis of current trends, however, there would still be a significant challenge. This is a matter of concern for the Government. My Department is working with the HSE to continue to obtain further clarity on the projected year-end position and to mitigate the deficit insofar as is possible. We are working closely with the Department of Public Expenditure and Reform. I do not yet have a projected year-end figure. I support Mr. Paul Reid, the new CEO of the executive, in his calls for people to live within their budgets and to come in on budget. I will share any further information with Deputy Donnelly when I have it.

I have emphasised to the HSE and its new board the need to address health spending urgently by means of the following measures: steps to ensure compliance with the staffing limits for 2019 - in other words, to hire more but only within budget; a reporting and monitoring structure around agreed savings targets in the national service plan, with responsible managers providing a monthly report; and a mid-year review of the HSE's performance on savings and staffing limits. In addition, the establishment on Friday last of a new HSE board governance structure with strong competencies across key areas will further contribute to strengthening the oversight and performance of the HSE pending its further reorganisation.

If I heard him correctly, the Minister gave a figure of €116 million for the period to the end of April. Does he have a figure for the period to the end of June? This would be the overspend to the end of quarter 1. If he does not have that figure, perhaps the Minister will indicate when he will have it. Has the Minister requested a projection to the end of the year? Given the enormous overruns during the past years and in light of the fact that we are overspending again - by more than €100 million for the first four months of the year - it would seem prudent to request a forecast for the potential overrun. There is no contingency in the budget, which seems to be a mistake in the context of allocating resources for healthcare.

At budget time, the Minister announced a 10% increase in the assessment threshold with regard to means-tested GP visit cards. This was in line with the Sláintecare proposal. At the time, neither he nor his officials were able to cost this. Will the Minister indicate if this cost is included? Is the increase happening? If it is, when will it come into place? Does the Minister have a sense of how much it will cost?

I shall recap. Does the Minister have the figure to the end of June? Does the Minister believe that it is sensible to not have a contingency in the budget? Is the 10% increase in the assessment threshold for GP visit cards going to happen? Does the Minister believe that he will be able to drive the costs back down to be in budget for the full year or is he anticipating coming back to the House with a Supplementary Estimate?

The 10% increase in the assessment threshold for GP visit cards was implemented at the start of April. The budget for this would have been held back as a reserve in my Department. I say that from memory. If my account is inaccurate, I will send a note to the Deputy.

My position is to allow the new CEO, Mr. Reid, who has only been in the office for a few weeks, and the new board, which has only been in office since Friday, to do their own due diligence regarding the actions the HSE can take. I have been very clear in my message to Mr. Reid and the board that we expect them to deliver everything in the service plan. It is not about cutbacks or doing less. It is about delivering all of the extra activity and all of the additional staff under the service plan; it is not about doing things that are not costed. There are already some things that we in this House have asked the HSE to do that are not costed, such as continuing Brexit planning, the CervicalCheck ex gratia scheme and the recent nursing agreement, which the Deputy supported. There are ongoing discussions with trade unions and I have seen the Deputy on the picket line in support of that.

I do not believe that a contingency has ever been held back in respect of the HSE but I will check this. I do not have a more up-to-date figure. The figure I have just given is the most up-to-date available. It is probably even more up to date than the figure previously presented by the HSE.

I accept the Minister's point that there is a new director general of the HSE and that he is sent a circular that everything needs to be brought back into budget. The question for the Minister and the Government is what direction they are going to take. We are halfway through the year. By the end of April there was an overspend of €116 million. Let us assume that this increased in May and June at the same rate. This would bring us broadly up to €140 million. On the current trend and if things continue as they are, we would be looking at an overspend of several hundred million euro. At a political level - and accepting that everybody will do everything they can to live within the budget - if the HSE comes back and states that the overspend will still be €150 million, €250 million or €350 million, will the Minister instruct it to do what is required to find the necessary savings in order to come in on budget or will he come back to the House with a Supplementary Estimate?

Every Government of every hue monitors healthcare spending on an almost monthly basis in the run up to any budget. My message to the HSE is to deliver the service plan in full and, in parallel, to put in place greater controls in respect of individual managers. We have discussed this matter in the House. One cannot have individual managers recruiting without paying heed to the budget. In addition, they need to reduce the waste and inefficiencies in the system in accordance with the savings plans they were instructed to put in place as part of the service plan.

It is understandable that the Deputy is trying to project from now until the end of the year. It is important to note, however, that when one looks at how the savings are profiled in the HSE Vote, many of them are profiled for later in the year with those targets set out in the national service plan. At a political level I ask the HSE to come in on budget as close as possible while delivering the essential services people need.

At a political level, every day Deputies call on me to spend more on the health service, with calls for more for SIPTU workers, more for consultants and more for home care just in the past six weeks. Like my predecessors, I will try to balance the challenge between bringing the HSE in on budget - or as close to budget as possible - meeting the needs of our people and meeting the many demands this House understandably places on me in terms of improving Ireland's health service.