The HSE’s latest income and expenditure position at 30 April 2019 shows a revenue deficit of €116.2m which represents 2.3% of the available budget. The main drivers of the deficit are acute hospitals, PCRS and demand-led schemes, disability services and the treatment abroad scheme. Current gross expenditure on the Health Vote, year to date, is 8.8% higher than the same period in 2018. This percentage varies on a monthly basis during the year depending on spending under various headings but is, nonetheless, a matter of concern.
Significant savings are profiled later in the year in line with the targets set out in the National Service Plan. However, on present trends, taking account of the pressure in certain areas, the HSE would have a deficit at the end of 2019. This is a matter of concern for the Government. My Department is working with the HSE to gain further clarity on the projected year end position and working to mitigate the deficit in so far as is possible, in co-operation with the Department of Public Expenditure and Reform.
I have emphasised to the Executive the need to address health spending urgently by means of the following measures;
- Steps to ensure compliance with the staffing limits for 2019;
- A reporting and monitoring structure around agreed savings targets in the National Service Plan, with responsible managers providing a monthly report from Quarter 1;
- A mid-year review of the Health Service Executives performance on savings and staffing limits, with further interventions as necessary.
In addition, the establishment 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. The newly-appointed CEO to the Health Service Executive has also committed to strengthening the HSE’s leadership and focus on performance, in line with my own identification of an effective performance management and accountability system for the HSE as one of the priority issues for the new Board.
In addition, outside of the National Service Plan there are other financial commitments, including costs associated with contingency Brexit planning; costs of the Cervical Check ex-gratia scheme; and the recent nursing agreement.
The National Service Plan requires the HSE to protect and promote the health and well-being of the population, having regard to the resources available to it, and making the most efficient and effective use of those resources. Implementation of the Service Plan is ongoing, and my Department understands that the position of the HSE is that protection of front-line service delivery is its priority. I have emphasised the need for the Executive to meet its service targets in line with the National Service Plan.