Officials in my Department are in ongoing contact throughout the year with officials in the Health Vote section of the Department of Public Expenditure, National Development Plan Delivery and Reform in relation to expenditure forecasting and expenditure management. These matters are also discussed on a monthly basis in the Health Budget Oversight Group.
On 9th November 2023, as part of discussions on a Supplementary Estimate for the Health Vote 2023, my officials submitted, by email to officials in the Department of Public Expenditure, National Development Plan Delivery and Reform, a forecast of projected expenditure to year-end for the Health Vote. This forecast was based on HSE expenditure data to end-August being the latest month available, as well as other relevant information. Following this, officials in both Departments engaged on the detail of this expenditure forecast, and a final forecast of Health Vote expenditure for 2023 was submitted, by email to officials in the Department of Public Expenditure, National Development Plan Delivery and Reform, on 16th November 2023. This forecast formed the basis for the Supplementary Estimate for the Health Vote for 2023 agreed between both Departments, subject to Oireachtas approval.
The Department of Health's expenditure forecast projected a Vote deficit for the Health Vote of €1,034 million for 2023, comprising a HSE Current expenditure deficit of €1,430 million and a a Capital requirement for an additional €22 million, offset by movements in HSE working capital €369 million, savings on Departmental spend of €22 million and transfers to the Department of Children, Equality, Disability, Integration and Youth of €27 million. It should be noted that of the projected Health Vote deficit of €1,034 million for 2023, it has been agreed that €70 million in Capital funding that will be unspent at end-2023 can be carried forward into 2024, meaning that the net cash drawdowns by the Health Vote in 2023 will be €964 million above the original allocation.
Within the projected HSE Current expenditure deficit of €1,430 million, this includes a projected HSE Core expenditure deficit of €1,251 million, and a projected HSE COVID expenditure deficit of €179 million on an accruals basis. Of the projected HSE Core expenditure deficit of €1,251 million, the Department projected that €243 million related to pay deficits to be managed in 2024 within the available pay budget allocation, and €1,008 million related to non-pay and income deficits in 2023 that would be carried into 2024. Taking into account of the fact that €383 million in non-Core funding has been allocated in 2024 to meet expenditure pressures arising from price inflation and demographic demand, this leaves €625 million of a funding gap carried forward, requiring either additional funding or expenditure management actions to be implemented in 2024. These figures were communicated by email from my officials to officials in the Department of Public Expenditure, National Development Plan Delivery and Reform as part of the final expenditure forecast submitted on 16th November 2023.
The Department of Health, the HSE and the Department of Public Expenditure, National Development Plan Delivery and Reform are all committed to implementing a range of expenditure management actions in 2024 in order to mitigate as much as possible the potential expenditure pressures on the Health Vote, without adversely affecting patient access to health care.
