Dáil Éireann Debate, Tuesday - 28 November 2023
26. Deputy Rose Conway-Walsh asked the Minister for Public Expenditure, National Development Plan Delivery and Reform the engagement between his Department, the Minister for Health and the director general of the HSE in advance of the budget 2024 announcement; and if he will make a statement on the matter. [52364/23]
View answerIt is disappointing that the Minister, Deputy Donohoe, is not here and that another Minister has not swapped dates with him so he could have a debate on the issue of our health services, which are important. The Minister and his Department were key in the Government's decision to underfund health. Will the Minister of State outline the engagement between the Minister, the Minister for Health and the director general of the HSE in advance of the 2024 budget?
I thank the Deputy for the question. The Government has overseen unprecedented levels of additional investment into our health services in recent years. Funding on a like-for-like basis, excluding disabilities, has risen by €7.4 billion from 2019 to 2024. This is equivalent to an average annual increase of 9% in spending.
This investment has facilitated considerable expansion of the health service workforce and it is expected that moe than 23,000 additional staff will, by the end of this year, have been added since the end of 2019. Furthermore, from a funding perspective, Ireland's health system compares favourably with other EU and OECD states across a number of different comparators, especially given our comparatively young population.
In relation to oversight of health expenditure, there is ongoing engagement between my Department, the Department of Health and the HSE throughout the year, including through the health budget oversight group, HBOG, on which the Department of Public Expenditure, National Development Plan Delivery, and Reform, the Department of Health and the HSE are represented. This group normally meets on a monthly basis to monitor health expenditure and staffing. There is also a series of detailed policy engagements during the year with the Department of Health, which feed into budgetary considerations. Similar to other Departments and the agencies and bodies under their remit, it is a matter for the Department of Health to engage with the HSE, as an agency under its remit, ahead of the budget. These engagements and subsequent analysis allow the Department of Health, as the relevant policy Department, to form a view on funding requirements. This is reflected in the Department of Health budget submission to my Department and in the subsequent Estimates negotiations between our respective Departments.
The 2024 Estimates process included an extensive series of meetings between officials in my Department and their Department of Health counterparts. As is the norm in the Estimates process, there were also a number of ministerial bilateral meetings ahead of final Government decision on the expenditure ceiling. Any questions on specific engagements between the Minister for Health and the chief executive of the HSE are best addressed to the Minister for Health. The health budget overall is a matter for the Department of Health.
The Department of Health requested €2 billion in order to meet the standstill costs for 2024. The head of the HSE, Mr. Bernard Gloster, wrote to the Minister for Health outlining his concerns before the budget. He said there would be significant and punitive risk to the public and that it was imperative that the Government should be in no doubt as to the position. This was in respect of the Government's decision to provide €708 million for existing levels of service, ELS, and €100 million for what are called "new measures". Was this letter shared with the Minister for Public Expenditure, National Development Plan Delivery, and Reform? When was this letter, and its concerns, shared with the Minister? What is the justification used by the Minister and the Government as a whole for dismissing the concerns of the head of the HSE? When the HSE is forced to run hundreds of million, if not billions, in deficit, it is forced into a situation whereby it cannot properly plan or prepare.
Negotiations happen between the Department of Public Expenditure, National Development Plan Delivery, and Reform and the Department of Health, or any other relevant Department. The Minister for Public Expenditure, National Development Plan Delivery, and Reform is not going to engage directly with agencies that are under the remit of another Minister. I understand the chief executive of the HSE sent an email outlining his concerns on the morning of the budget speech.
What I witness is that representatives of all Departments come into the Department of Public Expenditure, National Development Plan Delivery, and Reform every year and ask for more money than is available. They come in and make a request for money that is beyond what they are likely to get. They all know what they are likely to get because it is spelled out in the summer economic statement. The Department for Public Expenditure, National Development Plan Delivery, and Reform tells the world it will pay out, for example, 6.1% in extra expenditure for the year.
The Department of Health has not been underfunded. It now has €7.4 billion more in its budget than it had in 2019. It has 23,000 extra staff. It is not a case that the Department is not receiving very large quantities of money.
This is not extra money. It is money required by the health service to stand still and allow it to deliver what it has delivered heretofore. The Government forces health services to wait and react to demand rather than giving them resources that would allow them to plan and prepare. Representatives of the IFAC outlined to the Committee on Budgetary Oversight that spending less on health is likely to cost more money. A chief economist stated:
A bit of money probably needs to be spent to save money in the long run. There is an element of not going down the road of penny-pinching but spending to save money in the long run.
Fine Gael’s short-sighted approach to budgeting will damage healthcare even further but will also cost us more money in the long run. This does not make sense. The Minister of State knows what is happening on the ground. He knows because the money is not there to do what needs to be done in social care, community care and primary care. We also have a backlog in acute hospitals and capital projects are being left behind on top of everything else. We are in serious trouble in the area of health.
I agree that investing money in the healthcare system has a positive return on investment. I know the Ministers for Public Expenditure, National Development Plan Delivery and Reform and Health are carefully reading the words of the Irish Fiscal Advisory Council on that. To give an example of the words following that, the Department of Heath agreed to regrade public health doctors to consultant level so that this service would become consultant-led. Public health doctors sought that for a long time. That decision was taken partly in response to the experience during the pandemic, which showed that the only way we could deal with a large health crisis was through preventative healthcare. Investment in healthcare, particularly in prevention and early and primary healthcare, provide a good return. It would be wrong to say there has not been additional investment. Investment has increased by an average of 9% per year. The €1.14 billion provided in this year’s budget for next year and 23,000 extra staff cannot be ignored.
