Financial pressure in uncertain times

The 2019 plan, which was launched on 22 December, shows the financial position of the Executive to be precarious. On the surface, things look quite positive, with the €16.05 billion budget representing an overall increase of €848 million (5.6 per cent) on final 2018 funding. However, the cost in 2019 of providing the level of service activity in place by the end of last year is estimated at €15.805 billion, which is an increase of €597 million over the 2018 costs. This €15.805 million cost is €50 million higher than the €15.755 billion funding available to meet all 2019 costs and excludes the cost of additional service activity.

Medical representative bodies have strongly criticised the 2019 plan. The IHCA said it “fails to even start to address” major capacity deficits, while the NAGP branded the plan a “disgrace” for not providing a measurable increase in resourcing for services in the community. While some point out that Ireland is among the highest spenders in the OECD, analysts such as Brian Turner have pointed out that the cuts from the acute system in the 1980s and 1990s have never been fully reinstated.

It can’t be said that the HSE is satisfied with the current funding situation.  Speaking at the launch of the plan, Mr Dean Sullivan, HSE Deputy Director General — Strategy, stated: “While we will endeavour to ensure we provide value for the monies we spend, we are very cognisant that meeting both current and future challenges is not sustainable.”

This echoes many comments from the previous Director General of the HSE Mr Tony O’Brien about how the model for funding healthcare in Ireland needs to change. While Mr O’Brien arguably went too far in distancing himself from responsibility, it is true that the HSE can only do so much without the necessary organisational and financial backing. Mr O’Brien constantly repeated the need for a long-term plan for healthcare. This is what makes Sláintecare so important, and it is notable the strategy is mentioned 95 times within the document.  Planning for healthcare over the long term is notoriously difficult, with the HSE’s struggles to even prepare for the annual winter surge highlighting the difficulty of planning even for the short-term. The continuing anxiety around Brexit and other pessimistic economic forecasts makes the implementation of a long-term strategy for healthcare even harder, despite the HSE’s pressing need for greater financial stability.