Budget is boost, but no bonanza for health

While the funding announced for health in Budget 2025 is positive, it will not be transformative

Budget 2025, announced on 1 October, contained few surprises, particularly as most measures were well flagged in advance. However, it did contain a pleasant change (though not entirely a surprising one, as it had been indicated in the Summer Economic Statement), in that there was a meaningful increase in the health budget. This took into account the anticipated overrun of this year’s budget compared with the Budget 2024 allocation.

In recent years, health budgets have taken the previous year’s allocation as the starting point, ignoring the overruns which would have been known about by the time the budgets were announced (even if the magnitude of the overruns wasn’t known precisely by budget time, a pretty good estimate would have been known at that stage). This year, some allowance has been made for that, and an increased ‘existing level of service’ allocation of €2.68 billion across 2024 and 2025 was provided for in the Summer Economic Statement, which gives some certainty over budgets, enabling better planning.

Looking at the figures, the allocation for current expenditure on health for 2025 is €24.3 billion, an increase of €1.213 billion, or 5.3 per cent, over the 2024 figure, with an additional €1.46 billion of capital expenditure allocated. This makes health as the second-largest area of Government current expenditure, after social protection (€26.9 billion), accounting for nearly 27 per cent of overall Government expenditure in 2025.

Of the current expenditure figure, 48.5 per cent will go on pay and pensions, with the other 51.5 per cent on non-pay items. Viewed by programme, 39 per cent of expenditure will be spent on acutes and the National Ambulance Service (NAS), and 26 per cent on primary, community, social inclusion, the Primary Care Reimbursement Scheme, and local demand-led schemes.

In addition, older persons will get 11 per cent, mental health 6 per cent, capital 6 per cent, and ‘other programmes’ 12 per cent.

Priority is being given to maintaining existing services for a growing population, rather than introducing new services. Funding is being made available to recruit an additional 3,346 whole-time equivalent (WTE) staff (in net terms), bringing the staffing ceiling to 133,306 WTEs. To put this into perspective, this represents nearly half of 1 per cent of the entire number of people in employment in Ireland as at the second quarter of 2024.

The expenditure estimates note that, between July 2023 and July 2024, emergency department (ED) attendances were up by 9.4 per cent, day cases by 4 per cent, inpatient discharges by 6.4 per cent and outpatient attendances by 5.4 per cent. Reflecting this increase in demand for hospital services, provision is made in Budget 2025 to increase capacity by adding 335 acute beds, opening two new surgical hubs and providing funding for 49 new consultant posts. A provision has been included to expand EDs in five hospitals, while the NAS will receive an additional €8 million.

Continuing the focus on reorientating the health services more towards primary, community, and continuing care rather than hospital care, funding has been allocated to non-hospital services, including providing six injury units, wound care clinics and longer GP hours, as well as 455 replacement and 160 new community beds. Funding will also be continued to enable GPs to directly access scans and expand the GP-led chronic disease management programme. A chickenpox vaccination programme will also be introduced.

An additional €30 million has been set aside for new drugs, while investment will also be made in further developing ICT infrastructure, including digital health records. On the capital side, mention is made in the estimates of the progression of major projects including the National Children’s Hospital, the National Maternity Hospital, and elective hospitals, although no further details are given on these specific projects, all of which are significantly behind their respective anticipated schedules.

However, some of the health-relevant measures were contained in other areas of the Budget. Among the most obvious of these were the increase in excise duty on a packet of cigarettes by €1 and the proposal to tax e-cigarettes from the middle of 2025. These measures will hopefully help to reduce the number of people smoking and/or vaping, thereby reducing future smoking-related health needs.

Additional supports for carers will be welcomed, while the extension of the hot school meal programme to all primary schools will help children with nutritional challenges, which could further reduce long-term health issues.

Overall, there were some positives to take from Budget 2025 from the point of view of the health services, although these are incremental rather than transformative.