Despite this week’s ‘no-risk Budget’, our health service faces greater threat of cut
From the Irish Independent on 16 October 2015
Government spin doctors must be thrilled with themselves as they listen to the chorus of Budget 2016 being declared as ‘a Budget for everyone’. Even the usually cynical and numerate economic analysts heralded it as ‘a no-risk Budget’.But closer scrutiny of the health budget clearly shows this is not a Budget for everyone and there are huge risks for many citizens due to the choices made.
On Tuesday, Public Expenditure Minister Brendan Howlin said: “I am providing €13.2bn for the delivery of health services next year. I am happy to say, this restores the resourcing of our health services to its pre-crisis level.”
No matter which figures one uses, Mr Howlin is wrong. Health Minister Leo Varadkar admitted at the health press briefing after the Budget that Irish health spending levels are still below pre-crisis levels by at least €1bn.
The Department of Health press release stated the increase was “almost €900m more in 2016 compared to the 2015 Budget”. Yet in his Budget speech a year ago, Mr Howlin said “this Government will provide €13.1bn for the delivery of health services in 2015”. It was not unreasonable to assume that €100m more was being allocated to health next year. When questioned on this at Tuesday’s health press briefing, the minister and his official spouted mumbo jumbo.
In plain English, because responsibility for the health budget was transferred from the HSE to the Department of Health in January 2015, for accountancy purposes some parts of the HSE budget, such as income from hospital charges or private health insurance, (totalling approximately €1bn), were excluded from the health budget figure for 2015.
This ‘actuarial wizardry’ – as one health hack aptly said on Tuesday – meant the 2015 health allocation was €12.3bn in 2015. Next year’s will be €13.2bn, hence the €900m more claim.
Take a step back from these confusing figures. The only thing that really matters is whether the health services have enough to deliver quality, timely care to those who need it in 2016. We know that €600m of the additional €900m is to match the supplementary health budget for the same amount that will be allocated to health by year end.
The €600m will be spent meeting the increased use of services, as well as new money announced throughout the year to deal with the crisis in Emergency Departments – including the Nursing Home Support Scheme, more home care packages, more staff and beds; the waiting list initiative; free GP care for under sixes and over seventies.
It will also pay for extra staff appointed this year, the inevitable increase in drug costs, and €100m pay restoration promised to health service staff under the Lansdowne Road Agreement.
Yet, it is not clear where the inevitable €200m-plus required just to meet the natural increased pressure on the health services brought about by our growing, ageing population will come from. In fact, Budget 2016 provided no clear figures on anything.
Another headline figure was the €280m extra for ‘new measures’. These included free GP care for six to 11-year-olds; the expansion of therapies for children – especially for children with disabilities; the perennial €35m for mental health (which often does not materialise), as well as additional funding for maternity and ambulance services.
However, there was no breakdown given for these either, and only when the HSE service plan is published will the figures be available.
The health press statement also announced that €125m is to be saved next year in drug costs, procurement and prescribing, yet annually we get this mythical promise of hundreds of millions of euros of savings that rarely ever materialise. Instead of the more transparent government we were promised as part of the ‘democratic revolution’, the budgetary process becomes more farcical, with less detail and clarity provided year-on-year.
Speaking on ‘Morning Ireland’ yesterday, Mr Varadkar admitted all this extra money would allow the health system to largely provide “existing levels of service with some improvements or enhancements”.
The big game-changer in the year ahead is new European fiscal rules which mean the Government will not have its default position of mopping up the health overspend with a supplementary budget. Any overspend in health can only be dealt with by ‘savings’ from elsewhere, cutting back on essential care, or raising more money through increased taxation.
This Government has no intention of raising taxes – we have just had a tax-cutting Budget – this means the health system is more at risk than any year since the crisis began of having to cut services.
A poll three weeks ago asked people what one thing they would like to see the Government spend the promised €1.5bn on in the Budget.
The number one choice was investing money in the health services, way ahead of all other areas, including cutting taxes.
But the Government quite clearly doesn’t care what people think, it thinks it knows better. There is, after all, an election in the offing.