Health dominated budgets during the pandemic but now that the threat from Covid has receded, so has its prominence in economic thinking.
The sector wasn’t mentioned at all during Minister for Finance Paschal Donohoe’s Budget 2023 speech, and merited just a few paragraphs in the contribution that followed from Minister for Public Expenditure Michael McGrath.
The money keeps flowing, however, for the health service, which responded gamely in a time of crisis but shows little sign of being able to reform itself or properly tackle chronic problems around access.
Mr McGrath announced an extra €1.15 billion for health next year, which is just as well as the HSE is running a deficit for this year of about €1 billion. The bogey that is Covid is still around, so €439 million is being provided to ensure there are enough plastic gowns, free PCR tests and jabs in the arms to keep it at bay. At this stage, there is no knowing if this will be enough.
The surprise announcement that 430,000 extra people will be offered free GP care has enraged doctors. There is something Donough O’Malley-esque about announcing such a sweeping measure without any prior consultation.
The GP population is ageing. One in seven are aged 65 or over and will have to retire in less than five years. One in four are 60 or over.
The number of doctors training to be GPs has been progressively increased in recent years, from 153 in 2015 to 258 this year, but it will take time before the extra numbers impact on the overall stock of GPs. That hasn’t stopped the Government ploughing ahead with this vote-catcher now.
GPs argue they are already overloaded; most are unable to take on new patients, public or private. If patients start attending more often because services are free, care will have to be rationed and waiting lists will form. As many patients know, they already have.
Doctors were equally unhappy when free GP care for under-6s was introduced in 2015, yet the sky failed to fall in. The Government will be hoping any further incremental deterioration in service will be ameliorated by a rise in GPs qualifying from training schemes over the coming years.
Despite the vast sums that will be spent next year, we are no nearer to a solution to the waiting list crisis. Worse, the Government is slavishly committed to an approach that is doomed to fail.
Look at the extent of progress so far. This year, €350 million has been allocated to tackle long waiting lists. Yet 79,000 people are waiting for a hospital procedure at present, up from 70,000 at the time of the last budget. There are currently 629,000 people waiting for an appointment with a consultant, up from 567,000 when the last set of budget promises was being made.
Efforts to deal with emergency department overcrowding have made as little progress. On budget day last year, there were 506 patients on trolleys in hospitals across the State; this Tuesday, that number was 508.
No management team in the private sector would survive a set of performance figures like this. But instead of ripping up the script and coming up with new ideas, the Government now plans to spend even more on the same waiting list initiatives next year than it has in 2022.
The €443 million it intends to spend includes €240 million funnelled through the National Treatment Purchase Fund. Rather than investing long-term in the capacity of a reformed public health service, the NTPF spends much of its money on short-term digouts from the private sector.
There is nothing wrong with using the private health sector if it works. But previous experience showed that any improvement achieved was short-lived; it disappeared once the financial stimulus was removed. This time around, there isn’t even an improvement in the inpatient and outpatient figures to talk about.
Those doctors who are worried about the ability of the system to process the Government’s expansion plans can take comfort from the fact that so few of last year’s budget proposals were implemented.
In 2021, the Government promised an additional 8,000 staff but the HSE has been unable to recruit them fast enough – an additional 5,500 staff is seen as a more likely outturn for this year.
It also promised to extend free GP care to children aged six and seven, but this is still under negotiation with the Irish Medical Organisation.
It promised free contraception for women aged 17 to 25, which became a reality only in the last two weeks.
What if we wake up in a few years’ time, when the corporation tax windfall has run out, and realise the one chance we had to reform the health service had been squandered?