HSE warns it could need additional €2bn due to gaps in support and external risks

The HSE has warned it could need more than €2 billion in additional funding above its official allocation this year due to gaps in support and external risks such as inflation and the Ukraine war.

Record health service funding of €21.124 billion has been announced in the 2023 HSE national service plan, published on Wednesday.

This is 5.7 per cent higher than last year’s starting budget, though most of the additional money is needed to fund higher costs of providing existing levels of service. The plan includes €240.2 million to invest in new service developments.

HSE chief executive officer Bernard Gloster said this year’s allocation will be used to improve access to community and hospital services and to reduce waiting times, waiting lists and emergency department congestion.

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But he also warned of unprecedented levels of uncertainty arising from the Ukraine war, inflation, labour market issues and “ever-changing demands” on the health system, which he said make planning difficult.

“I expect that there will be very significant pressure on our available 2023 existing level of services funding and Covid-19 funding,” due to these uncertainties, he added.

The plan makes clear that the HSE and Department of Health are at odds over the extent of the financial issues it faces this year. It sets out a range of issues and risks the HSE feels could lead to a need for greater funding, which cumulatively amount to about 10 per cent of its allocation, some €2.2 billion.

This includes a 3.3 per cent shortfall in funding for core operations, though the plan notes the department’s view that “this overstates the level” of the financial issue.

“Both organisations are fully aligned on the need for any mitigation measures to ensure service capacity and therefore activity volumes and access times, for patients and services users, are not adversely impacted.”

The HSE has flagged a separate financial risk of about 3.3 per cent rising from costs related to the Haddington Road Agreement public pay deal, non-pay inflation, home support, pay costs and private income.

Separate once-off funding of €565 million is being provided for Covid-19 measures, but the HSE estimates the financial risk here at 2.7 per cent of total revenue.

Due to these risks “it is not practical to provide the usual level of assurance around the extent and overall affordability of likely 2023 activity, particularly in respect of acute hospital services, disability services and, older persons’ services”.

The plan includes an additional €14 million for mental health and €25 million for disability and proposes expanding the HSE workforce by a net 6,000.

Just 184 additional hospital beds will be provided, along with a further 26 critical care beds.

Minister for Health Stephen Donnelly said the “unprecedented” investment contained in the plan will support and help increase capacity and staffing levels, as well as advancing the goals of the Sláintecare healthcare reform plan.

“This ongoing reform will ensure the provision of a public health service which provides people with access to high-quality, affordable care when they need it,” he added.