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Hospitals are getting more money but why is this not resulting in more activity?

Productivity report likely to lead to calls for reforms but health chiefs advise against finger-pointing

Minister for Health Stephen Donnelly: While highlighting productivity with healthcare chiefs, he has been fighting with the Department of Public Expenditure over why the health service needs more money. Photograph: Brendan Gleeson

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Martin Wall
Mon Apr 15 2024 - 05:00

Minister for Health Stephen Donnelly last November told Health Service Executive chairman Ciarán Devane about visiting one hospital where local doctors had been campaigning for greater investment in the face of rising admissions and emergency department attendances.

Donnelly, who is known for liking to get stuck into the underlying data regarding an issue, pointed out the hospital concerned had seen bed numbers rise by 17 per cent since 2016 while consultant staffing had increased by more than 50 per cent and funding by more than 60 per cent.

The Minister observed that preliminary data, at the same time, indicated that composite or weighted activity at the hospital had increased by less than 7 per cent. He said the figures suggested that the number of outpatient appointments per consultant had actually fallen from 1,353 in 2016 to 894 in 2022.

Donnelly said that given the doctors at the hospital were dedicated and motivated, there was a need to understand what was driving this trend.

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It is understood that the Minister has raised similar concerns on visits to other hospitals. Why were activity levels not keeping pace when the overall health budget had increased from €13.7 billon in 2014 to €22.8 billion in 2024 and more than 50,000 additional healthcare staff had been employed?

The Minister asked officials in the Irish Government Economic Evaluation Service (IGEES) to produce a comprehensive report.

At the same time as Donnelly was highlighting productivity issues with healthcare chiefs, he was fighting with the Department of Public Expenditure over why the health service needed so much additional money.

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It is no secret that strong disagreements over spending overruns in the health service continued almost up to budget day in October and that ultimately the health service received about €1.3 billion less than Donnelly had sought.

The HSE has signalled that it will likely need another supplementary estimate this year.

In January, Donnelly established a taskforce to look at generating savings and boosting productivity.

The first action plan drawn up by this group will be released on Monday as will the IGEES report.

The findings of the evaluation service report suggests that the problem of activity not rising at the same scale as investment was not only occurring at the hospital identified by Donnelly to the HSE chair last November. It was happening virtually everywhere.

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“Our analysis shows the large divergence present in all sites between the expenditure and workforce provided, relative to the growth in either separate activity metrics or ‘composite’ activity.“ The latter is an aggregate of activity in inpatient, day-case, outpatient and emergency departments, weighted by unit costs for each area.

“In most cases, the divergence is significant, with the percentage growth in composite activity between 2016 and 2022 either negative, or two times behind workforce growth, and up to three times behind real expenditure growth over the same period.”

In the foreword to the report, the head of the HSE, Bernard Gloster, and the secretary general of the Department of Health suggest that its findings should not give rise to finger-pointing but rather to the encouragement of improvement.

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Coincidentally or otherwise, the HSE on Monday released data to show that more healthcare than ever was provided to patients across the country last year. It said both the volume of its scheduled care waiting list and the time people were waiting had reduced.

However, the demand for care will continue to rise as the population both grows and ages.

And while infrastructure or technological deficits may play some role in the figures set out in the IGEES report, across Government there are likely to be calls for productivity issues to be addressed. The taskforce on Monday will recommend several reforms. But whether they receive full support from management and staff across the system remains to be seen. As does whether the proposed €500 million in non-pay savings will be realised and the effect this may have on the negotiations for the health budget for next year.

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