Donohoe tells Harris he must table clear cost-control plan for HSE

The Health Service Executive has told the Government that “difficult decisions” will need to be taken if its financial deficit – which had reached nearly €170 million by the end of May – is to be reduced.

The Irish Times also understands that Minister for Public Expenditure Paschal Donohoe told Minister for Health Simon Harris in a letter last month that there was a clear onus on him and his officials "to bring forward a clear cost containment and risk mitigation plan for managing expenditure" within the approved levels.

However, it is understood that Mr Harris in reply said that while he was concerned about the budget overrun, he would not preside over reductions in the level of services to the public that were set out in the HSE’s official service plan for the year.

Meanwhile, as nurses strongly criticised the employment restrictions already put in place by the HSE as a means of controlling costs, and demanded that they be removed, official documents show that Mr Donohoe's department was deeply concerned that existing measures were having insufficient effect on spending.

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It maintained that by May the HSE had exceeded the number of additional staff it was to take on for the whole of 2019. It also raised concerns over the “credibility” of savings which the HSE has said will be realised this year.

Recruitment restrictions

The Irish Nurses and Midwives Organisation (INMO) has said it wants the HSE to scale back services and close many non-essential wards until staffing numbers reach a safe level. The union said there were now 1,317 funded nursing and midwifery posts vacant in the State's acute hospitals due to the HSE's recruitment restrictions.

The INMO said midwifery staffing levels are being hit hardest with one in six staff midwife posts now vacant.

However, official minutes of the cross-governmental budgetary oversight group for the health service show that the Department of Public Expenditure maintained that despite controversial employment restrictions being put in place, the scale of recruitment in the health service this year was greater than in 2018.

The Irish Times understands that Mr Donohoe told Mr Harris in the letter of July 5th that he wanted to see “a realistic set of measures” outlining how spending pressures could be contained and proactively managed. This was in order to avoid or minimise a supplementary estimate being needed for the health service and prevent a repeat of last year when a bailout of about €600 million was provided.

The minutes of the budgetary oversight group state that the Department of Public Expenditure was clear that there was no approval for a budget overrun and that costs needed to be contained.

According to the minutes, the HSE told the meeting in early July that “difficult decisions would need to be taken to reduce any potential overrun” and that spending in the primary care reimbursement service was “one of the areas driving the significant financial challenge”.

“There has been 30 new drugs introduced to date in 2019. The €10 million on new drugs for 2019 now has been exhausted,” the minutes state.

The Irish Times reported in July that HSE chief executive Paul Reid had told his board that his target was to confine financial deficits in the acute hospital and disability sectors to less than €100 million this year. He also said that in June the HSE had 1,030 more staff than officially permitted.