New HSE spending restrictions to affect elderly and disabled

Additional restrictions on spending for older people, those with disabilities and patients in acute hospitals are being put in place, with newly-released documents showing the Health Service Executive’s financial deficit reached nearly €170 million to the end of May.

Official minutes of a cross-governmental oversight group on health spending show senior officials believed additional measures would be needed to rein in expenditure, and that there were “serious concerns” over staffing increases in the health service.

It comes as the Department of Health increased the pressure on the HSE to keep spending on staff under control. In a statement on Monday night to The Irish Times, the department said the health service was "currently operating with unaffordable staffing levels, and this is contributing to the [spending] overrun".

The HSE was operating a financial deficit of almost €170 million at the end of May, up from €116 million at the end of April.

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Minutes of the May meeting of the budgetary oversight group on health spending show that during a discussion on cost-saving measures in late May, “it was acknowledged that further actions are required in particular with respect to primary care reimbursement service, disabilities, older persons and acute hospitals in order to break even”.

The minutes say officials from the Department of Public Expenditure and Reform "highlighted the importance of having clarity on the full level of necessary savings and that these savings need to be realistic and credible".

Achieving financial break even in the health service is a key goal of HSE director general Paul Reid, who told senior managers shortly after his appointment that breaching budgets “can no longer be considered an option”.

The Opposition said the documents showed the Government planned to “control spending by making cuts to essential services”.

Sinn Féin finance spokesman Pease Doherty said the documents showed that "saving measures include the 'low-hanging fruit' of disability and older-person services, such as the training allowance for school-leavers with disabilities that is due to be axed in September".

Many parts of the healthcare system are already under financial pressure. Official figures show that there is a deficit of about €20 million in the disability sector, with many organisations in receipt of public funding already cutting back due to budgetary pressures.

For example, Stewarts Care, which assists about 1,000 people with intellectual disabilities, ran a €6.2 million unauthorised deficit last year. The service has told trade unions it will curtail non-pay expenditure and operate only a “safe service”, without add-ons such as outings and activities for service users.

Similarly, the HSE had targeted home-help hours for extra spending controls as part of efforts to manage shortfalls in the health budget this year.

Mr Doherty called on the Government to release lengthy reports which outline exactly what saving measures are under consideration. He had requested this information under freedom-of-information legislation but it was rejected, a decision the Donegal TD said he would appeal.

Staffing increases

The minutes also show that officials from the Department of Public Expenditure and Reform advised the budget oversight group “that it is very concerned with the level of staffing increases”, pointing out that the level of recruitment into the health service was greater in the first four months of the year than in 2018, despite control measures being introduced in February. Responding to the concerns, the HSE said it would examine what growth in recruitment had taken place without authorisation.

A spokeswoman for the Department of Health pointed out that the Summer Economic Statement “recognised that health spending was a significant risk to the exchequer finances, and it is necessary for everyone to work together to mitigate the deficit to the greatest degree possible. Patient safety will remain paramount in all decisions.”

The spokeswoman said there had been a modest reduction in staffing levels in June compared with May, which was anticipated to continue and “allow the HSE to bring its staffing levels back towards funded level”.

However, there is pressure for professional bodies to increase staffing further, with the Irish Hospital Consultants Association on Tuesday releasing figures claiming the National Critical Care Programme has less than half the intensive care consultants required, with only 35 of 82 posts filled.