Health funding row one of many big political challenges on horizon

October has been a gloomy and ghastly month. The Middle East has erupted into horror with thousands of dead in Israel and Gaza. We have had Biblical rain that has swept across the south of the country for days leaving devastating floods in its wake.

The Russia-Ukrainian War will continue into its third calendar year with no sign of abatement. And the lingering news line about what was meant to be a feel good budget has been a damaging public row between the HSE and the Department of Health over allegedly “inadequate” budgets.

It is set to be a busy – and possibly difficult – day in Leinster House today as the Dáil grapples with a number of big issues, including a Sinn Féin motion on the funding of the health service.

The biggest focus at Cabinet this morning will be decisions the Government is set to make to deal with the substantial damage caused by the floods in Midleton, and other towns and villages in east Cork last week. With heavy overnight rain last night, there is even a possibility the extent of the damage will worsen .

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There will be a lot of attention at the health committee from 10am, where two political heavyweights, Robert Watt, secretary general of the Department of Health, and HSE chief executive Bernard Gloster will discuss the tangled question of health financing.

The background is well known. Within hours of Budget 2024 being published, Sinn Féin were accusing Minister for Finance Michael McGrath and Minister for Public Expenditure Paschal Donohoe of throwing Minister for Health Stephen Donnelly “under a bus” by providing significantly less than Donnelly had requested.

Given the scale of its current needs, the health provision on the day seemed modest indeed. Then there was a dramatic comment from Gloster who simply said the provision was inadequate. He has since repeatedly said the HSE will not have enough money next year to provide the current level of health services due to the costs associated with inflation and additional demand.

That is in addition to an estimated €1.5 billion overspend this year, which will require a supplementary estimate.

As Pat Leahy and Paul Cullen report this morning, Watt will tell TDs that savings and efficiencies will be required to control health spending. That will include restrictions on recruitment, overtime and the use of agency workers.

In his opening statement Watt will also say “major gains in output and productivity” will be required. Watt will also describe continuing increases in the costs of medicines as “not sustainable”.

If that were not enough, Sinn Féin has tabled a motion in the Dáil for debate this evening, which arises from that row over funding.

Flooding

The gravity of the flooding in east Cork has stunned the members of Cabinet. Eight of the 15 Ministers, including the Taoiseach Leo Varadkar and Tánaiste Micheál Martin, have visited Midleton and some of the other worst affected towns and villages such as Killagh, Cloyne, Silverbridge, Inch and Megooly.

A senior Minister texted me yesterday to say: “I don’t believe anyone has an estimate of the overall bill yet but it will be very substantial”.

Two local TDs, James O’Connor of Fianna Fáil and Fine Gael’s David Stanton, reckon a total of 600 houses and business premises have been badly damaged by the flood. O’Connor said the total cost could run to over €100 million.

The Government quickly came to the realisation that the existing compensation schemes would not meet the needs of those impacted. On Sunday it emerged that Minister for Enterprise Simon Coveney was going to propose to Cabinet a greatly increased level of compensation for businesses. As one source said on Sunday, the thinking was that the maximum available in assessed damages would rise from €20,000 to “in excess of €70,000″. When I asked if €100,000 was possible, that was described as too high. That was Sunday.

But 24-hours is a long time in politics and as Jack Horgan-Jones reports the compensation figure could now reach €100,000.

Jack also reports that Microfinance Ireland will also be asked to provide low-cost loans of up to €25,000 for businesses affected to allow them restock or to assist with cash flow.

Compensation and aid will also come from other Ministers including Heather Humphreys in Social Protection and Minister for State for Sport Thomas Byrne who has suggested once-off payments for sports clubs whose facilities have been damaged.

Best Reads

Jack Horgan-Jones has been at the forefront following another major policy development, namely a change in the treatment of Ukrainian refugees over the medium-term.

Jack reports that officials have been quietly working on what could be the most widespread overhaul of the State’s system for receiving those fleeing the war in Ukraine since Russia’s invasion in February 2022.

“While the plan does not yet have political sign-off, Coalition leaders were said to be discussing changes to the system on Monday evening, with a chance proposals could go to Cabinet today.

“If they mirror proposals circulated earlier this month, they would go significantly beyond previous efforts to tighten up the conditions being offered to those fleeing the war – known as beneficiaries of temporary protection (BoTP).”

At present, those arriving from Ukraine are provided with accommodation on an indefinite basis. But the numbers who have arrived – 74,000 or so now being accommodated by the State – have overwhelmed the system and placed large burdens on Roderic O’Gorman’s Department of Integration to deliver places.

New arrivals these days are given emergency accommodation, mostly hotels and guest houses, but occasionally suboptimal choices such as repurposed offices, or, in extremis, tents.

The most controversial proposal being floated – which Jack reported last week – was that from now on accommodation might be offered on a time-limited basis.

The central argument was that current arrangements were ad hoc and prohibitively costly on the State, and were “unsustainable and unsuitable”.

In a fascinating and learned column, Fintan O’Toole traces the idea that Ireland is “weirdly entwined” with the concept of a Jewish homeland in Palestine.

“Israel and Palestine are now used as proxies for our own tribes,” he writes. “The game seems easy: the Palestinians are the Catholic Irish; the Israelis are the Protestant settlers. If you don’t know this already, the flags and murals on the Falls and Shankill roads will identify the tribal affiliations for you.”

Mark Hennessy has an interesting story from the British-Irish parliamentary meeting in Co Kildare yesterday. Northern Ireland Minister Steve Baker argued that any All-Ireland referendum (as provided for under the Belfast Agreement) should require a “super majority” North and South to agree a United Ireland. At present, it is a simple majority.

Arguing against himself to a degree, Baker used the example of the Brexit referendum to explain why a super majority might be desirable. Baker, of course, was a leading figure behind the Leave campaign.

“Would anyone here seriously want a 50 per cent plus one united Ireland result in Northern Ireland? I speak personally,” he told the meeting.

“I deliberately say it like that because some of you I know would (want a 50+1 result). But just reflect on the trouble we had from running a 50 per cent plus one referendum in the United Kingdom.”

Playbook

The Cabinet meets this morning. Taoiseach Leo Varadkar will travel to a meeting of the European Council in Brussels later in the week.

Dáil

2pm: Leaders’ Questions

3.55pm: Finance (No. 2) Bill 2023 – Second Stage, Department of Finance.

7.37pm: Private Members’ Business. Sinn Féin Motion on Funding of the Health Service for 2024

9.39pm: Parliamentary Questions to Minister for Social Protection Heather Humphreys

11.57pm: Dáil adjourns

Seanad

1pm: Commencement Matters

3.30pm: Screening of Third Country Transactions Bill 2022 – Committee and Remaining Stages.

5pm: An Garda Síochána (Recording Devices) Bill 2022 – Committee Stage

Committees

10am: Health. The funding of health services in 2024 and the implications for health services and for the recruitment of personnel. Robert Watt, secretary general of the Department of Health and HSE CEO Bernard Gloster.

3pm: Housing and Local Government. Consideration of the Citizens’ Assembly report on the Directly Elected Mayor of Dublin (resumed)

4pm: Justice. Engagement on Policing Matters with the GRA, AGSI, and Restaurants Association of Ireland.

7pm: Finance. Discussion on APP (authorised push payments) Fraud with Meta, Amazon and Google.