Health Minister knew2023 of €2bn hole in budget when he approved plan
Board members were uneasy over being ‘railroaded’ into agreeing to a plan they knew was unfeasible
HEALTH Minister Stephen Donnelly and the HSE board approved the long-overdue plan to run the health system this year despite knowing the figures were up to €2bn short of what was required, correspondence reveals.
The massive shortfall in the 2023 National Service Plan was first revealed by the Irish Mail on Sunday earlier this summer.
The health plan was published only in March – four months after a draft version was initially approved by HSE board members.
Many members were concerned about the scale of the deficit and lack of transparency in the plan, which delayed its publication.
Concerns were voiced by HSE board members at a meeting in February, which was attended by Mr Donnelly and his department secretary-general, Robert Watt.
Now it has emerged that HSE board members were not given the opportunity to discuss their concerns at a meeting just before the report was published.
Instead, chairman Ciarán Devane wrote to fellow board members insisting they agree to the HSE’s €21.7bn plan, despite knowing the figures did not add up.
In an email to board members, Mr Devane said: ‘We are all agreed that the plan has an intrinsic and serious issue in that if we do everything in the plan we will not be close to hitting the money and if we hit the money we will not be close to delivering the plan.’
Mr Devane told the board that Mr Donnelly ‘is aware of the certainty of exceeding the financial plan and of the risks which mean this could be by a large sum’.
He added: ‘Bernard [Gloster, HSE chief executive] and I will be meeting him tomorrow and will strongly reinforce this point. The proposal is that we approve this latest draft by email. As a number of colleagues noted, further delays does not help the system. This will allow the minister to table it at Cabinet next week and for it to then be released.’
Sources said some board members were extremely uneasy about being effectively ‘railroaded’ into signing off on the plan.
One source told the MoS: ‘This shows that the National Service
Plan was a piece of fiction.
‘It was approved and launched when everyone in the Department of Health and the HSE knew it was not feasible. HSE board members were asked to approve an unrealistic plan by email. Even though a meeting was held in early March, people still wanted a meeting to finalise it. But no meeting was held to finally approve the document despite huge reservations expressed by a number of board members.’
The National Service Plan was initially approved by the HSE last November. But its publication was delayed because senior Department of Health figures did not want the €2bn deficit to be specifically mentioned in the plan.
It was launched in March, days after HSE board chair was asked if Minister Donnelly knew about a potential €2bn deficit.
Concerns over attempts to hide the shortfall led to the resignation of board member Brendan Lenihan, who also chaired the HSE’s Audit and Risk Committee.
In his resignation letter, Mr Lenihan warned the Minister that the service plan would ‘almost certainly give rise to surprise, anger, frustration and a loss of confidence’ in the HSE.
The deficit also sparked a series of further resignations, including three other key personnel from the Audit and Risk Committee. In each case, the departing board members opted to step aside rather than complete their full terms.
Two qualified accountants who served on the committee, Ann Markey and Martin Pitt, stepped down in March. A fourth member of the committee, retired Defence Forces risk manager Colm Campbell, stepped aside three months later.
As a result, the Audit and Risk Committee was left without any qualified accountants to oversee the HSE’s finances for months. In response to queries from the MoS this weekend, the HSE was still unable to provide a figure for the estimated shortfall for 2023 as we enter the final quarter of the year. The health authority also confirmed none if its current 12 board members is a qualified accountants. A spokesman said: ‘We have been working with our services to ensure core financial management controls are operating effectively and to secure greater efficiencies in the use of the resources available to us.
‘For the 2023 plan the HSE outlined
‘The National Service Plan was a piece of fiction’
‘Surprise, anger and loss of confidence in the HSE’
risks which if materialised would result in a potential financial pressure. The cumulative maximum risk assessed was in the order of €2.2bn.
‘We expect the year end position to be better than the aforementioned €2.2bn, even though our services are performing at a very high level, reducing waiting times for outpatients and procedures and improving on the experience of people in Emergency Departments.
‘We will be preparing an estimate of the year end position at the end of Quarter 3 [September].’
A spokesman for Mr Donnelly did not directly respond to queries asking why he approved the 2023 National Service Plan when the chair of the HSE board had a ‘serious issue’ with the deficit.
The spokesman said: ‘The National Service Plan (NSP) for any given year is only prepared after the budget for that year has been announced.
‘Once the budget is complete the Minister for Health issues a letter of determination (LoD) to the HSE outlining the level of funding that is being provided.
‘It is following the issuing of the LoD that detailed planning is undertaken to
prepare the NSP.’