Five weeks into 2024 and Donnelly STILL hasn’t signed off health budget
HSE spending plan has been sitting on minister’s desk for a month
HEALTH Minister Stephen Donnelly has still not signed off on the budget to operate the health service this year, despite receiving the HSE spending plan more than a month ago, the Irish Mail on Sunday has learned.
The revelation comes amid renewed tensions between the Department of Health and the HSE over perennial overspending.
This week, Mr Donnelly’s most senior civil servant, Department of Health secretary-general Robert Watt, told the Public Accounts Committee that the HSE must make changes to get its spending under control.
It follows last year’s debacle of the Health Service Plan (HSP) for 2023 being unveiled in March and – as revealed in the MoS – hiding a predicted €2bn shortfall.
This deficit would ultimately result in an extraordinary preBudget showdown between Mr Donnelly and Public Expenditure Minister Paschal Donohoe, who refused to sanction his cabinet colleague’s request for a €2bn increase in health spending.
Mr Donnelly was allocated only an extra €700m, and the shortfall forced the HSE to introduce an immediate recruitment freeze for staff including hospital doctors and healthcare assistants.
The head of the country’s A&E consultants’ association, Prof Conor Deasy, recently told the MoS the recruitment freeze was exacerbating overcrowding in emergency departments and contributing to preventable deaths.
As we enter the year’s second month, the Department of Health confirmed the minister has still not signed off 2024’s service plan.
A senior HSE source said the ‘final draft’ of the NSP ‘went to the Department of Health weeks ago’.
They told the MoS: ‘The HSE is now waiting for the department to sign off on it. The department could, of course, come back with a suggestion [for changes] but it is very important to have certainty as early in the new year as you can. As far as the HSE is concerned, the NSP 2024 is done.’
Mr Donnelly yesterday said negotiations between the department and the HSE are finished. The minister told the MoS: ‘They are concluded at this point. The revised NSP has been through the HSE board. I am finishing off a memo to the Government on it at the moment.’
Mr Donnelly added: ‘It’s a solid plan. It focuses on the ongoing increases in capacity and rollout of services while putting a very clear focus on the need for ongoing reforms, particularly increased productivity.’
The NSP outlines budgets and spending in the health system for the year ahead.
Last June, the MoS revealed how a senior HSE board member resigned after serious concerns he raised about a €2bn shortfall in the 2023 service plan were ignored.
Although the HSE approved last year’s NSP in November 2022, its publication was delayed because senior Department of Health officials did not want the €2bn deficit to be specifically mentioned in the document.
After a four-month delay, the plan was eventually published last March without explicitly outlining the extent of the shortfall.
Documents later obtained by the MoS under the Freedom of Information Act revealed the chair of the HSE board, Ciarán Devane, insisted his colleagues sign off on the plan despite knowing the figures did not add up.
In an email to fellow board members, Mr Devane stated: ‘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.’
In the wake of the pre-Budget stand-off between Mr Donnelly and Mr Donohoe, HSE chief executive Bernard Gloster said more money was needed to run the health service. He also said any deficit from 2023 would be carried into the following year.
After protracted negotiations between the Department of Health and the Department of Public Expenditure, the HSE received a top-up of another €260m last December.
But this still left the State health agency with a significant deficit.
Under recent amendments to the 2004 Health Act, it is illegal for the HSE not to stay within its budget allocation.
The legislation was amended after the transfer of responsibility for disability matters from the Department of Health to Minister Roderic O’Gorman’s multi-faceted Department of Children, Equality, Disability, Integration and Youth.
A source told the MoS: ‘Under the changes, the HSE is told during the budget process in the autumn what it is getting. This is called “the determination”, and it is the job of the HSE to send back a plan consistent with this as a maximum number. That is the law. So the question now is, what can be done so they meet their legal obligations?’
A HSE spokeswoman declined to reveal by how much the HSE expects to overspend this year.
Asked about the projected deficit and the HSE’s legal obligations to remain within its net non-capital allocation, she would only say: ‘The
‘We will not be close to hitting the money’
‘The plan was submitted on December 20’
HSE adheres to the legislative requirements and legal obligations regarding the NSP.’
A spokesman for the department confirmed that the HSE submitted the NSP last month.
‘The National Service Plan (NSP) 2024 was formally submitted by the Health Service Executive (HSE) on December 20, 2023,’ the spokesman said.
‘Engagements are ongoing between the Department of Health, the Department of Children, Equality, Disability, Integration and Youth and the HSE with a view to approving the plan.
‘Following its approval, the NSP will be published after it has been laid before the Houses of the Oireachtas,’ the spokesman added.