Elaine Loughlin: Despite a record €22bn set aside in budget, there is no money for health

It was a threatened motion of no-confidence in his predecessor Simon Harris that precipitated a general election back in 2020, and now Donnelly at the helm of health must feel like he is looking into the abyss.

With strike action by Section 39 workers looming next week; an inevitable trolley crisis later this year; staffing shortages across all sectors, and increased demand for services, Donnelly has another problem — he simply has no money.

Despite a record €22.5bn set aside for health next year, Donnelly’s has no funds for new drugs, no increase in the amount of money for new services in mental health, and no mention of the €20m needed to deliver the National Cancer Strategy in 2024.

“Disappointed,” is how Minister of State for Mental Health and Older People Mary Butler explained the lack of an allocation for any new adult ADHD services next year.

Her honesty was disarming and refreshing, but shows how persistent overspending has put her in the unenviable position of having to decide which groups of patients — all of them vulnerable — are most deserving of treatment and support.

“We have turned the focus now on youth mental health. Obviously, you always need more money, I would have liked to have secured more supports to continue the roll-out of the clinical programmes that we’re doing in relation to eating disorders, in relation to mental health intellectual disability, in relation to ADHD, in relation to self-harm, and suicidal ideation, but with what was available to me I decided to target the 75 Camhs teams we have the length and breadth of the country,” she said.

In the Dáil, Sinn Féin spokesman on mental health Mark Ward said the minister’s disappointment will provide “cold comfort” to those who need services.

He is right, it means nothing to more than 100,000 children currently on waiting lists of some sort, neither does it mean anything to the 460 patients who found themselves lying on hospital trolleys yesterday morning.

But at least Butler acknowledged her disappointment, a feeling which for many patients has turned to frustration, fury, and hopelessness.

Her admission is also at odds with many of her senior collogues, including Donnelly and Tánaiste Micheál Martin, who this week continued to point to record spending in health. Donnelly told reporters:

Healthcare has been heavily prioritised in the last three budgets, in this Government, there has been an 18% increase in core funding

Across the health service the money, while on a scale never seen before, is so tight that we are now in the midst of recruitment freezes and eyewatering overruns, and that’s before we even get into next year.

HSE head Bernard Gloster has warned that around €2.5bn extra will be required to maintain an existing level of services next year, almost three times more than what has been provided in Budget 2024.

Of the €800m additional allocation for core spending in health announced this week, just €100m will be available for new services or measures.

While Donnelly will point to the 22,000 extra staff and additional beds brought on since this coalition took office, those figures mean nothing on the ground where the number of midwives has decreased by 6% in the lifetime of this Government.

Neither does it take into account the 20% nursing vacancy rate at University Hospital Limerick or the 400 nursing posts currently not filled across our emergency departments alone.

With a €1.1bn overspend projected this year, a hiring freeze was yesterday extended to include home help workers, junior doctors, health care assistants, and extra agency staff.

So acute is the overspend in our health services that we have gone beyond the so-called pen-pushers and cost savings are now being sought from among the ranks of frontline workers, just as those hospital and community staff go onto the busy winter period.

The Irish Nurses and Midwives Organisation (INMO) said the recruitment freeze will send the healthcare service further into freefall and will have a direct impact on the ability of nurses, who fall outside the recruitment embargo, to deliver safe levels of care.

How have we got to the point where our health service, creaking at the seams with almost 700,000 people waiting on first-time appointments, needs €22.5bn just to stand still?

At a post-budget press briefing, Donnelly tried to explain. He put some of the increase in demand for health services, which also means extra spending, down to a “post-covid surge”.

But he admitted that there are areas where “productivity gains” can be made. In other words, the HSE is not spending the billions of euro it receives each year in a cost-effective manner.

“What I want to see is a systematic review, it’s mainly in the acute sector, the mental health services, the community service, and the social inclusion services, they’re not over.”

He added: “So in terms of productivity, we are looking at things like agency, over-time... generics, biosimilars, the big spending areas — can we gain more for example, through centralisation and procurement? We’re going to systematically through this to identify what can be done.”

Pressed on why these productivity measures have not been seriously looked at before now, Donnelly returned to the old chestnut: “We were not thinking about productivity while we were in the throes of a pandemic, but now that covid has receded we are most definitely thinking about productivity.”

While a productivity task force is set up and begins its work, the crisis in our health service will carry on as normal.

The latest figures released by the Department of Health last night stated that “progress is being made on waiting list reduction.”

This “progress” still left 431,883 people waiting more than 10 weeks for outpatient services at the end of September. The press release hailed a 1% decrease in this figure compared to August.

A total of 50,148 people exceeded the 12-week inpatient/day case target last month, but again the 1.9% decrease compared to the end of August was highlighted.

“This progress is even more remarkable given the challenging backdrop, in common with health services across Europe, of continuing significantly higher additions to waiting lists than projected,” the department statement added.

Remarkable alright.

The figures often bandied about in relation to waiting lists, trolley counts, staffing shortages and budget overruns have become so astronomical it can be easy to forget that at the heart of our health service statistics are children, women, and men who need care.

This time Donnelly, despite his billions, cannot spend his way out of the many issues he will be confronted with in the coming months.

This Government has already had to face a number of confidence motions and in what could be seen as a statement of future intent, Sinn Féin’s Pearse Doherty this week told the Dáil: “When things in hospitals get bad this winter, and when they get worse again next winter, the Government should remember why it is happening. It is happening because of the Government’s choices. That will be why it is happening.”