Health budget under scrutiny

Taoiseach Enda Kenny and Public Expenditure Minister Brendan Howlin have taken the unprecedented step of overseeing all budget changes by Health Minister James Reilly after repeated over-runs in the system.

The Irish Examiner has learned the move was signed off in the final days before Budget 2014 was finalised, in a bid to ensure the health service’s promised savings can be delivered.

Speaking to this newspaper last night, a spokesperson for Dr Reilly insisted the move was the minister’s own decision.

However, sources in the Department of Expenditure and Reform and the Department of the Taoiseach said the oversight step was effectively forced on the head of the health service as part of 11th-hour weekend budget negotiations.

“It’s no secret we’ve been frustrated for a while because there is no full oversight of the health budget. We’ve now a mechanism of ensuring this doesn’t happen again,” said a source from one of the departments involved.

The move played a role in yesterday’s health budget announcements, which include claims that a massive €666m more can be cut from the already over-stretched system — including hits on medical card holders and the elderly.

However, its key focus will be on the now imminent HSE national service plan — a document due by the end of November which provides specific details on how the Department of Health budget will be spent on frontline services.

While the health service repeatedly overshot its budget even in the celtic tiger era, a number of crisis situations in recent years — including high-profile supplementary budgets — has brought the issue, and respective ministers periods in office, into ever sharper focus.

Since 2008, the HSE has needed €345m, €254m, €595m, €148m, and €245m in extra funding to help it in the final months of each year, indicating that while Dr Reilly has been heavily criticised for budget overruns, the issue is not confined to him.

The minister said the 2013 budget overrun is expected to be €150m-€200m, although sources in recent days suggested the rate could be as high as €400m-€500m.

The news that Mr Kenny and Mr Howlin will be overlooking the health budget may help to explain why Dr Reilly reacted angrily in recent days when the latter figure was reported. It may also bring clarity to why he was unable to clarify how many people are likely to lose their medical cards as part of a “probity” review predicted to cut €113m in expenditure next year.

A spokesperson for Dr Reilly insisted the “cross-departmental” plan was requested by the minister due to the “enormous savings required” in the system, and was not forced upon him.

He said Mr Kenny and Mr Howlin’s role is one of “revision and validation” of the HSE’s national service plan.

Despite the suggestion Dr Reilly had no option than to accept the oversight mechanism, his spokesperson insisted this is not the case.

“It came from the minister. The issue is the scale of the savings,” he said.