Tensions have mounted within Government over Department of Health spending figures ahead of the budget amid lengthening hospital waiting lists and overcrowding.
With three weeks to Budget 2022, there is no agreement on the amount of money required to address looming crises for the health service, particularly spiralling hospital waiting lists — which top 907,000 patients — and the formulation of a winter plan to address an expected surge in demand for services.
There is also concern that the Department of Health and the HSE have “fallen way behind” in the recruitment of staff that would allow health service improvements and reforms to proceed.
Repeated attempts have been made by Public Expenditure Minister Michael McGrath’s department to get accurate spending figures from the Department of Health and Minister Stephen Donnelly ahead of next month's budget.
Mr McGrath and his officials have requested details of budget underspends within the Department of Health but have yet to get satisfactory answers.
Sources have told thethat, officially, the Department of Health is reporting a budget underspend, but Mr Donnelly’s officials believe the true position is one of “break even”.
Mr McGrath and his officials are understood to have repeatedly sought clarity, over several months, as to why such discrepancies — amounting to €700m — exist when accurate figures are required to allocate budgets for 2022.
“It’s hard to have confidence in their numbers at the moment,” said a senior source.
It is understood that the €4bn extra given to health last year — €2bn linked to Covid-19 — will be reduced, but there is an ambition to maintain the budget for the Sláintecare reform programme, which amounts to €1.25bn.
Sláintecare, the blueprint for reforming the health service by moving treatments and services into the community, has stalled in recent times, leading to the resignation of senior figures over the last fortnight.
One senior source described the situation of formulating the health budget as extremely challenging.
Much of the doubt around the figures stems from the Department of Health seeking a supplementary estimate, or mid-year bailout, in 2020, only to end up with a large cash pile at the end of the year.
This situation led Mr McGrath and his top officials to investigate what they believe could be an attempt to hoard cash in excess of the 10% threshold allowed by departments.
Amid an expected total underspend of €1.7bn across all departments, sources have said Mr McGrath warned Cabinet last week about failing to report such cash piles, saying he needs maximum flexibility in deciding departmental budgets.
According to sources, one of the points Mr McGrath made at Cabinet was that, in the eight months to the end of August, just 36% of the annual capital budget was spent.
In response to queries, a spokesman for Mr Donnelly told the: “Discussions on the budget estimates with the Department of Public Expenditure and Reform are ongoing and it wouldn’t be appropriate to comment on the nature of those discussions at this stage.”
Meanwhile, the budget is also likely to see increases in the fuel allowance, the qualified children’s allowance, and the living at home allowance to ease the pinch of rising energy prices.
The Government is bracing itself for rising energy prices this winter.
With Russia “turning down the tap” in terms of the flow of gas into Europe, people could be facing potentially very large energy bills over the winter.
Officials from several government departments are planning for what has been described as a very real situation coming down the track.