Budget bombshell has a long fuse wire stretching into heart of HSE

THERE is always a bombshell in a budget. Sometimes it can take a long time to spot, or to oppose. Sometimes the bombshells don’t get spotted for years. But there’s always something that, once it’s discovered, leads to unravelling.

Remember a few years ago, when Charlie McCreevy had nothing of any consequence to say on budget day, and decided to dress up his budget with a detailed announcement about decentralisation? It sounded dramatic at the time and, worse than that, it sounded popular.

Opposition spokespeople who wanted to attack the measure all drew in their horns because their own deputies were afraid of the consequences in localities that had been promised all sorts of new jobs.

Of course, decentralisation turned out to be an embarrassment, although it wasn’t one that ever cost the government of the day any votes. That was partly because, right or wrong, the opposition were seen to have agreed with the principle of decentralisation.

At first glance, it’s hard to see the bombshell in this year’s budget.

But it’s there to be found in the tiny amount of additional resources that have been made available for the entire range of public services we badly need.

The fact that so little extra has been allocated means that some of the cutbacks we experienced last year will get deeper and some of the queues will get longer.

In introducing his budget, Brian Cowen made it clear, almost in the opening paragraph, that it would cost an extra €2.3 billion to allow public services to stand still.

He provided that, and €1.7bn extra to allow some of the things to be done that haven’t been done this year. But half that extra amount was immediately eaten up by a range of necessary social welfare increases, leaving less than €1bn for essential initiatives.

Now, of course, less than €1bn still sounds like an awful lot of money. In fact it represents an increase of between 1% and 2% in the total of public spending.

And you can see how the whole €1.7bn is broken down in an interesting graph in the book of estimates, published on the same day as the budget itself: €800 million goes immediately on social welfare increases, €300m goes to healthcare, €100m to education, €50m to justice, around €70m each to agriculture and environment and the remainder — about €300m — is spread across the rest of the public services.

So on the face of it, public spending has gone up in total by about 8%, but 6% of the 8% is necessary to enable services to stand still. The pay and salaries bill across the public sector will go up, according to the minister’s estimates, by about 7% this year — and that figure is supposed to include a lot of extra staff in a number of offices we haven’t been told much about. For instance, there must be an awful lot of activity being planned on the legal front because Brian Cowen has provided for big increases in the staffs of the attorney general’s office, the chief state solicitor’s office and the DPP’s office.

No doubt they are all frontline jobs, making a real difference in our daily lives. But I wonder how their importance stacks up against, say, the role the HSE plays? The Government’s intentions in relation to the HSE become a little clearer when you look in a bit more detail at the figures.

Substantial increases in A&E charges are built into the figures, with a view to generating an additional €50m in revenue for the exchequer (they love their stealth taxes, don’t they?).

Despite that, they have provided for an increase in the pay bill of the HSE of 5.9% — that’s less than the average increase in pay overall. And the total allocation to the HSE is budgeted to go up by 7% — that’s less than the average increase in public spending as a whole.

The HSE will have a total of around €12bn next year, of which about €8bn will be accounted for by wages, salaries and pensions.

I’m not privy to the private negotiations that take place between the HSE and the Department of Finance, but we all know how much the HSE was forced to squeeze this year because of over-runs in its budget — or more likely because the Government refused at the start of the year to give the HSE what it needed to run a mammoth service.

It looks very much as if exactly the same thing is happening again. If that is the case, the consequences for our health service next year look severe.

And we already know that about one-third of the extra money allocated to health will go to fund the so-called fair deal, which is the Government’s proposed long-stay residential scheme for elderly people.

This is one scheme which, as it develops, will struggle very hard to maintain any semblance of fairness in its operation. But the fact that so much is allocated to the first year of operation of the scheme will leave even less for everything else.

The bottom line, I think, is fairly clear. The HSE has been under immense pressure since the day it was founded. It has been charged with a reform programme that has to take years to achieve. It has been denied any political support and has more or less been told to sink or swim on its own. It has been designed to take whatever flak is going over health issues, while ministers who ought to be accountable themselves join in the blame game.

And year after year, its budget has been squeezed to the point where it can just about hold its head above water.

NEXT year, HSE personnel will conduct most of the brain operations and lung transplants carried out in the State. They will be the ones who visit elderly people at home, especially elderly people who are frail.

Public health nurses and home-helpers will be the primary source of comfort for thousands of people. The HSE will deliver most of the babies born in Ireland next year — and there will be tens of thousands of them.

They will diagnose and treat tens of thousands of conditions, ranging from life-threatening diseases to minor ailments.

You could fill Croke Park about 25 times over with the number of people whose accidents will be cared for by the HSE. And they will protect thousands of children who are at risk in all sorts of ways.

Of course it’s essential they get all this right. And of course they can’t be immune from criticism when they get it wrong.

But if we don’t fund the HSE properly, we are guaranteeing that more things will go wrong in the future, that we will have more crises next year.

And we are also guaranteeing that we will have to depend even more than we do now on the private sector to deliver our healthcare at a profit.

But then, maybe that has been their real intention all along.