Warning from consultants - Crisis needs more than small change

Paschal Donohoe won’t be the first or last financial controller with an unerring ability to find a few bob down the back of the sofa when the political situation requires it. 

Some ministers have turned the ability to squirrel away a rainy-day fund into something of an art form.

Contingency budgeting is how the actuarial experts might describe it. The film actor Humphrey Bogart liked to talk about the importance of having “FY” money for those occasions when the going got tough.

Yesterday Mr O’Donohoe was able to provide a different form of comfort for those who were concerned at how the €178m cost of refunding water charges was to be managed without an impact on public services and without raising taxes or changing capital expenditure.

Happily the Government has a number of departments which have underspent so far during 2017 — over €300m behind the collective profile according to Taoiseach Leo Varadkar — so the unbudgeted expenditure is covered.

It is a black hole no longer and the grisly prospect of cancelling Christmas bonuses, or raising taxes is heading towards a vanishing point somewhere on the fiscal horizon.

News of the prudence demonstrated by spending ministries sits jarringly alongside another report which provides a poor prognosis for the Irish healthcare system.

The report from the influential Irish Hospital Consultants Association provides a depressing vision of a perfect storm with acute hospitals becoming overstretched by the day while attempting to treat increasing numbers of patients with equipment which is becoming ever more obsolete.

The IHCA reports that 500,000 of the Republic’s population of 4.7m are on a treatment waiting list with no sign of the increase in numbers halting, let alone being rolled back. Nearly 400,000 are waiting to see a consultant, while at least another 80,000 are on a list for surgery.

Almost 100,000 people were treated on trolleys last year because a hospital bed was not available. Over the last four years, the number of planned surgeries decreased from 187,000 to 86,000.

The capacity to deliver elective surgery to the public was cut by 54% due to a shortage of hospital beds, theatres and frontline staff.

In a hugely pessimistic pre-budget assessment the IHCA president Dr Tom Ryan said:

“Here we are now with a system that is patently a failure because it is not providing the public with the service that they need.

"The current levels of funding do not even meet the cost of maintaining and replacing existing equipment, never mind providing much needed additional capacity.”

By any criterion this is a bleak forecast for the future with the impact of an ageing population yet to be fully realised and life expectancy at the high level of nearly 82 years.

But beyond bleak, it is shameful for a country with a GDP approaching €200bn.

Tackling the health provision crisis is likely to be one of the greatest domestic challenges not only for the next government, but for the one after that, and the next one again.

It will make the problem of water taxation look like a small sideshow.



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