At the best of times publicly-available HSE financial data can be infuriatingly vague and unclear. Previous annual service plans have been, justifiably, criticised as being works of fiction for containing ambitious cost-saving measures that had not a hope in hell of being realised.
The HSE’s service plan for 2014 includes a potential €108 million hole in its savings targets about which no real clarity at all has been provided as to how it would be addressed.
As The Irish Times reported today measures aimed at delivering the required €619 in savings in the health service next year include a provision for €108 million which is attributed to “unspecified pay savings”.
HSE director general Tony O'Brien said this would form part of a process involving the Department of Public Expenditure and Reform and the Department of the Taoisheach.
He said it should not be confused with savings under the Haddington Road agreement on public service pay and reform. Around €140 million in savings under this deal are earmarked for next year.
However the Minister for Public Expenditure and Reform Brendan Howlin repeatedly told public service workers earlier this year that the Haddington Road deal would be the "last ask" the Government would make of them.
If this is the case what is the separate pay saving process that the HSE is about to embark upon in association with the Department of Health, the Department of Public Expenditure and Reform and the Department of the Taoiseach?
The service plan also raises questions about whether the Government’s assertion last week that the HSE recorded a net deficit of €199 million in 2013 actually represented a full picture of its financial health.
The service plan makes clear that in addition to the €619 in new savings that have to be made next year, the HSE also has an “underlying projected deficit” of €419 million including €190 million in the hospital sector which is being carried forward from this year.
While there is no cut to the overall allocation for hospitals, some individual institutions will have at address their own deficits or overdraft levels. This may involve local cuts which are not be spelled out in the service plan.
The service plan provides limited details on how patients will be directly affected by the financial figures set out in the document.
However it is certain that patients will be affected although the HSE made clear that patient safety would be a priority.
The plan provides for fewer people to be treated, as in-patient s, out-patients and day cases in hospitals next year. There will also be fewer people with medical cards by the end of 2014.
The plan also indicates that a number of planned developments such as the extension of the breastcheck service have been put on hold due to the lack of money.
Overall a large proportion of the savings next year are earmarked to stem from pay and flexibility savings as well as money originally envisaged to pay for pension lump sums.
Both of these areas present risks to the viability of the service plan. If the unspecified savings of €108 million does not materialise and/or if more staff than anticipated opt for retirement in the year ahead, the HSE may need to go back to Government for another bail out.
