Documents reveal dispute over staggered Health Department budget plan

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The Ministry of Health was informed that the budget estimates it had submitted were so out of step with what had been agreed that they could not even be considered for a ministerial commitment.

When preparing last year’s budget, the department under fire submitted a seven-page summary of its financial needs to the Public Expenditure Department.

However, public spending officials said the figures submitted were “not within the budget parameters” set out to them in correspondence or preliminary discussions.

An email from the Central Expenditure Policy and Reporting Division said: ‘These are certainly not the basis of the ministerial commitment.

We ask that you reconsider the offer over the weekend and submit a revised offer within the fiscal parameters.

In response, the department submitted a more detailed 37-page pre-budget submission, according to documents released under Freedom of Information.

The Ministry of Public Expenditure said the new estimates were welcome and formed the basis for “positive engagement”.

However, officials have warned that Minister Michael McGrath “cannot accept” a supplementary budget given the level of resources already allocated to health in the 2021 budget.

He also warned that allocations for the development of health care capacities and the implementation of Sláintecare must be used for the purpose for which they are intended.

An email said: “If for any reason this does not prove to be the case, the corresponding allocations will not necessarily be repeated in 2022.”

Public Expenditure Department officials also reported an “information deficit” on spending last year, particularly on staff pledges.

“We need information on what has been delivered and what has not,” reads an email between the services, “and we consider that there are significant savings that have not been quantified , for example compared to the last successful projects that recruitment will be 7,000 below the objective”.

The email also said that the tax parameters had been clearly defined in a letter to the Secretary General of the Ministry of Health as early as July last year.

The ministry had been asked to deliver existing services in 2022 under these budget guidelines.

However, the email read: “Despite this, the ELS [disability service] the requested allocation is far beyond (double) the total allocation allowed under the SES [Summer Economic Statement] and leaves no provision for new developments or for Covid.

The Public Expenditure Department asked for a wide range of clarifications, including the possibility of double counting in disability services and other areas, and overstating other likely costs by using average figures.

In the pre-budget submission, the Department of Health warned of significant “salary cost pressures” that would arise this year.

He said a combination of national pay deals, pay rises and industrial relations issues risked leading to large additional bills.

The heavily redacted document also said there was a shortfall for pension benefits with reported underfunding and a likely increase in payouts and volatility around lump sums.

He also warned that acute care hospitals were likely to face record daytime cases, hospitalizations and emergency presentations throughout this year and last.

In a statement, the Department of Health said “vigorous discussions” had taken place ahead of the budget.

A spokeswoman said: ‘Health spending proposals for the coming year have been discussed and reviewed by both departments.

She said monthly engagement also takes place between the Department of Health, the HSE and the Department of Public Expenditure under the Health Budget Watch Group.

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