What a difference a year makes; this time last year a hang-dog James Reilly presided over a post-budget press conference that was as depressing as political car-crashes can get.
Yesterday, Leo Varadkar, the new man in Hawkins House, was all smiles and positivity as he outlined a budget that was neutral in many respects and positive in some. And that, thanks to an extra €305 million in funding for 2015, is as rosy as it has been in the health garden for many long years.
Health isn’t “awash with cash”, as Varadkar put it, but in this budget it got the first increase seen since 2008. “Quite tight” is how he described the budget he has been given for next year.
Last year, Reilly was forced to announce an ominous €666 million cut in health spending for the year to come, not to mention the infamous €113 million “probity” drive on medical cards that was to cause him so much grief in the months that followed.
Additional €305m
This time around, Varadkar has already been guaranteed the €500 million he requires to balance the health budget this year, so no need for any end-of-year haggling at Cabinet, unless there’s a further overrun. For next year, he has an additional €305 million to play with, so that means some belt-tightening will still be necessary to avoid the need for another supplementary budget next year.
The increased money allows Varadkar to tick off another few programme for government commitments, most notably the extension of the Breastcheck screening programme to women aged 65-69 years.
It emerged this will take six years to fully implement, so perhaps it should have been approved earlier in the Government’s term of office.
Mental health
There’s also more ringfenced funding for mental health, and hopefully this will be delivered on time, unlike allocation announced in previous budgets and not spent.
We already knew about the extension of free GP care to under-sixes and over-70s, although contracts and fees for these have still to be agreed with family doctors. That will mean over half the population are in possession of a medical card.
It’s a case of “as you were” for hospital and emergency charges for patients, and the thresholds for medical cards and drug payment schemes. The Minister has elected to leave the prescription charge at the current level of €2.50 per item, which is something of a missed opportunity given the unfairness of this level of charge.
There was no extra money for the Fair Deal scheme, despite evidence of a growing crisis in funding long-term care for older people. However, there is an extra €25 million to take the pressure off hospitals by dealing with delayed discharges.
Savings will still have to be made, but the Minister says they won’t be at the expense of patient services. Procurement, drug costs, agency staff costs are area expected to yield up to €130 million in savings.
Clinical audit
Varadkar also promised more clinical audit and a special investigations unit to check if patients are receiving more investigations than required. Rather than saving money, this will allow more patients to be seen.
His predecessor favoured the introduction of a sugar tax to combat obesity but Reilly's proposal was parked for discussion with the Department of Finance.
Varadkar cited legal issues and the lack of European precedents for the fact that this proposal remains marooned. Yet the same arguments could be levelled at the proposal for plain packaging of tobacco, which the Government is proceeding with.
Varadkar said he “didn’t anticipate” needing a supplementary budget next year, but he didn’t rule it out either.
