HEALTH MINISTER JENNIFER Carroll MacNeill has said some regional health services are overspending on payments to staff and that is why they have had their day-to-day spending powers stripped. 

Speaking to The Journal, MacNeill said that some regions are performing better than others when it comes to managing budgets. 

Public Expenditure Minister Jack Chambers told The Irish Times’ Inside Politics podcast this week that four Health Service Executive (HSE) regions were “going to lose autonomy on day-to-day spending and there’ll be much greater controls introduced on all elements of pay and non-pay spending”. 

MacNeill said that she and Chambers are “very much at one on this”.

“The whole health service has experienced a fairly significant increase in demand this year, particularly in our emergency departments, but nothing like the level of demand that would match the spending increases on pay,” she said of the four regions. 

Chambers said there would be “much greater centralisation” of financial management, despite recent initiatives to decentralise decision-making across the HSE.

MacNeill said today that some things, like demand, are beyond the government’s control but that spending on recruitment is not one of them.

“We can control who we recruit and when we can recruit them. We control how we use agency and how we reduce agency,” she said.

“Those things are within control, as are the non-pay savings. So those are the areas that demonstrate real concern to myself and Minister Chambers because they demonstrate a lack of grip of the organisation.”

She said that the HSE “can’t just keep adding more and more people to the health system”.

“They have to be deployed and used to do better across everywhere. And there are some regions that really are doing that.” 

Dublin North East and the Midwest were two such examples MacNeill mentioned. 

“They are much closer to managing their pay budget than the other regions that are not, which are the Southwest, Mid-Leinster, Southeast, and to a slightly lesser extent the Northwest,” she said. 

“If you don’t reduce your agency cost, you can’t hire other people. If you hire nothing but expensive consultants, you can’t hire other people,” she said. 

“You have to balance your overall pay budget.”

She added that the health system “had been well stabilised” by former HSE chief executive Bernard Gloster and her predecessor as head of the Department of Health, Stephen Donnelly, last year.

“This year is different, and we are so determined not to let it go back to the way that it was. And so that’s why we feel the need to take additional steps at this point.”

Sinn Féin’s health spokesperson David Cullinane said the stripping of budgetary control from the four regions “would represent a serious setback for regionalisation” and warned the government against “scapegoating regional management for the consequences of unrealistic budgets, rigid recruitment controls and rising demand”.

“Barely a year into the new structures, this reform is already beginning to crack,” he said.

“Instead of making regionalisation work, the government is now threatening to take power and responsibility back from four of the six regions.

“There must be accountability at regional level and proper oversight of public spending. However, the minister for public expenditure cannot simply blame regional managers for problems created by government policy.”