# Why doesn't any TD vote against spending increases?



## Brendan Burgess (3 Oct 2018)

Séamus Coffey has a good article in today's Irish Times about 

*Runaway health sector spending putting public finances and economy at risk*
* Almost €2bn of unplanned increases in health spending in just four years*

He points out that the budget is examined by the Health Committee and not by the Finance Committee. 

_Unplanned increases in expenditure require supplementary estimates to be passed by the Oireachtas. These first go to a committee for scrutiny and approval before being voted on by the Dáil and Seanad. But the committee the supplementary estimates must pass through is the joint health committee rather than the finance or budgetary oversight committees.
_
The same happened with the increases given to public servants recently. 

Not one TD or Senator spoke against them.

Brendan


----------



## Delboy (3 Oct 2018)

Other people's money Brendan. Easier to spend.
Voting no might cost votes too.

The joys of democracy!


----------



## Purple (4 Oct 2018)

I often look at the USA where much of the national dialogue is that the State (the government) takes your money and wastes it. When a new programme/initiative/spending measure is proposed the first question from most people is “how much will this cost me?”.

I think that if that is the only dialogue it is dangerous because it is divisive and creates a fractured society.

The opposite happens here; spending is seen as unreservedly good. We should build more houses, we should spend more money on health, we should increase everyone’s wages, we should increase pensions, we should increase welfare and allowances. I think that is more dangerous. It is socially and economically damaging and encourages a culture of mediocrity within the State sector. We need to change our national dialogue to add in a little bit of the “how much will this cost me?”. Throwing money at problems rarely fixes them. I firmly believe that the problem within the State Healthcare  system, and the Healthcare delivery industry generally, is cultural rather than financial. When there is a culture of management excellence, a culture of identifying and adopting best practice in administration, a culture of sensible and real KPI’s that are identified and managed at a front line management level, then we have some chance of our Public Healthcare Service actually serving the Public properly.


The same applies to all State bodies and all organisations both private and public. It just so happens that with health it really is a matter of life and death.


The result of doing nothing, i.e. continuing to do what we are doing, is the continuous hollowing out of the middle ground in politic and society. The result of incompetent and wasteful public administration is the undermining of democracy with justifiable anger pushing people further to the left and right. The result is Trump or Corbin, Sinn Fein and populism, Brexit and Nationalism. The people who run the State, the Public Servants who are the permanent Government behind the transient political circus, are also the custodians of our democracy as their actions determine whether the people consider the authority of the State to be legitimate.


So, why don’t TD’s vote against increases in spending? It’s the same reason that we cough when we’ve a cold; it is just a symptom of a bigger problem.


----------



## Brendan Burgess (5 Oct 2018)

Hi Purple 

Agree. 

The only organisation speaking up against public spending is the Hibernia Forum.  But they rarely get media coverage.  The media is much more interested in the populist : "I have been living in a hotel for two years because the government won't give me a free house". 

Of course, the media is just reflecting what its customers want. They enjoy the outrage much more than the analysis. 

Brendan


----------



## odyssey06 (5 Oct 2018)

Is the background of TDs a factor? They don't seem to come from sectors of society where money had to earned, wealth created in a competitive global economy but rather where the income comes directly or indirectly from the state ... they seem to think there's a magical money tree in Dublin and the only reason the money doesn't flow from it is that it hasn't been shaken hard enough \ it shows you don't "care" about the issue.


----------



## Brendan Burgess (5 Oct 2018)

What astonishes me is that the Chairman of the Irish Fiscal Advisory Council can say the following: 

*Runaway health sector spending putting public finances and economy at risk*

and there is almost no response from anyone.

Brendan


----------



## BilliamD75 (5 Oct 2018)

You are so right  if we want real democracy we need to eliminate career politicians one term and your out it will never happen though turkeys voting for Christmas springs to mind.


----------



## galway_blow_in (5 Oct 2018)

Purple said:


> I often look at the USA where much of the national dialogue is that the State (the government) takes your money and wastes it. When a new programme/initiative/spending measure is proposed the first question from most people is “how much will this cost me?”.
> 
> I think that if that is the only dialogue it is dangerous because it is divisive and creates a fractured society.
> 
> ...



media is overwhelmingly left wing in ireland so a narrative has been created in which high spending is both beneficial and morally right .

besides , would the whip system not compel TD,s to support increased spending ?


----------



## Delboy (5 Oct 2018)

Have I this right....€500m increase in the Dept's budget in 2018 v's 2017 final spend. And yet they're going to be €700m over that?
So €1.2bn more spend in 2018 v's 2017 

How can they spend that much more without any visible improvement in services? 2018 saw new records set in A&E trolley stats for example.
Where has that money gone?

Callan's kicks took off Harris perfectly on his show which returned at 6.30pm this eve on Radio 1. Well worth listening back to


----------



## Brendan Burgess (6 Oct 2018)

Cormac Lucey has written about it here: 

http://cormaclucey.blogspot.com/2018/09/ailing-health-system-needs-dose-of.html

And in today's paper, they say that the unexpected Corporation Tax excess will be used to pay the health service shortfall.

Brendan


----------



## elacsaplau (6 Oct 2018)

To answer Brendan's original question, I would quote Mitterand……

_Politics is a career not an ideology_


----------



## Delboy (6 Oct 2018)

There was a protest march in Dublin today calling for the rapid introduction of Slainte healthcare. The protestors say another €1bn is needed for the plan.
At the current rate of spending, the health system will have clocked up that extra billion by Oct 19, new health plan or not.

This is insane stuff and no one is calling stop


----------



## bleary (7 Oct 2018)

People get what the people want. The decision to grant orkambi after initial refusal was estimated at 650 m over 10 years. Similar campaigns for multiple drugs that have been refused in the UK and worldwide. There's a new campaign every month or so and typically with drug company support. The campaign to fund versatis patches and the personal vilification  of people trying to do their job who restricted its distribution like sweeties. 
The cervical retests offered to every woman and the scare mongering by certain politicians over the whole issue for starters. None of these help to run a health service on budget and are dictated by political whims at the pointy end of social media campaigns.


----------



## Brendan Burgess (7 Oct 2018)

At least Séamus Coffey of the Irish Fiscal Advisory Council is shouting stop!

*IFAC chief warns against using €1bn windfall in Budget *

_The Chairman of the Irish Fiscal Advisory Council has warned the Government against using a €1bn corporation tax windfall to announce a bigger than expected Budget on Tuesday.
...

Minister for Health Simon Harris said he was frustrated to hear the health conversation being reduced to one about economics.


"When you are the Minister for Health and patients turn up at hospital looking for a service, what are you meant to say? Are you mean to say sorry we've spent all the money for this year," he said._


----------



## odyssey06 (7 Oct 2018)

Brendan Burgess said:


> _Minister for Health Simon Harris said he was frustrated to hear the health conversation being reduced to one about economics.
> "When you are the Minister for Health and patients turn up at hospital looking for a service, what are you meant to say? Are you mean to say sorry we've spent all the money for this year," he said._



I don't think this guy is intellectually capable of understanding where money comes from.
Career politician and it shows in everything he does, very good at getting laws passed in the Dail, completely useless at achieving anything real.
You could give him 10 billion more and you'd have nothing to show for it.


----------



## Delboy (7 Oct 2018)

Brendan Burgess said:


> At least Séamus Coffey of the Irish Fiscal Advisory Council is shouting stop!
> 
> *IFAC chief warns against using €1bn windfall in Budget *
> 
> ...


I heard Harris say that on the radio show today and nearly fell about my kitchen laughing. This guy is allegedly 1 of the leading lights in the new wave of politicians coming though here.
There may come a day soon when we year for Charlie, Albert, Garrett etc again


----------



## odyssey06 (7 Oct 2018)

Delboy said:


> I heard Harris say that on the radio show today and nearly fell about my kitchen laughing. This guy is allegedly 1 of the leading lights in the new wave of politicians coming though here.
> There may come a day soon when we year for Charlie, Albert, Garrett etc again



Merely by asking for an increase in funding, Harris has reduced it to a matter of mere economics. He should tell all HSE staff and suppliers that they won't be getting paid for any services or products supplied for the rest of the year because if people turn up to hospital they expect to be taken care of.


----------



## Sophrosyne (10 Oct 2018)

I listened to the Pat Kenny show this morning.

A person contacted the programme. They served on the bord of a major hospital during the recession as a representative of business with no links to health care.

One observation they made was that hospitals have very little discretion over spending.

Salaries are per public service agreements
Drug purchases are managed via central agreements
Large equipment was capital budget,
leaving only minor expenses as discretionary.

And yet, at least with acute hospitals, they have very little control over their intake and often they cannot discharge patients because of well-known shortages of step-down facilities particularly in certain geographical areas, such as North Dublin.

Process changes can be made to improve efficiency only to a certain degree before the unions baulk.

The picture often painted of hospital management being very poor is untrue and unfair

Hospital management weren’t in a position to defend themselves publicly because it would often entail criticizing the HSE which controls the budgets. -_end_


Both Pat Kenny & Regina Doherty, a guest on the programme, wondered, in the light of this, where were the overspend. It can’t be pay, it can’t be drugs, it can’t be equipment.

Since constant overruns very much impinges on other spending, instead of trying to guess the reason, perhaps we should demand a detailed breakdown of the overspend.


----------



## RETIRED2017 (10 Oct 2018)

Sophrosyne said:


> I listened to the Pat Kenny show this morning.
> 
> A person contacted the programme. They served on the bord of a major hospital during the recession as a representative of business with no links to health care.
> 
> ...


Hidden in there is big savings now being made by the HSE when it comes to pensions to people now retiring on an PRSI A1 stamp 12700 euro per year now comes out of the PRSI fund for each A1 retiree,
There should be major savings in the pension bill from now on,

I suspect Regina kept Quite about that it is coming out of her  Department PRSI  budget,


----------



## Sophrosyne (10 Oct 2018)

Ok, there should be some savings, but in view of the massive overruns in recent years, precise details relating to overspends should be made public as soon as possible, otherwise we a just talking around in circles, while nothing changes.


----------



## Sophrosyne (10 Oct 2018)

In relation to health overruns, this report by the Parliamentary Budget Office is relevant.

It is not for the faint hearted but the gist of it is that reporting programmes between the Health Vote and the HSE are misaligned so that the relationship between the Health Vote and the HSE’s budget cannot be readily understood *by anybody*.

*Alignment of the programmes in the Vote has been a recommendation for reform since at least the Considine Report in 2008.*

If information cannot be understood by either government or opposition, where does that leave accountability?

It might also explain why nobody challenges spending increases.


----------



## Protocol (11 Oct 2018)

http://www.budget.gov.ie/Budgets/2019/Documents/Health Budget Oversight and Management.pdf

More reading.


----------



## Sophrosyne (11 Oct 2018)

@Protocol, I think there is ample evidence in both reports for immediate change.


----------



## Sophrosyne (11 Oct 2018)

It seems the reports mentioned above have had effect.

They reveal a chronic lack of planning and controls in managing health expenditure. The “pay and numbers strategy” which was supposed to be supplied at the beginning of each year, was actually only provided in November 2017, and again in August 2018.

“These timelines result in the Strategy having no impact on the planning and monitoring process,” it said.

It said that if legislative requirements were met by the HSE – in other words, if it complied with the law – it would help control costs.

According to this article in the Irish Times, new controls, including an oversight group made up of officials from the Public Expenditure Dept., the Health Dept. and the HSE will be initiated shortly. 

The new body will monitor and control health spend and staffing within the budget allocation and develop an early warning mechanism for any deviations.


----------



## Delboy (11 Oct 2018)

The new body will be able to do very little on the control side if the accountants within the HSE for example cannot pinpoint where the money is going.


----------



## Purple (15 Oct 2018)

Managers, managers everywhere but very little data so what do they use to make management decisions?
Maybe they should be called overseers?


----------



## Protocol (15 Oct 2018)

Yes, HSE managers are not managers.

They are more like administrators.


----------

