Health and Disability in Budget 2023

The COVID-19 pandemic highlighted shortcomings in our healthcare system across a range of areas and also demonstrated how vital an integrated public system of care is. It must be a starting point for major changes in our approach to healthcare. We cannot return to a two-tier healthcare system and access to healthcare based on need, not income, should remain an important aim for Ireland’s healthcare system. Furthermore, investment in a reconfigured model of healthcare is overdue, one that emphasises primary and social care.

The period ahead is one where there is a unique opportunity to implement significant reform of Ireland’s healthcare system. It is important to ensure that the approximately €4bn additional resources committed for the development of the healthcare system in 2021 are retained and sustained, and used throughout 2023 and beyond to fully  implement Sláintecare. We regret that Budget 2023 failed to allocate the resources required to invest in public healthcare in order to deliver the modern, responsive, integrated public health system that the Sláintecare report envisages. In particular Budget 2023 did not make the necessary investment in Enhanced Community Care and expansion of GP and Practice Teams to support delivery of primary and  community based care.

The limited access to care for people with health conditions not related to COVID-19 and unmet needs for medical care because of delayed or missed consultations are likely to lead to poorer health outcomes in the future. Ireland’s rate of ageing continues to be higher than the EU average, especially among people aged 85+.  Our longevity is a welcome success story, but it must be planned for using an appropriate model of healthcare. Ireland remains the only western European country without universal coverage for primary care. 

Ireland’s health system ranked 22nd out of 35 countries in the 2019 Health Consumer Powerhouse report and on the issue of accessibility, ranked worst. 1 in 8 people were waiting for outpatient treatment in May 2022 with more than one in five waiting for 18+ months. Unmet need for prescribed medicines in Ireland is on average more than twice as high as the EU average and highest among people with lowest levels of education.

IFAC estimate that, allowing for price and ageing pressures, at least an additional €900m is required in Health per year just to stand still. People on the lowest incomes report poorer health outcomes across the lifecycle, with a widening health and social gap evident by the time children are just 5 years old. Funding and delivery of mental health services, particularly services for children and adolescents remains a concern.

What did Budget 2023 do for Healthcare?

• Allocated €23.4bn (current & capital) €22.6bn core and €0.8bn non core.
• Additional €1.15bn core funding, €0.7bn for COVID-19 with €88m contingency.

Current expenditure is €22.24bn incl.

• €553m Carryover, Demographics and other ELS  plus €343m Central Pay.
• €707m COVID 19 funding including €439m for PPE, testing & tracing & vaccination. €443m to reduce waiting lists for priority areas such as Obesity/Bariatrics, Spina Bifida/Scoliosis and Gynaecology and NTPF.
• €47m for GP diagnostic tests, €11.7m to address backlogs in disability services with €9m for orthodontics and €12.3m for HPV.

 €254m Additional Resources

• €107m for cost of living measures including abolition of inpatient hospital charges, extension of GP visit cards to 340,000 people, expanding free GP care to children aged 6&7 and extension of free contraception scheme for women up to 30 years of age.
• €11.2m for older persons including healthy aged friendly homes, meals on wheels and introduction of safe guarding policy.
• €14m Mental Health incl. accommodation costs and emergency placements and €4.2m increased capacity for acute and critical care investment.
• €24.3m for workforce measures including expansion of Advanced Nurse Practitioners and Midwives.
• €29.3m for disabilities action plan / WHO and assisted technologies.
• €23.3 for national strategies & services including €13.3m for Primary Care new developments and continued roll out of Enhanced Community Care Programme

Social Justice Ireland welcomes many of these initiatives, including the continued commitment to Sláintecare. We welcome the cost of living measures in particular the expansion of GP Visit Cards, the extension of free GP visit cards to 6 & 7 Year olds as well as the commitment to significantly invest in supports for GP practices, which will be essential if the additional demand is to be met. We also welcome  the commitment to expanding the Health Service workforce and the €29.3m for Disability Service, however, we are concerned that this is insufficient to meet the current unmet needs for residential and day services as well as the significant waiting lists for children services.

We also welcome the additional €14m for mental health measures. This area that has been persistently underfunded with over 2,000 on CAMHS waiting list. We acknowledge the continued commitment to Community Healthcare Networks , however, we are concerned whether sufficient funding has been provided to maintain progress. We welcome the emphasis on safety of staff and patients through a continued focus on COVID and provision of PPE and vaccination programme. In particular, recognition of the needs of vulnerable Homeless people and those with addiction problems is welcomed. Recognising the additional resources, we highlight again the lack of transparency in information available which makes it difficult to establish if funds provided to maintain existing services and COVID expenditure are sufficient within the overall allocation.

Disability

Disability is strongly associated with poverty in Ireland. Among people who are unable to work due to long-standing health problems almost one in four (39.1%) live on an income below the poverty line. People with a disability are more than twice as likely to experience poverty and deprivation and have an employment rate of just 36 per cent, the fourth lowest in the EU. People with disabilities face significant challenges in finding employment and remaining in a job given the daily challenges many face.

Budget 2023 did not take the necessary steps to improve services and funding for this area. We regret that the Budget did not move to introduce an ongoing cost of disability payment despite the findings of the Cost of Disability in Ireland report. If people with a disability are to be equal participants in society, the extra costs generated by their disability should not be borne by them alone. Progress on this issue is long overdue.