Daniel McConnell: Sense of dysfunction around health service is bonkers

Rogan and Murray’s report set out in forensic detail the unfettered discussion among the officials about significant failures and weaknesses in the controls over the annual health budget of €22bn.

The recording of an internal Department of Health meeting on January 27 contained references to ‘fake targets’, concerns about the HSE’s financial ‘sloppiness’, and the credibility of the health budget.

Two officials at the meeting on January 27 said in no uncertain terms that 10,000 WTEs (whole-time equivalent employees) would not be recruited, giving the updated figure as just 5,500.

“They’re not going to fill 10,000. So forget about that. That’s out of date. Forget it. It’s not going to happen,” one official said at the meeting.

Most significantly, the story exposed a “fundamental error” in the HSE’s 2020 accounts, potentially relating to hundreds of millions of euro, and incredulity that the Comptroller and Auditor General (C&AG) had signed off on the accounts.

At one stage in the meeting, one official said that the Department of Public Expenditure and Reform was “a little bit incredulous” that, on January 27, the Department of Health still did not know the end-of-year financial position of the HSE.

The official then revealed that during a call with HSE financial staff, he had been informed that the health agency was “talking about doing prior year adjustments” for 2020, which he described as an “interesting development”.

A prior-year adjustment is usually a correction of errors in the reporting on a company’s prior period financial statement.

In the official’s view, they are “kind of a no-no in the accounting world” and he said that this was evident by the facial expressions of some health officials reacting to the news.

“Effectively, if any plc company does a prior year adjustment, it’s a huge red flag that there is something amiss in their original estimates for that year, and that’s equally applicable here,” the official said.

There were repeated mentions about unachievable political targets, meaning that money was being spent on the HSE which could not be used for the budgeted purpose, such as in this year’s record mental health allocation.

Officials discussed the “dysfunction” and lack of trust at the heart of the country’s health service, particularly between the department and the HSE.

It was powerful stuff, and the potency of the story was that this was a group of officials, not minding their ‘Ps and Qs’ before an Oireachtas committee, but instead speaking candidly as to how much of an omnishambles the situation is.

While the story was shocking in its level of detail and what that detail alluded to, what was not shocking was the nature of the ‘nothing to see here’ type response from the HSE, which has been a hallmark of its communications in years gone by.

The playbook was simple.

Allege the story was wrong or “misleading” in some way, throw as much mud at it as you can, and hope to discredit it in order to nullify its impact.

I know it, as I have been on the receiving end of it several times during my career, even when the HSE rebuttal to us turned out to be utterly incorrect, and senior bosses had to apologise to an Oireachtas committee over it.

Paul Reid, the HSE chief executive, took to the airwaves on Monday to refute the story, saying the issues in relation to recruitment and financial management were “factually incorrect”.

But, as Mr Reid and other officials continued speaking throughout the week, they actually confirmed the primary elements of the story.

Reid confirmed that 5,500 and not the 10,000 staff numbers would be recruited. At a committee, Robert Watt, the top official in the Department of Health, admitted hitting a target of 10,000 new hires will be “very, very difficult” to reach.

The minimum target is now for 5,500 new hires, and the original target of 10,000 is a “stretch target”, he told committee members.

Despite criticising the Business Post, the Taoiseach, under pressure in the Dáil, confirmed that the recruitment of new staff to the HSE is likely to be half of what the funded target is this year.

In the recorded meeting, officials speculated the budget adjustment could be in the hundreds of millions of euro, but Reid on Monday it would be “under €100m,” thereby confirming the most significant aspect of the story.

This means large volumes of money were accounted for as spent by the HSE in its 2020 statements and signed off on as legitimately spent by the Comptroller and Auditor General, when in fact that money was not spent.

When pressed as to why public officials in that meeting suggested it could be “hundreds of millions” all Reid could say was that such comments were “unfortunate”.

Reid also accepted the fundamental point that the HSE — our health service — does not have a proper financial management system 17 years after its creation.

Much of the mud slung at the Business Post by the Taoiseach and others were that the Zoom meeting was recorded and it was a breach of confidentiality.

That is true, it was. However, what is also true is that the defence for publishing in the public interest is overwhelming.

Deficit in transparency

In a normal functioning world, minutes of meetings such as these would be made public. And no, not the meaningless versions of minutes that departments put out which give no substantive insight as to the discussions undertaken.

Real minutes. But in Ireland, that never happens.

Such a deficit in transparency forces whistleblowers to take extraordinary risks in terms of their own futures to speak out when they see wrong.

Such a deficit in openness is not acceptable. It is our money, after all, they were so casually throwing around. The experience of many whistleblowers in this country is far from pleasant.

Just ask Maurice McCabe, Claire Looney, and Noel Wardick.

Reading between the lines of the meeting were the levels of distrust that still exist between the HSE and its mother department of Health.

Added to this is the near-toxic mistrust that exists in the Departments of Public Expenditure and the Taoiseach toward both the Department of Health and the HSE.

These hostilities are not new.

One thinks back to when then money ministers Brendan Howlin and Michael Noonan rejected a plan from then Health Minister James Reilly to introduce universal healthcare, saying it would “threaten the financial viability of the State”.

Howlin has been on record that during Reilly’s time in office, the budget numbers being offered up were not reliable.

Just last year, current money minister Michael McGrath and his officials cast grave doubt over the reliability of the spending numbers coming from Health, with a gap of €700m emerging.

Indeed, as we reported on Friday, the Department of Health was told that budget estimates it submitted were so out of kilter with what had been agreed that they could not even be considered for ministerial engagement.

In the run-up to last year’s budget, McGrath’s officials said the figures submitted were “not in line with the fiscal parameters” that had been set out in correspondence to them or preliminary discussions.

When you step back and consider how wide and deep the sense of dysfunction around our health service actually is, it is simply bonkers.

The upshot to all of this is a health system which has almost 1m people on waiting lists and hundreds of people on trolleys in emergency departments this week, as well as massive gaps in services for children, the disabled, and the elderly.

That is the reality, that was the reality set out in that recorded meeting, and that is why we the public deserved to hear it, warts and all.