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Tuesday 17 October 2017

So that was it. The end of austerity.

So that was it. The end of austerity.

After weeks of public spats and leaks and years of painful budgets, Tuesday, October 14 promised if not a giveaway then at least no further cuts.

Welcome news for health, especially after €666m was removed with disastrous results in 2013.

This year there is some wiggle room, but not much. Not much at all, a point that Health Minister Leo Varadkar (below) repeatedly made yesterday.

As usual, health received a huge portion of the overall budget, approximately €13.1bn, an increase of €305m on last year.

A further €330m will be provided to service financial over-runs within the HSE. While this undoubtedly is an enormous amount of funding, throwing money at health problems rarely provides sustainable solutions, as past experience has proved.

The Good

This Budget finally takes into account the fact that the health service can absorb no further cuts. It has been a good budget for Mr Varadkar.

Only weeks after entering the ministry, he has put clear distance between himself and the tenure of his predecessor, Dr James Reilly.

As part of this, the decision to dedicate €25m to deal with delayed discharges in acute hospitals is welcome, particularly as recent figures showed that more than 600 patients were awaiting discharge from hospital.

It has also proved popular with groups such as the Irish Hospice Foundation, which believes that the money should be prioritised to allow patients nearing end-of-life to die at home.

Other good news includes the extension of the hugely popular and positive BreastCheck to women aged between 65 and 69. It was also announced that €35m would be ring-fenced for mental health services.

However, the relatively modest budget increase does mean that Mr Varadkar may be running to stand still. The HSE's financial condition remains perilous, and its over-run could be as much as €600m.

The Bad

Along with A&E and in-patient charges, the prescription charge, although increased significantly since its introduction, was left unchanged.

This charge is deeply resented by the hundreds of thousands of people with medical cards and has been criticised as a barrier to accessing medical care.

Elsewhere, the duty on alcohol also remained unchanged, something that may anger public health advocates.

However, the other old reliable, tobacco, increased by 40 cent, bringing the price of cigarettes beyond €10, which pleased the Irish Cancer Society and the Irish Heart Foundation.

But the foundation did criticise the lack of a sugar tax within the budget, calling it a missed opportunity.

The ugly

After this year's discretionary medical card debacle, the Government did use the Budget as an opportunity to mend fences. Minister Howlin allocated €3bn to support older people and disabled services in 2015.

Furthermore, it was announced that next year the number of people with full and doctor-visit medical cards would grow to 2.1 million, a figure that includes the people covered by the planned extension of free GP care to all under-sixes and over-70s.

However, we should take this with a note of caution. Earlier this year, attempts to introduce free GP care for the under-sixes ran aground almost immediately, with GPs furious at the terms of a draft contract. The Health Minister caveated the move by saying that these changes would be introduced after negotiations conclude with the Irish Medical Organisation.

So as the era of austerity ends, will we notice the difference in health? Probably not.

James Fogarty is the editor of The Medical Independent

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