Health service spent €250m more on ‘higher-cost’ agency staff than budgeted for

The health service spent more than €250 million on higher-cost temporary staff provided through agencies than the amount set out in its official budget in the first eight months of the year, a new internal Health Service Executive report shows.The HSE’s cost and productivity oversight group report, dated September 25th, says €522 million had been spent on agency staff by the end of August. The budget for agency personnel for the period had been set at €272 million. The report shows spending on staff overtime was about €52 million higher than the official budgetary figure. However, the bill for staff who were directly employed was about €220 million less than the €7.29 billion provided for in the health service budget to the end of August.The HSE told the Dáil Public Accounts Committee in September that an employee provided through an agency can cost about 40 per cent more than a conventionally-recruited staff member.READ MOREThe oversight group’s report says that by the end of August the HSE had a financial deficit of just under €660 million.This was made up of an overspend on pay of €172.5 million, a deficit on non-pay expenditure of €423.6 million and a shortfall in income of €63.2 million.Within Government there are concerns the overall HSE deficit could hit €1 billion by the end of the year.The report indicates the health service is experiencing a significant reduction in income as a result of the abolition of private medical practice in public hospitals. Under changes introduced as part of the Sláintecare health reforms, consultants who had signed up to the public-only contract – which offered higher salaries – could not see fee-paying patients from the beginning of this year.Previously hospitals as well as doctors received payments in respect of private patients treated in public facilities.[ How can runaway spending in the health service be reined in?Opens in new window ]“Income remains a challenge, driven by reduced income from private consultant work as a result of public-only consultant contract implementation. Expected income from private consultant activity is behind August year-to-date budget (€99.0 million/44.2 per cent variance) and total such income for August year-to-date is approximately €91 million lower than the same period in 2025,” the report says.The report maintains that demand for care in hospitals is also significantly higher than set out in the HSE’s national service plan (NSP) for the year.“Continued demand growth [above NSP levels] is evident across urgent and emergency care. Over 1.1 million people attended emergency departments by August, representing a 7.2 per cent increase on last year and 4.7 per cent more than the NSP plan allowed for.” “Admission including over [age] 75-plus remain high year on year.”The report also says the HSE spent €27 million more than anticipated in its budget to provide what is known as surge capacity to prevent patients having to be treated on trolleys.“Total surge capacity of 124,288 has been utilised August year-to-date. This is 44.1 per cent more than last year and is necessary to keep patients off trolleys. The incremental costs associated with this are estimated to be €27 million higher than last year.“Demand has also outpaced targets in other areas such as cancer care and home support (August year-to-date). Demand has risen this year across symptomatic breast and rapid lung clinics with activity running 19.5 per cent and 23.4 per cent above NSP targets respectively. The number of patients having completed radical radiotherapy treatment is 17.5 per cent above the NSP target.”