The new head of the State’s acute hospitals is only the latest in a long line of senior officials to look at costs in the health service and go “OMG!”

Dr Tony O’Connell is clearly aghast that spending is running well over budget so early in the year. Not only that, he has spotted that many of the savings hospitals claim to be delivering are bogus. How else to explain the yearly charade in which promises are made but seldom kept, resulting in perennial budget overruns at the end of the year?

Dr O’Connell warned the hospitals in a letter this week thattheir costs are running at unsustainable levels and must be addressed immediately.

But Dr O’Connell, who hails from Australia, will need more than a gift for straight talking to whip the hospitals into line.

The fact is that the paradigm of health spending is broken.

Further cuts

Either the health service, which has cut spending by €4 billion during the recession, can still make further significant cost savings, as the troika and the Department of Public Expenditure believes; or else it can’t, having been cut to the bone, as Minister for Health James Reilly, the top officials in the HSE and the health unions believe.

Most of those working in the service believe funding should be increased, not decreased.

What can’t be sustained, though we are asked to believe it can, is an adherence to both positions: ie that we can continue to make swingeing cuts and yet pump out more services.

This fantasy is at the heart of current debate about the health service. “Doing more with less” remains a mantra for those still racing headlong towards the cliff, even when the evidence tells us the system is breaking down. We are now “doing less with less”.

The medical card fiasco is a good example of this double- think. Dr Reilly and his fellow Ministers would have us believe no cull of cards is under way. Yet, under pressure from the Department of Public Expenditure, his department sought to make huge savings in the area. The contradiction involved was plain from the start, but it took an election for it to explode in the Government’s face.

Cheque book

It isn’t as if the politicians have contented themselves with waving the big stick of fiscal rectitude at the health service.

Pity the poor bureaucrats: the moment Ministers come under serious political pressure, they take out the cheque book. From expensive new drugs to medical facilities, the Government has made decisions that add to the cost of running the health service.

Three years into the job, Dr Reilly has run out of road. His political capital is low, his Labour colleagues in Cabinet mistrustful.

Perhaps it’s time the Minister said what everyone in the health service wants him to say: if we want a better health service, we’ll have to pay more for it.