Or indeed the lack of a realistic funding increase.

Ever since Budget 2024 was announced, opposition parties have expressed shock at how small the extra money is that the service is getting – just €800m in core extra funding.

Department of Health officials have admitted they had sought an extra €2 billion next year.

But clearly the money ministers McGrath and Donohoe were having none of it.

Even the Minister for Health Stephen Donnelly has looked a bit stunned and has done no big media interviews about it.

Also the head of the HSE, Bernard Gloster has been exceptionally blunt in saying that the funding this year was not enough and neither is the money for 2024.

In a very unusual move, he has predicted a health service deficit next year, on top of this year’s €1.5 billion deficit.

What it all means is a very difficult health service next year.

That’s an odd place for the Government to put itself, as we head into an election cycle.

There will be the Local and European elections next year and potentially a General Election.

The next General Election must be held at the latest in Spring 2025.

There is genuine fear among health officials of what this Budget shortfall will all mean for hospital overcrowding, waiting lists and service developments – and of course for patients.