Dáil Éireann - Volume 653 - 29 April, 2008

Priority Questions. - Departmental Expenditure.

Deputy James Reilly asked the Minister for Health and Children if she is satisfied that the finance allocation to the Health Service Executive in 2008 will enable it to deliver the 2007 level of services in addition to specific service improvements; and if she will make a statement on the matter. [16775/08]

  Deputy Mary Harney: Our democratic system means that, fundamentally, there is no public spending decision without a tax decision. The two cannot, and should not, be separated. That is why both expenditure Votes and taxes are set by the Oireachtas annually around the same time, and both have to be adhered to. The Oireachtas has voted a budget for the HSE for 2008 from resources provided by taxpayers. Excluding the long-stay repayment scheme, the gross current amount is €14.2 billion which equates to approximately €3,380 for every person in the country or €9,732 for every income taxpayer. This amount is more than a quarter of voted Government current expenditure. It is almost the equivalent of total estimated income tax receipts. This allocation is an increase of 8% on the 2007 outturn of the HSE. By any national or international standard, that is a high level of increase for a national health service. Few other countries maintain such levels of increases year after year. The OECD reported yesterday our rate of increase in public health spending was the second highest in the developed world between 1995 and 2005. Many people say recent levels of annual increases are unsustainable.

No health system in the world operates without implicit or explicit budget limits and benefit limits. It is also the case that every health system, including our own, needs to deliver the most effective services for given resources and to constantly improve, that is, to make value for money and efficiency gains. The HSE has incorporated value for money targets within its service plan. Those who support increased efficiency in public services will fully understand and support the fact that a 1% increase in efficiency for the HSE means, in financial terms, providing the same level of services at a cost of €142 million less; a 2% efficiency gain means providing the same level of services at a cost of €280 million less.

Additional information not given on the floor of the House.

The services and targets to be provided by the HSE in 2008 are set out in the national service plan, which I approved in November 2007 and the addendum to the service plan which I approved in February 2008. Both of these documents have been laid before this House and published. In its Exchequer issues return to end April, the HSE is reporting an overspend [224] against profile of €95 million, excluding the long-stay repayments scheme. I have had discussions recently with the chairman and CEO of the HSE about these emerging budget pressures. The imperative for efficiency gains and more effective practices is all the greater to deliver services, consistent with Government priorities, and within the annual budget allocated by the Oireachtas and the profile of expenditure planned for each month. The HSE is considering the steps it should take in this regard. When I receive the HSE’s proposals in this regard, I will report to Government as part of the normal expenditure management process.

  Deputy James Reilly: It is no surprise we have the second highest increase in spending while we have come from being the second lowest out of 28 countries only a few years ago. I have a letter from Mr. Woods, the national director of finance. The HSE sought €14.7 million to maintain existing services but the Minister has decided to give them €14.1 million. Was there an agreement to that effect or was it determined by her Department that this is how it should be? This being the case, is this the reason we have had promises of such a run of cutbacks in this coming year? I refer to a reduction of 25% in orthopaedic elective surgery in Our Lady’s Hospital, Navan, a reduction in surgical activity in Louth County Hospital, including elimination of on-call and the establishment of a shorter working day, a reduction in outpatient clinics in Our Lady of Lourdes Hospital, possibly being reduced by one day per week, Friday, reduced outpatient clinics to four days a week——

  An Leas-Cheann Comhairle: A question please, Deputy.

  Deputy James Reilly: The question is coming.

  An Leas-Cheann Comhairle: It had better come quickly.

  Deputy James Reilly: ——the reduction of elective surgery to four days a week in Cavan-Monaghan; the closure of ten beds in Cavan-Monaghan; and Monaghan to be taken off call. I also refer to the intended closure in August of UCHG, the hospital which is designated to be the regional centre of excellence for cancer care in the west and is the centre of tourism for this country. How clever is that? An embargo on staff, cutbacks in Connolly Hospital——

  An Leas-Cheann Comhairle: A question please, Deputy.

  Deputy James Reilly: Was this by agreement or is this the reason we have this never-ending list of cutbacks, including cutbacks to home help for the elderly, home care packages for the disabled and now the hospital in the home scheme to be removed? While we are talking about cutbacks, has the Minister made any progress on redundancies in the HSE and how much does she hope to save? I ask her to answer my first question clearly and concisely, as I know she will. How did the Minister reach the figure of €14.1 million when the HSE sought a figure of €14.7 million? I ask her not to mention the extra €200 million for particular new services.

  Deputy Mary Harney: The Deputy may not be aware but what happens in the Estimates bid from every Department, including when the health boards existed, was that those health boards would make their bid. The Minister for Health and Children engages in discussions with the Minister for Finance and a budget limit is agreed.

  Deputy James Reilly: We no longer have health boards.

  An Leas-Cheann Comhairle: Allow the Minister to continue without interruption.

[225]   Deputy Mary Harney: I am explaining there is a finite amount of money which the Minister for Finance can allocate across Departments. The line Ministers discuss this with the Minister for Finance and this is how the budget is agreed for health, education or whatever it might be.

The Deputy’s colleague, Deputy Bruton, has been lecturing us about slicing off 2% for value for money initiatives across the public service and this year we expect the HSE to achieve value for money initiatives. In the first two months of this year, there has been an increase of 7.6% in the number of inpatients discharged and day cases, and a total of more than 14,000 extra people being treated in our hospitals in the first two months of 2008, as against the first two months of 2007. This is an increase in activity.

  Deputy James Reilly: In that case how can the Minister explain this long list of cutbacks? Will she answer the question in respect of progress made on redundancy packages within the HSE, especially in light of the threat to strike by IMPACT trade union because of the recruitment ban?

  Deputy Mary Harney: As I informed the Deputy on a number of occasions and as I have repeated publicly, I have discussed this with the chairman and board of the HSE, which I addressed recently, and with the chief executive officer of the HSE. If there are people in one area in the health service who are superfluous to requirements while there are shortages in other areas, we must make decisions. A manpower analysis has been carried out in recent months within the HSE and the hospitals and community services operated by the HSE. A new human resources director will start work on either 3 June or 4 June. In that context I expect the HSE to be in a position to make proposals about where it intends to make reductions in some areas so that more people can be employed in other areas.