David Cullinane (Waterford, Sinn Fein) | Oireachtas source

What you cannot do is challenge facts. I am entitled to my opinion and the Minister is entitled to his. Earlier, I raised what are legitimate concerns and issues about a perceived mistrust between his Department and the Department of Health and the language in these documents and then he has come back to say that this just the normal cut and thrust of the ELS process every year. That is not reality, given that the head of the HSE has been on an RTÉ radio programme saying that 2024 would be very challenging for the health service. There is a recruitment embargo in place, as the Minister knows, and he will have to build a deficit into the service plan and that will be guaranteed. This year the proof was in the pudding. We had a very substantial Supplementary Estimate and even though the Minister was warned about building that into the base, which he did not do, it is not recurring next year. That is a problem.

The Minister spoke about mismanagement of health funding. I will read from his own briefing note. These are not my words. These are words in a briefing note presented to the Minister. It state that the Department's position is that the very maximum affordable settlement for health is €808 million. The Minister knows that the Department of Health and the HSE have a completely different view, which they would say is based on science. They would say it is based on fact, on evidence and data. That is not to say that everything the HSE or the Department says is right but when you look at the huge gap between the two, there is a concern. The note goes on to say that at present, the Vote has not been given to the Department of Health, given the gap between both Departments, the lack of meaningful engagement on a revised bid and the risk that this will be used as a starting point for negotiation of a higher amount. It is quite critical of the Department. It also says that the Exchequer cannot be expected to address the 2023 overspend problem, which has been allowed to get out of control. Those are not my words. Those are the words of the briefing document done for the Minister stating that health spending is out of control.

On inflation, the note says the Minister does not accept the arguments on inflation. It actually says "inflation, if needed", which I am assuming was the prompt for the Minister to respond. I put it to the Minister again that there are very sharp differences between what should be factual positions. Either inflation is at 10% or it is not. When the head of the HSE was before the Oireachtas health committee after the budget, I asked him if he still stood by the assertion he made when he came before the committee before the budget that health inflation is at a minimum of 10% and in some areas up to 17%. He said he did. Yet ELS, as the Minister knows, is only 3.5%. The Minister's own briefing note says that his Department does not accept the information it has got from the Department of Health.

I may well be sitting across from here one day as Minister for Health, and I may not. If I am, I acknowledge there are difficult decisions to be made. I cannot envisage a circumstance where ELS is based on available funding, contrasting that with what might be available for new measures, as opposed to what is actually needed to stand still. That is what the Minister did. His Department advised him to provide ELS funding for next year that is a fraction of what is needed, and the result of that is a guaranteed Supplementary Estimate for 2024 and another big hole in the HSE's finances that will have to be filled in at some point. Maybe the Minister is waiting for the next Government to fill it in; I do not know. It is not a way to fund a health service.

Everything I have seen from all the briefing notes and from the commentary from the Department and the HSE shows that there is a lack of trust between the two Departments. That is beyond the normal cut and thrust of negotiations. I am not apportioning blame one way or another. I am saying that for the public, for the people who use our health services and for those of us who are trying to make sense of all this, it does not make sense. Either facts are facts or they are not. I have to put it to the Minister again that the level of ELS that has been funded for the health service next year will clearly not be enough. Let us see what happens. If I am wrong there will not be a need for a Supplementary Estimate in health next year. We will see this time next year who was right about that, as we did this year.