Ms Bairbre Nic Aongusa:

Deputy Conway raised the issue of how we could reward efficiency in the system. This was one of the issues highlighted by the Ogden review of financial management systems in the HSE, commissioned by the Secretary General in June. It identified a wide range of areas for improvement in the systems, processes and structures around the financial management system. One issue it picked up on was the fact there is no reward for a manager to remain within budget and no incentive to achieve savings. Neither are there penalties for people who overspend. The Deputy is correct that there may have been a culture of no incentive to make savings. On foot of the Ogden report, measures will be put in place to address its recommendations.

The Ogden report identified a need to improve the capacity and capability of the financial system in the HSE. For example, the proportion of qualified accountants working in finance in the HSE is only 10% whereas in the UK the norm is 25%. The Secretary General earlier referred to the need to invest to improve efficiency in the system. The Ogden report identifies a need for investing not just in improved ICT financial systems but also in human resources and capacity, along with better procedures to ensure better oversight and control of expenditure. There is a need for us to focus on the financial management systems in the HSE. To do that, we will have to achieve savings elsewhere in the system. The Ogden report, we hope, will be published shortly.

Deputy Colreavy asked whether there is a limit below which the health service cannot be funded. The extent to which we can deliver on the health reform programme and on providing an efficient, effective and high quality service is dependent on the degree to which we can extract efficiencies and costs savings from the existing system, as well as addressing existing inefficiencies and improve the processes, procedures and the models of delivery of care. In a great many areas, a different model of providing care would provide a more efficient service as well as improving quality of care for patients.