Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

The question is this: what are the hidden costs of restructuring? We never seem to get any definitive answers to that question. Are there initial costs in terms of the Minister's restructuring programme? I refer not to the roll-out of universal health insurance and all the other areas, but to the internal restructuring under which the HSE is being brought into the Department, with the Minister sitting at the top of the new organisation with full accountability to the Dáil, as stated in the programme for Government. The Minister never seems to be able to explain whether this will be cost-neutral, whether there will be a cost benefit or whether there has been a cost. That is something we need to hear when he speaks of savings and efficiencies in the Estimates.

We have been warned about speaking about next year's Estimate and the upcoming service plan but the bottom line is that when the Minister kicks decisions such as that on under-expenditure pertaining to pension lump sum payments and capital down the road to next year, he starting off with a deficit. The lump sum pension payments will have to be paid next year. There were factored into the accounts for this year. Capital under-expenditure, unless it arises from actual savings achieved because of new tendering processes or otherwise, means the Minister is starting off with a deficit in the capital area also.

The Minister stated yesterday or the day before in Brussels that he did not believe this Supplementary Estimate would have any impact next year. The bottom line, however, is that, even on a cursory look, I contend it will have an impact of minus €82 million and minus €50 million, which amount to minus €132 million before starting at all next year. Perhaps the Minister will clarify these issues.

I blame the Minister for many matters but I certainly cannot blame him entirely for the recruitment of specialist nurses from abroad. We spoke about this before and warnings were issued. Retirement schemes were put in place and we lost key front-line personnel. That the HSE and Department must start trawling the world to find nurses of specialist grades to replace those who have actually left this country seems to point to a failure in planning and oversight in the longer term. I am not holding the Minister responsible in this regard but believe it is a very serious shortcoming if we must try to recruit nurses internationally to replace those who have left the country in the past two or three years. It simply beggars belief.