Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein) | Oireachtas source

What we are being presented with is a request to provide to the HSE €219 million, €20 million of which the Minister is providing from Vote 38. Some €199 million is now sought to address deficits to bring the HSE to the end of this month. Bearing in mind the Minister's opening remark that this is a considerable achievement given that the figure is less than 1.6% of the health sector budget for 2013, it is not a matter of congratulating anybody in these circumstances. I have great sympathy for front-line staff and those entrusted with oversight and management across the HSE. They most certainly have had a very difficult task. I sympathise with the remark because the contraction in budgetary provision over recent years has made the task of the staff infinitely more difficult. I will not be opposing the request, nor did I oppose the €360 million sought this time last year to bring the HSE to the end of 2012. The wonder is that the amount is not even more. One cannot demonstrate on the balance sheet the real cost. This is only in terms of euro and cent. Despite the Minister's talk about demographic pressures, the prioritisation at all times of patient safety and challenging service delivery targets in respect of phenomena such as waiting times, and despite his natural focus on defending what he regards as his and his colleagues' achievements over 2013 and 2012, he ought to be equally aware that the position is far from what it ought to be. An inordinate number of people are waiting to get onto a waiting list to be seen for the first time. The number is in the tens of thousands, which is very distressing for people. When people enter the system, the experience is generally good. However, getting into the system is a huge part of the difficulty that is raised frequently with elected representatives.

I, too, I am interested in the detail on the Supplementary Estimate calculation. Deputy Kelleher referred to the pension lump sum payments. There is under-expenditure of €82 million. I, too, question this. With regard to the under-expenditure in the capital area, what capital works have not been undertaken?

I would like the Minister to elaborate on the services deficit of €111 million. The figure pertaining to the primary care reimbursement schemes is €104 million, yet, in the course of the Minister's contribution, he spoke of savings having been made. An additional €104 million is required to bring the schemes to the end of this month. An explanation on this is required.

Regarding the new integrated financial management system that the Minister referred to in his introductory remarks, and his reference to changing the financial management system, there is relevant legislation to be considered, the Health Service Executive (financial matters) Bill, which has not yet been published. I questioned the Taoiseach on this yesterday. It is to disestablish the HSE Vote and establish a statutory financial governance framework for the HSE. Can the Minister elaborate on that? What will be the impact of the presentation of that legislation and its processing in regard to the democratic engagement at this committee? With regard to disestablishment of the HSE Vote, we are dealing with the HSE Vote now in supplementary terms. Will the Minister advise us on the intent of the legislation and its impact on the process in which we are currently engaged?

On the deferral of the introduction of the charge for private patients using public beds, which is coming into effect as of 1 January, the targeted savings amounting to €60 million in 2013 were not realised. What is the savings target to be realised in 2014? I recall a figure of €30 million having been mentioned. Can the Minister clarify what is expected to be realised? Why would he put the brake on that? I can understand the impact on the private health insurance sector but no mistake should be made in acknowledging that if the commitment exists to move and motor this process, the slow-down is not excusable. It needs to be grappled with as part of the move towards universal entitlement to health care on the basis of need, and need alone.

The Minister talks about the Haddington Road agreement and the main drivers of savings under the agreement, as he sees it. He refers to the commitment of additional hours by staff that will lead to a reduction in overtime and agency staff. Can the Minister indicate what reductions in agency staff have been achieved in the course of 2013? What prospect is there for any genuine reduction in agency staff - primarily nursing staff but also administrative staff - when the Minister continues to operate under the embargo placed on recruitment? Will this matter be addressed in 2014, and will we see a move from agency staff to properly employed, full-time, permanent and pensionable nursing staff and other operators within the health services?