James Reilly (Dublin North, Fine Gael) | Oireachtas source

The pension payment reduction was mentioned by Deputy Kelleher. Mr. Tom Byrne will be very happy to address that. The underspend in capital was also mentioned by Deputy Kelleher and Ms Bairbre Ni Aonghusa will address that. Can I take the opportunity to thank both the members of the Department and the HSE for being here?

The issue of longevity was raised by a number of people. I would be the first person to put my hand up and say that is not all down to health. They say about 50% of that is down to social conditions - living conditions. Nonetheless, health has a very large influence on it.

We were talking about praising the HSE. I am praising the people who work at the top of it who have brought in new financial reforms, put in a reformed board and got much greater control and command over the finances, which is something we did not have in the past to the extent that we should have. This issue has been raised by a number of people in terms of being able to follow money and where it goes.

The Deputy asked about the costs involved in restructuring. I believe it is saving rather than costing money. Of course, there is always some initial cost. The Deputy also mentioned the effect of the Supplementary Estimate on next year. The Supplementary Estimate cannot be carried to the next year so moneys and debts that crystallise during this year are dealt with this year. If any money is left over, we would have to hand it back to the Exchequer. In respect of the key retirements at specialist grades and the fact that we must look abroad for key specialist grades of nursing, that is not down to any directive from us per se but rather a public service agreement that allowed people a grace period to February to go if they felt it was more beneficial to them. We had no hand in it and could not direct who could stay or go. It was down to the individual's choice. In respect of the incentivised career break scheme, it is very much in our gift to decide who goes and who stays and that is why out of the 2,700 who applied, so few have been let go because they were front-line staff who were key to our service delivery requirements and we could not let them go.

I believe this Supplementary Estimate, which is less than last year's Supplementary Estimate despite the hugely challenging year we have had, compares very favourably with the last Supplementary Estimate of the previous Administration, which was €595 million. Deputy Ó Caoláin asked about the health service being far from what it must be. We all accept that it is far from what it must be and we aspire to make it a much better and fairer service. However, I would like to put on the record of this committee that it is far from what it used to be. It is an awful lot better. It was only January two years ago when we had 569 people on trolleys. Since we came into Government, we have seen a reduction of 34% in the number of people who must endure long trolley waits. I will return to that issue.

Deputy Ó Caoláin spoke about the savings relating to the charge for private patients using public beds. It is €30 million. That is what we hope to realise next year with the new charge regime. I have very strong feelings on this and have it made very clear to the VHI and other insurers that they have not done anything remotely like what they should be doing in terms of controlling private health care costs in this country. The audit was very weak in respect of ensuring that things that were charged for were actually done. There was no clinical audit, which still astonishes me. In other words, there was nobody to challenge the doctor as to when the tests were done in the first place. There is no point in sending a surgeon to challenge a cardiologist. You need a cardiologist to challenge a cardiologist. In respect of benchmarking, the question arises as to why we are still paying several hundred euro for procedures that used to take two hours but now only take 20 minutes. Benchmarking and auditing in the private hospital sector are issues.

Deputy Ó Caoláin mentioned savings relating to agency staff. I will ask Mr. Byrne to address that. Deputy Healy spoke about the budget being deliberately under-funded. This is absolutely not the case but one must understand that health is unique in this regard. It is demand-led and unpredictable. An area like social protection gets the benefit straight away if there is a drop in unemployment but that is not the case in health. We have an ageing population and it is great that we are all living longer but as we live longer, our demands on the health service increase. Consequently, we have seen an increase in activity in the region of something like 2% this year. We sought €190 million for a 1% increase and got €90 million. It turns out to be 2%. We are not in the position that we can decline to give service to people who are acutely ill. People who turn up have to be treated and treated quickly and we are seeking to improve that from the point of view of the initiatives we took around the waiting times. In the first year, over 95% of people were treated within the year. Last year, over 95% of people were treated within nine months. This year, we aim to do it in eight months. On top of that, one must note the astonishing fact that no previous Government ever bothered to count the outpatient waiting list or quantify what it was. We have done that. It was 386,000. As I said before, the real disgrace is not that number but the fact that so many people waited longer than four years. We have already seen a 75% reduction in that since March 2013 and that has declined further since I received the latest figures although I do not have them. We want everyone seen or treated within a year having been referred by their GP. That is an enormous challenge given the constraints we face with a 20% reduction in budget and a 10% reduction in staff yet the men and women of our health service have not just maintained a safe service, they have made it better, as I have outlined. I want to put on record my gratitude and thanks to them for the hard work and the great work they do on a daily basis. What we are trying to do is create a system that allows them to do that rather than frustrating them in trying to do that.

Deputy Healy also spoke about how you cannot maintain a service having taken €3 billion out of it. I think we have proved that you can and can improve as well. As for taking any more out-----