Mr. Tony O'Brien:

We will be happy to deal with follow-up questions to those today. Given that we were together just 38 hours ago, I will limit my opening remarks to issues that were not covered the day before yesterday. In regard to service plan activity, my remarks relate to the first 11 months of 2013 as we do yet have the fully validated data for the full 12 months. Those first 11 months saw the HSE maintain or increase levels of service activity compared with 2012 despite the significant challenge of maintaining the budget and reducing employees. The overall waiting list growth trend seen in the first half of the year had been reversed by the end of November, with a 5% reduction in the total number of patients waiting for admission compared with July. A significant effort has gone in to increasing the number of new patients seen at outpatient departments and the numbers have increased by 5% in that period. Emergency admissions for the 11 months up to November numbered more than 350,000 and were broadly in line with the previous year. A total of 945,836 elective admissions, inpatient and day, were carried out in our acute hospitals during those first 11 months of the year. Some 25 intermediate care vehicles and 73.4 whole-time equivalents have been introduced into the National Ambulance Service in 2013. GP out of hours contacts, at 882,000 up to the end of November, were slightly ahead of 2012 nationally, but there was a significant increase in activity in the north east which is over 6% ahead of their expected level of activity. This service plays a very important role in pre-hospital emergency care. At the end of November, 1,983,572 people were covered by a either medical card or GP-visit card. In that month 23,833 long-term public and private residential places were supported under the nursing home support scheme compared with November 2012 when the figure was 22,985. More than 14,000 referrals were received by the child and adolescent mental health teams, nearly 1,000 or 8% more than projected in the national service plan for 2013, and 70% of those referrals were being seen within three months.

There have been reports recently in the media in relation to delays in ambulance response times. The continuous improvement in ambulance response times is a key priority for the ambulance service and a performance improvement action plan is in place focusing on a number of key areas as follows: call taking and dispatch, use of intermediate care vehicles for inter-hospital patient transfers, introduction of a single national control centre, and turnaround times at emergency departments.

A review of recent incidents has shown that at some emergency departments ambulance vehicles have been delayed for longer than the 20 minute target time. This in turn has an impact on response times. An enhanced escalation procedure is being developed in relation to delays beyond 20 minutes. This enhanced escalation procedure will provide for an RAG, - red, amber and green - rating whereby such delays can be treated as an adverse incident.

During 2013 and 2014, there has been significant investment in ambulance services. Last year, €25 million was allocated, which included capital investment to provide for a single national control centre as well as for the purpose of 25 new intermediate care vehicles. These new intermediate care vehicles are now in place. This year a further €3.6 million has been provided to progress the single national control centre. These investments will allow for significant improvements in response times as well as being able to cater for an increase in the volume of emergency DELTA calls which are currently about 10% more than the same period last year, the equivalent of about 1,000 extra calls per month.

Turning to 2013, the deficit for the HSE prior to the application of supplementary funding of €219 million was €205 million, a €14.1 million Vote surplus after supplementary. This compares with a Vote deficit of €337 million for 2012, prior to the application of supplementary funding of €360 million. This deficit is also inclusive of any once-off savings, mainly in pensions, available in 2013 which will not be available to the HSE in 2014. The deficit is a reflection of the overall challenge within the HSE in 2013 when account is taken of the risks that were set out in the national service plan for that year. These included the Haddington Road agreement, HRA, which took effect from 1 July 2013, the potential value of the risk in terms of projected deficit which has undergone a detailed review, and an assessment of the likely 2013 savings that are expected to be delivered. Some €46 million of the HRA target has not been achieved in 2013.

The private patient charges provisions were originally due to take effect on 1 July 2013 and generate €60 million for the latter half of the year. These measures took effect on 1 January 2014 and therefore there was no generation or collection benefit in 2013 to the HSE. The financial impact of the delayed implementation of the legislation started to materialise in July 2013, with an increase in deficits being reported by relevant hospitals. This deficit includes shortfalls in the four key risk areas which the HSE had previously identified as follows. In the primary care reimbursement service, PCRS, where the target was €353 million, a deficit due to the delay in implementation of the financial emergency measures in the public interest, FEMPI, regulations amounted to €41 million. A dental treatment service scheme had a deficit of €13 million. A shortfall on a non-FEMPI target of €303 million amounted to €49 million. A reduction in the number of items claimed on medical cards has offset these deficits. The PCRS is expected to deliver a final deficit in the region of €70 million. The effect of the delayed implementation was to increase deficits by 2013.

Unusually, today, HSE officials are appearing simultaneously before two Oireachtas committees. With the Chairman's permission, it might be worthwhile to say a little about that. Obviously the Committee of Public Accounts is focused on the follow-up to the audit carried out within the HSE in respect of remuneration of section 38 organisations. That is obviously the subject of an inquiry by the committee and is receiving considerable attention. The committee will also be aware that in 2013, for the first time, we required section 39 organisations to return to us details of the pay levels of all personnel above grade eight and, consequently, a full validation process is under way in relation to the information received. A question has been tabled today on that issue. Clearly, the issue of appropriate compliance with public sector pay policy by section 38 organisations, where personnel are fully public servants, and section 39 organisations, where they are not public servants, is a key issue for us at the moment. The organisations are asked for full disclosure and to have due regard to public pay policy.

From a financial performance perspective, when account is taken of the four key risk areas which I have mentioned for 2013, which were outside the direct control of the HSE, a break-even position on direct services, that is, hospital and community services, was delivered. This is after the application of once off surpluses which primarily related to lower than expected retirements in 2013.