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

I have given careful consideration to this Bill. I indicated on Second Stage that I saw the question of whether we had two allocations - one to the Department and one to the HSE - as a technicality. This Bill seeks to create a single allocation and places the Minister in a pivotal role in relation to the subsequent reallocation across all the service needs.
I wish to set out the backdrop against which we are working. I have calculated that by the end of this year, the amount of money that will be available for our health services will be €4 billion less than the amount of money that was available in 2008. That is a phenomenal figure. Others might argue that the shortfall will be even greater. My calculation is based on the most reasonable outworking. The Minister has signalled that a further 2,600 staff will be removed from the health service during the course of this year. That reduction will be on top of the reduction of 12,500 that has taken place since 2007. That will make a total of 15,100. I accept that I am open to correction with regard to some of the smaller numbers contained within the greater numbers. That is the figure that has been cited time and time again when people have been talking about the reduced size of our health services by the end of the year. The cuts in the amount of money available to deliver on people's health care needs and the number of staff available to ensure that delivery is safe and effective are phenomenal.
Under the HSE divisional plans for this year, it seems that hospitals are being expected to function as they did last year even though their budgets will have been reduced by €200 million across the board. I am particularly, but not solely, concerned about the impact this will have in the hospital context. I am very worried about what we are witnessing. The hospital issue is at the heart of the amendment proposed by the Minister. The many struggling hospital sites in this country are already facing an average reduction of 4% in funding this year. That is not small change on top of everything they have had to contend with. I refer, for example, to the front-line care figures that have been indicated by the Minister. The HSE has confirmed a projected decrease of 25,000 in the number of day cases this year. It has said that the number of inpatient treatments will decrease by 3,000 during 2014. These reductions will have a deleterious impact on access to health care over the course of the year.
I would like to give a little example of how unrealistic the national service plan and the divisional plans are. One of the targets set in the plans involves reducing by 4% the delayed discharge of patients from acute hospitals, even though the allocation for nursing home beds has been reduced. I contend that this will mean many more older people will have to remain in acute hospital settings for longer periods of time. This will add to the significant problems that exist currently. We cannot function without adequate nursing home provision and adequate numbers of step-down and rehab beds. They are simply not available in sufficient numbers. It has been signalled that the situation will get worse over the course of this year.
I have described this Bill as primarily a technical one. Nevertheless, I am very concerned about section 10 of this Bill, as set out on page 7 and to which the Minister's amendment relates. The clause that this amendment would immediately follow, which proposes the insertion of a new section 33B(a) in the Health Act 2004, would mean that an overspend in any one year would be carried over to the following year as a charge on the budget of that entity, facility or hospital. I think that is an horrific situation. If Supplementary Estimates had not come on stream over the last few years, I cannot for the life of me imagine what it would have been like to try to sustain services at hospital sites where those involved have not been able to work within the very restrictive budgets that have been allocated.

If, despite the best efforts of all concerned, an overspend is to be carried on into the next year’s allocation, it will put hardship on top of hardship for front-line service providers and hospital managers, as well as having a serious impact on patient care and safety. It is an absolutely horrific proposition and nightmare scenario that cannot be faced. There are many other facts I could share.

It is a fantasy to suggest there could be a scenario of an underspend. I cannot for the life of me imagine that could present at any of our hospital sites. The Minister’s amendment seeks to write in the Minister for Public Expenditure and Reform into this process. He or she, depending on who is in office at the time, will have a say-----