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

In fairness, one must always allow for underspends and overspends within a system and attempts are made to balance them out. One cannot have a situation where those who do not make the effort to control their budgets are rewarded while those who make Herculean efforts get no reward, that is, the latter get no increase because they kept to their budget while those who did not bother to keep to their budgets get more money the following year and their base keeps rising. We cannot have that situation. Equally, there are better times ahead and we can see that. Employment is going up, unemployment is falling and confidence is returning to the economy. That will mean there will be less call on health, which is demand-led, in terms of the Primary Care Reimbursement Service, PCRS, into the future. The ongoing reforms, particularly through the new GP contract - which is a whole new kettle of fish - place more emphasis on prevention and chronic-illness care in the community and should mean fewer hospital attendances and admissions.

To give the committee some startling facts, 2,000 beds in our hospital system out of a total of 11,500 beds are occupied every night by people suffering from an alcohol-related illness or injury. Countless tens of thousands of beds are occupied every year by people with cardiovascular, lung and other diseases caused by smoking. I do not think it is unreasonable to look to the day when, if we can get the public health message across and educate our people on the dangers of alcohol and smoking and prevent our children from taking up smoking or abusing alcohol, there will be less need for major budgets for our health system. I know that day may be some time off but it is coming.

Finally, decisions regarding the Supplementary Estimates are made by the Government as a whole; they are not made by the Minister. Section 10 does not preclude the Government from making those decisions. It is a standard provision which gives the Department of Finance the final say and that has always been the way. I would prefer to have the final say but if each Minister had the final say the books might look a bit funny at the end of the year. We all have to operate within budgets and the fight, as Deputy Ó Caoláin has said, is to make sure we get a proper budget that reflects the need to provide a safe service.