Dr. Ambrose McLoughlin:

I want to comment, which I do with great respect. The Chairman asked me to comment on a Government decision and to say whether the HSE got the correct budget. Government decided on the budget. We have been through an extraordinary international economic crisis at a financial level. I clarify that the recent reductions in expenditure per capitain Ireland are the highest experienced in any OECD country with the exception of Greece. I ask the committee to understand that as a civil servant, I am obliged to carry out the decisions of the Government and the Minister in these matters, as is Mr. O'Brien. We accept that we are in an extremely challenging environment and will do everything we can to take on board the constructive recommendations the Chairman and many members of the committee have made in respect of medical cards and other issues. However, Ireland's position in terms of public health expenditure has changed dramatically. We have lost €3 billion and 12,000 staff since 2008. We have been providing more services for less and reached a point where we will have to provide less for less. We have done everything we can.
I am precluded from getting into the political space, but I want the committee to understand that I have been diligent in every respect in terms of discharging my office, as has Mr. O'Brien. The health committee of the Cabinet is made aware of our concerns and those of our Ministers. Our Ministers have stated in public that there have been very significant reductions. At the same time, there have been dramatic improvements in productivity. We are working on Haddington Road and dealing with a variety of issues. We have seen significant reductions in cost - a macro number of €950 million from 2007 to 2013 in respect of drug costs - but there are significant challenges in reforming the health system. We are addressing that.
I want to recognise the contribution the committee made to section 38 and 39 bodies. However, I remind the committee respectfully that it was the Department of Health and its Minister who uncovered this following a HIQA report and sought the investigations. We are obliged to follow due process. We share the committee's concerns and will deal with the issues in a proper manner having regard to natural justice. We will get the very best result in respect of the top-ups and all our actions will, of course, be subject to audit by the Comptroller and Auditor General in due course.