Dr. Ambrose McLoughlin:

For the record Chairman, I was the chairman of the HSE and I requested Mr. Magee, following consultations with the Minister, to have an internal audit in this respect carried out.

There is one item I need to address before I leave the meeting. In September 2013, more than 1.8 million medical cards were in circulation, covering 43% of the population and representing an increase of 590,000 or 46% since the start of our economic crisis in 2008.

The reality of life is that the health service budgets across the system are under pressure. These budgets are determined not by me or the head of the HSE but by Government and Government was operating under extraordinarily serious constraints until the recent departure of the troika at the end of last year. We will learn from the experience we had today and the observations of the members but we have been through an extraordinarily difficult period and the budgets of the health system are squeezed to the bone. Ministers have made this clear in public. However, it is ultimately a matter for the political system to decide the level of funding it wishes to put into the health care system. It is not a matter for officials and I completely reject the contention that I or Mr. O'Brien have acted improperly. I have discharged my office with due diligence and I have discharged every single request that has been made of me by the Department of Health and its Minister.

Notwithstanding all the challenges we face, there have been significant improvements in the Irish health system and enhanced productivity that has been recognised. As Secretary General, I recognise the difficulties that staff on the ground have in extraordinarily difficult circumstances with increasing pressures. These include an ageing population, increasing chronicity, in other words, people having more complex issues, and increasing challenges in the context of the manpower area, which have been there for many years. We have initiated the Brian McGrath exercise where we are looking at career structures for non-consultant hospital doctors and consultants. The Minister will make significant announcements in due course that will deal with problems that have been part of the Irish health system since 2003. The reality of life is that we are in a challenging environment. I am asking the members of this committee to understand that those challenges are very significant and I will leave it at that.