Mr. Tony O'Brien:

Some of those savings are savings and some of them are targeted at core payments. Those which are set out in the service plan and in the Estimates would be achievable as a result of the increase in prescription fees or the effect of implementing reference pricing. Those things are delivering well. Essentially, 75% of that challenge is in hospitals and covers the areas Mr. Mulvany has referenced. Hospitals are dealing with increased pressure at the front door at the emergency end. They are dealing with challenges within the staffing space. The reason for the increased dependency on clinical agency services - and, therefore, the increased cost - is the twin challenge in some areas of attracting both consultant personnel and non-consultant personnel into permanent employment. Those areas in the hospitals which are dependent upon cost extraction are where we are most challenged.

The second area of recourse is that in the original €666 million there was a cost extraction from the Vote of €113 million which related to medical cards, of which €47 million was reversed by way of additional funding, but we have to fill the remaining gap from within our own resources, and that is also providing a challenge. Across the spectrum of the savings measure, some are working perfectly and others are much more challenging.