Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I welcome the Minister. We are in the invidious position of short timescales for advancement of information and looking at the principle of Supplementary Estimates in the no-change policy areas. We accept there have to be Supplementary Estimates. However, year in and year out we have notifications of a Supplementary Estimate, knowing well in advance that there has to be a requirement for a Supplementary Estimate simply because there was inadequate planning, forecasting and demographic proofing. That all flows from the inability of the Department of Health and Children and the HSE to actually assess what it needs for the year ahead, and put a figure on it. The Department and the HSE is incapable of doing it and this has not changed in recent times, in fact it has become progressively worse. The figure of €665 million, some of which I know has been because of changes in policies, is still a significant Supplementary Estimate considering that some of the policy decisions announced in 2014 that would have had an effect could have been factored into the 2015 figures also.

We have not progressed in accountability either. The Department of Health, the Minister, senior officials and the HSE at senior management level are incapable of actually managing a budget. It is a harsh thing to have to say but that is the simple fact of it. It has been chaotic at times. I understand the need for Ministers to flex muscles at times or to try to get a headline in the newspapers. We have seen the previous Minister for Health trying to face down the cuts that were forced by the Department of Public Expenditure and Reform. However, behind all that and when one strips it away there is a chaotic system - which is an oxymoron I suppose. It is an issue which must be addressed because, fundamentally, if we are serious about delivering health care and services for people under the obligation of the State to provide public health services, there needs to be a foundation and a base upon which the year ahead can be planned.

The question must be asked whether the Minister holds back on always having a Supplementary Estimate because he knows full well the HSE is incapable of managing its budget itself. If that is the case it is a damning indictment of the HSE. Does the HSE always know there will be pressure on at the end of the year and that a Supplementary Estimate will come in anyway so there is no real inclination or obligation to make an effort to maintain the services within budget? It is probably a little bit of all of the above. When one does not have certainty, security or a defined plan to implement health services then one gets panicked situations at the end of the year. It happens time in and time out in the provision of health care. With the Supplementary Estimate some procedures can be ramped up while other services are cut in order to try staying within budget. It all seems to be chaotic.

The Minister talks about the potential privatisation of hospital trusts in the years ahead, or at least farming out the management of hospital trusts or groups to private companies. Is the Minister concerned about the consistent, major overspend in our acute hospitals as currently constituted? Is there an incentive for acute hospitals to overspend on a continuous basis knowing that when the trolleys are out as far as the car park, the ambulances are backed up and patients are unable to discharge, the political pressure comes on and all of a sudden extra money is allocated at the end of the year under a Supplementary Estimate? Old habits seem to not have gone away on the Minister's watch. Perhaps he could elaborate on that.

The Minister made announcements on increases such as the €74 million for emergency department overcrowding and late discharges and €25 million for the fair deal scheme. That was indicated to him as far back as July 2014 when, on taking up his position, the Minister was briefed that delayed discharges were going to have a major impact on health care in terms of freeing up additional beds, moving patients from emergency departments into the hospital proper and moving people out of hospitals into step-down facilities in the community, nursing homes and home care packages.

It seemed there was a very long and lethargic effort to address that obvious challenge facing the health services in general. I acknowledge matters are moving along much better in the accessing of nursing home care. Clearly, much work needs to be done on the community care area, home package supports and so on.

With regard to the National Treatment Purchase Fund, I note the Minister stated that, "Funding of €51 million was provided to ensure that these massive waiting times would be achieved .... across the public voluntary hospitals ... [and] outsourcing activity where the capacity is not available." He abolished the National Treatment Purchase Fund and set up a special delivery unit but who procures the extra capacity? Is it the National Treatment Purchase Fund and, if it is, why do we not say that? Why are we pretending that the National Treatment Purchase Fund has been castrated and is now effectively unable to do what it was meant to do? We should try to bring it to the fore again to deal with the capacity issues. We all accept there are difficulties with capacity in the public health system. That is the reason we have seen major increases until recently in the number of outpatient, inpatient, day-case and other elective procedures. If there is a capacity issue in the public hospital system, admitting it would help and the National Treatment Purchase Fund should be reintroduced to provide and procure private capacity to deal with the backlogs. I cannot understand why we seem to be pretending that we do not outsource when we are outsourcing, which effectively means purchasing from the private sector.