Oireachtas Joint and Select Committees
Wednesday, 6 December 2017
Select Committee on Health
Estimates for Public Services 2017
Vote 38 - Health (Supplementary)
11:45 am
Simon Harris (Wicklow, Fine Gael) | Oireachtas source
I thank the Chairman. I will take some of my statement as read but I will highlight a few points.
I thank the committee for the opportunity to bring forward this Supplementary Estimate for Vote 38 this morning. The total additional funding I am seeking for 2017 is €195 million. Of this, €40 million is for a winter programme and €155 million is towards overspends in non-performance related areas of the HSE. While the amount sought is significant in monetary terms, it is important to point out that it represents less than 1.4% of overall health expenditure this year and is indicative of the particular challenges to be balanced in health and the priority the Government attaches to addressing areas of particular concern.
It is fair to say that the improving economy has made extra spending on health and other priority areas of public expenditure possible. We need to keep our economy strong so that we can continue to develop our health infrastructure and the provision of our health services into the future. The mid-year expenditure report highlighted the issue of health funding as a major policy challenge, not just in this country but internationally. Despite welcome increases in recent years, a financial challenge remains as we deal with a larger and older population, more acute health and social care requirements, increased demand for new and existing drugs and the rising costs of health technology. The costs of payments under the State Claims Agency are also rising, increasing the cost of health above that necessary to meet the health demands of our changing population.
This year, the anticipated level of overspend by the HSE is linked to the impact of the 2017 pay agreements for which the health service was not funded, State Claims Agency settlements being above budget, a shortfall in income in the acute hospital sector and expenditure in a number of service areas. The HSE, through its performance and evaluation framework, has undertaken to reduce the level of the final potential overrun in the performance areas. I am aware of both the limited Exchequer funds available and the need to ensure that poor financial performance is not rewarded. In this Supplementary Estimate, we are addressing the funding requirement arising from decisions made subsequent to the national service plan, particularly central wage agreements and shortfalls arising from items outside of the management's control of the health service, such as income shortfalls and the overrun in settlements by the State Claims Agency. It is important to say that these items are outside the immediate and direct control of my Department and the HSE and are as a result of central decisions made by Government since last year's budget or by the actions of third parties.
I welcome the fact that this year's economic performance has provided us with the scope to increase budgets again, providing €40 million for the early commencement of a range of measures to address winter pressures. This will provide additional acute hospital capacity, long-stay and home support for older people and measures in primary care. The 2018 budget will allow for further developments in these areas, as well as in areas like new drugs, the national cancer strategy, the national maternity strategy and the continued development of the National Ambulance Service. I also welcome the fact that, in general, where service improvements were approved and implemented in 2017, the funding is in place for 2018 for their continuation. This is important. We cannot have stop-start measures in the health service. When we fund something in one year, we want to be able to continue that and, indeed, grow it where possible in the next.
I will now set out briefly the items that make up this year's Supplementary Estimate. The sum of €50 million relates to the State Claims Agency. I have already outlined the rationale behind that sum. A total of €75 million of the Supplementary Estimate relates to central pay decisions taken after the 2017 budget was finalised. This funding primarily relates to the acceleration of the Lansdowne Road agreement and the reinstatement of the non-consultant hospital doctor living out allowance. Members will be well aware of the decision to bring forward earlier payments under the Lansdowne Road agreement. Obviously, that has had a knock-on effect in the context of a health service that employs over 100,000 people. A total of €30 million of the Supplementary Estimate relates to a shortfall in income generated in acute hospitals. The core purpose of the public health system is to provide services for public patients. Nonetheless, as we have discussed on many occasions, historically and currently a proportion of activity in public hospitals involves the provision of care to private patients. It is only right and proper that insurance companies make a contribution to the cost of using our public facilities. In his 2010 report, the Comptroller and Auditor General identified that for 50% of private patients, no private inpatient charge applied as patients were either accommodated in a designated public bed or a non-designated bed. The Health (Amendment) Act 2013 was implemented to address this issue. It is Government policy that the users of private services in public hospitals should pay for the cost of providing them. It is also important to say that a working group comprising representatives of my Department and the HSE is looking at all of these issues in terms of the public and private sectors and how they interact. Committee members will also be aware that in the context of the Sláintecare report, I have set up the de Butléir group to look at the question of decoupling private from public in the health service. I have made my own position on that issue very clear. I would like to see them decoupled but it is important that we consider any unintended consequences through the aforementioned group.
Finally, €40 million of the Supplementary Estimate of €195 million relates to measures to improve scheduled and unscheduled care. Members will be aware that this money will allow for the early commencement of a range of measures aimed at alleviating pressure in our acute hospital system. It is made up of €30 million for winter and unscheduled care measures and €10 million for further work through the National Treatment Purchase Fund, NTPF, and the HSE's waiting list initiatives. There are lots of figures out there relating to waiting lists. Sometimes it is quite hard to digest the very significant range of figures out there and to what each list refers. In that context, Trinity College in Dublin is doing work on how best to record and report waiting list figures so that we can have accurate data comparable with that of other countries. It is important to say that the numbers on inpatient and day case waiting lists, that is, the number of patients waiting for a hospital procedure has fallen for three months in a row and I expect that trend to continue into 2018.
In view of the fact that the items giving rise to these increased costs are, in the main, outside the immediate and direct control of the HSE or are in an area in which we would like to make further improvements in terms of scheduled and unscheduled care, this request for a Supplementary Estimate is fair and reasonable. This additional funding combined with the 2018 budget provision is a practical example of how we are now reinvesting in our health service. I seek the committee's approval for this Supplementary Estimate.
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