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

I welcome the Minister, the Secretary General, Mr. O'Brien and everyone else. We are here again at the start of a new year talking about potential difficulties in budgetary management and the stress under which the budget will find itself in the time ahead. In that context, there is no doubt that issues have been raised by the HSE, the Opposition and many commentators on the budgetary process, or how the budget is arrived at. If one looks back at the last number of years, it is evident that the HSE is almost always right about the shortfalls that will arise by the end of the year whereas the Department of Health and the Department of Public Expenditure and Reform are always wrong. That is a fact of life.

Is our process for budgetary arithmetic and assessment completely dysfunctional? Every year the HSE goes in and we accept that a certain amount of horse-trading is involved. The HSE goes in with a figure, outlines the reasons it was arrived at and the Department of Health and the Department of Public Expenditure and Reform insist on a reduced figure and the making of value-for-money savings and, perhaps, names other key areas where budget savings can be made. Almost consistently, that has proven to be a flawed policy.

If one looks back over the years, one had probity in terms of medical cards and other value-for-money savings measures which were farcical from start to finish. Let us be honest about that. It puts the HSE in a very invidious position very early on in every year. The HSE is planning to deliver health services knowing it cannot achieve that because sufficient funding is not in place. The Minister will point out that there is an additional €600 million being made available to health services this year and that this year's budget of €14.5 billion is the largest in the history of the State. Of course, that is true but there are also a lot of issues giving rise to additional funding requirements, including population increases, changing demographics, the complexity of health care and all the challenges that flow from that. Just because one has a larger budget does not mean it is, pro rata, a major improvement on previous years. When one looks at the changes in profile and the various clinical problems in our health services, it is clear we need additional funding in key areas.

I raise this because the Department of Health sent a letter to Mr. O’Brien on 26 January 2018 on issues which have been previously raised by him on the budget process and the funding of services. It refers to Mr. O'Brien's letter, received on 8 December, enclosing the HSE's 2018 national service plan and its view on the financial challenges for the year. The letter stated: "As we enter the new year and begin to implement the plan, it would be useful to set out my response to the comments in your letter."

The comments in Mr. O’Brien's letter were primarily about highlighting the major challenges ahead where the budget provided was, in his view, insufficient. Of course, he is right. We know that as we sit here on 7 February because he has been right every year. It is not because he is smarter than anyone else, it is because of the conflict between the process on his assessment and the agenda from the other side to contain public expenditure. It is Mr. O'Brien who is charged, fundamentally, with delivering health services in this country and ensuring we have a safe and improving health service. In view of its consistent failure to address and put together a budget in a meaningful way and have it approved by the Department of Public Expenditure and Reform for implementation by the HSE, I wonder sometimes whether that is the agenda of the Department of Health any longer. There are consistent overruns.

I am amazed that the letter was sent. Are there agendas undermining the budgetary process between the HSE, the Department of Health, the Minister for Health and the Department of Public Expenditure and Reform? The letter the Minister sent to Mr. O'Brien on 26 January was extraordinary. There seems to be some handwashing or pointing the finger of blame in anticipation, which is unhealthy in trying to arrive at a sustainable, fair and rational budget with which to deliver enhanced services. That has not been done in the budgetary process to date. The freedom of information requests published recently by The Irish Timesindicate that the process is flawed, does not serve the HSE well or its clients in long-term budget planning. The Department of Health seems to be playing both ways, in respect of the Government's request that it cap expenditure, but it is in no man's land in advocating for health services.

We do not want to see any industrial action or any impact on the clients of section 39 organisations. There seems to be almost a Machiavellian intent at work because the starvation of these organisations has been a very successful policy from the point of view of the section 38 organisations and broader health services which can now recruit large numbers of staff from section 39 organisations. Many section 39 organisation staff are opting to move to section 38 organisations and the HSE. The difficulties in retaining and recruiting staff, compliance with the Health Information and Quality Authority, HIQA, standards for the correct numbers of staff with the proper training in section 39 organisations have been flagged for a long time. How long will it take for the process outlined by the Minister of State to come to fruition?

In January approximately 12,000 patients were on trolleys, the highest number on record. There have, however, been some extraordinary achievements in Beaumont Hospital but huge challenges in Cork and Limerick. Has any assessment been made of what was done right in Beaumont Hospital and the challenges faced in other hospitals? Can there be cross-fertilisation of the good ideas that have an impact on patient experiences in the health service or are there silos which affect the impact decisions have on the roll-out of services? Beaumont Hospital was a serial offender for numbers on trolleys and waiting times. Why is it now a star? Why can the other issues not be addressed? It is hardly because the Minister of State, Deputy Finian McGrath, is the local Deputy.