Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I will take the queries in order. I thank Deputy Kelleher for his questions. I very much appreciated that when he said "Here we go again", he included the word "again". He spoke about observing HSE budgets for the last seven years. If one examines budgets since the HSE was established, one sees a recurring issue. In fact, looking at some of the progress we made on the HSE's budget last year, one can see that the demand-led schemes broke even. Moreover, the nursing home support scheme broke even, and the additional funding that I required was very small when compared with the additional funding other Ministers required in the past. This would have made their budgeting process blush. I am very satisfied that the phenomenon we are seeing in this country is not just an Irish one. Looking at health services throughout the world, including in our neighbouring jurisdiction, in Northern Ireland or in many European countries, it is clear that the challenge of budgeting for health services is genuinely a global issue. That is not to say that we should not continue to strive to do better. We absolutely should. However, it is too simplistic to state the HSE is always right or that the pesky old Department of Health is always wrong.

Of course the HSE has a job to do. I respect the job they do and take it very seriously. I read about rebukes and fraught relations. I do not see any such thing. What I see is a health service doing what it is meant to do, that is, advocating and highlighting what it believes are its needs now and in the future. I see myself as a Minister going to the Government table, putting forward a case for the health service and obtaining additional resources. I see the Government expecting to see demonstrable improvement in certain areas in return for those resources.

The people of this country voted, quite rightly, for a stability treaty that brought in fiscal rules by which we are bound. We are bound to a maximum amount the State can spend. If someone approached this objectively from the perspective of another jurisdiction, was apprised of the annual budget for Ireland and saw the proportional increase the Department of Health and the HSE received for the delivery of health services when compared with other public services, I would contend I had fought my corner very well. The Government has prioritised health yet again.

Perhaps the only mistake the director general and I have made is that we are too transparent. Excellent health correspondents use freedom of information legislation and find all our letters back and forth. I can assure the Deputy, who has been a Minister in Departments and has been around long enough to know, of one thing. There is no agency in this country that does not look for more money than the Government of the day is able to provide. That is the reality. Perhaps they do not all write letters back and forth to each other. Maybe we are guilty as charged of being too transparent, in that we put our discussions in writing so that they are available to read. If anything, the letter the Deputy describes as extraordinary is quite ordinary, in that a Minister wrote back to one of his agencies to state it must live within the budget it was given. It is appropriate for organisations to seek value for money. It is even more appropriate to seek value for money at times of economic boom and budget growth, in order that we do not slip back into mistakes of the Celtic tiger era. I emphasised in my letter that since budget 2015, the HSE's allocation has increased by €2.4 billion, or 20%, averaging an increase of about 6.6% per annum.

The point I was making in the letter is that there is a difference between a challenge and a shortfall. There are more things that the health service would like to do, and that I would like it to do. We are going to do them, together, on a multi-annual basis. However, that is different to a shortfall. The director general and his organisation have a legal obligation to produce and sign up to a service plan that they intend to deliver. I approve this plan, bring it to the Government and publish it. I am not going to speak for the director general, who will speak for himself in a moment, but when I launched the service plan I heard the HSE state clearly to the people of Ireland that this document outlined the services it would deliver this year. In every single case in that service plan, there is at least maintenance of last year's service level and in many cases, there is a significant increase in service provision, be it in respite care, waiting list funding, access funding, speech and language therapy or mental health services.

That is not to say that there is not substantial pent-up demand in our health service and indeed in our public services. I think the Deputy and I will agree on this. We have discussed some of these problems already in addressing capacity issues and we clearly have work to do there. I am excited about being able to grow the health budget again. I am excited to be able to build on the work of my predecessor, the Taoiseach, who also did so. However I think the committee would agree, as would the HSE and every citizen in this country, that it is not all about money either. If it was all about money, my predecessors would have solved this a long time ago. Our approach has to be about funding linked with progress. It has to be about targeting specific areas. We must not attempt to boil the ocean. Instead, we must pick certain areas of the health service to improve on in a given year.

I have proven already that when decent funding is allocated to the health service, as the Government did last year, the health service, with careful management, can provide many parts of its services within budget. The budgeting assumptions that my Department and the Department of Public Expenditure and Reform must make were proven correct last year where several parts of the health service budget are concerned. In particular, the nursing home support scheme, which received a budget of almost €1 billion, and the demand-led schemes in areas pertaining to the primary care reimbursement service, PCRS, have shown that we can budget correctly.

There are other parts of the health service we all know are a bit harder to predict and to budget for. That is not a uniquely Irish phenomenon. How many people will turn up at the door of a hospital? How bad is the flu going to impact this year? That is something on which we must continue to work. We can absolutely manage our processes better.

It is too simplistic to say that one agency is always right, that the other is always wrong and to try to paint it in a confrontational way. I am not suggesting that the Deputy tried to paint it in a confrontational way but some commentary does. We go through a very robust process, set out in law, which results in a HSE service plan being produced every year. My job is to make sure that the Government's priorities for the health service, which we often discuss here, are reflected in that plan. The director general's job is to deliver that plan. I would think that it is a job for both of us to continue to put forward new ideas on how we can do things better and continue to deliver services in a better way for our people. A number of building blocks which we have published and produced in recent weeks and will continue to produce, with the next big ones being the Sláintecare implementation plan and the Government's capital plan, will give real life to some of those ideas.

I take the Deputy's point about section 39 bodies. I visited, as I am sure the Deputy has, a number of section 39 bodies. They tell me that they have a situation where they try to recruit staff, such as nurses or health care assistants, or others, and find that a nearby State agency or section 38 body is able to pay those people a better wage. They tell me that the section 39 bodies therefore become uncompetitive and while they might be called a section 39, to the man or woman who comes in off the street and uses the services, they are a core component of the provision of public health services. We have to work out a way to address that. There are many section 39 bodies of different sizes, shapes, composition and even governance structures. The financial emergency measures in the public interest, FEMPI, saw a swift introduction of pay reductions back in the dark days, first with our public servants, then with fees to contractors. Section 39 bodies were also asked to make cost savings. There is no doubt about that. They subsequently took a range of measures, including pay reductions in many instances. Last summer, the public service pay agreement formed an agreed pathway for public service pay restoration. We saw the first benefit of that before Christmas with more in the new year. That will continue. We now have to seek to address our section 39 bodies. It is fair to say that the position relating to these agencies is more complex. We need an analysis. Each organisation might be different. We need to know if they applied a reduction, how they applied it, if they have restored it and when it was applied. I note, in correspondence from unions, that they are looking for a process to validate and interrogate the realities of the situation. I do not wish to be coy and not more forthcoming but I am conscious that discussions are ongoing with unions, which management is engaged in with a view to averting industrial action. I hope they can yield a positive outcome. As a part of that outcome, we need an agreed process and a timeline for that process. I have no doubt that at the end of this process, there will be a funding requirement for our section 39 organisations. It is a matter of how we get there, how we validate and verify, and the thought process that we put in place.

The Deputy's point about trolleys is one that I make all the time. A number of our hospitals perform well and a number perform very badly. I need to be careful not to be overly simplistic in suggesting that it is all down to one issue because there are certain challenges in certain hospitals. Looking at Limerick, for example, we know that there is a bed capacity shortage in the mid-west that goes back many years. There are issues with management and clinical leadership in every hospital, ensuring that discharges are done by the weekends, and other operational issues, but there is also a need for investment. My understanding of the issue at Beaumont Hospital is that we have seen excellent managerial grip and excellent collaboration with clinical leadership, but we also saw that on the back of investment, including investment in the hospital, which the Minister of State, Deputy McGrath, knows about from experience over the years, and investment in the community which serves the hospital with home care packages and transitional care. The audit of capacity in general is under way. I have made it clear that while the capacity review talks about the extra beds which will be needed by 2031, it also makes it clear that we need some of those beds now. I am not saying that this is a ten-year plan, and to come back to us in 2031 when we will have all the beds. We need to look at what we can do quickly. I have asked the HSE to identify and report back to my Department how, if coupled with investment, we could quickly open additional beds in advance of the next winter period. Beds are quite a big part of the answer but only if they come with reform. We have seen extra beds go in in some hospitals but have not seen significant improvements in trolley numbers. In Galway this winter, extra beds were received but the hospital made a number of changes to pathways which resulted in a significant improvement in Galway's numbers for a significant period of the winter.

The Deputy is right about the issue of nursing homes and referrals to hospitals. I was going to ask the Minister of State, Deputy Daly, to address it but he has had to go to the Seanad. That is an issue which can be dealt with in three ways. We can investigate what else we can do with the general practitioner, GP, contract and with GPs linking with our nursing homes to keep patients in what might well be a private room with an en suite rather than a busy emergency department. On nurse-led care, there is definitely a role for our nurses. Our Irish Nurses and Midwives Organisation, INMO, colleagues have clear views on that. There is also the integrated care programme for older people. There is no doubt that there are far too many patients who have to leave their nursing homes and go to hospitals. It is not a criticism of nursing homes but we have to look at how we can help to keep patients there where we know they will have better outcomes. The last thing one wants is to send a vulnerable older person into an overcrowded hospital if one can provide that person with an isolation facility. Equally, our nursing homes locally have to know that they have that support. The GP contract and a nurse-led service are the key ingredients for that.

Deputy Murphy O'Mahony joined the queue of everybody other than me as nearly always right. Deputy Billy Kelleher said he was told he was nearly always right. The Fianna Fáil position is that Deputy Kelleher and Tony O'Brien are always correct.