Mr. Jim Breslin:

A Supplementary Estimate per se is not evidence that the figures are wrong. To take the example of 2017, the Supplementary Estimate was €195 million and some €75 million of that figure was to do with the national pay deal, where the pay increases were brought forward. In fairness, I have robust debate with the HSE on their finances, that is something that was imposed on them. The Government met that cost. There was a €40 million Government initiative to try to improve winter responsiveness and try to open extra beds in acute hospitals and try to get home care levels increased. Again that was a Government initiative. Consequently, €115 million from a total of €195 million arose as a result of two Government decisions.

There was €50 million for the State Claims Agency, with which members of this committee will be familiar and this reflects settlements and court settlements, which can be very significant. One can have a €10 million settlement and these figures can be both significant and unpredictable. That is not say that we do not try to estimate them and try to provide funding for them but it is hard to get it exactly right. The other area foe which the Supplementary Estimate was made available in 2017 was the area to which we have given some time, namely, the income area. We provided €30 million for that. Above and beyond that Supplementary Estimate, last year there was a figure of €140 million for the deficit that the HSE had generated at the end of the year. I would see issues within that where again, although we made €50 million available to the State Claims Agency, we got it wrong by €10 million. By the end of the year, during November and December, it was €10 million above the figure we expected. There are certainly other areas, where the Department would consider that it gets a budget that is set by the Government and which is based on the fiscal rules. We are told that is the total amount of funding that is available for the health service and then we work with the HSE, outlining that it must come up with a service plan that can deliver the greatest value within a budget of €15 billion. There must be some areas of the health service, even though they are complex and difficult to manage, where people seek to manage their budget in such a way that by the end of the year, they do not have a deficit. If there is not, the difficulty becomes that the people who have the deficit get that dealt with and the people who seek to manage without having a deficit have to bear it. Although it is hard in the health service and there is demand that is hard to manage, we are seeking with the HSE to improve upon the budgetary discipline in the health service.

To bring it back to the Estimates process, we would look at each element of the HSE's budget with them. As part of that we would engage with the Department of Public Expenditure and Reform and then we would conclude a service plan. I do know, in terms of Supplementary Estimates for example, that in previous years there were areas, perhaps pensions and retirements costs, demand-led schemes and fair deal schemes. Where people seek to retire they must be paid their lump sum and these cases have been difficult to predict in advance. Last year, no costs arose excess to what our predictions were in respect of areas like the primary care reimbursement service, PCRS, pensions, demand-led schemes and fair deal schemes. Last year, we did a better job in those areas and we continue to refine our methodologies. Ultimately, it is the Oireachtas, on the recommendation of the Government, that decides the health budget but we and the HSE must come up with a service plan to deliver upon that.