Mr. Stephen Mulvany:

One needs to look at the specifics for each year and what happened in it. We have set out where the deficits have occurred in the year to date and people can form a judgment on which of them was anticipated. In looking at the performance at the end of last year, if one adds the Supplementary Estimate at the time for €208 million and the residual deficit with which we were left of €166 million, one ends up with a €374 million problem. It is a larger deficit than in other years such as when the health service broke even, but one must bear the components in mind. About which parts of that €374 million could one realistically say it was a performance issue or potentially a performance issue? There was a central Government decision to make a pay award on 1 October 2017, but the Government decided to bring it forward to 1 April. The first part of the Supplementary Estimate was a €75 million increase in the allocation to allow for this. Is that a performance issue? No; it was simply a decision made by the Government, which was entirely appropriate.

The cost in respect of the State Claims Agency is €50 million. It is a difficult area in which to predict expenditure. It is difficult to come up with the actual figure between actuarial and run-rate estimates. The key point from a performance management perspective, as people in this room know, is that the State Claims Agency is not the HSE's lawyer but its insurer. It has its own statutory powers. While the money we pay to the agency is in respect of HSE-related claims, it is in respect of claims made a number of years ago. Is the figure of €50 million related to a performance management issue in the health service? I think that is the root of the question, to which the answer is no.

In 2017 the Government decided to make an access-winter investment plan, following the national service plan. That is not unusual. It accounted for €35 million of the overall Supplementary Estimate and the residual deficit.

People can form a judgment on the next big item. In 2017, €121 million of the overall €374 million is the impact on the income of acute hospitals. It includes bad debts as a result of what we refer to as the actions of private insurers. Leaving aside the question as to whether what they are doing is appropriate, the reality is they are doing it. Despite the fact that hospitals have improved their income processes, there is an element with which they cannot deal. The sum of €121 million is in the performance management space because we must manage income and seek to management the budget we have rather than the one we would like to have, but we are satisfied that the sum of €121 million does not broadly constitute a performance management issue for hospital groups.