Mr. Stephen Mulvany:

I will have to send the Deputy something on the staffing costs. We can certainly show the movement of staff over any period, but the Deputy's general point is absolutely correct. It is possible to predict, or make estimates of the required staffing level to retain the existing level of staff and demographics. The Estimates and planning process has two large components across the public sector. The first runs up to budget day, where Departments and agencies like the HSE set out a view of what is required for the following year. The second then is budget day, which tells one what is available. The planning piece is then about how one fits the demands as best one can within what is available.

The HSE can make estimates and assumptions about what the costs will be in the following year on both sides of that process. Without looking to offer excuses, the health service is large and complex. Its system challenges are well documented and we are working on that. Progress is being made, albeit slowly because of the scale of the system. We rely on more than 2,000 organisations - 50 of them very large - to deliver the overall service. We do not ask them all to feed into the forecasting estimates process, but we do ask a number of them. Any future-focused exercise carries risk. Typically when the service plan is made, data are available for August and September, so we are looking 15 or 16 months ahead. One makes assumptions. Given the scale of our budget, every margin of error of 0.1% is about €15 million. That is a big margin.

In the context of all that, for the HSE preparing bids and service plan estimates, and obviously for those in the Department and other colleagues who review them, one is looking at a set of estimates and assumptions. In terms of calculating the value improvement programme target of €346 million in the service plan, we went through an iterative process which looked at what was the level of service it could currently provide with the available funding, what level of activity within that could be tailored to fit the funding and what level of activity was almost entirely driven by demand. The health service, as the committee knows, is complex. It is the provider of last resort, the provider of 24-7 services and the place of safety. There are a number of areas, including emergency departments in hospitals, disability, residential placements and similar areas in which a level of activity will happen even if there is not specific funding for it. Through that iterative process, we determined there was a need for savings of about €346 million. It was set out in three tranches. The first was the more immediate and urgent priority, that was about €77 million. As I said in the opening statement, we would expect to deliver about €60 million of that. We are challenged in terms of delivering much beyond that against that figure of €346 million.

I mentioned other areas of savings where money is being delivered but that is against targets that are set for them. Against that €346 million, the figure I mentioned is about what we will get.