Colm Burke (Fine Gael) | Oireachtas source

I thank the officials for their presentation. One of the issues about which I am very concerned in the HSE is the growth in staff numbers since December 2014. My understanding is that there are now 12,000 additional people working in the HSE, of whom over 2,600 of them are working in the area of administration and management. In the past three to four years I have not seen a clear plan being set out by the HSE for where it needs to increase its workforce. Yes, we have heard about increasing the numbers of nurses and doctors, but in the area of administration generally I have not seen an overall plan. If we take it that there are an extra 12,000 people working in the HSE, the additional cost is roughly €600 million per annum, but I am open to correction on that figure. I am not clear on the stage at which there was a plan set out for the key areas in which personnel were required. It seems to have been very much hit and miss and a case of whoever shouted the loudest got additional staff. The number of staff in the area of administration and management has jumped from 15,000 to 17,600. I am concerned about the lack of planning in that regard. I have not seen any overall plan for how it is going to progress in the next few years.

When we are talking about planning, are we still only working on a one or two-year basis without having an overall objective? In the area of computerisation we have focused on employing additional staff, while we do not appear to have an overall plan, or certainly it is very vague. We are way behind other health services throughout Europe. In Denmark they worked out that their computerisation programme was saving a huge amount of money each year and they have been at it since 1996. I have not seen one coming from the HSE.

In respect of the State Claims Agency, Mr. Mulvany has said it is an additional cost. The agency is able to predict the value of cases well in advance of being settled.

As such, it should be able to flag well in advance of drafting a budget what will be paid out in the coming year. It has already made out for the next five to six years what it predicts the level of claims will be. I am a little surprised that the figure is €32 million for the agency. It is a huge figure. I imagine it has not got its figures that wrong in predicting the value of claims. As such, when the HSE corresponds with the agency before it prepares its budget, the agency is surely able to provide a good guideline for what is needed. Mr. Mulvany might clarify the issue.

I am not sure if any effort is being made by the HSE to deal with the following. There is a lack of capacity to make decisions. A huge amount of time and effort is wasted which results in the waste of a huge amount of money. I gave the recent example to the committee of 12 people within the HSE having to have a meeting in Dublin about an issue which had been raised 18 months earlier. That meeting was cancelled two days beforehand because one person had moved to a new job within the HSE and could not, therefore, attend. The meeting was cancelled which resulted in a huge loss of time in planning for it and everyone organising for it. I find that it is consistently the case in the HSE that people are not able to make decisions and that a huge amount of time is wasted. How can the organisation be made more efficient? We do not seem to have done any major work on that issue in the past few years.

Deputy Donnelly referred to the sudden increase in figures in the past few years. We are all concerned about this continuing into the future. If we are planning a 12-month budget, we should be able to plan carefully in order that there will be no overrun. We have the figures for changing demographics and the number of people with disabilities. We also have the figures for the huge numbers of elderly parents looking after people with disabilities, which will mean a huge demand on services in the next few years. Another issue I encounter a great deal is the lack of access to respite care for carers once their children with disabilities reach 18 years of age. We have known for ten years how many are in that cohort and would reach the age of 18 years, but no planning seems to have been done to make provision for them. These are issues about which I am concerned.

Mr. Mulvany referred to savings in healthcare organisations and hospital groups of €37 million under the value improvement programme. Can we have detailed figures for savings within the HSE? I have not seen a huge amount in savings. It is easy to impose savings on healthcare groups and voluntary organisations by simply setting a budget and providing it. However, I do not see the same effort being made to make savings in sections of the HSE. It is an issue about which I am concerned. There are over 2,500 organisations which rely on HSE funding. While it is very easy for the HSE to dictate and important that we get value for money from these organisations, the same set of rules does not appear to apply to internal sections of the HSE. I seek clarification in that regard.