Mr. Colm Desmond:

From the Department's perspective, regarding the national service plan, certainly, it is a challenge to provide the services required each year within the overall allocation. The Department and the HSE strive to achieve what is feasible and realistic within the allocation provided by the Government.

As for the examples in the disability sector and other sectors, many challenges are continuous in terms of the ongoing upward demand in such areas - for instance, to create enough space to provide the services at community level in order that the dependency on the placements and the residential component can gradually over time be reduced while at the same time recognising that this latter area is the subject of significant regulation, as it should be, and presents its own challenges in terms of catering for people's need to have placements in residential settings. The objective is to frame the service plan in 2019 from the point of view of the most efficient use of the resources available to the health sector and to have an examination from the beginning across all these areas. Mr. Mulvany alluded to this in the context of the value improvement programme as it relates to where funding needs to be spent on an ongoing basis and the possibilities and the capacity to achieve greater efficiencies in this area. This would guide the development of the service plan. As part of that, it would be accepted in all health services that there should be an objective of achieving efficiency savings in any event.

It is certainly challenging but at the same time the legislation requires a service plan and it provides a significant over-arching framework and discipline within which the HSE presents to the Minister as required. That is the structure as it exists now along with the other objectives.

Mr. Mulvany might give some detail on health insurance. Similarly, on the primary care reimbursement service, PCRS, we may be able to provide the Chairman with some details on the composition of that figure. The matter of private health insurance is now being examined by the De Buitléir group. There are legal and other issues which come to bear on that which are also being considered by the HSE and the Department.