Bernard Durkan (Kildare North, Fine Gael) | Oireachtas source

As it happens, I must go to the Chamber to ask a question on the same issue. I am somewhat concerned about some of the answers. It is bad budgeting practice to repeatedly fall short of the target on either side, unless there is some serious explanation. Take the PCRS. Drug costs can and will impact. We need a counterbalance such as a reduction in the costs through the things this committee has discussed so many times, such as the power of European Union as a procurement lever. Over the course of any year, drugs come on the market and cause problems. There will be patients for whom those drugs are suitable. A practice should be established whereby an immediate assessment is done as to how the budget will be affected, rather than waiting until the end of the year to see how much of an overrun there is, or if there is a surplus.

I have been around the health services for a long time. I remember the health boards and the overruns during that period. There were overruns as far back as 2000. There must be a time when we identify what practice is repeatedly causing this problem, and deal with it. If we do not deal with it, it goes on forever and in 20 years' time, someone will be sitting here talking about the same thing.

I remember the American politician who spoke of known knowns and unknown unknowns. At a certain point, we need to know where the particular bodies are buried so that we can navigate our budget accordingly. Take the issue of finding accommodation for certain people who require it after their parents have passed on. The HSE deals with that. Crooksling has the capacity to cater for up to 100 people, yet the HSE wants to close it and is undermining it and slowly strangling it to do so. That accommodation is already there and there would be no capital costs involved at all. However, the HSE says it wants a different system in a different place but to what benefit? I do not know. I was on the visiting committee of that nursing home many years ago. It is still structurally sound. An engineers report might say that is not the case but it is. We must sometimes dispute the opinions of engineers as well as economists and financial controllers. However, there is no use in saying on the one hand that we have a budgetary overrun and that we are providing alternative accommodation when we already have accommodation that is built and paid for. I would like clarification on that.

The greater incidence of treatment for an ageing population was raised and I accept that but it must be possible to budget for it accurately. The information is already there. Unless there is a particular issue that we are not being told about something must be done.

There is a simple way to deal with matters relating to the State Claims Agency. How are the overruns of its expenditure monitored? Is this in line with neighbouring jurisdictions? If not, if they are above or below, then we must ask the reason.

Private insurance and providers' reluctance to deal with emergency cases was raised. I would like to know more on this. It looks as though the public health sector could be subsidising the private health sector, if we are to assume what I think that means.

It must be possible within the public health sector to take a hospital, for instance, and compare it with the private sector. It must be possible to make a comparison on a like for like basis. I do not accept that it cannot be done and it is like comparing chalk and cheese or apples and strawberries. It is possible and needs to be done as a matter of urgency because otherwise we will continue to embarrass ourselves by suggesting that something is wrong that we cannot identify it.

My last point relates to my own hobby horse of how the chain of command operates within the health services. If a consultant wants access to facilities in a theatre or to radiography, for instance, and cannot avail of those services, that represents a loss of money and potential lost revenue. If one holds up the facilities that are there, and does not use them for any period over a working day, that is a financial loss and a liability on the system. I would like to see someone identify those blockages once and for all. They may be explainable and it may be possible to explain them away, but I have not heard anyone do so yet. I am concerned that we continue on with the same issue year after year, and we are no closer to getting to the bottom of it.