Mr. Stephen Mulvany:

On the example of the consultant who feels he or she can make a saving, if there is some detail we can share on that, we will certainly seek to track it down. The HSE is trying to promote a culture that allows people to interact in respect of some of these issues. However, an aspect of this is a cultural matter relating to values rather than value for money. Are the different parts of the team - cleaner, porter or consultant - in a hospital all able to speak frankly to each other? There is a piece around that and how that is changed over time. Work is under way on that. A values and action programme is under way. It is not about money, it is the overall culture.

People have different views about what constitutes a saving. There are savings that simply take cash out while others are valuable but what they mean is that we can get extra for less than would be the case. Some of those savings will actually increase the cost. I take the point that we must pursue the stuff that is safety or quality driven in any event . That must happen.

We are going to continue the value improvement programme. It is accepted that we need to energise it more. It is clearly set out in the service plan that this ought to identify additional levels of savings beyond those that our system generates on an ongoing basis throughout country at hospital and ward level and in the community and psychiatry, not all of which we can capture, cost, measure or report. Part of our system is about continuously making improvements at individual team level. That is something to be encouraged. We cannot report on all of that and some of it gets swallowed up because something else happens or costs grow and they are not funded for one or the other. We have a substantial amount of work to do in the context of trying to develop and promote savings initiatives, but significant savings are already being driven in parts of the health service. The €60 million we will get this year in value improvement is not insignificant. It is a problem when we compare it with the overall target. Hundreds of millions of euro in savings are being delivered by our primary care reimbursement service every year to try to contain drug costs so that we can allow more new drugs in that are needed. Those savings are built into the base. Their targets are driven by the base so they do not close any of the gaps. We would be wrong to say that there is only €60 million worth of savings in clinical service. The issue is capturing and reporting on some of them.