Mr. Jim Breslin:

It is regrettable the Supplementary Estimate is the size it is this year. I would not accept, however, that it is €700 million every year. We were here last year with a Supplementary Estimate of €195 million. In fairness to the HSE, significant parts of that were due to centrally made decisions. For example, €75 million of the figure from last year's Supplementary Estimate involved bringing forward the national pay agreement. There will be times the Government makes a decision to take a policy initiative or on pay which imposes costs on the HSE. The Government then proposes to the Oireachtas that such decisions must be funded.

A Supplementary Estimate is not unique to the HSE. It happens across the public service. The HSE is the largest funded organisation in the State. When it has those issues, it involves hundreds of millions of euro when for other Departments it may involve tens of millions of euro.

That does not take away from the regret that I have about the €700 million this year. That is substantially beyond any type of margin around the Government making decisions over and above what is in the service plan. Some of that is due to subsequent decisions made by the Government. The slippage this year is beyond what we had planned for and what we expected. We are advanced in the process with the HSE of developing the service plan for next year. The objective is that we develop a service plan that is fully funded, not one that is partially funded.

I have spoken to the Chairman before about Sláintecare. From where he is sitting, it might look like a lack of urgency. From where I sit, I see people running to get Sláintecare implemented. I see the executive director for Sláintecare putting a significant focus on it. I see the teams across the Department and the HSE putting a significant focus into getting Sláintecare done. The implementation plan for next year, which will be developed next month, will show in a practical way what the milestones are. I am confident that we will have significant milestones delivered next year. One of the areas we will be able to show form on is one that the Chair has always raised when we have been before the committee, namely putting a framework in place for general practice which will start to modernise it, make it more sustainable and attract people to work in that area. I am confident that this will start to bear fruit.

The Chairman referred to the 240 and the other 79 beds. We will make decisions with the HSE on further bed capacity to be introduced in 2019-2020 over and above that. There will be further beds to be introduced. It is worth reflecting on the fact that the bed capacity report stated that without reform, we will need more than 7,000 beds. It is not a bed capacity report which is about 260 beds. It is a bed capacity report which references 2,600 beds but with significant reform as to how we are currently organised and how resources are distributed to clients.

Coming back to what Deputy Donnelly asked earlier, this is not the most effective and efficient way to organise a health service. Sláintecare shows us how we not only right-size the health service but how we change how it is organised. Significant change is required. We will have to shift our health service away from acute-focused and episodic service into one that is preventive and works with people on diseases to avoid acute presentations. If we do not get that right, we will not be able to tackle the demographic challenges we face. We will have plans for further bed capacity. Like the GP framework, we also have to strongly support and plan the shift in resources that we will need to ensure more integrated care with less focus on beds as the only part of the solution.