Pearse Doherty (Donegal, Sinn Fein) | Oireachtas source

While there are many things I could talk about since there was so much in the report, I want to return to the health issue. The committee will be involved in a number of meetings which look at health and, flowing from the report, the health expenditure. We need to start getting this right. The council has made a number of suggestions in the report. One which I was not aware of was the Connors report, with regard to what is set out in legislation about job increases and the number of staff. That is the main driver for the yearly increases in health expenditure. I was not aware that these reports were being submitted in October and November, which makes a farce of it all. They are technically within the law. I must look back at the legislation but it is helpful to have that footnote. We can pursue that as a committee.

The council has called for more adequate data to be made available and that the Government should develop and publish more data on health expenditure than are currently provided, including monthly in-year forecasts of the expected annual outturn for health expenditure. How challenging would that be? How difficult is that? Will the Government tell us it cannot do this? We know the challenges it has. We did not know what the overrun was until days before the budget. It is trying to forecast as well as it can. If it cannot do that up until a budget where it really needs to do it, otherwise it does not get the money, how difficult would it be to do what has been called for by the Irish Fiscal Advisory Council? Are there any other measures outside of the issues of staff recruitment and the monthly in-year forecast that the Irish Fiscal Advisory Council would suggest so that we can improve our forecasting and monitoring of health expenditure? We call these overruns for the HSE but I believe it is underprovision. The HSE tells us that it thanks us for the budget but cannot deliver the services. It is not like other services because we are dealing with HSE managers who have just knocked off all home care packages. Only palliative care patients now get it. Somebody was discharged from hospital last week but the home care package is not there because of the overrun.

It is an underprovision and an unrealistic budget. We can monitor how the Department of Health is spending the money that it has but is there not a step which needs to be before that? The confidence and supply letter between Fianna Fáil and Fine Gael said they will not allow for unrealistic budgets and they are supposed to be independently assessed. Every budget in the last three years has had an unrealistic overspend. What is the council's advice? Is there anything further? How difficult would it be to do monthly in-year forecasts? What would the council say about making sure that the budget provided to the agency which has to deliver the service is realistic? If it is not realistic in the first place, the council is only monitoring that it is overrunning again.