Jim Daly (Cork South West, Fine Gael) | Oireachtas source

That is a good question and probably gets to the heart of the issue we are discussing today, namely, the difference in planning and implementation between the two years. Separate issues can arise, but demand was the main issue. There was an increase in demand. Our ageing demographic increased pressure on our health services, which has shifted the overrun's dynamic. Demand is increasing at a faster rate than we projected. That is the first difference.

Individual issues arise. For example, we must guesstimate how much our complex appropriations-in-aid payment arrangement with Britain regarding pensioners in Ireland will cost and then negotiate it down. Incidentals arise every year. Storm Emma and so on were of a smaller scale, but other incidentals can be much larger. I referred to a number of headline issues, for example, primary care and high-tech drugs. The largest increase in demand in 2017 was down to pay awards. That arose as the economy recovered and do not arise every year. They came off the back of a recession. Our appropriations-in-aid were small.

As the Chairman will know, we are currently agreeing the service plan with the HSE. There is a keen focus on every aspect of that plan so that we do not perpetuate this cycle of overruns year after year. Even at this preparatory stage, we are trying to monitor expenditure with the HSE stringently so that the service plan can be on target and realistic, but there will always be "Events, dear boy, events" that are unforeseen and detract from the plan. For example, this year saw the CervicalCheck issue. Its cost would not have been that major, but there were cost runs in that of, I believe, €4.6 million for general practitioners. Small payments like that are not massive in the bigger scheme of things, but they take up a lot of attention and many staff are moved onto such issues. We want to try to be readier for such developments next year so that there can be a more consistent and constant focus on the implementation of the service plan month after month and that we are coming in on budget.