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

It is a difficult one to get right. I am not a forensic accountant, which the Chairman appreciates, so I will not be able to answer as definitively as I would like. In 2017, the overrun was much higher than the figure cited. We are taking the €139 million deficit from 2017 this year, but there was a Supplementary Estimate of €200 million on top of that in 2017.

We could decide to provide €300 million for unforeseen developments, but that would be absorbed by and used up in the day-to-day running of the HSE and none of it would be left by the end of the year. It would be a blank cheque and could loosen the checks and balances on value for money. Alternatively, more political decisions could be taken to do this or that or to make pay awards with the €300 million. Providing it in advance is difficult. I am focusing on the macro, headline stuff instead of getting into the details with the Chairman.

That is one step that could be taken. Then we just learn from the previous year and the anomalies that arose and try to use that in projecting as best we can for the year ahead. There is an ebb and flow that will always have to be there and that tension between allowing an envelope, a little headroom, in the fiscal space and at the same time it being gobbled up by some demand-led service.