Mr. Stephen Mulvany:

In terms of some of the areas the Deputy mentioned, going back to the €16 billion, €4 billion of it is in the areas of PCRS, pensions, State claims and overseas treatment, treatment abroad and the cross-border directive. They are largely matters of Government policy and legislation. We do not have specific interventions we can make in those areas unless somebody changes policy. There are some exceptions around probity and PCRS. PCRS is focused on making sure people get the eligibility they are entitled to as quickly as possible. The bit we can control is ensuring there is probity, that is, no breaking of the rules by a small minority of contractors who might be tempted to do so, in respect of the €2.7 billion we are handing out. That allows us to make some savings that do not impact on patients and in fact are to the benefit of patients, because the money tends to stay in PCRS and gets used for services. Through PCRS, we are also encouraging hospital consultants to prescribe biosimilar drugs where appropriate. That is a positive thing and we hope it will save us a lot of money next year in the sense that it will provide space for effectively neutral costs. That is a cost saving measure that is not negative in any way around services. Neither of those could be called cuts. They are just the right thing to do. We are assume that we are expected to live within the resources where we can.

On the operational service areas, yes, there is an element of operating within budget. In home help services, for example, there has been about €150 million extra invested in home help over the last three or four years. We are requiring our services to live within their budgets for home help. There is more demand for home help services on which, if we had the money, we would want to spend it. Home help is a valuable service and it is excellent for patients. However, if we do not have the money, are we going to spend it on something we do not have, rather than simply making best use of what we have? We are not. Our intention is to live within the home help budget and home support budget on the basis that doing so should assist us to secure greater investment in future years. Is that a cut?