Bernard Durkan (Kildare North, Fine Gael) | Oireachtas source

I get more and more confused as time goes on. I am not sure if that is as a result of my hair going white or if I am missing something. I have tabled numerous questions to various Ministers about the cost of our health services and the adequacy of the annual budget to meet the requirements throughout the country each year. I have always been assured that adequate provision has been made but every year, without fail, a Supplementary Estimate has been required to meet the budget overruns. Two things happen at Estimates time.

Each Department must supply its requirements, whatever they are. This entails an evaluation of what is being delivered, how it is going to be delivered and how it was delivered last year. For some unknown reason, we do not seem to be working in the health services. We do not seem to be connecting. This year will have the lowest overrun in several years by the end of the year but I remember having the same problem when I was on the health board. We had the same problem during the boom. We have had a continuous problem. Nobody can tell me what the actual requirement in the delivery of health services is in financial terms.

Reference has been made to the operation of the delivery of the services. The Sláintecare programme was supposed to do that. That is the prototype and we have been told that it will deliver. The witnesses' colleagues appeared before us last week. Their opening statement was that politics should be taken out of the health service. Mind you, they were quite political themselves when they elucidated further and there will be another debate on that as well. I asked a question and was not given an answer. What is the cost of delivering? What more is required in terms of budget? Is it €5 billion, €10 billion or 30% of the existing budget? It would appear to be that. If it is 30% of the existing budget, I am afraid we are in the wrong place because the HSE appeared before us some time ago and told us that with regard to all appointments of consultants, GPs and specialists of all descriptions, it must compete with New York, London and Sydney. New York, London and Sydney have not been through the kind of economic crash we have been through by a long shot.

The question arises as to what we do. Can the witnesses tell us, based on their involvement inside the system, what percentage of an increase in the health budget is required and to whom do we give it to get delivery of the services that are now required? We have an increased population but that is not the only problem. We have an increased number of taxpayers as well. We also have an increased number of young people. The ageing cohort is referred to all the time as being the reason for the problems we have. This is not entirely accurate for the simple reason that a significant number of people who have come into this country in the past five years are young people so it is not all tilting towards the elderly. This is balanced by a young population. Based on their knowledge of the system, can the witnesses quantify what is needed? Reference has been made by my colleague to OECD countries and charges levelled at us at all times, and we are only members of this committee, to the effect that we are the third or fourth highest spender on health in the OECD so what is going wrong?

During the boom, things were better, although I am not sure, but the country was broke. We can very easily go back to that spot and it could happen overnight because trends can emerge very quickly, the budgetary situation can go wrong overnight and we are back to square one and will do the same thing again in ten years time because there will be more cuts. We all hear the witnesses with regard to what happened in 2012. The alternative was not going to be nice. Everybody everywhere would have been let go. There was no money to pay anybody. Pensions and all the rest of it would have been cut. There were cuts at that time that were harsh. I assure the witnesses from a Government perspective that these cuts were very difficult to sell but they were the lesser of two evils because the alternative was everything collapsing in which case we would not be here at all. What is required to be spent to deliver a comprehensive health service? Could the witnesses tell us whether they think we should have to compete with New York, London, Boston and Sydney for consultants? I have a follow-up question. Does the Chairman want me to put it now?