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

I understand what Mr. Bell is saying but to go back to the various drags on the system, they are different. One is capital expenditure and there is a different means of funding that, as those of us who are involved in the health service know, which does not affect the current expenditure at all. I accept that it affects overall borrowing but not current expenditure. I have strong views on that issue. I have long been a member of this committee and I was a member of the committee that devised Sláintecare. I have been on all sorts of committees in recent years. I was around when an bord snip nua became involved. I was very conscious of the recommendations of an bord snip nua, which dug much deeper than was applied eventually, unfortunately so. The point is that we were forced to live within our means, and our means were very limited and they were on a downward trajectory at that particular time.

I do not expect Mr. Bell to have the answers to my questions but he does have a pivotal role in dealing with the issues at ground level and on the front line, whereby he may have a different assessment of what is required. Regarding the cost of the children's hospital, I have looked everywhere and I have found no solid assessment of an estimate based on anything other than a guess. The overrun, as it may well be considered in some quarters, is not an overrun. It was a failure to assess accurately the costs in the first place, based on sound economic advice. That is not my problem. My problem is to try to do something in the aftermath or to make some contribution to it.

In terms of value for money, my belief has always been that the permanent filling of posts is better with less reliance on agencies, but it never seems to change. Even when we had money during the Celtic tiger boom, there was no shift or change at all in that regard. That ties in with what the witnesses said. One could find oneself with fewer staff at the end of the year, depending on where one was when the chopper came down. We accept all of that. The next part is how we proceed from here. Sláintecare will be expensive and there is a lot of other attendant expenditure as well. What I cannot understand is why it is not possible within the health service to identify precisely, within reason, the budgetary projections. That has not happened for some years. It has not happened for a long time, even though my colleagues might tell me that it is a recent phenomenon. That is not true. It has not happened. I am concerned whether a means can be found whereby all those responsible, including the witnesses, the committee, or whoever is responsible, can identify the projected expenditure or if we need to opt for a flexi-budget that has a contingency built into it because it is a demand-led service and we can expect the demand to increase in one area or more or whatever the case may be and how and if we can provide for that. We must keep in mind also that taxpayers must pay for all this and the extent to which they are able to shoulder the burden.

SIPTU is in a unique position to be able to identify the things that happen at ground level and the outcomes relating to which might be better determined if we took a different approach.