Mr. Robert Watt:

The budget increase for 2021 was very unusual but it is the largest core increase in spending ever. I have no doubt the Minister, Deputy Michael McGrath, will be making announcements but I am not going to pre-empt the budget. In my experience Ministers prefer to announce the budget themselves, which makes sense. Next Tuesday, the Minister, Deputy Michael McGrath, will be announcing plans for 2022. It is not agreed yet of course but I am hopeful there will be another significant investment in the health system.

On top of the initial resources we have spoken about, which are absolutely critical, we must reform the structures and the system to get more out of those resources, and everybody accepts that. We must ensure more of our citizens are treated closer to home in the community by community teams and GP teams. We need to keep people out of hospital and when people get into hospital we must get them out quickly. More and more treatment must take place outside the acute system. That is not only better for patients but it is also a more efficient way of providing that care. A key part of our role is not only to argue for and get more resources but to drive efficiency and change across the system.

There are many issues here with the drugs budget, for example. We are negotiating with the pharmaceutical companies in the context of the drugs budget as we need to get savings on drugs. It is very expensive and going up all the time. We cannot meet the need that is out there. There is the use of existing facilities. Can we get more out of the diagnostic machines we have? Can we get more out of the operating theatres? Can we look at changes in work practices to drive efficiencies? Thus there is a whole agenda which we are committed to, as is the HSE. We are committed to it because no matter how successful the Minister is at extracting money from the Department of Public Expenditure and Reform, those resources are finite and are never going to meet the needs we identified, so we must ensure we are maxing out all the time. That is an ongoing challenge for us. It is the challenge we face in the Department but it is a challenge every healthcare system in the developed world is now facing. We have a demographic change which is absolutely profound and is going to have profound implications for our society. It would be useful, Chairman, to talk about that at some future date when we can get into the detail of it. Respectfully, it is a much more important issue than people resigning from councils or whatever. How are we going to deal with the enormous changes that are going to be brought about by the fact that, thankfully, our citizens are living longer? The number of people now over 85 years of age and indeed over 65 years of age will have a profound effect on the health system.

Those are the big challenges we face and that is what we are focusing on.