Mr. Sebastian Barnes:

This is something we have had big concerns about. Wrote a paper on it a number of years ago. One of the things that was frustrating in writing that paper was, as the Chair said, the information that is available is incoherent and incomplete, which made it difficult for us to make an assessment. We are not health experts and are not trying to second guess the way the health system should run, but our interest is in the budgeting.

The pandemic has been an unusual period for the health system. There have been significant pressures on the system and the people within it. For example, even now we know that the health system was sanctioned for a large number of posts that it is unable to fill. The big question is whether those posts will be filled. If there are filled, that will create a big pay pressure. We do not really know if that is budget for.

We had concerns from before the pandemic when the background was a bit more stable. The budgeting process around health was very unsatisfactory. Usually, the Government put in an amount for health that did not allow for the irregular stand-still and wage increases. What used to happen was that there would be big health overruns during the year, but they would often only appear in October or November. At this time of year, officially it would look as though the health spending was on budget, but we would discover at the end of the year that there was a big hole in it. In the years before the pandemic, that was running at about €500 million or €600 million a year of overruns. That hole was essentially being filled by corporation tax, which was a very unhealthy dynamic during that period. Many things have changed since. The pandemic makes is hard to know what the underlying situation is now. It remains an area of concern, however. It is a big area of spending where we know there are naturally big pressures. In the past, the budgeting relating to it was very poor and created risks for overall public finances.