Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I thank the Deputy for raising the points. I will run through the three issues he raised.

It is important to recognise that the shortfall this year has been generated by a larger than hoped-for Covid need in response to the Omicron wave and by decisions taken by the Government after the budget. The cost of Covid-19 has come to a little less than €1.2 billion. It was signalled when we were putting the budget together that it was likely this additional money would be required. The decision taken, which was the right decision, was to provision significantly less than that, and if we had something like the Omicron wave, we would convene an extraordinary session. The Department's view and the Government's understanding early on was that additional funding for Covid-19 might well be needed, but we decided to request it if it was needed rather than put it into the base in case it was needed.

Second, additional Government decisions ran to €643 million and they cannot be provided for in an Estimate if they happen after the Estimate. The non-Covid health budget comes in under budget when decisions taken after the budget are not included - and they should not be. The reasons for it being over budget are the Omicron wave and decisions the Government took this year such as Haddington Road, the recognition payment and so forth.

There is a real and growing problem in the scale of medical negligence claims. For the benefit of the committee, in 2010, the State Claims Agency paid out €81 million. That has risen steadily. In 2016, it rose to €232 million; in 2020, it rose to €373 million, last year it jumped to €461 million; and this year it will jump again to €530 million. The advice I have received is that if we do nothing, that number will increase. I am not satisfied with that and I am talking to the Department about options to address this. We do not have sufficient mechanisms in place to identify systematically the root causes, primarily for patient safety, but with the knock-on effect of reducing State claims payments. However, patient safety must be the start and end of everything. While good progress has been made on the recommendations made by Mr. Justice Charles Meenan, more can and must be done in healthcare. For example, there has been talk for many years about a no-fault compensation scheme. We do not have one. I wholeheartedly agree with Deputy Durkan that more needs to be done. It is urgent given these payments are rising quickly and the advice I have received is that it is expected they will continue to rise.

Deputy Durkan raised an important point about medical cards. There are a lot of medical cards out there. John Wall and others advocated, quite rightly, for a two-year extension where there is a terminal diagnosis, and we introduced that in 2021. We are rapidly expanding GP visit cards, as the Deputy will be aware. In the coming months half a million more men, women and children will have GP visit cards. However, I take the Deputy's point that when someone needs a medical card, the administrative burden and the public face of that, as it were, can vary in how easy it is to navigate. Medical card forms are highly complex. They require a lot of supporting documentation. Sometimes there is good support, but in the case of some of my constituents in Wicklow, they needed a greater level of support than was available and it is something we need to tackle.