Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

On the overall direction of travel in terms of the amount of money spent on capital in healthcare, be it primary care centres, new hospitals or whatever it may be, the total amount and the major projects the Government is backing are set out in the national development plan. We have an allocation within health. I would obviously like it to be larger, just as I am sure all my colleagues in the Government would like their capital envelopes to be larger. That agrees the total amount and then it agrees the priority projects like the children's hospital, the elective hospitals or whatever it may be. Major policy decisions on substantial capital projects are made by the Government within the national development plan. Locally, there is a process within the HSE where it does a strategic assessment review and assesses a project internally. It goes up through various parts of the HSE, including the services line and the estates line. Ultimately, these things are decided by the HSE board and then they are funded within the envelope of funding for that year. As an example, the capital plan, which I will sign off on shortly, has two appendices. Appendix 1 is the list of projects that are currently active. Appendix 2 is the list of projects that are in the appraisal phase the Deputy is referencing. What moves from appendix 2 to appendix 1, that is, which of those go from being actively considered to we getting authorised, depends on the project. A small project like adding ten beds or even 20, 30 or 40 beds to a hospital would ultimately be agreed by the HSE board, with oversight from the Department and the Minister.

Essentially, the major capital projects are Government decisions. However, even Government decisions such as those on the national maternity hospital and elective hospitals still have to go through the full public spending code.