Mr. Bernard Gloster:

I thank the Chair and the members of the committee for the invitation to meet with the committee today in the resumption of the examination of the financial statements of the HSE accounts. I welcome the opportunity to join with colleagues from the Department of Health and the Department of Public Expenditure, National Development Plan Delivery and Reform to discuss the matters set out in the committee's invitation. The Chair has already introduced members to my witness colleagues. I am supported by my business manager, Ms Niamh Doody.

On the Comptroller and Auditor General's report on the emergency procurement of ventilators, the committee will be aware of the unprecedented context within which these matters occurred. The onset of the pandemic in early 2020 was a period of enormous uncertainty. Health systems across the world were challenged beyond capability, particularly in the phase of what was not known and what would be needed to respond. There was no vaccine to what was a deadly and novel disease at the time.

The first case in the EU was on 24 January 2020 and the first case in Ireland was on 29 February 2020, followed by the first death in Ireland associated with the disease on 11 March 2020. The WHO assessment was that Europe was the epicentre of the pandemic in March 2020. Scenes from Italy were the reference point of what was to come. There was a serious excess in demand in the global healthcare products market with what were then characterised as eBay-style bidding wars. Normal purchasing and sourcing practices did not apply. Payment in advance was effectively mandatory, even then with no guarantee it would secure delivery.

Assessing requirements for volume of products, including ventilators, was an impossible task with no realistic predictability models in the early months. The staff involved at the time had to deliberately over-order to try to secure necessary volume of supply, knowing that cancelling later and managing the financial risk would be factors that might arise. The HSE stopped ordering ventilators on 20 April 2020, which was a very short window from the commencement.

There was no compromise on quality or actions that put lives at risk, with ventilators tested after delivery and before any were put into service. The entire process in those weeks was about balancing risks. A greater level of financial and procurement risk outside of the norm was and had to be preferred over the very real risk to the public. The more significant risk was associated with newly sourced or identified providers as part of the overall pandemic response.

An overview of the detail in appendix 1 is provided by the procurement service of the HSE.

Overall in this period, the HSE spent €20.5 million with established suppliers and €81 million with previously unknown suppliers, of which €8.1 million was the value of ventilators received, €50.5 million was refunded from suppliers to date for non-delivery and €22.3 million is being pursued through legal process.

The committee has previously received detailed briefing papers on this matter and an updated version is contained in appendix 2 of my statement, having been prepared by the relevant technical staff of the HSE. I appreciate these matters are detailed and complex, however I am satisfied that the HSE has acted appropriately in the public interest on the following three key milestones given the prevailing circumstances at the time: the initial response to purchasing in the pandemic, the previous briefings to the Oireachtas and other accountability mechanisms and the co-operation with the Comptroller and Auditor General's special report.

Waiting lists are another matter on the agenda for today. The HSE is currently working through a targeted waiting list action plan. The plan, approved by the Minister, includes both core activity in the service plan and dedicated additional funding for both the HSE and the National Treatment Purchase Fund, NTPF. I have previously advised committees that the issue and focus of waiting list management is not significantly the volume of people waiting but the length of time waiting. Looking at the end of March 2023, we can examine the position through two waiting time views. I have set out the approach to that, and from the figures already published to date. As of the end of March 2023, 490,993 people are waiting longer than the Sláintecare maximum wait times, which is a 5% decrease in comparison to the end of February. For the most recently available 12 months of hospital activity data there were 3.4 million outpatients and 1.7 million inpatient and day case attendances. In addition to this planned scheduled care, our hospital system also treated 1.6 million patients during this same period in emergency unscheduled care, which represents a 10% increase on pre-pandemic 2019 levels. This reflects the ongoing pressure on hospitals from viral surges and increased emergency department attendances.

In our service plan hospital and scheduled care waiting list targets, targets continue to be challenged. We are seeing people well ahead of target and more people are being seen and treated. We are, however, experiencing pressure as more new people are being added to the lists than was anticipated and so affecting overall volume. I am advised this experience is not unique to Ireland in 2023. Dedicated additional resources across our hospital and community services have been provided and will continue throughout 2023.

On the issue of the home care service, matters are subject to very complex tendering processes and other expert reports, including a workforce advisory group. At the end of March the hours targeted to be provided by the HSE were 5.84 million and the actual activity was 5.2 million. The number of people targeted to be provided with the service at the end of March was 55,000 and the actual number was 56,980.

The current matters that have been aired in the media this week are the subject of ongoing negotiation with the providers and engagement with the HSE and the Department. There are significant commercial sensitivity matters within that. Currently, 6,400 people are approved for funding for the provision of home care and they are waiting for the home care. This was the concern expressed by the Cathaoirleach. It is to our regret. There were only seven people to the end of March actually awaiting the approval of funding. It is about the provision of the home care itself. I have discussed the matter with my Department colleagues practically every day over the past couple of days, and late last evening with the Minister. While I do not want in any way to influence the discussions that are ongoing, or the potential outcome of any processes that remain, I do hope the matter will come to a resolution at a very early stage.