Professor Michael McMahon:

Okay. This is a test of my knowledge of the fiscal history of Ireland. I am going to start looking to Dr. Casey and give him time to check, if he can. Off the top of my head, I do not know the answer. Let me answer, though, from the place of first principle on what we would like to see or expect to see. Ignoring existing overruns can occur and it can be sensible to occur, if those are extraordinary overruns that it is genuinely thought will not occur again. As we presented in a very long note the last time we appeared here but which coincided, unfortunately, with the Finance Bill, when we talked about the existing level of service, ELS, and our approach to standstill, work from the council has shown that since 2019, the sort of increase in demand for health services can be, or at least a big chunk of it can be, predicted very well because of our demographics, particularly our increase in those in the population aged over 65. People in this cohort tend to have a higher frequency of use and a higher cost of use of acute services. There are elements, then, where this direction of travel is going in one direction.

When we did our own calculation of what would be a reasonable standstill estimate for next year, the way we approached it was to work out what we thought would be the price costs of that and the demographic contribution to that context. That sort of builds up. Typically, you would build in those overruns from this year that you believe will persist into next year. As we identified it, there are two elements to the bad budgeting for next year. One is that the existing level of service estimate and the overall allocation look to be falling way short of our estimate of the standstill. Moreover, it does not include substantial overruns from this year, which are likely to continue.

Deputy Conway-Walsh may remember, because what I said was in response to one of her questions, that there is sympathy for people in the health service and the Secretary General who can predict that if you continually underbudget when we know we want our hospitals to still serve the over 65s and everybody else, we will be back in this situation again next year of needing Supplementary Estimates of relatively large amounts. We do, therefore, worry about this type of budgeting.