Mr. Tony O'Brien:

There are undoubtedly a variety of answers to that question rather than a single one. To answer at a general level, hospitals are required to reduce their spend very considerably this year in line with the overall reduction in funding to the HSE and a number of hospitals carried forward reasonably significant deficit positions arising from their end of year position in 2011. Many hospitals are performing reasonably well in their in year position or what is known as their run rate while still carrying the deficit. I cite an example of a hospital which came into the year carrying a €23 million deficit and had to sustain a €12 million reduction in its in year funding. It has successfully done that by making significant improvements in its accident and emergency department, treatment waiting times and so on but, nonetheless, it is not yet in a position to manage down its carried forward deficit.

Each hospital will have a different story but it may be helpful to address an earlier question of the Deputy's, which related to the issue of the current position this year versus previous years. Over successive years, in what we believed were the good times and now know were not and the less good times, there were successive periods during which the HSE ran into financial difficulties at or about this time of year - sometimes a little sooner or a little later - so this is not a current year issue. I believe that the absence of contemporary accounting systems - unified accounting systems of the type one would expect to see in an organisation of this size and complexity - is a significant contributory factor to that challenge. In addition, in this particular year, the HSE faces what might be broadly referred to as significant demand-led challenges. The number of patients presenting in accident and emergency departments is significantly up. We have referenced the detail of the number of additional persons over and above the number expected who have become eligible for medical cards and, therefore, have received medical cards. It may be instructive to note that if everything else had gone absolutely perfectly, the HSE would probably be on track without corrective measures. There is something approaching a €200 million deficit on that account alone so aspects of the HSE's operations are difficult to control, financially speaking, because of the nature of eligibility and the nature of demand. That is an important factor to be taken into account but I do not in any way wish to diminish the significance of the absence of some of the basic enterprise-type systems which would go a long way to helping an organisation of the scale and complexity of the HSE to manage its affairs more effectively. That is not, however, the total story; it is much more complex.