Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I was somewhat surprised at the level of Supplementary Estimate being sought as announced towards the end of last week in that it is only €680 million rather than the amount speculated. I have no issue in agreeing to the Supplementary Estimate but I do have some specific questions for the Minister.
First, the Minister in his concluding remarks accepted that this Supplementary Estimate will enable the HSE to go forward into 2015 without the baggage of significant so-called overspend in 2014. He also referred in his contribution to the passage earlier this year of legislation under the stewardship of his predecessor which provides that so-called overruns or overspends in 2015 by each of the component parts of the health service will be carried forward to 2016. While this is laudable and acceptable in the context of what is proposed today, given the great difficulty of properly projecting footfall, throughput, usage, patient presentation, etc., how realistic is it to categorically state that there will be no Supplementary Estimate required in 2015 and that the overspends will become the first charge on the new provision for the subsequent year?
I would like to address a number of other points made in the Minister's presentation. In regard to the service arrangements and grant aid agreement for the coming year vis-à-visthe HSE and section 38 and 39 funded agencies, perhaps the Minister will expand on the status of the service arrangements and grant aid agreement, including whether they have been finalised and are already in place.

What is the position vis-à-visthe sections 38 and 39 funded agencies? It is an issue the sub-committee has not had a substantive opportunity to address in a timely way. It was taken from us by another committee of this institution. In the next paragraph a very strong assertion is made vis-à-visthe very first point I raised where it states: "I will be insisting that in return those who hold budget responsibility must plan and deliver services within the resources available."
The hospital element is projected to be €270 million of the total by the end of this month and is the largest single element of the projected deficit of €510 million. The percentage increases which have already been recorded in 2014 could not have been so accurately envisaged 12 months ago. The numbers of bed days and day cases have increased by 3%, emergency admissions by 3% and elderly patients aged over 85 years by 4.5%. What certainty can the delegation have that we will not see a repetition in the course of the year, given the current demographics, an increasingly ageing population, greater demands and the fact that people are living longer and presenting with a variety of challenges in terms of their health needs? Will the delegation accept that significant overspends in 2015 and 2016 will not only have a crippling effect on the budgets of these hospital sites but will also have a serious impact on the quality of services and the general morale of those involved in management and front-line provision and that holding to this template will ultimately have a significant negative impact on the quality of the service being provided?
State Claims Agency payments have increased by €54 million on what was projected. I note the explanation for this. Will the delegation advise us as to at what point is the preparation of the legislation on periodic payment orders? It was indicated that it would be progressed in early 2015. To what does this translate? When does the delegation expect to see publication of the legislation? Does it expect it to be enacted in 2015?
On the additional €5 million for antiviral drugs for people with hepatitis C, it is very important that we provide for the advances made in medicine which can have a very positive impact on the lives of individual sufferers across a range of areas. We should respond to, accept and warmly adopt these advances in the interests of our fellow citizens. Will the delegation indicate where it stands on the drug Fampyra for sufferers of multiple sclerosis? I make the case that after the trial involving some 1,500 MS sufferers, there is undoubtedly a sustained case to provide for access to this very important drug that clearly makes a difference for a significant number of them.

I acknowledge that the drug is not effective for all who suffer the challenges imposed by multiple sclerosis.

If I could just conclude with this point, money follows the patient. We have an increasing and aging population and I have never opposed a Supplementary Estimate for health services. I believe that health services must be demand-led and we must be prepared and willing to respond. In this spirit, I conclude by saying that the signalled intent of the legislation I opposed and referred to earlier will spell dark and difficult days for our health service after 2015 if it is not revisited in the intervening period. I appeal to the Minister to use his position to re-evaluate this issue. I do not believe in wastefulness, inefficiency and unconditional bail-outs but, when it comes to quality support and care for people, I believe we must be able to respond appropriately. I will support the Minister's request for an additional €680 million.