Billy Kelleher (Cork North Central, Fianna Fail)
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I welcome Mr. O'Brien and the officials. I would like to ask Mr. O'Brien and Mr. Breslin about an article in The Irish Timestoday which refers to the €1.4 billion increase sought last year in the allocation for the budget to provide safe clinical care in our health services.

Reference was made to the debacle associated with probity and medical cards and many other dysfunctional areas. I refer to the budget allocation in the Estimates for previous years, which we knew almost immediately was unsustainable.

I ask Mr. O'Brien to say whether the clinical pressures are generally across the health services or whether there are key areas of major concern. I assume we are talking about patient safety as well as the clinical pressures. When did Mr. O'Brien become aware that this would create significant problems? For example, is he referring to emergency departments or to the Fair Deal scheme? Due to the shortfall in funding, what other areas of health services were identified?

At previous committee meetings Mr. O'Brien stated that while he always sought more funding, this year's budget was realistic. As today is 12 February, how realistic is the budget looking so far in the profiles that are being done? Mr. O'Brien stated that €200 million to €300 million is required for demographic proofing annually. In view of the fact we have €115 million extra, is that before or after demographic proofing of €200 million to €300 million? If it is not, it means we are in a negative situation before we even start the year. Does Mr. O'Brien envisage significant difficulties in the future?

Mr. O'Brien referred to the winter pressures plan. I do not think that plan - if it exists - has really covered itself in glory. It was a reaction to an issue as opposed to a plan. A total of 601 people were on trolleys in emergency departments earlier in the year. As I said at the previous committee meeting and as everyone is talking about, our emergency services are chaotic at the moment. This is not just Billy Kelleher making it up; it is a fact. The HSE's own statistics verify the situation regarding the number of people on trolleys. Clinicians are telling us every day that patient safety is being compromised constantly in emergency departments throughout the country. How does Mr. O'Brien envisage the current budget providing the funds to address this issue? He referred to delayed discharges and the number of people that would have to be moved from the acute hospitals into step-down facilities or home care packages. There has been a slight improvement in the waiting time for approval for the Fair Deal scheme, from 15 weeks to 11 weeks. However, there remain significant pressures on our emergency departments and, as a result, patient safety is compromised and clinicians and front-line service providers are under pressure. How will this translate over the next number of months into an improvement in the situation?

Is the Secretary General permitted to speak? An Acting Chairman indicated-----