Oireachtas Joint and Select Committees
Thursday, 8 October 2015
Public Accounts Committee
2013 Annual Report of the Comptroller General and 2014 Appropriation Accounts
Vote 38: Health
Chapter 13: Irish Blood Transfusion Service Pension Funding
10:00 am
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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At this session we will deal with Vote 38 Health and Chapter 13: Irish Blood Transfusion Service, IBTS, pension scheme. In the second session of the meeting we will deal with the National Paediatric Hospital Development Board financial statements 2013.
Before we begin, I remind members, witnesses and those in the public Gallery to turn off their mobile phones as the interference from them affects the sound quality and transmission of the meeting. I advise witnesses that by virtue of section 17(2)(l) of the Defamation Act 2009, they are protected by absolute privilege in respect of the evidence they are to give this committee. If they are directed by the committee to cease giving evidence in relation to a particular matter and they continue to so do, they are entitled thereafter only to a qualified privilege in respect of their evidence. Witnesses are directed that only evidence connected with the subject matter of these proceedings is to be given and they are asked to respect the parliamentary practice to the effect that, where possible, they should not criticise nor make charges against a Member of either House, a person outside the House or an official by name or in such a way as to make him or her identifiable. Members are reminded of the provisions within Standing Order 163 that a committee should also refrain from inquiring into the merits of a policy or policies of the Government or a Minister of the Government, or the merits of the objectives of such policies.
I welcome Mr. Jim Breslin, Secretary General at the Department of Health, and I ask him to introduce his officials.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I welcome Mr. Andrew Kelly, chief executive officer of the Irish Blood Transfusion Service.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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The committee also welcomes Mr. Barry O'Brien, Mr. Peter Brazel and Mr. Brian Naughter from the Department of Public Expenditure and Reform. I invite the Comptroller and Auditor General to make his opening statement.
Mr. Seamus McCarthy:
I thank the Chairman. I will confine my remarks to Vote 38 and to the report on the IBTS pension issues. I will comment on the children’s hospital at the later session.
In 2014, Vote 38 for health received Exchequer funding to meet the cost of salaries and expenses incurred by the Office of the Minister for Health, to provide grant funding for a number of bodies under the aegis of the Department of Health, and to meet the cost of certain other services. Members will be aware that for 2015, the Vote for health includes Exchequer funding for the Health Service Executive. In 2014, this did not go through Vote 38, the HSE had its own Vote. As a result, the structure of the Vote for health will be radically different in the future.
Gross expenditure of €194.8 million was incurred on Vote 38 in 2014, against an estimate of €205.9 million. The underspend of €11.1 million, combined with higher than budgeted receipts of €800,000, resulted in a surrender of €11.9 million to the Exchequer. By 2014, most Votes had moved to presenting information on a programme basis. The objective of that format is to try to present financial information in a way that facilitates a focus on the objectives of spending, rather than on inputs or on spending types. Vote 38 was an exception; grouping spending under headings related to administration, recurring grants, capital grants and a miscellaneous other services category, which accounted for 55% of the overall vote expenditure.
At an individual subhead level, the most significant Vote expenditure in 2014 was on: recurrent grants to development, consultative, supervisory, regulatory and advisory bodies for the health sector, totalling €47.8 million; research grants totalling €34.9 million; payments totalling €27.2 million related to ongoing compensation for victims of hepatitis C contamination of the blood supply, and payments totalling over €17 million in relation to inquiries, legal fees and settlements. Administration costs incurred by the Department totalled €26.9 million.
A primary aim of appropriation accounting is to report and explain variances between the sums voted by Dáil Éireann and the outturn. Explanations for significant variances in expenditure are given in note 3 and for variances in amounts receivable by the Vote in note 4. The main areas where the expenditure outturn was significantly lower than the amounts provided were in respect of administration costs, which were some €4 million less than the estimate. Amounts of recurrent grants paid to health sector agencies was €8.8 million lower than budgeted - this was largely due to unfilled posts in agencies, including the Health Information and Quality Authority HIQA and the Mental Health Commission. The lower than budgeted expenditure in these areas was partly offset by higher than budgeted expenditure of €6.9 million under subhead D, which is provided to cover the cost of inquiries, legal fees and settlements. The Department noted that the excess on this subhead arose largely as a result of higher than expected payments made under the Lourdes Hospital and symphysiotomy payment schemes, and in relation to medical negligence claims.
The Irish Blood Transfusion Service is a statutory body established in 1965 and operating under the aegis of the Department of Health. Its primary functions are the collection, processing and supply of blood and blood products. The safe supply of such products is a critical element in the provision of health services in the State - the importance of this activity is underscored by the number of citizens who in the past suffered serious infection through the blood supply, and the ongoing cost to the taxpayer of compensation payments and of the provision of services to them.
The IBTS does not receive State funding by way of an annual grant. All of its recurring income is derived from charges in respect of the supply and testing of blood and blood products. The charge out rates are decided by the Minister for Health. In 2009, IBTS earned income in the region of €118 million. By 2013, its income had fallen to approximately €66 million, reflecting the transfer of responsibilities to St James's Hospital, changes in demand for certain products and price reductions.
The Report on the Accounts of the Public Services 2013 includes a chapter in respect of a long-standing dispute between the Department and IBTS about amounts deducted from staff salaries in respect of pension-related deductions.
I should point out here that pension-related deductions are not the same as employee pension contributions. In effect, the deductions are a salary reduction measure. The 2009 FEMPI legislation provided for pension-related deductions from the remuneration of public servants from 1 March 2009. Between 2009 and 2013, IBTS deducted €8.7 million from staff remuneration in this regard, but at September 2014 had not paid over any of these amounts to the Department of Health as provided for in the legislation. The 2014 financial statements indicate that the amount due to the Department at the end of that year had increased to €10.3 million. As a result, funding of that amount receivable by the Vote for health has not been received, and the provisions of the FEMPI Act are not being complied with in that regard.
The second issue in dispute relates to IBTS pension funding. IBTS operates a funded defined benefit pension scheme for its employees, which is contributory. In common with many other funded defined benefit schemes, the IBTS scheme is a balance of cost scheme. This means that while the contribution rate for employees is fixed as a percentage of salary, the contribution IBTS, as the employer, is liable to pay into the fund goes up or down as required to ensure that the funding will be sufficient to meet the liabilities when they fall due. Between 2011 and April 2014, IBTS made additional contributions of €9.3 million to the pension scheme. Notwithstanding the additional contributions, at the end of 2013 the pension fund deficit was estimated at €42 million. By end 2014, this had increased to €92 million. The movement year-on-year illustrates the volatility of pension liability estimation, which can be seen in the accounts of many State bodies. At the time I reported, discussions were ongoing between IBTS, the Department of Health and the Department of Public Expenditure and Reform on the resolution of both of these matters.
Mr. Jim Breslin:
I am here today to deal with the annual report and appropriation accounts of the Comptroller and Auditor General in respect of Vote 38, the Department of Health. I am very happy to be here on my first occasion as Accounting Officer for the Department of Health's Vote. The Department of Health is relatively small, with 350 staff directly on its payroll. In 2013 it was responsible for a budget of some €248 million and, as the Comptroller and Auditor General has said, that budget was €206 million in 2014. The budget covered the salaries and expenses of the office of the Minister and certain other services administered by that office, including grants to research, consultative and advisory bodies.
After more than a decade of change in the wider health sector, it is important that the Department of Health redefine its role to take account of these developments and to meet future challenges. The Department's statement of strategy for the period 2015-2017 identifies the following four main elements to the Department’s role: leadership and policy direction for the health sector to improve health outcomes; governance and performance oversight to ensure accountable and high-quality services; collaboration to achieve health priorities and contribute to wider social and economic goals; and the creation of an organisational environment where, on an ongoing basis, high performance is achieved and the knowledge and skills of staff are developed. A programme of change is under way in the Department and our aim is to create an organisational environment that will position us to fulfil our role and achieve our priorities in the most effective way possible. This programme of change also includes new assignment of management team responsibilities and the recruitment of new members to the management team, including a deputy secretary general for governance and performance and a deputy secretary general for policy and strategy, together with an assistant secretary for research and development and health analytics.
I will turn now to the IBTS pension fund. When the Financial Emergency Measures in the Public Interest Act 2009 was initially introduced, the IBTS questioned whether its staff should be liable for the pension-related deductions provided for under the FEMPI legislation, as employees of the IBTS are members of a long-standing private pension scheme. The Department communicated to the IBTS from the outset that its staff were subject to the pension levy and stressed at every opportunity the necessity of remitting the pension-related deductions collected from employees. The IBTS, which subsequently accepted that the legislation applies to its employees, linked the non-remittance of pension levy funds to the need to address a deficit in the IBTS pension fund. Various efforts have been made to resolve the issue and considerable progress has been made in recent months. The Department of Public Expenditure and Reform and the Department of Health are participating in conciliation talks with the IBTS and employee representatives under the auspices of the newly created Workplace Relations Commission with a view to reaching a sustainable conclusion. In line with the IBTS pension fund's trust deed, any changes in pension arrangements have to be agreed by the employees. At a Workplace Relations Commission conciliation conference attended by all parties on 2 October 2015, a proposal was put forward by the commission. This proposal will be considered further by the IBTS and its employees. However, the proposal is acceptable to the Department of Public Expenditure and Reform and the Department of Health, and it is the hope of both Departments that it can bring resolution to the matters set out by the Comptroller and Auditor General in his report.
I will now set out the main points of the 2013 accounts as they pertain to Vote 38. Funding is allocated to the Department of Health under Vote 38. Through this Vote, funding is also allocated to bodies under the aegis of the Department, such as the Mental Health Commission, the Food Safety Authority of Ireland and the Health Information and Quality Authority. The 2013 provision, current and capital, for Vote 38 was almost €248 million. The 2013 outturn was almost €220 million, leaving an overall saving of €28 million. The 2013 provision for current expenditure was €233 million and the outturn was €208 million, giving a saving of €25 million. In 2013, €20 million of this saving was used to offset the Supplementary Estimate requirement for Vote 39, the Health Service Executive, thereby reducing the call on the Exchequer. The 2013 provision for capital expenditure was almost €14 million and the outturn was €11 million, a saving of €4 million. The majority of this saving was due to timing issues on projects, particularly the construction of a clinical research facility at University Hospital Galway, which, I am delighted to say, was recently opened. The contingency allocation was not required. Further detail is provided in the opening statement on the breakdown of the appropriation account, and I might skip over that in the interest of time.
As members will be aware, under the provisions of the Health Service Executive (Financial Matters) Act 2014, the Vote of the Health Service Executive is disestablished and funding of the HSE is now provided from the Vote of the Minister for Health, Vote 38, with effect from 1 January 2015. I look forward in future years to accounting to the committee for this expenditure as part of my Accounting Officer duties.
In my capacity as Secretary General I am seeking to develop the Department’s policy and performance oversight of the entire range of complex services falling within total public health expenditure. I have mentioned the change programme under way in the Department, including the revised management team responsibilities which seek to equip us for this aspect of our role, amongst others. I look forward to working with the committee, and with the Oireachtas generally, on this objective. I am happy to take any questions.
Mr. Andrew Kelly:
My opening statement will deal with the issue of the IBTS pension scheme under four headings: the background to the scheme; pension-related deductions; the funding requirement; and discussions to resolve the issue.
The IBTS, formerly the Blood Transfusion Service Board, was established by a statutory instrument, SI 78/1965, to organise and administer a blood transfusion service. The pension scheme was set up under indenture, or a trust deed, in 1963. When the Blood Transfusion Service was established in 1965 to replace the National Blood Transfusion Association, one of the functions of the new body was "to take over the property (including choses-in-action), assets, rights and liabilities of the Company." This would have included the pension scheme.
The IBTS operates a defined benefit pension scheme, which is a balance of costs scheme. Under the terms of the trust deed, any increase in contribution required to be paid following an actuarial valuation to ensure that the benefits under the scheme are funded falls to be paid by the employer. Currently the employer pays 30% of payroll and the employees contribute, on average, 6.3%. The benefits under the scheme are broadly in line with other public sector models and these have been actuarially evaluated and found to be comparable.
I will now discuss the Financial Emergency Measures in the Public Interest Act 2009 and the pension-related deduction. The background to the application of the FEMPI Act 2009 is dealt with in detail in the briefing paper. The FEMPI Act was introduced at a critical point in the consultation process with employees regarding funding of the scheme where the employer was seeking an increased contribution from employees to address the funding issue.
However, it is necessary to reiterate that initially the IBTS was informed that the Act did not apply. This was subsequently changed to state that the staff in the IBTS were covered by the terms of the Act and should pay the PRD. The board sought legal advice from senior counsel, which advised that the IBTS pension scheme did not fall within the definition of a public service scheme in the Financial Emergency Measures in the Public Interest Act 2009 and, therefore, the terms of the Act did not apply. The board decided to deduct the PRD from staff but the moneys were not remitted to the Department of Health. Since April 2015, the IBTS has remitted the PRD collected from members of the single public service pension scheme and the amount in excess of €10 million in respect of all other staff. The total amount remitted to 30 June is €1.268 million. In addition, the IBTS pension scheme was deemed a private pension scheme for the purposes of the Government levy on private pension schemes. This resulted in €2.44 million being deducted from the value of the assets in the IBTS pension fund.
I refer to the funding requirement. As with a large number of defined benefit schemes, there is a deficit in the IBTS fund. The deficit from the most recent actuarial valuation on 1 May 2014 was €27.921 million. The funding requirement has increased substantially over the past decade. The following shows the increase in the employer contribution required to fund the current level of benefits: 2005, 14% equation to a value of €2.93 million; 2008, 19.5% or €5.33 million; 2011, 20.7% or €5.74 million; and 2014, 30% or €7.22 million. This is placing an unsustainable burden on the employer and it is clear that the current situation cannot continue. The IBTS has recognised this for some time and has been in negotiations with staff on changing the terms of the scheme. This level of increase is having a serious consequence on the funding of the IBTS. In the current financial year, the core business is performing well except for the increased cost of the pension contribution which has put the organisation into deficit. This is a very serious issue and needs to be addressed if the IBTS is to continue to provide a blood supply as safe as we can make it. This means continuing to be current with technological developments.
The IBTS in the period 2009 to 2014 has, like all public sector bodies, undergone significant change and has reduced its cost base significantly. This has occurred through a mixture of reductions in pay, controlling and reducing non-pay costs and reducing staff numbers. In this context, the following reductions-savings have been achieved: pay , €8.578 million or 20.85%; and non-pay, €6.2 million or 18.96%, giving a total of €14.8 million or 20.1%. At the same time, there has been a reduction in whole-time equivalents of 89.95 or 15.46%. These have been achieved at a time the income of the IBTS has reduced by €20.969 million, or 25.7%. This is primarily as a result of the reduction in the use of blood and platelets. These have reduced by 13.45% and 14.64%, respectively, in the period 2009 to 2014. Consequently, the scope for further significant reductions in spending is minimal. Therefore, the provision of pension arrangements for staff must be addressed In the context of the funding model of the IBTS.
With regard to discussions to resolve the issue, the IBTS has been engaged with staff and their representatives since 2002 on finding ways of resolving the increasing cost of funding the pension scheme. To prevent the problem becoming worse, the IBTS changed the pension scheme for new entrants after 1 May 2009. There is now broad recognition by all parties that the current situation cannot continue and that the measure taken in 2009 is not sufficient. This means there needs to be a change to the benefits for existing members of the scheme. The current series of negotiations is about finding a solution that will resolve the pension issue and secure the necessary funding for the IBTS into the future. These negotiations are being held under the auspices of the Workplace Relations Commission. The Departments of Health and Public Expenditure and Reform are involved in this process. Progress has been made and we will all continue to work together to resolve this outstanding issue. We are hopeful of a successful conclusion to these negotiations and then the proposal will have to be put to a ballot of all members of the pension scheme.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I thank Mr. Kelly. Can we publish your statement, please?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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We will also publish Mr. Breslin's statement.
Áine Collins (Cork North West, Fine Gael)
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I welcome all the witnesses. I will put questions to the Department of Health first. With regard to the financial statements, a contract was awarded relating to University Hospital Galway, UHG, to the value of €62,000 but there was no public procurement process. The reason cited by the Department was that specialist expertise was required. What expertise was required? To whom was the contract awarded? Had the person who got the contract any connection with the Department or the HSE?
Mr. Jim Breslin:
Deputies will be aware of the very tragic incident, resulting in the death of a patient in the maternity unit in UHG. A report into patient safety was conducted by HIQA. That report recommended that a national clinical guideline be developed to try to assist in similar situations in the future. The urgency of that, and public concern attaching to it, meant that it was necessary to develop that guideline as a matter of some urgency. Added to that was the very particular skills set required. Although in the period since then, we have developed this capability within the Department, this is not an area in which the Department had expertise nor is it an area in which there is a range of providers in the country. It involves of a mix of specialist clinical and economic skills that are not easily found. The Department was able to source a person with the requisite skills to conduct that research. They were not employed by UHG; this was an investigation into UHG. We provided the rationale for this in the annual report. I was not in the Department at the time it was done but when I did my 2014 return, because I had not signed off on this myself, I asked that the file be looked into very carefully and that the internal audit unit review it. It conducted a report for me and I was fully satisfied that the rationale given for conducting that, through a non-competitive procurement process, fully stood up both in the context of the public concerns around the tragic incident in Galway and the requisite experience, which is not commonly found within the jurisdiction.
Áine Collins (Cork North West, Fine Gael)
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I do not know who got the contract but had the person previously worked in the Department or with the HSE?
Áine Collins (Cork North West, Fine Gael)
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I thank Mr. Breslin for clarifying that.
There was a total payment of €24 million under the hepatitis C scheme and there were legal costs of €17 million. Is my analysis correct? I understand the legal expenses were €7 million, which was unexpected.
Áine Collins (Cork North West, Fine Gael)
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Those who were involved in the hepatitis C scheme and other vaccination schemes had to wait a long time. There is also an issue in respect of narcolepsy, which resulted from the vaccine given for swine 'flu. The lives of some young people and families have been transformed and they are waiting for support from the Department. This is a huge burden on families as they need extra support to physically manage the effects of the vaccine and support is also needed by schools in respect of these young people. Will there be another long waiting period? How will incidents such as this be managed where vaccinations have resulted in the health of individuals deteriorating? Another case was brought to my attention last week. It relates to a young girl who had the recent cervical vaccination and who has been in chronic pain since. Her hip is affected. She is on a crutch and is constantly on medication.
She is a teenager. I appreciate that these things cannot be foreseen but do we have a process in place that can make it easier for people and families to adjust? I would like to hear more about that, as opposed to spending the money on legal fees.
Mr. Jim Breslin:
The hepatitis C compensation tribunal has been in existence, associated with the other chapter before us, the contamination of the blood supply that occurred in Ireland. In 1996, the first awards from the hepatitis C compensation tribunal were made. Sizeable awards have been made in the interim period and as the Deputy can see, they are set out in regard to both 2013 and 2014. In total, €689 million has been paid out in awards under the hepatitis C tribunal over that interim period. There is a further reparation fund payment that totals €152 million and, as the Deputy rightly points out, there are significant legal costs attaching to the operation of the hepatitis C compensation tribunal, which is a statutory tribunal, of €165 million in legal fees over the period 1996 to 2014. The number of awards made is 3,423 and in each of those awards there is representation of the tribunal itself in regard to counsel and also representation in regard to the claimants. The Deputy can see that there are significant legal costs attaching to the tribunal based on it being a statutory tribunal where people are allowed to engage counsel to represent them in the tribunal.
Áine Collins (Cork North West, Fine Gael)
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Are there many more cases to be adjudicated?
Mr. Jim Breslin:
There are. They continue to make their way through for two reasons. Cases will come before the tribunal for the first time but mostly at this stage they are cases of people not infected themselves but relatives of people who are infected.
There is also the ability to re-enter a case. Over the years, the tribunal will have made a provisional award to somebody but if that person's illness associated with their having hepatitis C were to deteriorate, they might seek to re-enter the tribunal at that stage.
The State's involvement in this is a very sorry tale. The Deputy can see the size of the compensation being made and the absolute imperative to try to ensure the safety of our blood supply and that we never have this issue arise again.
The only positive I can mention in regard to this entire area is that in the current year, 2015, Ireland has taken account of the developments that have taken place internationally and we are now funding therapies for people with hepatitis C, not just those contaminated through the blood supply but people in Ireland who have hepatitis C. Those therapies now have a very good effectiveness in delivering not just improvement in the person's condition but, in some cases, curative.
We put in place a €30 million programme in 2015, and that is being rolled out on a clinical basis where consultants identify those most urgent in clinical terms to be treated. The Government has announced that as a multi-annual programme so I hope in future years to be talking about the money we spent on curing people with hepatitis C rather than compensating people for hepatitis C. We cannot undo the damage of the past-----
Áine Collins (Cork North West, Fine Gael)
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I accept that.
Mr. Jim Breslin:
-----but that would be a much better use of the State's resources.
In regard to the wider issue of vaccines or other instances where people have adverse events, the first requirement is to try to establish a linkage between people and the vaccine. Work was undertaken internationally and in Ireland to try to identify the association between people with narcolepsy, mostly young people, and those who had taken the vaccine. An association was found. There was a further requirement to prove causality, which is very hard to do because somebody may take a vaccine but something else may happen at the same time. That being said, the Health Service Executive has worked with relatively small numbers of people in that category to try to put services in place around their needs. We have increased the staffing around some of the specialist services that are needed for that and I know that is the case across Government, including in places like the Department of Education and Skills where people in the leaving certificate cycle, for example, have needed extra support with that and at university level.
There are likely to be some claims around that issue. There has not been a settlement. That has not reached a conclusion at this stage.
Áine Collins (Cork North West, Fine Gael)
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How long does Mr. Breslin think it will take?
Mr. Jim Breslin:
I would not like to prejudge. Obviously, the merits of the case are being looked into.
To move it into another associated area, also in the account is the symphysiotomy compensation scheme. We would all prefer not to be in a very legalistic place. Our learning over the years is to try to put in services early and address genuinely the life circumstances of people in these situations and, where issues arise, not to go to the Four Courts or even into very judicial processes. The reason I reference the symphysiotomy situation is because that is operating under the Department's Vote in 2015 in a very speedy fashion where the same level of legal representation is not required, awards are being made and people are getting on with their lives. All those processes have to be worked through as a general policy matter.
Regarding any specific vaccine, we have to look at the fine detail of that to determine the merits of the argument so I do not want to prejudge that. In any event, what we try to do is tackle the underlying issues around services because in terms of people who have narcolepsy, other issues the Deputy flagged, a medical condition or who require other supports, the first thing we should do is try to address that as the most immediate need, and we are seeking to do that.
Áine Collins (Cork North West, Fine Gael)
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Where should the young girl who came to my attention over the weekend who may have had a reaction to the cervical vaccine go to get help?
Áine Collins (Cork North West, Fine Gael)
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Is there a process in place in Mr. Breslin's Department?
Mr. Jim Breslin:
If there is a vaccine taken, and normally they would be delivered by the general practitioner, the patient would return to the general practitioner and explain that they consider that they have had an adverse reaction. The general practitioner would then report on that adverse reaction. The pharmaceutical companies are required to follow up on adverse reactions and the Health Products Regulatory Authority monitors all adverse reactions. Adverse reactions could be something relatively minor such as swelling on the arm when one gets an injection to something more serious, and the regulatory authorities work across Europe to share information on adverse reactions. One isolated event would not be a pattern. One would look to see a pattern established that showed some causality between what happened to somebody and the actual vaccine. I have no information on adverse reactions regarding other vaccines. If there were-----
Áine Collins (Cork North West, Fine Gael)
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What I am trying to get to is that while all this is going on in the background, and I understand these have to be proven, the person on the ground is struggling to cope with this real issue and at the same time trying to get through the system.
Áine Collins (Cork North West, Fine Gael)
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Is it something the Department will be examining in the future where there might be a more serious reaction that has life complications in the sense that the person's quality of life has changed? I am not talking about a swelling in the arm, a rash or something like that-----
Áine Collins (Cork North West, Fine Gael)
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-----but that there would be somewhere they could go to get early services while the proof issue is going on. I am talking about cases where somebody's life has changed. Obviously, it cannot be proved beyond reasonable doubt, and we are not talking about a court of law, but I imagine we would want to help where something like this has happened-----
Áine Collins (Cork North West, Fine Gael)
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-----get in early, do the intervention and make their life as comfortable as possible. Has the Department a process in place for that?
Áine Collins (Cork North West, Fine Gael)
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Mr. Breslin would say they should go to the doctor but they may need other services.
Áine Collins (Cork North West, Fine Gael)
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In this particular case this person now has chronic hip pain. She cannot walk and may need support to take her bag to school. How does she get to and from school? Her life has been transformed. She is on a serious amount of medication. While the family are struggling with that, and they have been to their general practitioner, the hospital and so on, there is no support from the Department in terms of counselling or all the other soft supports, as we would call them. I am not talking about payment but early intervention when something like this happens.
Áine Collins (Cork North West, Fine Gael)
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Neither am I.
Mr. Jim Breslin:
The first thing in something as immediate as this is to try to get the diagnosis and get the issue resolved. The most vital thing, both for the health service and for the individual, is that we try to get to the underlying issue and get it resolved. We are probably not in the first week of it but if we are in a situation where somebody has a chronic or long-standing condition, the health service has a range of services, including counselling and patient support services, to support people in that situation. I do not wish to speak about the individual incident but my guess in something so proximate, if it happened last weekend and the issue is now present, is that the concentration of the effort, both by a GP and by specialists, would be on trying to get a handle on what the underlying issue is.
Áine Collins (Cork North West, Fine Gael)
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The issue happened last year and I only became aware of it last weekend. My point is that a year later they are still struggling.
Áine Collins (Cork North West, Fine Gael)
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I appreciate that, but I am not getting the answer I seek to my question. Is there a process in place whereby if something happens, somebody can say, "I believe I have had a reaction here. I have been to the doctor and the family needs support", and a team can go in and help the family? I get the impression that there is not. It is a case of going back to the doctor to get the proof and going back to the hospital. Mr. Breslin and I, as non-medical people, know that this can take a year or two.
Mr. Jim Breslin:
My point is that this is not a question of proof. If we were to put up a hurdle of proof, that would not be the response that should be given in this situation. The response should be proportionate and in line with the underlying condition, regardless of where the origins of the condition lie. It is a separate, subsequent and perhaps a parallel process to try to establish what its origins are. I have no clinical evidence that the origins could be related to the vaccine. It could be coincidental. It really does not matter in terms of the underlying condition. If somebody has it and is experiencing it in that way, I would want them to be met by the health service in a compassionate way with a range of responses. I would be happy to take the details and see what has happened in this instance.
Áine Collins (Cork North West, Fine Gael)
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Regarding Mr. Breslin's work in overseeing the HSE budget of €12 billion, he is going from €200 million to managing a €12 billion portfolio, which I believe started on 1 January this year. Could he talk about the change management programme he mentions and the skills sets. Are there integrated financial accounting records? How is all of that being managed?
Áine Collins (Cork North West, Fine Gael)
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I also wish to hear about the skills set of the staff and the number of staff involved.
Mr. Jim Breslin:
One is the ongoing development of HSE capability in this area, of which the committee is aware. That refers to its own financial systems, operating systems and skills set. There is a programme of reform being led by the chief financial officer in the HSE. It has both skills and capability in staffing and also technology. Over a period the HSE has had to come from a situation where it had multiple financial systems across former health board areas into a consolidated place where it has a single financial system.
Áine Collins (Cork North West, Fine Gael)
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Has that not been rolled out?
Mr. Jim Breslin:
We are not at the point yet where we are rolling out that financial system. We are at a peer review process for procurement of a national financial system. However, the learning is that a great deal can happen before we implement a new national financial system. There is a huge amount of process change that must be consolidated and made consistent across the country. The way in which information is captured and recorded must be made consistent, and the processing of financial information can be streamlined through reducing the number of points in which it is being captured. The overall reform is not simply about a piece of technology. It must be about a changed way of managing the financial recording and management within the HSE.
Áine Collins (Cork North West, Fine Gael)
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What is the position in that process?
Mr. Jim Breslin:
At present, the process is at peer review stage, which involves any major ICT expenditure going to a peer review process of independent people. They are commissioned by the Department of Public Expenditure and Reform to look at projects objectively, to bring their expertise to that across a range of areas, including ICT, and to question the project approach that is being taken. We have just entered the peer review stage. When we conclude that stage we would hope that we would finalise a procurement process that would lead to phased implementation. It will be a multi-year implementation, probably starting with those areas of the country that have the most urgent need for new technology in this area. We will phase in the implementation of that. It will be a major multi-annual programme. It will run to tens of millions of euro in terms of budget. In the capital review announced last week by the Government additional provision has been made for a national financial system for the HSE.
Áine Collins (Cork North West, Fine Gael)
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Can Mr. Breslin give a timeline from when it started? How long will it be until there is an integrated financial system?
Mr. Jim Breslin:
I sit on the national financial reform programme board and I asked that question at our last meeting. At the end of the peer review process, which should be relatively speedy, we have undertaken to devise a timetable and publish it to show the exact milestones and how long it will take. We will not know that until we are out of the peer review process because that process could change the approach we take. I will be happy to do that in the coming months.
Áine Collins (Cork North West, Fine Gael)
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Are we talking about five or ten years?
Áine Collins (Cork North West, Fine Gael)
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This has been talked about already, but with an extra three, so we are talking about eight years to implement an integrated financial accounting system.
Áine Collins (Cork North West, Fine Gael)
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That is clear.
Mr. Jim Breslin:
-----but there has been significant upgrading of financial systems. We have not put our request to the HSE for enhanced financial information on hold while a national financial system is delivered. We must come up with work-around approaches that deliver better and more reliable information across the interim period. Investments have been made to do that both in terms of technology and also the right calibre of skilled staff. That is the HSE's piece of this. It has been working on it and the committee will have heard about it in the past. The piece for which the Department has assumed an added responsibility is that from 1 January I take Accounting Officer duties for that expenditure. We are developing the capability in the Department to enhance the skills it currently has. As I said, it is a relatively small Department. We have put in place enhanced financial leadership within the Department and we are going to-----
Áine Collins (Cork North West, Fine Gael)
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How many accountants are managing this in the Department?
Áine Collins (Cork North West, Fine Gael)
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There are four accountants in a Department managing a €12 billion budget.
Mr. Jim Breslin:
Yes. There are plans to recruit more. The other area of this is that in the past two weeks we have recruited a new deputy Secretary General for performance and governance. It is not simply about finance; it is about what we get for the €12 billion. The focus of that area will be to try to line up the financial outputs of the HSE with the outcomes it is achieving in areas such as access activity and so forth.
Áine Collins (Cork North West, Fine Gael)
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Surely to be able to evaluate any information, one must have information that is accurate and on time. However, there is no integrated approach and only four accountants to manage a €12 billion fund.
Áine Collins (Cork North West, Fine Gael)
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It is also taking eight years to roll it out.
Áine Collins (Cork North West, Fine Gael)
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This is the stuff that drives people absolutely insane, including me, and I speak with a little experience from a financial background. When something needed to be done in Galway, and I agreed it had to be done, approximately €62,000 was spent on that. Yet we have this, which is ongoing for the past 15 years. We cannot seem to make it happen.
Áine Collins (Cork North West, Fine Gael)
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I am not asking for that.
Mr. Jim Breslin:
Prior to the 1 January going live, I took up duties last September. What we have done is put together a programme of change within the Department that tries to recognise the enhanced role it will have in this area. That is laid out in my opening statement. We visibly and tangibly take the challenge of performance oversight, not just for the HSE-----
Áine Collins (Cork North West, Fine Gael)
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There are four accountants-----
Áine Collins (Cork North West, Fine Gael)
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-----for a budget of €12 billion.
Áine Collins (Cork North West, Fine Gael)
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I appreciate that.
Áine Collins (Cork North West, Fine Gael)
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Does the Department have any people with the skill set of data analytics?
Áine Collins (Cork North West, Fine Gael)
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How many?
Mr. Jim Breslin:
Three or four, and we have further posts to resource that area further. We have not yet arrived there, but the process of recruitment has been finalised for a post for the management team for research and development in health analytics.
It will be the first such post across government where information and evidence will be at the heart of our management team discussions. The person will come with a very strong track record in the area of data and analytics.
Áine Collins (Cork North West, Fine Gael)
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Without information that is accurate and available on time it is very difficult to make decisions.
Mr. Jim Breslin:
Yes, but it is not only financial information that is used; we also have other information sources. We receive information through the hospital information inquiry system. We also have information on medical cards and so on; there are good IT systems in the PCRS. We have to develop capability while information systems are developed in parallel rather than waiting for everything to be perfect. There is a significant IT programme under way under the chief information officer in the HSE. It has identified this as an absolutely priority in improving health service performance. In so many areas of health service performance, information is key to the quality decision-making needed.
Áine Collins (Cork North West, Fine Gael)
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I imagine that if we had one system, it could capture all data, both financial and-----
Áine Collins (Cork North West, Fine Gael)
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Yes.
Mr. Jim Breslin:
The trick is to feed the financial system from, for example, the laboratory system in order that one can actually see in detail what is going on in laboratories and what it is costing. We will, therefore, always have multiple systems, but the important thing is that they converge and talk to each other.
Áine Collins (Cork North West, Fine Gael)
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I wish to ask the IBTS questions about the €10.3 million in pension-related deductions not being handed over. Where are we on this matter? How long will it take to resolve it?
Mr. Andrew Kelly:
Recently we have had negotiations with staff. In fact, last Friday we were at the Workplace Relations Commission when I think we had a very productive meeting. There is a proposal on the table which the staff and unions have gone off to consider. We are recommending that it be accepted. Effectively, we have a three-month window to try to influence people to find a solution to resolve this issue which has been ongoing for a long time. People want certainty in their pension arrangements and I think the proposal made offers them that certainty. I am hopeful that when they look at it and consider it in detail, they will ballot in favour of accepting it.
Áine Collins (Cork North West, Fine Gael)
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What will happen if they do not?
Mr. Andrew Kelly:
If they do not, we will be back at the drawing board with a much bigger issue to resolve. To be honest, I do not know the answer to that question. I think there is broad acceptance that the situation cannot continue and that change needs to happen. It is a question of everybody accepting that they need to change something in the pension scheme to make this work.
Áine Collins (Cork North West, Fine Gael)
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Is Mr. Kelly talking about moving from a defined benefit pensions scheme to a pay-related pensions scheme?
Áine Collins (Cork North West, Fine Gael)
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A very defined benefit pensions scheme.
Áine Collins (Cork North West, Fine Gael)
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How will that impact on those now in receipt of pensions?
Áine Collins (Cork North West, Fine Gael)
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Will it change from the date the vote is cast?
Áine Collins (Cork North West, Fine Gael)
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Will people's pension be split or will everything change from that point?
Áine Collins (Cork North West, Fine Gael)
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Okay.
Áine Collins (Cork North West, Fine Gael)
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I wish the IBTS luck and hope it will work out.
Áine Collins (Cork North West, Fine Gael)
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I thank Mr. Kelly. I have stayed within my time.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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The Deputy has plenty of time.
Áine Collins (Cork North West, Fine Gael)
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Thank you, Chairman.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Mr. Kelly said in his opening statement that "the IBTS was informed that the Act did not apply".
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Who told the IBTS that?
Mr. Andrew Kelly:
It was the Department of Health, but it was for a period of about two months. The issue was that we were almost seen as not having a pension fund or pensions scheme and when the issue was raised, it was not clear if the Act applied. The matter was clarified in April, following the introduction of the Act.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Was it the Department of Health that informed the IBTS?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Was it after the matter had been clarified, two or three months later, that the IBTS began to collect contributions?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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To the beginning.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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When did the IBTS reach the decision to withhold the money?
Mr. Andrew Kelly:
I think it was early on in the process, probably around 2010 or 2011. After the organisation was established, the pensions scheme was established in 1963. There was a pension fund and every three years under the Pensions Act an actuary made a valuation to see what contributions were required to fund the benefits payable under the scheme at the time. The trustees or the board of trustees, three of whom are appointed by the employer and three by the staff, operate the scheme on behalf of members and it was deemed that there would be a private pensions scheme. The issue then arose, as there was a deficit in the scheme. We were in discussions with staff at the time - in 2009 - to make increased contributions to secure their benefits under the scheme. We were actually involved in conciliation on the day we found out that this scheme did apply. The conciliation process broke down and they were not willing to pay any more if there was to be a pension-related deduction also. They were not going to have a PRD of 6% or 7% and pay a further 6% or 7% to secure their benefits.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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How much money had the organisation collected?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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What gave the board the right to have this discussion in the light of the confirmed position of the Department of Health that the IBTS was subject to the FEMPI legislation? What gave the board the right to second guess the legislation?
Mr. Andrew Kelly:
When the Bill was published initially, the board looked for advice on whether it would be covered. In the very early stages there was uncertainty, which went on for about two months maximum. The board sought advice from senior counsel on whether the IBTS pensions scheme fitted the definition of a public service persons scheme within the terms of the FEMPI legislation. The view of senior counsel was that it did not, that it was not a public service pensions scheme within the terms of the legislation. Under our scheme, on retirement, the trustees calculate a person's pension based on the final salary given to them by the employer. An individual member of staff retired and the employer told the trustees that the retirement pension was to be based on final salary which had been cut a number of months earlier. The person concerned challenged this in the High Court saying, "If you cut my pay on the basis of FEMPI 2, then that Act should also apply in giving me the benefit of a grace period and retiring on a pension based on pre-cut salary." The trustees said, "Not according to our trustee rules; therefore, it is to be based on final salary." The person concerned did not accept this and took a case to the Ombudsman. He supported her case and also determined that we had a public service pensions scheme. The trustees then had no option but to appeal the decision to the High Court. Even though he said at the beginning of his judgment that he was not going to deal with the substantive issue, the President of the High Court asked the hypothetical question whether the Oireachtas had intended to exclude the IBTS from the FEMPI legislation when it was brought forward and, using section 5 of the Interpretation Act 2005, decided that it had not been its intention to do so. He, therefore, decided that it was a public service pensions scheme. He went on to deal with the individual case later in the judgment.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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In what year?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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The IBTS continued to withhold the money.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I will outline what happened. The IBTS withheld the moneys which had been collected.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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The IBTS was going through a court process which ended in the High Court.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Did the IBTS collect the money until then?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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In 2013 it was made very clear that the money was due to the Department. If the IBTS had the money collected for a specific purpose and it was due to the Department, why, at conclusion of the case, did it not pay it to the Department?
Mr. Andrew Kelly:
I think in May 2011 there was a proposal made by the Department of Public Expenditure and Reform that some of the moneys collected on a 1 for 1 or a 1 for 2 basis could be used to resolve the pensions scheme issue. In that context, there was a proposal in May 2012 to resolve the issue by using some of this money to find a solution because, obviously, we needed to address the deficit in the scheme as pensioners might actually have to be paid from the fund as opposed to public moneys. It had been going on for so long that it seemed at the time-----
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Did they approve it?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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The IBTS has no right to that money.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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No, I am right. The IBTS collected it for one purpose. It is bad enough to see the Government raiding moneys that were collected for road tax and sending them off to Irish Water. In this case, the IBTS collected a sum of money, which was intended to be given to the Government for a particular purpose under particular legislation, from its employees. Therefore, the IBTS is legally obliged to hand over that money. This has actually been tested in court. The IBTS lost the case and now the money is due to the Department. Does the IBTS have that money in a separate account?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Where is this balance of money then?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Why did the IBTS not give it to the Department?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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The IBTS has no right to discuss the issue. It collected the money. Mr. Kelly can correct me if I am wrong. The IBTS has collected the money and it has it in an account. I suggest it should pay it over to the Department unless the Department excuses it and says it does not have to pay. That is the question. Mr. Kelly is arguing that the IBTS wants to keep part of the money it has collected to fund its pension scheme. Is that correct?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Obviously, they disagree because they have not come to a settlement with the IBTS.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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It is only a long-standing issue because the IBTS is keeping the money. Legally, it has no right to keep that money.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Sure it is resolved. The IBTS owes the Department the money.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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The IBTS collected the money for a reason.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Where does the right for the IBTS to keep that money come from?
Mr. Andrew Kelly:
I would not describe it as a "right". I think I would say we are looking for a solution in the best interests of all concerned that will resolve all of these matters, including those associated with FEMPI, the pension fund and the funding of the IBTS, which is the most important issue to be resolved. As I have mentioned, we are at a very delicate stage in those negotiations. We are hopeful that this will be resolved in the next three months and that all of the issues around what we are discussing here this morning will be resolved with it.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Is it the case that the IBTS has the lads in the Department over a barrel because it has this money, and it is going to extract as much as it can on that basis?
Mr. Andrew Kelly:
Absolutely not. Every time I meet representatives of the Department, as I do on a quarterly basis at the governance meetings, the first question I am asked is whether I have brought the cheque along and whether I have the money with me. They have consistently asked us for the money.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Mr. Kelly has looked at them straight in the eye and said "No, I have not".
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Fair play to you. I ask the Secretary General to set out the view of the Department of Health on this matter.
Mr. Jim Breslin:
Our view was put on the record early in this process. The Act commenced on 1 March. On 4 March, we corresponded with the Department of Finance, as it was at that stage, in response to a question that was raised about the application of FEMPI to the IBTS and the Department of Finance responded to us. On 6 April, we gave our definitive position in writing to the IBTS, which was that it needed to deduct the levy and remit it to the Department. That has been our position ever since. Predecessors of mine and Ministers have written letters on this issue. We have maintained that position. The IBTS has linked the two issues of the FEMPI reductions and the financial position of the pension fund. I do not underestimate the pension fund issue. We have actively tried to work on that with the IBTS in the latest manifestation of this process. In fairness to the IBTS, this is not simply an issue between two organs of the State as there are also employees involved. The agreement of the employees will be needed if the issues in the pension fund are to be resolved. The Workplace Relations Commission has been engaged on that part of this piece of work. I think all of us, including the two Departments and the IBTS, are optimistic that the basis of a resolution is on the table. That will require employees to sign up to revised pension arrangements. If that is done, the two Departments have indicated that a contribution towards resolving that can be made in some or in part of the €10 million that is outstanding. We would like to bring this saga to a close.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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If Mr. Kelly was a director of a private company, what form of action would the Department take against him and against the board? Would it be the same? Would the Department have been willing to wait from 2009 or 2010 for a court case to conclude as it did recently when it found against Mr. Kelly? Would the Department have the same consideration?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Would the Department have the same consideration in such circumstances?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Would the Department have the same consideration?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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It sets an example for all other Government agencies and Departments to take the same position when they are conducting their deliberations and arguments with the Department of Health.
Mr. Jim Breslin:
I do not think so, because I think this has clouded the relationship between the Department and the IBTS to nobody's satisfaction. There is a complexity to the pension fund issue, which has proved to be relatively intractable. It is our hope that the resolution of that issue through the recommendations of the Workplace Relations Commission will draw this matter to a close, and all of our accounts can be put right.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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It is pretty simple. They owe the Department the money and the Department has to get it back from them. They are in a bit of financial bother and the Department has to resolve it. That is the answer. If the figures in what the Department is saying are correct, the cost so far in relation to hepatitis C, for example, is approximately €1 billion. I was just reading the different figures off the screen. It is a little over €1 billion. That is the cost in terms of the compensation. Then there is the €132 million, the €165 million for legal fees and so on. Separate from and parallel to that, concern is also expressed in the report that this "could also seriously impact the organisation’s capacity to deliver a safe and sustainable blood service, to the appropriate standards of quality and efficacy". It is in everyone's interest that this matter be dealt with immediately.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Does Mr. Breslin think this will be resolved before he comes before us again?
Mr. Jim Breslin:
We have set about that task this year. In fairness to the three organisations that are represented at this meeting, they have set about trying to do that with a very serious purpose. We think we are closer now, following the intervention of the Workplace Relations Commission, than we had been. The employees will be required to sign up to a pension scheme that will still be very good but will have some modifications on the current arrangements.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Can Mr. Breslin keep us informed on this matter? I am not going to go around in circles with him today. Will Mr. Breslin explain what happens, or has happened up to now, in relation to the budget for the HSE? Is it a case of the HSE, through the Department of Health, negotiating with the Departments of Finance and Public Enterprise and Reform? Who asks who for the money and how much?
Mr. Jim Breslin:
Generally, the process would be that the HSE would do many of the calculations around both - the cost of delivering the existing services and other priority initiatives that might be undertaken. The Department would take a view on that, working with the HSE, based on our own calculations and information sources.
That would form part of a negotiation process led by the Minister for Health with the Minister for Public Expenditure and Reform that would lead to an Estimates settlement that would be voted on in the Oireachtas. Prior to 1 January, that Vote went directly to the HSE from the Oireachtas with the director general of the HSE as Accounting Officer. Since 1 January this year that money passes through the Department of Health Vote and then we allocate it to the HSE as part of an allocation. That would be a more normal funding arrangement between a Department and an agency.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Who has carried out the direct negotiations up to now?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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For example, in recent years, what would you have been asking the Department for?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Yes.
Mr. Jim Breslin:
Normally one would start the discussions for the year with an estimation, if one was to maintain the services one is currently providing, of what would that cost one next year. One would have to factor in items such as medical inflation where technology is introducing extra cost. One would try to factor in issues of demography, for example, under the fair deal scheme where more older people are going to require long-term care. One would factor that in. One would come up with a set of estimations across the major budget headings. That sounds like a very technical exercise and there is a lot of technicality to it, but I think it is only proper to reflect back since 2008 on the reality of where we have been, which is that we have faced the Department of Public Expenditure and Reform saying: "It really doesn't matter what the technical calculations are." I am doing them a disservice; we are interested in the technical calculations, but in the final analysis, this is the only money that is available.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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How much did the Department of Health request in 2013? What does it cost to run the health service?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Let us say we understand all of the technicalities and all of the makeup. What would the Department request as its final figure?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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How much would the Department of Health request?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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What is it?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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What is the figure that the Department of Health would request to fund everything?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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What is the figure for running the health services now?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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What would the Department of Health request? What did the HSE request?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Any year that comes to Mr. Breslin's mind.
Mr. Jim Breslin:
It would be different. Let me talk in general and I will try to put figures on it, but it will be different in different years. As the Chairman knows, in the current year one will often have an overspend, as has been the pattern in recent years. So one will have an over-expenditure in 2015. That would be one of the first things that one would try to address in the 2016 Estimate. One would also seek to put in place something to provide for demography. I have given the example of €200 million. One would then adjust it for movements in pay rates. So, in relation to next year, there would be an increase in pay rates. In some of the years over this period, that has been a reduction in pay rates and, therefore, one could reduce it down. One will look at the cost of drugs and we have been successful in reducing the price of drugs, but the volume of drugs that are being prescribed continues to rise as it does in most jurisdictions. So we would put in an estimate of that. So they are the constituent elements that we would build up to an overall figure and it would depend on the given year as to what that would be.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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That does not answer my question. I am puzzled as to what the Department of Health requests as a budget to run the health services. So it is €12 billion. Would the Department of Health have requested €14 billion?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Not this year. I am only trying to find out how it works.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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What happened last year?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Just give me-----
Mr. Jim Breslin:
My recall is that the HSE looked for €1.4 billion last year and I think that probably was subsequently on the public record.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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That is €1.4 billion on top of-----
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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What had it?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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What had it in the budget?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Let us say it was €12 million.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Let us say its budget was €12 billion and it would have looked for €13.5 billion or €13.4 billion.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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How much did it get?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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It got a Supplementary Estimate at the end of the year of approximately €600 million. Is that right?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Therefore it is €12.5 billion, €13.9 billion plus €600 million. So it is €14.5 billion.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Help me out there.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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It would be reasonable to keep it that way. It is €14.5 billion. So it takes roughly €15 billion to run the health services every year, give or take.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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One has €12.5 billion. One has €1.4 billion.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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So you looked for-----
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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You looked for €1.4 billion.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Therefore €12 billion, €1.4 billion and then there was €600 million of an overspend.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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What does Mr. Breslin expect the overspend to be in 2015? What is it running at at the moment?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Does Mr. Breslin think that will go up significantly between now and-----
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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September.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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What does Mr. Breslin think?
Mr. Jim Breslin:
There is significant work under way in the HSE across headings that can be managed back to try to manage that back. The main areas of overspend in relation to that are acute hospitals; demand-led schemes, which in fairness to the HSE would be difficult for it to manage back; the State Claims Agency; and pensions. The Government has also committed to spending an extra €135 million in the current year on a series of initiatives on waiting lists and emergency department overcrowding, reducing the fair deal waiting times-----
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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That is not included in-----
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Is it likely to be €500 million or more?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I am just pressing Mr. Breslin. It is not to catch him out.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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It is just to get someone to acknowledge what is going on within the Department of Health and the health services to give us a clear picture and not be afraid of it. That is my concern. Over the years we have seen Estimates that have simply been way too low in the context of the eventual Vote and what was there. It would be good for someone in your position to come out and simply say, "Look, we asked for €15 billion and we got €12 billion, which is totally inadequate." Alongside that presentation we need Mr. Breslin to answer the question as to how many, if any, HSE employees within middle management or senior management are surplus to requirements. Has he estimated that?
Mr. Jim Breslin:
In a reformed system where we consolidate roles, there would be an opportunity to redeploy people from current roles into more analysis, proper management. What we have at the moment is quite a lot of transactional processing going on. The best-in-class approach to that would be to bring technology to bear on that. I would like to see more people doing the job that the Deputy in her questioning asked which is really getting under the information and seeing what can be done to make a difference and make more value out of the money we are having. So I do not think we are overstaffed and over-managed relative to other countries.
However, we are not asking the right questions, and are not using the intelligence that it is possible to generate through modern systems, to the benefit of patients, primarily, but also the taxpayer.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Is it the case that the Department has not analysed the structures of staff in place at the moment to tell us whether there are people who are surplus to requirements in the management system? We have been told as much and the comment has been made by consultants and others.
Mr. Jim Breslin:
We would have a particular focus on particular parts of the HSE. In these areas, changing the approach around process could free up staff. However, if we simply took away the staff at the moment without changing the process, we would grind to a halt. Improving financial processes and bringing technology to bear will release staff. We are keen to see them deployed into higher value work involving analysis and trying to manage to a higher level.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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There is another area I want to ask you about because you have brought clarity at least to the matter this morning and I thank you for that. It relates to the integrated national financial system - I understand that is how you describe it. The last time I asked about this I was told that a proposal had been made to the Department of Public Expenditure and Reform and that it was generally being considered. You have given us far greater detail and clarity in that you are looking at delivery in five years and a roll-out of eight years. This means the Department is at a given stage now in terms of determining what it wants within that system and how it will operate. Up to now we have had the most evasive answers from the Department of Public Expenditure and Reform and the same from the HSE. I am pleased to hear now that at least we have got this far with it. However, I had thought it was far more advanced than it appears. You have said the delivery of the system will be in five years. When will we be at the point of delivering an agreed system with the ability to talk to the other systems in place?
Mr. Jim Breslin:
The first stage will be when we go to procurement and advertise in the market to bring in technology suppliers and implementation providers. The second answer is that we will not try to implement that in every part of the HSE all in one go. We will undertake a phased implementation throughout the HSE. The timeline I have referenced is to the end of the process. In advance of that, proven technologies are available to us which can suck the information from existing systems and make it more accessible, including data warehousing and use of technology in that area. We are doing it in two stages. The first is to get to an endpoint with one financial system throughout the health service, that is, the same proprietary financial system everywhere. That is the real endpoint. However, in advance of that, as we develop our instances of implementation, we will draw that information into a central source and have better and more reliable information.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Therefore, we will not see one system for some time yet. Is that correct?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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You have referred to a roll-out of eight years but that is not relevant to the single system. It is beyond that. Is that correct?
John Deasy (Waterford, Fine Gael)
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I want to ask something that I have flagged already before I exhaust this.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I am exhausted, having listened to all of that. I am simply giving myself a break.
John Deasy (Waterford, Fine Gael)
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That is fair enough. This is something you have brought up as well. I imagine you know what I am going to bring up. It relates to the foster home we have dealt with and the HSE's involvement. I thank Mr. Breslin for coming in and he is welcome.
Mr. Conal Devine was commissioned to undertake a report on everything surrounding the foster home located in the south east of the country where some serious allegations have been made. We are getting conflicting views with regard to the position of a Garda investigation in this regard. The Chairman was formally notified that there would not be any prosecutions in this case. That much has been repeated to several people.
As far as the Department is aware, what is the status of a Garda investigation? I am asking because those responsible in the HSE are using the excuse of an ongoing Garda investigation. They maintain it precludes them from releasing the report, even in redacted form. What is Mr. Breslin's understanding of it? Frankly, we are getting two stories.
Mr. Jim Breslin:
My understanding is that when we have checked, it seems the process of determination on the part of the Garda has not concluded. The Chairman may have been informed differently. Obviously, we do not try to intervene in the process, but we have sought to check where the process is at. We have been told it has not concluded and this may relate to a number of lines of inquiry. That rings true with the line the HSE has given us, which is that the executive is precluded from publishing until it gets word from the Garda on the matter. That is the current situation, as we understand it.
John Deasy (Waterford, Fine Gael)
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Since we are at that juncture, I have another question. People have contacted the Garda and have directly asked the Garda whether there is an issue with publishing this report and the Garda have said "No." Some people are making the point to us that they do not believe there is an issue with the publication of this report. Can Mr. Breslin shine any light on that?
Mr. Jim Breslin:
It is our intention to do so. I have written to the committee on the subject. The Minister has requested that we organise a senior counsel, Mr. Conor Dignam, to look into the matter. One particular aspect that the senior counsel has been asked to look into relates to the reasons the reports have not been published and whether these reasons are well grounded. An interim report is due back shortly from Mr. Dignam. We hope that will assist the Deputy in the question he is asking.
John Deasy (Waterford, Fine Gael)
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Mr. Breslin is getting to the kernel of what we have discussed in the committee. This report was commissioned using public money. The Department of Health funds the HSE budget. I have to ask a particular question but no one seems to know the answer. What is the natural course when it comes to a report like this? Public money has been used and spent to commission it. It has been lying somewhere for years now. What role does the Department have? Do we need to ask counsel every time to examine why a report has not been published? Does Mr. Breslin get to see this report once it is finished? Does the Minister get to see this report? Does the HSE keep it locked up? I am beginning to suspect that HSE is not releasing some of these reports because they would damage the organisation and some individuals and because the HSE is potentially protecting some individuals by not publishing.
John Deasy (Waterford, Fine Gael)
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Mr. Breslin needs to request them. Is it correct?
John Deasy (Waterford, Fine Gael)
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They do not arrive on Mr. Breslin's desk as a matter of course once they are finalised. Is that the case?
Mr. Jim Breslin:
No, but in the vast majority of cases these matters are not only of concern to the HSE but also to the Minister or the Department. We get many reports in these scenarios. Situations could arise which are more local and are less obviously matters of public concern, but the HSE may take the view that they are worth looking into in any event. We would not necessarily get all of those. However, in such instances where we do not have An Garda Síochána's involvement, we would request the report. In this situation where we have done so, we have not been content to wait. We have agreed with the HSE that a senior counsel will review the reports. The Ministers have been at a disadvantage in the debate on the matter because they have not seen the reports - nor have I. However, they will have the benefit of a senior counsel having reviewed the report as well as a clear position from the senior counsel.
John Deasy (Waterford, Fine Gael)
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Did Mr. Breslin say he has not seen the report?
John Deasy (Waterford, Fine Gael)
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Why not?
John Deasy (Waterford, Fine Gael)
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Even Mr. Breslin has not seen the report because of the Garda. Mr. Breslin has characterised this as the routine way of doing business. Is that the case?
John Deasy (Waterford, Fine Gael)
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Mr. Breslin is saying that he has contacted the Garda and he is satisfied that there are valid reasons for the report not being published at this stage and that those responsible for making that case are in the Garda. Is that correct?
John Deasy (Waterford, Fine Gael)
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Until that occurs, do I take it that Mr. Breslin is not privy to that report?
Mr. Jim Breslin:
Other than we have agreed with the HSE, and the HSE has facilitated access by the senior counsel to these reports. That will establish two very important things for us - one, whether the reasons for not publishing them to date well grounded; and, two, whether they are in a format that can be published.
John Deasy (Waterford, Fine Gael)
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I have a bit of a problem with this whole system. It comes back to public expenditure, even when one gets into redaction. If a report such as that comes back to Mr. Breslin, is it redacted? If Mr. Breslin finally gets that, does he get to see the unblemished report or does he get a redacted version? Does Mr. Breslin know?
John Deasy (Waterford, Fine Gael)
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I have a bit of a problem with this now. This system really needs to change a little bit.
John Deasy (Waterford, Fine Gael)
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A second set of eyes on the unredacted report is necessary when it comes to Mr. Breslin's office and the Minister.
John Deasy (Waterford, Fine Gael)
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I understand, but Mr. Breslin is telling me that even if the Department gets the report and wants to publish it, and Mr. Breslin is making it clear that his intent is to do that,-----
John Deasy (Waterford, Fine Gael)
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-----Mr. Breslin might only get a redacted version of it.
John Deasy (Waterford, Fine Gael)
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I do not know Mr. Breslin very well but I will tell him why I have a problem with this. Social workers and people who have been around this for the past ten years have seen fragments of this report. They know that it is hard-hitting. They know it is a good report, and that is how they have characterised it to me. Mr. Breslin does not know; they do. A lot of people who are working in this area know exactly what has been written in that report and are very keen that it be made public, and they are very clear about their opinions as to why it is being held back.
I take everything Mr. Breslin said at face value. He stated that the Department of Justice and Equality and the Garda have made it clear that there are still issues that need to be dealt with. I am beginning to get worried, though, that the HSE sits on such reports and then redacts them, and it is in the public interest for that to change. A second set of eyes needs to be brought into this to make a decision on whether it is good public policy to continue that system.
As for some of the issues, I have never dealt with anything like it. I have been in politics since 1999 and I have never dealt with anything as serious and as disturbing as these allegations. I think Mr. Breslin gets my drift. I note the Chairman has been involved in this and we are on the same page when it comes to this.
Mr. Jim Breslin:
I think it might be of interest to Deputy Deasy - it does not directly answer the concern he raises - that one of the other concerns of the committee in these discussions has been the selection of people to undertake the work and how a report gets commissioned. The Minister of State, Deputy Kathleen Lynch, has written to the HSE suggesting that there are already processes in place in acute care to ensure that nominations of people to undertake reviews are not done by the HSE; they are done by an external party.
John Deasy (Waterford, Fine Gael)
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Unfortunately, the external parties in some cases are people who were former HSE employees.
Mr. Jim Breslin:
This is the point I am coming to. Deputy Lynch has written to the HSE to say that the selection process around that could benefit from it being more independent. In particular, the HSE's attention has been drawn to a practice that has developed, and one that I am very aware of, in the child welfare area where an external party to the HSE, somebody of objective standing who stands apart from the HSE - a professor in a university, not an employee of the HSE - selects from a panel of people who might undertake the review. There is the occasion where members of that panel have worked in the HSE because that is by far the biggest provider of health services but a studied eye is given to the composition of the panel, to ensure that it has clear independent status to it. We think this is an area, and the HSE is working with us and the Department of Children and Youth Affairs to try to develop a methodology that in the future would not lead to the kind of the concerns that members at the committee here have expressed, and we will have that.
John Deasy (Waterford, Fine Gael)
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Mr. Breslin is making me feel a bit better now. We have been dealing with this for the past year. We have been dealing with the methodology, the panels and the independence of these reports and reviews.
That is news. That is something we have not heard previously. We put a lot of work into this with regard to the independence of these reviews. Mr. Breslin states that the Minister in question, the Minister of State, Deputy Kathleen Lynch, has written to the HSE stressing that the reports should be more independent. Is it a bit more concrete than that? Does she have a proposal that she sent to the HSE or is it merely a request?
Mr. Jim Breslin:
She sent a proposal to them and the Department has followed up with a series of meetings with the HSE, who can see the merit in this because it does not do anybody any good, and the Department of Children and Youth Affairs. Indeed, she has met with people involved in the panel in the children area to try to get the methodologies right as we implement something similar in this space.
John Deasy (Waterford, Fine Gael)
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The families involved in the foster home and those who have been in contact with us will take something from that. If the system is changed because of this issue, the raising of it and our continual contact with the HSE and the Minister in question, that is useful.
I am glad I asked Mr. Breslin the question and thank him for the response. I would like it if the clerk to the committee, without saying anything, could correspond or communicate with Mr. Breslin's office so that we could get a copy of those proposals so that we can take a look at them. We made some definite recommendations in this area but if Mr. Breslin can give us that information, we would like to take a look at that.
John Deasy (Waterford, Fine Gael)
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I thank Mr. Breslin.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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We can welcome what might happen in the future on the lines of what Mr. Breslin described, some of which comes out of recommendations made by this committee. I am happy with that.
What I am deeply concerned about is the fact that the health boards, dating back to their time, and therefore the Department of Health, failed a high number of vulnerable young adults in this State, and probably continues to do that in this case. Within the organisation of the health services, someone knows what happened in relation to this. It did not go unnoticed. A senior social worker and an independent organisation felt strongly enough about it to make a protected disclosure on a number of different occasions, and felt so strong about it that they raised it at a restricted public meeting of employees with the HSE.
It also was raised here. Deputy Deasy and I raised it, and I made a disclosure to Pearse St. Garda station. This is what annoys me about it. Some employees of the health board at that time must have known about this and that was said by the whistleblower in greater detail. I have not heard from the HSE or from the Department of Health to say they have identified the various persons who engaged with this issue at that time.
I want to put this on record because of what Mr. Breslin said. I was asked to attend a meeting in the Garda station some months ago where I was told that the evidence had been presented to the DDP and that no action would be taken. Mr. Breslin states that he is waiting on the Garda report or the Garda is dealing with it, and I have been told that the Garda has dealt with it. They either have or they have not dealt with it. In my opinion, someone is covering up or playing games, and we need to come clean on all of this issue, not only in the interest of accountability, transparency and all of those words that are used nowadays, but in the interest of the families concerned.
Some of those young adults may have continued through their lives being affected by what happened. I have read some of the reports and, quite frankly, in my time in the public arena I have never read anything so horrifying. Both the reports and the verbal explanations given to me by the social workers are horrifying. That is what disturbed me most about this. We had an exchange here with the HSE on this matter and I must say that its arrogance and stonewalling on the occasion in question was breathtaking. A bit of truth and a bit of effort would really change things around here and would also the circumstances of the people affected. In light of what I have been told and in view of the fact that the Department of Health, at some stage in its history, employed people who were directly responsible in this area, there is an onus on the Department to conduct some sort of investigation into both itself and the individuals concerned. It should not be held back by the report or the information to the effect that there is a Garda report. The witness can say that I told him there were no prosecutions to happen. That is what I was told. I will leave it at that but I could not leave it at the exchange with Deputy Deasy because so much has happened since.
Mr. Jim Breslin:
I am happy to do this. I do not want this to be an ongoing issue. The purpose of commissioning the senior counsel is to get us to a point where we can put whatever we can into the public domain. One of the key issues the senior counsel is to examine is whether this concept of not publishing the report is well grounded. That finding will answer at least part of the question that the Chairman has posed. Officials at the Department and Ministers have met some of the people who have concern and local knowledge of this issue and everybody's concern is shared here. This is not something where we lack concern on this issue.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Did Mr. Breslin meet the officials within the health system who, at that time, were to the fore of the care of vulnerable young adults?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Yes.
Mr. Jim Breslin:
We have met certain people who have made themselves available to us. The process of commissioning the senior counsel is to look at the two reviews that were conducted to see whether they were adequate in who they met and how they went about their job but we have not met everybody who was working on this.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Given Mr. Breslin's exchange here this morning and how upfront he has been on some of the questions that we have asked, which is a little bit different than what we usually get here, I think he should ask them. I think he should seek the names of the individuals who were at the forefront of this at that time and determine whether they have all been questioned or made a contribution to the investigation. Quite frankly, it does Mr. Breslin, the committee, and the Garda no good to say that such a serious issue has not been brought to a conclusion one way or the other. I have two questions for Mr. Breslin.
John Deasy (Waterford, Fine Gael)
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Can we stay on this point for one second? I want to reiterate one thing. Mr. Breslin has made it clear that the process involving the choosing of the individuals who do these reports will now change which will end potential conflicts of interest that have arisen in the past. Very clearly, that is what we have seen and that is good and the people involved in this will be pleased with that. I have to return to the reports that are commissioned using public money and the way they are treated once they are completed. I think Mr. Breslin's office, on the basis of good public policy, needs to take a look at redaction and the circulation of those reports and, in my opinion, the continual suppression of these reports within the HSE. I could make a good argument that, for the public good, that system can no longer continue. I think Mr. Breslin needs to provide a second set of eyes or a different system or proposal to the HSE. I think, as a matter of good public policy, that needs to be considered at this point.
Mr. Jim Breslin:
I will say two things on that. I speak with some knowledge of the children's area because that was my former posting. The approach that is taken there is that the reports are published. The important thing in the terms of reference when something is set up is that the person who is doing the inquiry is told that the report will be published. If they go off and do the report and then one decides whether to publish it or not, one gets into redaction terrain, so it is important that we set up a process that is for the publication of reports.
John Deasy (Waterford, Fine Gael)
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I thank Mr. Breslin.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I have two questions. Bord Altranais comes under-----
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Is Mr. Breslin aware of how difficult it is to get through to it or, indeed, to get information from it?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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As to the registration of different nurses who have to go through the process of re-registering.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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If I was looking, yes.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I am referring to instances where individuals experiencing difficulties in registering contact their public representatives in order to seek their assistance and the problems the latter then have in contacting the board. Does Mr. Breslin know how difficult it is for the person attempting to register or for the public representative to get in touch with it?
Mr. Jim Breslin:
I was aware of the difficulty for registrants and the backlog that is there but I was not aware that Deputies had specific experiences of this. We have sought to work with the NMBI to get this issue resolved. We have recruited additional staffing for the registration process and the NMBI is about to introduce a proper call centre for taking calls and working through inquiries from people who are in the registration process. Although it will not be completely resolved, we hope to put a very big dent in it in the coming weeks and there is work under way on that.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I want to record my dissatisfaction with the spending of public money on that service. I will give one example of 15 phone calls being made in one day, with no response forthcoming.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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It should be easy, because it is at nil at the moment. It should be easy to improve on that. It is nil. I want to recognise the Minister's secretary, to whom I was obliged to go in order to obtain some information. I eventually got the information in question. I understand that this is an issue across the entire country. Nurses are returning home. There are services seeking nurses but the latter cannot get the appropriate certification and registration as efficiently as one would expect in the circumstances in which there is almost a crisis in that area. It is an appalling service.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Can Mr. Breslin do it before polling day because I am trying to impress a couple of people?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Can Deputy Deasy-----
John Deasy (Waterford, Fine Gael)
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What is that?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Polling day.
John Deasy (Waterford, Fine Gael)
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I will tell you both later. I do not want to do it on the record.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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For the information of the committee, an ex-member here, former Deputy Charlie O'Connor from Tallaght, has said that the election date will be in November and February.
John Deasy (Waterford, Fine Gael)
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Bring it on.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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In the Irish Blood Transfusion Board accounts for 2013, under the heading of miscellaneous expenses, an amount of €688,000 is listed. Under miscellaneous expenses in 2014, the figure is €1.284 million. There is nothing miscellaneous about those figures.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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They are substantial figures. I am not sure how the Comptroller and Auditor General feels about figures like that under a miscellaneous heading.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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If I sent those into Revenue, they would quickly be knocking on my door asking me to explain them.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Will Mr. Kelly give us a breakdown of both of those?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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If it is okay with members, we will conclude this section of the meeting.
John Deasy (Waterford, Fine Gael)
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Perhaps I am repeating myself but some people give out about the Committee of Public Accounts. On occasion, however, I think we can make a difference when it comes to public policy. I will take at face value what has been said about reports and changing that system. I am pleased that we are coming to a conclusion on a couple of these issues.
Sometimes this place can be the cradle of parliamentary hyperbole. Words like "disgrace" and "outrage" flutter in the air like confetti. I think we can make a difference, and if we were able to do so in this area, I would be very pleased. The work we have put in has been worthwhile, so I will follow up on this.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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When Mr. Breslin gets the Vote, does that mean the Department, rather than the HSE, answers the parliamentary questions which are tabled?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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What about the parliamentary questions directed to the HSE?
Mr. Jim Breslin:
Some of them will go to the HSE, especially if the question relates to an individual case. That will continue to be the case. Members may have noticed that in the most recent replies, including the replies to representations, the Minister states that if the Deputy has not got an answer from the HSE within 15 days, he or she can contact his office. We have sought to try to intervene where there are delays.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I think one would have to kick some "you know what", because it does not usually happen within the 15 days. I will admit that the Minister is making an effort.
Mr. Jim Breslin:
In regard to the earlier comments, the figures have changed due to things coming into and out of the Vote but I want to answer the Chairman's question about how much the HSE sought for 2015. As I recall it, it was €1.4 billion, which I think is correct, but €610 million was provided to the HSE following the negotiations on the Estimates process. Alongside that would have been savings initiatives to try to find further resources. One can see that the HSE tends to go for the desirable funding and then we have to go through a process with the Department of Public Expenditure and Reform to see what is achievable.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I wanted to find out the figure. I know Mr. Breslin gave all the technical detail to keep me busy but I only wanted the figure of how much the HSE asks for and how much does it get.
Mr. Jim Breslin:
In 2015, the HSE asked for €1.4 billion and it got €610 million. A little less than half of what it asked for.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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All right. I thank Mr. Breslin and his team for appearing before the committee this morning. Does the committee agree to note Vote 38 - Health - and dispose of chapter 13? Agreed.
Joe Costello (Dublin Central, Labour)
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Are we having a break?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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We will take ten minutes.