Mr. Liam Woods:

I will answer the earlier questions first. I saw the "RTÉ Investigates" show and we would be concerned about any of those allegations being substantive. We are aware of the waiting lists in the public health system. Both speakers raised the issue of stretch income and perverse incentives. The origin of this dialogue was in the Sláintecare committee. I will say broadly what is happening. The HSE is funded annually with an income target for the acute system of €938 million. Of that, €620 million is for what one would think of as private charging in public hospitals or charging of patients who choose to be private in a public hospital. That is €620 million that the hospital system collectively is seeking to charge and collect on an annual basis. The stretch income issue that was referred to in previous committee discussions was that the target was proving difficult to achieve. The point being raised by Deputy Kelleher was whether it is giving rise to a skewed or perverse incentive within the system. What I would say to that in the context of the current year and just dealing with the facts is that the HSE will be short in its income collection by about €90 million in the current year. Neither the HSE centrally, nor the director and I, seek to source private patients to try to grow that, which was a concern of Sláintecare. It does not seek for public hospitals to take measures to manage cost because there is a shortfall in income. There is a wider point in what the Deputy is saying. If we look at the source of private income in public hospitals, 79% of the private income arising in public hospitals is from patients coming through the emergency department or maternity services for which there is no queue. The balance results from inpatient elective work. It is important that we examine that closely and understand the trends in that. The macro position is that nearly 80% of the total private work done in the public system comes through the emergency department or maternity hospitals. There are wider policy issues that are not really for the HSE to comment on in terms of the tensions between the perversities to which the Deputy referred. What I can say is there is an income target. It is a difficult target to achieve. There is a series of campaigns by insurance organisations in the health sector to, in effect, minimise claims payments of the public system. From my point of view in terms of public patients being treated, that is not at present impacting on the financial position of the hospital groups or hospitals in such a way as to give concern to the public provision. There are wider issues around the linking of that with some of the points Deputy Billy Kelleher made. They are more in the policy domain. That was the issue of stretch targets. My colleague, Ms Colette Cowan, may wish to say more about that from a hospital group perspective in a few moments if I go through the other questions.

There are stretch targets and they are in place within the system. They were known to be €44 million in the current year but the reality is they will be more like €90 million because of the way the finances are working out in the current year.