Mr. Jim Breslin:

As Accounting Officer for the Department of Health’s Vote 38, I am pleased to be here today to deal with the 2016 annual report and appropriations accounts of the Comptroller and Auditor General. The other item on today’s agenda, the HSE financial statements 2017, will be addressed in the first instance by Mr. Connaghan, as the accountable person for those accounts.

Since 2015, under the provisions of the Health Service Executive (Financial Matters) Act 2014, funding of the HSE is provided from the Vote of the Minister for Health - Vote 38. Accordingly, in 2016 the Department was responsible for a budget of €13.649 billion for the salaries and expenses of the office of the Minister and certain other services administered by that office, including grants to the HSE and to research, consultative and advisory bodies. The budget includes the additional €500 million provided by Government in 2016 to the health Vote, by way of mid-year adjustment, to improve the base funding of the Department of Health. This succeeded in 2016 with the health Vote coming in under budget by €2.221 million without recourse to a Supplementary Estimate.

I will now set out the main points of the 2016 accounts as they pertain to Vote 38. Funding is allocated to the Department of Health in respect of its own costs and in respect of grants to a number of bodies under the aegis of the Department such as the HSE, the Mental Health Commission, the Food Safety Authority of Ireland, the HIQA and a range of other bodies. In 2016, the Department had 400 staff. The Department’s role is to provide strategic leadership for the health service and to ensure Government policies are translated into actions and implemented effectively. We support the Minister and Ministers of State in their implementation of Government policy and in discharging their governmental, parliamentary and departmental duties.

Much of the public debate tends to be on weaknesses in our health services. Identifying measures to address these in association with our colleagues in the HSE undoubtedly demands continuing work on the part of the staff of the Department. However, we also have other roles. Importantly, we seek to frame policies and legislation to promote health. Under the Healthy Ireland umbrella, we work cross-sectorally to achieve this objective. Our life expectancy, at 81.8 years, is now one year above the OECD average but there is much more that can be done to better promote health and prevent ill-health. We also work internationally with EU colleagues and the World Health Organization on health issues. Considerable work is under way with the EU and the United Kingdom to address the health challenges caused by Brexit and to ensure that North-South and east-west co-operation on health matters is maintained. We also support the Minister and Ministers of State in their work including their legislative priorities and their public and parliamentary accountability. For example, in 2017 the Department processed over 11,000 parliamentary questions, representing 22% of all parliamentary questions tabled to Ministers across Government.

The 2016 gross provision, current and capital, for Vote 38 was €14.109 billion. The 2016 outturn was almost €14.107 billion, leaving an overall saving of €2 million. Of the 2016 gross provision for current expenditure, €205 million was provided to the Department-related subheads in respect of its own costs and in respect of grants to agencies under the aegis of the Department, other than the HSE. The 2016 outturn for these subheads was €176 million, giving an underspend of €29 million, and €13.387 billion of the 2016 gross provision for current expenditure was provided to HSE related subheads. The 2016 outturn for these subheads was €13.405 billion giving an overspend of €18 million. The overspend primarily related to funding the existing level of service in both acute and community services and pension costs. This overspend was met from savings elsewhere in the Vote. The 2016 provision for capital expenditure was €516 million and the 2016 outturn was €525 million. However, funding was transferred by means of virement to the capital subheads from savings elsewhere in the Vote to provide for capital developments at mental health facilities. The 2016 appropriations-in-aid to the health Vote was on profile at €460 million. The end year net outturn for current and capital was €13.647 billion against a net provision of €13.649 billion, resulting in a saving to the Exchequer of €2 million.

The Department continues to develop its policy and performance oversight in respect of a range of complex services falling within total public health expenditure. We are working on a significant reform agenda in line with the report of the Oireachtas Committee on the Future of Healthcare. This includes, as an initial important step, legislative proposals approved by Government to improve governance within the HSE through the introduction of a competency-based governing board this year. Subsequent policy development is likely to see a strong national centre but with greater devolution of decision-making and accountability, including financial accountability, to regional integrated care organisations. The further development and linkage of corporate and clinical governance at all levels within the health service, again in line with the Sláintecare report, will be a priority in ensuring the delivery of effective, safe and accountable health services.

I look forward to continuing to work with the committee and with the Oireachtas generally on this objective and am happy to take any questions.