Mr. Liam Woods:

In terms of the question about the key drivers in the hospital system of pressure on budget and cost overruns, in 2017, as was referenced in the director general's opening statement, there were two big factors, namely, the position relating to income and the charging and collection of statutory maintenance charges for people who opt to be treated privately. The behaviour of insurers around that gave rise to a probable €73 million of the total, which was €139.7 million. On the service delivery side, the biggest driver last year both in terms of growth year on year and against budget was the non-pay clinical costs of treating patients. That was a €44 million figure within a total service deficit of €67 million. Driving those costs are two factors, namely, the volume of care provided, which is increasing, and the complexity of care. They underlie what is going on in the hospital system operationally.

The other factor the director general mentioned is that there was a €13 million challenge against the pay budget. That is against a pay base of over €3 billion. There are a couple of factors driving pay. One is that it would include agency and locum costs, so the specialing within the hospital system of cases that have high-intensity need around the clock is a factor. That is growing as an element of cost. Clearly, effective movement to community of people who are fit for discharge is an important piece in managing that. That is a driver. The other is to control the total numbers of those employed within the health environment.