Louise O'Reilly (Dublin Fingal, Sinn Fein)
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It is not the income targets, it is the stretch target. There are the targets and then there is the imposition of stretch income targets. That goes beyond the simple practice that if a hospital has a private patient, it levies that private patient, which of course it does. That gives rise to what happens if there are two patients in an accident and emergency department and only one bed is available where both patients have similar levels of acuity and one patient has private health insurance but the other patient does not.

When there are two identical patients, there is a perverse incentive for the patient with private health insurance or the means to pay privately to go into that bed because the stretch income target will then be met. This is not about whether people are collecting money at local level. That money is being collected. This is about the setting of targets and the stretching of those income targets, which creates a perverse incentive for people to prioritise. I am not suggesting that clinicians do it on any basis other than clinically, but in a situation where there are two people, both at the same level of acuity, and one bed, a perverse incentive has been created by the finance side of the house for people on the other side of the house to give that bed, in that scenario, to the patient who has private health insurance. That is fundamentally wrong. If that figure forms part of the €346 million, then it is no surprise to me that the HSE was massively wide of the mark.