Mr. Paul Bell:

Before I defer to my colleague, Mr. Figgis, I will answer one question. Deputy Durkan talked about the budgetary provision or the Estimate. Perhaps we should ask ourselves while we are in this forum, who makes the final call on the budget? I think I know the answer to that. When health service managers put forward their requirement, it is based on what they anticipate to be the patient and service user need. The cost of those objectives are then presented, and this is about maintaining the normal service. The HSE, when agreeing the Estimate, has a lot of interaction, I suggest, with the Departments of Finance and Public Expenditure and Reform about what will be spent. One then finds that the actual estimate of what the HSE believes it requires to operate a full complement of public health services, whether we like it or not, is cut back. In every single year in which I have operated in this service, which amounts to 21 years, I have witnessed a situation in which either the budget was not sufficient or we had supplementary budgets, even though we were told some time ago we could no longer have supplementary budgets for health. The budget, or the Estimate, is therefore doomed to fail right from the start because it does not address the actual needs that will present or that are projected to present. It should be remembered that this is not an exact science; as Deputy Durkan said, it is a demand-driven service. We are not saying we should just see what falls out at the end of the year. We understand that there must be a budget, that managers must manage their budgets and that our members who perform those services have a role to play. If, however, we do not face up to what the actual budget requirements are and how they are arrived at, we will end up in the same position all the time.

When it comes to recruiting and retaining staff, we are wasting a lot of money. I ask the committee to consider the agency costs that have arisen, which are one example, and the amount of money being spent on contracts. I do not wish to be confrontational, but I take slight issue with the idea that the cost of the children's hospital does not impact the health service. It does because we cannot invest in capital projects that are required in the health service. We saw the recent concerns of the citizens of Waterford about their mortuary. That is just one example. We have other services in respect of which our members are fighting off private sector interests. In the Mater Hospital here in Dublin, for example, a new sterilisation department is required for the preparation of surgical instruments. The Department of Health says it has no money to replace the existing facility, that it would much prefer a private sector organisation to be brought in and that perhaps that the latter could build the facility and run the service. Ultimately, however, with respect to everyone here, it is still the taxpayer who will pay for that, and that is before we stray into the other areas of diagnostics and what happened with CervicalCheck.