Mr. Paul Reid:

Sure. On wider issues, I made a point earlier about the investment that we have made. We have an extra €1 billion in health expenditure this year compared to last year, an increase of 6.3%. From what I have seen, investment in the areas we have spoken about is key, as is investing in a different way for the future. We are finalising next year's service plan at the minute and it will start to make that step. As the Deputy will be aware, the way that we can relieve the pressure on acute settings is by investment in community settings. Our service plan for next year starts to make that shift in an incremental way, which is valuable. There is a challenge for us, as I said in our opening statement, about how we manage with the funds that we have in an effective manner to make the right decisions and investments, and to hold local management to account. It has to be about safety, improving access and managing within a budget. Those are three relative challenges that have to be run in parallel, though they are not always conflicting.

I made the point in my opening statement that we have done the State some good this year with our oversight of the health spend. The overrun will be less than half that of last year. The overrun last year was €650 million plus a €150 million first charge for the following year. It will be significantly less than half of that by the outturn this year. That has largely been through the discipline of working with line managers, holding people to account and making sure that we are recruiting in the right places. I know recruitment has been difficult for everybody. We have to make sure we are recruiting where we have a budget and that we are recruiting skills that add to service delivery. The point I made earlier is that we are looking at the centre of the HSE to see what size it should be in the future. I believe it should be scaled down and that we should devolve more of what we have in the HSE centre to the regions to some hospital acute settings and community settings. We have to look at it very differently. That is about management of finances.

With regard to lay discharges, I spent some time in Kerry in a hospital in an acute setting and in a community setting. I was a little frustrated on the day I was there when it was highlighted that there were some beds available in the community and we had delayed discharges in our community setting. We immediately convened a meeting that evening with the relevant CHO and the hospital manager. The CHO has worked to increase capacity through a number of initiatives that it has put in place since. Some beds were available in Killarney at the time and some of those are being utilised. Some of that is now built into our winter action teams. Kerry has a good interface and integration between community and acute settings. A number of initiatives in community settings are giving relief to acute settings. While they have a challenge in delayed discharges, they had some good initiatives working in a way that we want them to in the future. I hope that answers the Deputy's questions.