Mr. Robert Watt:

I wish good morning to the Chairman and members of the committee. It is good to join them this morning. I have a brief statement, as the Chairman mentioned. As Accounting Officer for the Department of Health’s Vote 38, I am pleased to be here today to discuss the 2020 annual report and appropriation account of the Comptroller and Auditor General. I am joined by my colleagues, Mr. Kevin Colman and Mr. John O’Grady, from the resources division, and Ms Fiona Larthwell from the social care division in my Department. I will now set out the main points of the 2020 accounts as they pertain to Vote 38.

The initial 2020 net provision, current and capital, for Vote 38 was €17.9 billion, which consisted of a gross provision of €18.3 billion and appropriationsinaid of €430 million.

As the scale of the challenge presented by Covid19 became clear, it was evident that unprecedented action was needed here to prevent the spread of the disease, high rates of hospitalisation and intensive care unit admissions, and significant mortality. New structures and processes were put in place between the Department of Health, the Department of Public Expenditure and Reform and the HSE to facilitate timely decisionmaking while also ensuring that high levels of governance were maintained, where the HSE reported to the Department each week on the estimated Covid19 related noncapital and capital expenditure that had been incurred to date.

Additional funding of €1.997 billion was voted to the Department in a Revised Estimate in June 2020 to support the measures outlined in the national action plan on Covid19. This represented the expenditure approved by the Government for Covid19 measures taken up to the date of the passing of the Revised Estimate. A further net Supplementary Estimate of €514.5 million was approved to meet additional funding requirements that arose to the end of 2020. As the Comptroller and Auditor General stated, this resulted in a net overall provision for Vote 38 of €20.44 billion, incorporating a deferred capital surrender of €30 million carried over from the previous year. The 2020 outturn was €20.3 billion, leaving an overall surplus of €120 million. The Department of Health received sanction from the Department of Public Expenditure and Reform to carry forward €68.2 million of unspent allocations in respect of the capital elements of subhead M2 into 2021.

As members are aware, the pandemic has been an extremely difficult time for frontline employees and workers in the health service. They have responded with diligence, resilience, agility and a level of commitment that has been extraordinary. With the support of the Department and the Government, the HSE has introduced new capabilities and innovations across the system. These include implementing eprescribing in general practice and introducing alternative care pathways and new models of care.

An example of the innovation of the health system was seen in responding to Covid19 last year. New testing and contact tracing capability was implemented, with the delivery of 720,000 GP referrals, 2.3 million laboratory tests and more than 440,000 contact tracing calls during the year. We have implemented a hugely successful Covid19 vaccination strategy with one of the highest levels of uptake in Europe and we are making very strong progress in delivering booster vaccines across the population.

Further investment in the overall reform of the health system includes very significant investments in clinical strategies such as the cancer, gynaecological and maternity strategy, coupled with an unprecedented investment to address the shortcomings identified by the 2018 capacity review that has seen us deliver the largest increase in acute and critical care beds and in community beds in decades. Allied to increasing acute capacity, we are undertaking a critical shift left in moving care out of acute settings and into the community, with the recruitment of an additional workforce of more than 3,000 staff to implement community care networks across every community in Ireland.

The Department has continued to successfully discharge its other functions. Importantly, we seek to frame policies and legislation to promote health. The life expectancy in Ireland is now estimated at 82.8 years, which is above the EU average of 81 years. However, with the prevalence of preventable noncommunicable diseases, it is important to promote healthy behaviours and prevent ill health. Under the Healthy Ireland umbrella, which is a Government of Ireland initiative, we work crosssectorally to achieve this objective.

We also support the Minister, Deputy Stephen Donnelly, and the Ministers of State in their work, including their legislative priorities and their public and parliamentary accountability. For example, in 2020, the Department processed more than 9,224 parliamentary questions, representing 24%, or almost one quarter, of all parliamentary questions tabled to Ministers across the entire government system.

The Department continues to enhance its governance and performance oversight in respect of the services and reform being delivered by the HSE. In line with Sláintecare, legislation was enacted in 2019 to introduce new accountability structures in the HSE, with the formal appointment of a non-executive and competencybased governing board. In recognition of these new structures, the Department put in place a revised engagement model with the HSE and its board with a view to strengthening the oversight of governance and performance management and accountability of the HSE. This oversight model is operational and will continue to be improved and enhanced as necessary to ensure there is more effective oversight within the Department.

This improvement work continues. The Government has committed to bringing forward regional health areas. A business plan for the implementation of regional health areas been developed by the Department. The HSE has provided feedback and implementation considerations on this business plan. A memorandum for Government on the next steps for implementation is being drafted. I anticipate the Minister will bring the memorandum to Government for decision in January 2022. To ensure we have front-line and expert input as we move forward, the Minister established an advisory group. Given this progress, the Minister has informed the hospital group boards that they are being stood down this month as their terms of office expire. There are many reforms and improvements taking place that are providing better healthcare to citizens. Together with our colleagues in the HSE, we are focused on further reforms in 2022.

Finally, I thank the staff in the Department of Health for their ongoing commitment and dedication to our work programme across many dimensions of our work. I look forward to continuing to work with the committee and with the Oireachtas and am happy to take any questions.