Mr. Seamus McCarthy:

The annual financial statements of the Health Service Executive are presented in the form directed by the Minister for Health, as provided for in the Health Act 2004. The direction requires the HSE's expenditure to be split between what is referred to as "revenue" or current expenditure and "capital" expenditure.

Within the revenue income and expenditure statement, spending is broken down into pay and non-pay, with further analysis of non-pay spending under a mix of resource type and national scheme categories. However, the amount spent on mental health services in 2020 is not disclosed in the audited financial statements. Separately, the HSE’s annual report discloses an unaudited figure of just over €1 billion of current spending on mental health services in 2020.

What is referred to as an indicative appendix to the revised Estimate for the health Vote includes some budgetary information by service type. This indicates that for 2020 there was an original budget of €1.057 billion in Exchequer funding for mental health services, including a capital allocation of €26 million. The capital allocation was subsequently increased to €44 million.

The indicative appendix also sets out a range of output and activity measures and performance targets for the mental health services. However, the appropriation account for the Vote does not report the outturn for the mental health services, either in terms of delivery performance or of service-related expenditure. Reconciling the budget figures for mental health funding to the HSE’s annual report spending figure for mental health is further complicated because of the different bases of accounting used.

The framework of accountability for public expenditure on our health services is therefore very complex. The committee may be aware of a briefing paper prepared by the Parliamentary Budget Office in 2018 which examined the systems in place in the HSE and the Department of Health for budgeting, performance measurement and financial reporting. That paper concluded that there is a requirement for a significantly better alignment of the programmes of Vote 38 with the HSE’s internal allocations, to make the relationship between what the Oireachtas approves and what is spent on the ground more transparent. The HSE will be able to update the committee on developments in that regard.