Oireachtas Joint and Select Committees
Wednesday, 30 November 2022
Select Committee on Health
Estimates for Public Services 2022
Vote 38 - Health (Supplementary)
Seán Crowe (Dublin South West, Sinn Fein)
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This meeting has been convened to consider the 2022 Supplementary Estimate for Vote 38 - the Department of Health. I thank the Minister, Deputy Stephen Donnelly, the Minister of State, Deputy Mary Butler and their officials from the Department for coming to today's meeting to consider the Supplementary Estimate and the provision of a briefing note related to the Estimate.
I presume members want to complain. We got the Minister's opening statement between 4 p.m. and 4.30 p.m. having received the Minister's briefing note at 8.30 a.m. this morning. I presume members want to speak on that before I start.
David Cullinane (Waterford, Sinn Fein)
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It is completely unacceptable and treats this committee with contempt that we get a 24-page briefing document a couple of hours before the session. The Minister is coming in looking for an additional €1.3 billion, much of which is Covid expenditure. Then there are figures of €600 million and €500 million, and on cash reserves, etc. We are trying to figure that out. One cannot figure it out from the Minister's opening statement. That is what we got last night.
We received the briefing document only a couple of hours ago. The Minister might tell me how we can do our job and go through that document in any level of detail in a couple of hours before a session starts. The Minister knows that is unacceptable. The Minister's officials should know it is unacceptable.
To be honest, if I had my way, the Minister would be sent packing and would be coming back next week because it is no way to treat an Oireachtas committee. I do not know if it is the Minister's fault or his officials' fault, or whose fault it is, but the Minister has to accept that it is outrageous when we are already dealing with an overspend and additional money being sought, and the level of accountability that deserves, to be treated with contempt as far as I am concerned.
I have to leave for an interview at 10.10 a.m. Other members will have their own view but I have made my feelings clear. I will be back after the interview.
Seán Crowe (Dublin South West, Sinn Fein)
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I will let members speak and then we will return to the subject of the meeting.
Róisín Shortall (Dublin North West, Social Democrats)
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This is not any way to do business. It is extremely disrespectful to members here.
We cannot engage in debate on the Supplementary Estimate for €1.3 billion. It is a significant amount of additional money yet we have no detail on it. This 24-page document was circulated at 8.30 a.m. this morning. Most of us were commuting at that stage. I gather it came in some time late after close of business last night-----
Seán Crowe (Dublin South West, Sinn Fein)
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At 6.30 p.m.
Róisín Shortall (Dublin North West, Social Democrats)
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-----and was circulated this morning. It is extremely disrespectful.
It also means that we cannot properly invigilate the figures. That is supposed to be our job here, to examine all of the figures and to consider them. We are not in a position to do that because of the failure of the Department to allow sufficient time for us to consider the briefing material.
I would be very much in favour of abandoning this session also because it will not be meaningful when we are not in a position to ask the Minister relevant questions because we are not adequately briefed. We have not had time to read the document.
It is no way to do business. We should not be treated like this.
Bernard Durkan (Kildare North, Fine Gael)
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Notwithstanding the reservations that members may have, and I agree that it is short notice, there is a lot of work to be done and it is important fundamental work in relation to the end of year business for the Department, we should proceed as far as we can and do whatever we can. If we find it impossible to finish the job that we are given to do, we should look for another facility. Realising that we are coming near the end of the Dáil term, we should utilise whatever time is available to us as often as possible in order to deliver as much as possible within time.
Seán Crowe (Dublin South West, Sinn Fein)
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I intend to go ahead with the meeting but I ask the Minister to note the concerns that members have.
Róisín Shortall (Dublin North West, Social Democrats)
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Maybe we could have an explanation as to why it has been handled so badly.
Stephen Donnelly (Wicklow, Fianna Fail)
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I would be more than happy to respond, if I may.
All I and the Department have tried to do is to get committee members documentation that would be useful. I sat for many years on committees and got financial information from Departments that was completely indecipherable and set up in terms of heads rather than programmes. What I wanted to try to ensure was that there was documentation available to the committee that would be useful.
My understanding is the invitation from the committee came in on Thursday last. The officials, the committee members will appreciate, are in the middle of a wide range of different activities at present. The invitation came in on Thursday, which left two working days. The officials dropped everything. They worked through the weekend. I engaged extensively with the document the committee has because the original version that I saw was not a version that I would have liked to have received.
It was not circulated by us this morning. It was circulated by us yesterday evening. Whilst I fully appreciate that the committee quite rightly would want several days, if we only receive an invitation to come in here on a Thursday, the committee will appreciate it takes several days to pull all of this information together.
I am entirely in the committee's hands. If the Chairman would like me to come back later this week or next week, I am more than happy to do that. With the time we had available, the Department worked hard through the weekend to try to get the committee what it wants.
I fully appreciate the comments in terms of the time.
Róisín Shortall (Dublin North West, Social Democrats)
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Maybe we could have an explanation as to why we are having this meeting today. How did it originate, because we had intended having another meeting today about Sláintecare?
Seán Crowe (Dublin South West, Sinn Fein)
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It was agreed at a private meeting of the committee that we would go ahead. It was to facilitate the Minister and the Department to try to get this Estimate through. That is the reason we pushed ahead.
Seán Crowe (Dublin South West, Sinn Fein)
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This committee does not have many days left. We have an update on Sláintecare with the interim CEO of the HSE, Mr. Mulvany and Mr. Watt from the Department in next week. We do not really have any additional time for this.
Róisín Shortall (Dublin North West, Social Democrats)
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Did the request not come from Mr. Watt?
Seán Crowe (Dublin South West, Sinn Fein)
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No. The request came through the system that the Estimate was coming up. We would have thought that at this late stage that whatever the Supplementary Estimate was had been agreed by the Department and that the Minister was trying to get it through the House. Am I wrong about that?
Stephen Donnelly (Wicklow, Fianna Fail)
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All I know is we got the invite. I am not trying to blame anyone. I am just saying that the Chair and the committee has an absolute right to timely, high-quality information. I am very happy to make myself available at the committee's convenience to give members a few days, a week or whatever is required to go through this. I can assure colleagues that from the moment the request came in last Thursday, the officials and I really have put in a lot of work to try to get the committee a document that would be useful. I am genuinely sorry if it has caused frustration. That was certainly not the intention.
Róisín Shortall (Dublin North West, Social Democrats)
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Why are we having this Estimates meeting today rather than next week?
Seán Crowe (Dublin South West, Sinn Fein)
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It is on the back on the recommendations of the private meeting of the committee that we had.
Róisín Shortall (Dublin North West, Social Democrats)
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Yes but there was a request, was there not?
Seán Crowe (Dublin South West, Sinn Fein)
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No. It was one of the times on the agenda.
Róisín Shortall (Dublin North West, Social Democrats)
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I thought that Mr. Watt suggested that we swap the meetings.
Seán Crowe (Dublin South West, Sinn Fein)
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We will go into private session for a couple of minutes.
Seán Crowe (Dublin South West, Sinn Fein)
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Witnesses are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against any person or entity either by name or in such a way as to make him, her or it identifiable or otherwise engage in speech that might be regarded as damaging to the good name of the person or entity. Therefore, if their statements are potentially defamatory in relation to an identifiable person or entity, they will be directed to discontinue their remarks.
It is imperative they comply with any such direction.
Members are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the Houses or an official either by name or in such a way as to make him or her identifiable. I remind members of the constitutional requirement that they must be physically present within the confines of the Leinster House complex to participate in public meetings. I will not permit a member to participate where he or she is not adhering to this constitutional requirement. Therefore, any member who attempts to participate from outside the precincts will be asked to leave the meeting. In this regard, I ask members partaking via MS Teams to confirm, prior to making their contributions, that they are on the grounds of the Leinster House campus.
To commence our consideration of Supplementary Estimates, I invite the Minister for Health, Deputy Donnelly, to make his opening remarks.
Stephen Donnelly (Wicklow, Fianna Fail)
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I thank the select committee for the opportunity to bring this Supplementary Estimate for Vote 38 before it. I am seeking total additional funding for this year of €1.392 billion. This request is primarily driven by Covid-19 expenditure, which makes up €1.181 billion, or 85%, of this supplementary. Members will recall that Estimates 2022 assumed that Covid-19 impacts would diminish significantly during the year and, as a result, Covid-19 spending would be considerably lower. A total €200 million was set aside in contingency funds, held centrally for the health Vote in the event that additional funding was required. Unfortunately, the Omicron surge in early 2022 drove higher levels of testing and tracing activity than anticipated and there was a consequent need to deliver Covid-19 vaccination booster programmes. The nature of Covid-19 meant that both acute and community settings needed to continue to manage services in line with public health advice. Consequently, expenditure did not reduce as expected this year.
The second major strand of the Supplementary Estimate is made up of costs associated with post-Estimate decisions, excluding Covid-19 decisions, totalling in excess of €500 million. A further ask of €600 million for non-Covid-19 expenditure and €90 million for capital projects has been mitigated by savings within the non-HSE elements of the Vote, totalling €70 million and an expected reduction in the cash holdings of the HSE of approximately €409 million. As the committee will be aware, for the first time in a number of years, the health Vote did not require a Supplementary Estimate this year. This reflects investments made by Government last year. The drivers behind this year’s supplementary are different from previous years and arise primarily as a result of post-Estimate Government decisions and Covid-19 expenditure. I am committed to strengthening the performance management relationship between the HSE and my Department and to improving overall financial performance. In this regard and in the context of the emphasis in next year’s budget on delivery of a range of strategic capacity and reform measures, it is appropriate we have a renewed focus on ongoing modernisation of how we plan for and fund our health services into the long term. It is also critical we continue to support the HSE in the delivery of its ongoing financial reform programme. I will now set out the items making up this year’s Supplementary Estimate.
Under subhead 1, which is net pension costs of €116 million, €99.1 million is required to fund projected pension spend to year end and a further €17 million is required as a result of the public sector pay deal. Under subhead J1, which concerns the HSE, including service developments, an additional €39 million is required. HSE core current expenditure requires a Supplementary Estimate of €448 million, of which €328 million relates to post-Estimate sanctioned expenditure, including €215 million for the new pay deal, €108 million for the once-off energy inflation package, and €102 million for the cost of the Haddington Road agreement hours restoration as a consequence of Government policy. Projected reductions in HSE cash balances from the end of 2021 to the end of 2022 partially offset the Supplementary Estimate requirement in 2022.
Under subhead J2 on HSE Covid-19 action plans, a net €1.18 billion additional is required. Covid-19 expenditure requires a Supplementary Estimate of €1.18 billion. This was driven by the fact that the assumptions underpinning Estimates 2022 that Covid-19 impacts would diminish and, consequently, spend would be considerably lower. This did not transpire for a number of reasons: he Omicron surge in early 2022, which drove high levels of testing and tracing activity; the need to deliver Covid-19 vaccination booster programmes; and the fact it was necessary to maintain Covid-19 measures within acute and community health services during 2022. This included, for example, infection prevention and control measures, safety net arrangements and significant costs relating to staff absence. It was important that front-line staff who bore the brunt of the country’s response to Covid-19 were acknowledged for their sacrifices, so this figure also includes €189 million for the pandemic recognition payment. It should be noted that the overall projected spend of €1.878 billion on Covid-19 is lower than the €2.5 billion spent on Covid-19 in each of the years 2020 and 2021.
Under subhead K4 on payments to the State Claims Agency regarding clinical negligence, €95 million is required to fund the total cost of claims which will be settled in respect of 2022. Under subhead M4 on capital Covid-19 actions, €90 million is required from the €100 million set aside in the contingency for Covid-19 related capital projects.
It was acknowledged when the original Estimate for this year was approved that there was a risk associated with Covid-19 and how it might impact the Vote if, as transpired, we were hit with another wave. The Supplementary Estimate seeks to address the additional funding requirement to allow the health service to continue to take appropriate measures in responding to the Covid-19 pandemic. The amount sought is significant in monetary terms. The supplementary funding requested represents 6.5% of overall health expenditure in 2022 and brings total expenditure for this year to €22.575 billion. While the financial impact is significant, the value of this investment in protecting our citizens in the face of this global pandemic is immeasurable. The Government is steadfast in its commitment to protecting the citizen and to enhancing the resilience of our health service. This commitment is not only evident in the level of funding made available this year but also by the actions in this year’s Estimates to increase permanently the size and capacity of our public health service and workforce. The HSE has increased its workforce by more than 16,275 whole-time equivalent staff since the pandemic. We have delivered 25% more critical care-ICU beds and we have added 924 more hospital beds. These are significant achievements during a global pandemic. While some measures, including recruitment of additional staff, could not be fully delivered, I am pleased the Government has made resources available to enable this to take place in 2023. I now seek the committee’s approval of the Supplementary Estimates of €1.392 billion for Vote 38.
Bernard Durkan (Kildare North, Fine Gael)
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I welcome the Minster and his officials. We have had a discussion about the late arrival; I am not going to go into that at this moment. I am concerned about the size of the Supplementary Estimate at this stage. We need to get ahead of dead reckoning where budget is concerned in the delivery of health services. The dead reckoning is arrived at for a variety of things, which I am aware of. We can claim Covid-19 was an unforeseen circumstance, but it was not. It was always there. It was with us all the time. In any Estimate, there had to be a provision for that. We still have not got away from the shortfall at the end of the year. We still have that problem. There is a bigger shortfall than anticipated this time, even though the budgetary provision initially anticipated the challenge that lay ahead. We have not got up to speed in the way we should have at this stage. Are we putting all the figures together at the time of budget in such a way as to ensure we do not have an unforeseen shortfall? The comments about foreseen and unforeseen, anticipated and otherwise is something we come across every year. We should not have that situation in the health service because it is a very important area that affects every household, family and age group in the country in one way or another. Will the Minister comment on that?
I would like to pursue a few things that come to mind. I hope to contribute again if we have a second round of questions. I know we have other places to be as well. We keep getting complaints about the delivery of services in particular situations. I know there are legal cases and provision is made for State claims and so on. Is the value of State claims increasing? Are the claims normally anticipated or is there anything we should know about in that area? I have come across a number of cases, as has everyone present, and some could have been prevented. Accommodating such situations by way of State claims is not an answer. We need to get to prevention as quickly as possible or make the necessary provisions to ensure the likelihood of State claims is minimised to the greatest extent possible.
I have raised the issue of public services at different time in recent weeks. One of the things I have come across is patients with a life-threatening illness looking for a medical card as a means of security. They want to be reassured that this challenge, along with all the others, is being handled and managed. The response is simply not satisfactory. I have spent hours chasing phone numbers where there is no one to talk to. I am a public representative so I should know where they are, but the point is, that is not good enough when dealing with situations where patients already have enough of a challenge in a life-threatening illness or an illness resulting from a previous surgery that went wrong. We need to focus seriously on those issues to reassure the public. If we cannot reassure the public in the House, the public outside have no chance. I am not satisfied with the extent to which there is an urgent response in those situations. I have three such situations on my desk at present and the number is growing. This is a new issue. It was not, and should not be, part and parcel of the delivery of services in a vital area on which the public depend. I will give the Minister an opportunity to respond.
Stephen Donnelly (Wicklow, Fianna Fail)
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I thank the Deputy for raising the points. I will run through the three issues he raised.
It is important to recognise that the shortfall this year has been generated by a larger than hoped-for Covid need in response to the Omicron wave and by decisions taken by the Government after the budget. The cost of Covid-19 has come to a little less than €1.2 billion. It was signalled when we were putting the budget together that it was likely this additional money would be required. The decision taken, which was the right decision, was to provision significantly less than that, and if we had something like the Omicron wave, we would convene an extraordinary session. The Department's view and the Government's understanding early on was that additional funding for Covid-19 might well be needed, but we decided to request it if it was needed rather than put it into the base in case it was needed.
Second, additional Government decisions ran to €643 million and they cannot be provided for in an Estimate if they happen after the Estimate. The non-Covid health budget comes in under budget when decisions taken after the budget are not included - and they should not be. The reasons for it being over budget are the Omicron wave and decisions the Government took this year such as Haddington Road, the recognition payment and so forth.
There is a real and growing problem in the scale of medical negligence claims. For the benefit of the committee, in 2010, the State Claims Agency paid out €81 million. That has risen steadily. In 2016, it rose to €232 million; in 2020, it rose to €373 million, last year it jumped to €461 million; and this year it will jump again to €530 million. The advice I have received is that if we do nothing, that number will increase. I am not satisfied with that and I am talking to the Department about options to address this. We do not have sufficient mechanisms in place to identify systematically the root causes, primarily for patient safety, but with the knock-on effect of reducing State claims payments. However, patient safety must be the start and end of everything. While good progress has been made on the recommendations made by Mr. Justice Charles Meenan, more can and must be done in healthcare. For example, there has been talk for many years about a no-fault compensation scheme. We do not have one. I wholeheartedly agree with Deputy Durkan that more needs to be done. It is urgent given these payments are rising quickly and the advice I have received is that it is expected they will continue to rise.
Deputy Durkan raised an important point about medical cards. There are a lot of medical cards out there. John Wall and others advocated, quite rightly, for a two-year extension where there is a terminal diagnosis, and we introduced that in 2021. We are rapidly expanding GP visit cards, as the Deputy will be aware. In the coming months half a million more men, women and children will have GP visit cards. However, I take the Deputy's point that when someone needs a medical card, the administrative burden and the public face of that, as it were, can vary in how easy it is to navigate. Medical card forms are highly complex. They require a lot of supporting documentation. Sometimes there is good support, but in the case of some of my constituents in Wicklow, they needed a greater level of support than was available and it is something we need to tackle.
Bernard Durkan (Kildare North, Fine Gael)
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I agree it is unacceptable that families or individuals with a life-threatening illness, have to go back again and again to refill forms while a medical or some other kind of expert decides they do not yet qualify. It is not good enough. It impacts negatively on the health of the patient at the time. It is especially unacceptable they have to get a letter stating the person only has six months to live or something like that. That is not what was intended. I would love to know who made that rule because that was never intended. If it goes on like that, a lot of people will virtually have warrants issued. We are supposed to be compassionate and caring and we should be able to respond in a way that meets the requirements of the patient. Some of us have been patients. What are we waiting for? Do we need to weigh the cost of the hurt to the patient against the cost to the Exchequer, especially when we have overruns all over the place? The Minister does not have to respond. I will come back in again.
David Cullinane (Waterford, Sinn Fein)
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We have had a discussion on what happened this morning. The Dáil granted leave for the Revised Estimate to come before this committee two weeks ago and, in fairness to the staff of the committee, they were chasing his Department to get the information this committee needed during that time.
The Minister has to appreciate that. To unpack some of the figures that have been presented to us, because it is quite complicated, I put it to the Minister that the Supplementary Estimate is actually bigger than the €1.392 billion that he suggests. The €1.392 billion figure is made up of €1.19 billion of Covid-19 expenditure, as I see it, and €190 million from the contingency fund. Is it correct that this makes up the €1.39 billion figure?
Stephen Donnelly (Wicklow, Fianna Fail)
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The €1.392 billion, Deputy, is a combination of more than that. If he looks at the main table-----
David Cullinane (Waterford, Sinn Fein)
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I will read what is in the Minister's opening statement because he is giving us this information and so if there is more than that, it is not in the opening statement. The opening statement states "This ask is primarily driven by COVID-19 expenditure which makes up €1.181 billion or 85 per cent"of it and then that €200 million was set aside in the contingency fund. The briefing document we got, however, makes reference to €190 million drawn down from the contingency fund. Be that as it may, my point is that the sum of €1.39 billion is mainly comprised of the €1.18 billion in Covid-19 expenditure, as well as money from the contingency fund. That is what I seek clarity on. Is that not correct?
Stephen Donnelly (Wicklow, Fianna Fail)
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The €1.39 billion is net of quite a number of movements so as the Deputy says it is the €1.181 billion on Covid-19. It includes accessing the contingency fund and then it includes a lot of other items that are listed in the main schedule.
David Cullinane (Waterford, Sinn Fein)
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Which we have only got sight of. According to the opening statement provided, the €200 million was set aside in the contingency fund but it does not give any more detail, and that document is all we had to prepare for this session. However, it is actually more than that because the opening statement goes on to state there was "A further ask of €600 million for non-COVID-19 expenditure and €90 million for Capital" projects, which it states was offset by cash reserves of €409 million and an underspend in the Department of €70 million. When you do the sums and the maths on this, we have €1.392 billion which is being sought and is part of the Supplementary Estimates, there is €409 million in cash reserves that will be spent and there is €70 million from the Department. That actually brings the total overspend to €1.871 billion and not €1.39 billion for the year 2022, does it not? Perhaps the Minister's official could clarify if my reading of that is correct.
Stephen Donnelly (Wicklow, Fianna Fail)
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As Deputy Durkan and I were just saying, the Covid-19 amount is around €1.2 billion and on top of that there were in-year decisions by the Government of €643 million, which gets us to about €1,850 million, give or take. Then, as the Deputy quite rightly says, the cash reserves bring that down and as he is aware, there was an underspend in certain areas, for example on recruitment. So yes, the-----
David Cullinane (Waterford, Sinn Fein)
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Can I just go by the Minister's figures? I can only go by what he has provided in his opening statement. We can agree on the €1.39 billion figure, that is the substance of this Supplementary Estimate and that is what is being sought, which is fine. Separate from that, it makes reference to a further ask of €600 million for non-Covid-19 expenditure and €90 million for capital, that is, €690 million. It then notes that €409 million of that is coming from cash holdings and €70 million from an underspend in the Department. My point is that if we add all those up, it is almost hitting €1.9 billion of additional money being spent. The Minister might unpack this from me because I cannot figure out from the information we have received what is going on here at all because when the Minister said €600 million for non-Covid-19 expenditure and €90 million for capital, that comes to €690 million. The Minister then states it is offset or mitigated by €70 million from non-HSE elements of the Vote total - an underspend - and €409 million from cash holdings, which is €479 million. The statement refers to €690 million of additional spend and the Minister is telling us where the €479 million is coming from. Where did the rest come from?
Stephen Donnelly (Wicklow, Fianna Fail)
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There is a lot in that; it is in main schedule, Deputy.
David Cullinane (Waterford, Sinn Fein)
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Can the Minister tell me where it comes from?
Stephen Donnelly (Wicklow, Fianna Fail)
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I can walk the Deputy through it but-----
David Cullinane (Waterford, Sinn Fein)
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Please.
Stephen Donnelly (Wicklow, Fianna Fail)
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-----it will take time. If he would like me to, I can.
David Cullinane (Waterford, Sinn Fein)
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The Minister should at least know, in the general ballpark, where that money came from.
Stephen Donnelly (Wicklow, Fianna Fail)
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I do and what I am saying is that there is a detailed schedule that gets you to the €1.392 billion. All I am saying is-----
David Cullinane (Waterford, Sinn Fein)
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I am not talking about the €1.392 billion; it is separate from that. The Minister has to read his own opening statement. The €1.392 billion is that figure and if the Minister's official might just confirm if I am right, the opening statement goes on to say a further ask of €600 million for non-Covid-19 expenditure. Can I ask if the €600 million is separate from the €1.39 billion?
David Cullinane (Waterford, Sinn Fein)
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I have to stop Mr. O'Grady there. This is just getting bizarre because the Minister says in his opening statement that the €1.39 billion is primarily made up of 85% or €1.181 billion for Covid-19 expenditure. It goes on to state, in the Minister's own words, there was "A further ask of €600 million for non-COVID-19 expenditure [in current] and €90 million for Capital" but now the Minister's official is saying that €600 million is part of the €1.39 billion. How can it be when we have just been told that 85% of this is part of the €1.181 billion?
Stephen Donnelly (Wicklow, Fianna Fail)
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That is because the Deputy is comparing gross and net figures. The net figure that is being sought is the €1.392 billion.
David Cullinane (Waterford, Sinn Fein)
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Yes, I understand that.
Stephen Donnelly (Wicklow, Fianna Fail)
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At a gross level, there is approximately €1.2 billion on Covid-19; there is around an additional €643 million on in-year decisions like Haddington Road and so forth; there are other in-year overruns and then there are net off various things where there was an underspend.
David Cullinane (Waterford, Sinn Fein)
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That is my point, I am not confusing anything. That is the figure I came to a second ago, the €1.8 billion and not the €1.3 billion. The Minister's official has just said that the €600 million is in the €1.3 billion, which does not make sense to me.
Stephen Donnelly (Wicklow, Fianna Fail)
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I think-----
David Cullinane (Waterford, Sinn Fein)
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What I am putting to the Minister is that the actual figure, the actual additional overspend if he wants to use that expression, is €1.8 billion. It is very hard to make sense then of the figures, particularly when we have only had an hour to go through the document, which we actually could not do. The Minister is putting this to me and is telling me to read it. I have tried to read it but I am trying to get the Minister to appreciate how difficult it is for us.
Stephen Donnelly (Wicklow, Fianna Fail)
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When we are talking about gross-----
David Cullinane (Waterford, Sinn Fein)
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I do understand the difference between that.
Stephen Donnelly (Wicklow, Fianna Fail)
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I will just come back quickly on that because I do appreciate and want to acknowledge the frustration. I fully appreciate this was circulated this morning and that is a very difficult position to be in. I think Deputy Cullinane might have been out of the room but I have offered, if it is useful after this session, to meet up again and go through everything.
David Cullinane (Waterford, Sinn Fein)
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Here is what I see. I see the €1.39 billion figure, I see the Minister say 85% of that is for Covid-19 expenditure and €190 million is from a contingency fund. Then there is a separate discussion about €600 million of additional spend for unforeseen events and I know what it is, it is pensions and all of those demands and so on. Then we talking about cash reserves and so on. With respect to the Minster, this is not a way to present a Supplementary Estimate that actually makes sense to an Oireachtas health committee. It should have been more clearly outlined. It still does not make sense to me because the Minister is saying there are lot of moving parts. Of course there are, which is why we should have more time for preparation.
I will put one more question in relation to the Estimate itself. Why is there an underspend on Sláintecare?
Stephen Donnelly (Wicklow, Fianna Fail)
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This is under subhead H. The underspend is primarily due to the timing of round two of Sláintecare funding. Consultations with Pobal, which is managing the fund on behalf of the Department, were unfortunately delayed by the very extensive commitments Pobal had regarding the Ukrainian situation. That money will be spent and that funding round is proceeding; it is just a timing issue.
David Cullinane (Waterford, Sinn Fein)
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Going back to the €600 million, is any of that money that was earmarked for the additional staff we were not able to hire? In 2022, it was anticipated that 10,000 staff would be hired and we might have reached approximately 5,500. We are still approximately 300 beds shy of the 1,200 beds that are funded. All of that money was allocated and of course it was not spent, so does that make up some of the money that was then used?
Stephen Donnelly (Wicklow, Fianna Fail)
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Yes it does and that is the point. The point Deputy Cullinane is making is that there is a gross figure-----
David Cullinane (Waterford, Sinn Fein)
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So we used money that was provided for beds and staff for this year for other purposes-----
Stephen Donnelly (Wicklow, Fianna Fail)
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Can I-----
David Cullinane (Waterford, Sinn Fein)
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-----which I cannot see really in any of this.
Stephen Donnelly (Wicklow, Fianna Fail)
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The point the Deputy is making, if I understand it, is that there is a gross figure that is several hundred million higher than what I will call the sum of €1.4 billion. Absolutely, there is. What was net off that was cash balances and underspend in some areas, including in recruitment, yes. From an Estimates perspective, what we have to do is ask for a net amount of money.
I will add one caveat, and I fully accept the Deputy's point that the gross figure is higher than the net figure. The point I made in my speech was that the majority of that gross figure is driven by about €1.2 billion extra in expenditure related to Covid and about €643 million in decisions taken after the Estimate was signed.
David Cullinane (Waterford, Sinn Fein)
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I appreciate that.
Seán Crowe (Dublin South West, Sinn Fein)
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I call on Deputy Shortall.
Róisín Shortall (Dublin North West, Social Democrats)
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Bearing in mind that we are facilitating the Minister this morning and that agreement was reached last Thursday, it is disappointing that this document came to us only this morning. As I said earlier, it makes it very difficult for members of the committee to interact with these figures.
I will concentrate on the first few pages of the document the Minister has provided. The reality is that it is a 24-page document but most of it relates to expenditure generally within the Minister's Department. It is really only the first few pages that relate to the Supplementary Estimate and-----
Stephen Donnelly (Wicklow, Fianna Fail)
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Is the Deputy referring to pages 3 and 4?
Róisín Shortall (Dublin North West, Social Democrats)
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Yes. A lot of the rest is, while interesting in its own right, not business for today, so the Minister has actually provided only pages 3 and 4 in respect of the Supplementary Estimate and a lot of questions arise from that because of the lack of detail. Rather than submitting 22 pages of general stuff that does not relate to this morning's business, it would have been better if we had a more thorough briefing document on the Supplementary Estimate today. I wish to go through some of the figures in the document.
The additional spend in respect of Covid is nearly €1.2 billion, a huge figure. Can the Minister give us the breakdown of that figure?
Stephen Donnelly (Wicklow, Fianna Fail)
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Yes, I can. Personal protective equipment, PPE, accounted for €118 million; testing, tracing and public health surveillance for €403 million; and vaccinations for €466 million. The access to care fund was €7 million; the Covid acute hospital response came to €397 million; and the Covid community response was €275 million. That was the total spend. Then, subtracted from that was the amount allocated in the Estimate, which was €697 million, giving a net sum of €968 million. On top of that, we had the Covid recognition payment at €189 million and Covid therapeutics at €24 million. That gives the figure of €1.181 billion.
Róisín Shortall (Dublin North West, Social Democrats)
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It would have been helpful if that detailed breakdown had been provided to assist us. It was not provided at all. Will the Minister explain some of those figures for us? On the acute side, what does the €397 million cover? The Minister says there is a figure of €397 million there.
Stephen Donnelly (Wicklow, Fianna Fail)
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Yes.
Róisín Shortall (Dublin North West, Social Democrats)
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What does that entail?
Stephen Donnelly (Wicklow, Fianna Fail)
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It entails various adaptations the hospitals had to make for Covid. The Deputy will be aware that a lot of hospitals had two separate areas in their emergency departments, for example, or had to hire extra staff or had to have new isolation areas. All the extra Covid pathway work is covered in that figure.
Róisín Shortall (Dublin North West, Social Democrats)
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Does any element of it relate to the private hospitals?
Stephen Donnelly (Wicklow, Fianna Fail)
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Yes, the amount for private hospitals is in that as well.
Róisín Shortall (Dublin North West, Social Democrats)
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How much is that?
Stephen Donnelly (Wicklow, Fianna Fail)
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I will get the Deputy a breakdown of that. The estimate is €130 million, approximately.
Róisín Shortall (Dublin North West, Social Democrats)
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What was the total spend for the year on private hospitals?
Róisín Shortall (Dublin North West, Social Democrats)
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That is the total.
Stephen Donnelly (Wicklow, Fianna Fail)
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On Covid.
Róisín Shortall (Dublin North West, Social Democrats)
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It was all in the Supplementary Estimate then. Is that right?
Stephen Donnelly (Wicklow, Fianna Fail)
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Yes.
Róisín Shortall (Dublin North West, Social Democrats)
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The Minister had not allowed for any expenditure on private hospitals.
Róisín Shortall (Dublin North West, Social Democrats)
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If we could have a breakdown of the €130 million, how it was spent, that would be helpful.
The Minister also talked about a figure of €24 million for therapeutics. What is that?
Stephen Donnelly (Wicklow, Fianna Fail)
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That is the antivirals. Paxlovid is one of the main ones.
Róisín Shortall (Dublin North West, Social Democrats)
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On the question of the €118 million for PPE this year, was there a separate figure - presumably, there was - in the original Estimate for PPE?
Stephen Donnelly (Wicklow, Fianna Fail)
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There was. To be clear, these figures - the €118 million etc. - add up to the €1.8 billion, but there was an Estimate in of €697 million, which would have included PPE at the start.
Róisín Shortall (Dublin North West, Social Democrats)
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Sorry. There was an original allocation of €679 million for PPE.
Stephen Donnelly (Wicklow, Fianna Fail)
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No. How it happened was-----
Róisín Shortall (Dublin North West, Social Democrats)
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What is the total estimated spend on PPE this year?
Stephen Donnelly (Wicklow, Fianna Fail)
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It is €118 million.
Róisín Shortall (Dublin North West, Social Democrats)
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That is the figure in the Supplementary Estimate.
Stephen Donnelly (Wicklow, Fianna Fail)
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Yes. That is the estimate for the total full-year spend on PPE. It is €118 million.
Róisín Shortall (Dublin North West, Social Democrats)
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But this is presented to us as a Supplementary Estimate, in addition to the original Estimate.
Stephen Donnelly (Wicklow, Fianna Fail)
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Yes, that is right. We have shown the total amounts, which are the figures I have given the Deputy, and then we have subtracted the €697 million, which is what was in the budget, to give the net figure, which is the supplementary spend required, that is, the €1.181 billion.
Róisín Shortall (Dublin North West, Social Democrats)
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Sorry, but that does not make sense to me. If there is in the Supplementary Estimate a figure of €118 million for PPE-----
David Cullinane (Waterford, Sinn Fein)
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That is additional.
Róisín Shortall (Dublin North West, Social Democrats)
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-----that is additional to what the Minister estimated for PPE, presumably, at the start of the year.
Stephen Donnelly (Wicklow, Fianna Fail)
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No. If I may explain, and I will round the figures up to make it easier for all of us, the amount provisioned for was about €700 million. The total amount that will be spent on Covid-----
Róisín Shortall (Dublin North West, Social Democrats)
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No, I am looking just for the total amount on PPE.
Stephen Donnelly (Wicklow, Fianna Fail)
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I hear the Deputy. The total amount that was provisioned for Covid was €700 million. The total amount that will actually be spent on Covid is about €1.9 billion.
David Cullinane (Waterford, Sinn Fein)
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That is the additional Estimate. That is-----
Stephen Donnelly (Wicklow, Fianna Fail)
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No, that is the total amount and, therefore, the Supplementary Estimate is the difference between the two, which is €1.2 billion.
Róisín Shortall (Dublin North West, Social Democrats)
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I am asking what the total spend on PPE is for the year.
Stephen Donnelly (Wicklow, Fianna Fail)
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It is €118 million.
Róisín Shortall (Dublin North West, Social Democrats)
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This is the problem. We do not have the figures. We do not have the breakdown of any of this. There is a whole lot of surplus stuff in this documentation but we do not have the core stuff in respect of the Supplementary Estimate.
Stephen Donnelly (Wicklow, Fianna Fail)
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It is on page 19 of the document the Deputy got.
Róisín Shortall (Dublin North West, Social Democrats)
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At the end of last year, what did the Minister estimate would be needed for PPE in 2022?
Stephen Donnelly (Wicklow, Fianna Fail)
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Not far off the €118 million; a little less than €118 million. What the Deputy is looking for is the breakdown of the €697 million at the start of the year.
Róisín Shortall (Dublin North West, Social Democrats)
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A Supplementary Estimate is additional funding.
Stephen Donnelly (Wicklow, Fianna Fail)
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Yes.
Róisín Shortall (Dublin North West, Social Democrats)
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What was the original funding for PPE and what is the additional funding for it in the Supplementary Estimate?
Stephen Donnelly (Wicklow, Fianna Fail)
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Do you have the breakdown of the €697 million, Mr. O'Grady?
Róisín Shortall (Dublin North West, Social Democrats)
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I am asking the Minister about individual areas. Our job is to engage with these figures and to ensure we are getting value for money for the taxpayer. The Department has not provided us with enough material today to assure ourselves that we are getting value for money. We should not have to drag detail out of the Minister. I will leave that because I want the Department to supply us with those details, the figures I have requested.
I will move on to the Covid payment. How much is the Department spending on the payment this year?
Stephen Donnelly (Wicklow, Fianna Fail)
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Is that the recognition payment?
Róisín Shortall (Dublin North West, Social Democrats)
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Yes, sorry, the recognition payment.
Stephen Donnelly (Wicklow, Fianna Fail)
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The figure is €189 million.
Róisín Shortall (Dublin North West, Social Democrats)
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How many people does the Minister estimate are entitled to the payment?
Stephen Donnelly (Wicklow, Fianna Fail)
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Approximately 189,000 or 190,000 people. Some people will get less so the total number who will receive some amount will be higher than that.
Róisín Shortall (Dublin North West, Social Democrats)
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How many people does the Minister estimate are entitled to the payment?
Stephen Donnelly (Wicklow, Fianna Fail)
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I will get the Deputy an exact estimate.
Róisín Shortall (Dublin North West, Social Democrats)
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The Minister has proven our point.
Stephen Donnelly (Wicklow, Fianna Fail)
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What point?
Róisín Shortall (Dublin North West, Social Democrats)
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We cannot accept this while the Minister does not have basic information and a breakdown of the figures.
Stephen Donnelly (Wicklow, Fianna Fail)
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Deputy, when it comes to the recognition payment, the HSE at the moment is asking private nursing homes and private providers, and some of the section 39s, to come back to them with a self-assessment.
Róisín Shortall (Dublin North West, Social Democrats)
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We have been told that for months.
Stephen Donnelly (Wicklow, Fianna Fail)
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No, you have not been told that for months.
Róisín Shortall (Dublin North West, Social Democrats)
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We are getting calls from people asking when will they get the payment.
Stephen Donnelly (Wicklow, Fianna Fail)
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Yes. As the Deputy will be aware now, the nursing homes, the section 39s, are now getting paid so they have the self-assessment. They are returning them. The money is transferring now, and more and more nursing homes are getting those payments.
Róisín Shortall (Dublin North West, Social Democrats)
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So it is approximately 189,000 people who will be entitled to the payment. Is that what the Deputy is saying?
Stephen Donnelly (Wicklow, Fianna Fail)
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The estimated money is €189 million, which at €1,000 a person would be 189,000 people.
Róisín Shortall (Dublin North West, Social Democrats)
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Yes.
Stephen Donnelly (Wicklow, Fianna Fail)
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The point that I am making is that there are some people who are getting less than €1,000 so, on average, it will be somewhat above 190,000 people.
Róisín Shortall (Dublin North West, Social Democrats)
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So, say, 190,000 people. To date, 124,000 people have got it, which was stated in a reply to a parliamentary question last week. So, in terms of the balance, there is a very large outstanding number of people who have not received the payment. How many of those additional people does the Minister expect will get the payment before Christmas?
Stephen Donnelly (Wicklow, Fianna Fail)
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That depends, to some extent, on how many of the nursing homes and the section 39s return the self-assessment. The Deputy and many colleagues have made the point - and it is something that I was acutely aware of myself - that the proposed approach, while it worked for HSE employees, was not working for section 39s and nursing homes and there was also a delay in paying firefighters and the Defence Forces so I intervened. On Defence Forces and firefighters, the money transferred some time ago from the Department of Health to those line Departments so that money is being paid out. On the much larger number of people that the Deputy referenced, I asked the HSE to take a different approach. The HSE, as the Deputy will be aware as we have discussed this before, was going to hire a firm to do an audit to have very detailed information and then send the money out. What I asked the HSE to do instead of that was send out a self-assessment, get those self-assessments in, pay out the money and then audit afterwards. Quite a significant number of those self-assessments have come back and quite a significant number of those people are now being paid. What I want to see is the maximum number possible paid before Christmas for the obvious reasons.
Róisín Shortall (Dublin North West, Social Democrats)
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So there are 66,000 people waiting for the payment for a very long period. Can the Minister give an assurance that all steps will be taken to ensure that the payment is made before Christmas?
Mary Butler (Waterford, Fianna Fail)
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Up to 18 November, 452 employers had submitted funding applications to pay their employees the recognition payment. That would include a lot of nursing homes and healthcare workers.
Róisín Shortall (Dublin North West, Social Democrats)
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Out of how many?
Mary Butler (Waterford, Fianna Fail)
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We know that there are 433 private nursing homes, for example. In total, it is 452 employers so that would include conventional nursing units.
Róisín Shortall (Dublin North West, Social Democrats)
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Is that a very high percentage?
Mary Butler (Waterford, Fianna Fail)
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Yes. To date, 23 nursing homes have received their payments so this is ongoing at the moment.
Róisín Shortall (Dublin North West, Social Democrats)
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Has the Department got returns from the vast majority of employers?
Mary Butler (Waterford, Fianna Fail)
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From 452 employers.
Róisín Shortall (Dublin North West, Social Democrats)
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So what is holding up the payment?
Mary Butler (Waterford, Fianna Fail)
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They only came in on 18 November so this is ongoing.
Róisín Shortall (Dublin North West, Social Democrats)
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Does the Department expect to be in a position to pay all of those before Christmas?
Mary Butler (Waterford, Fianna Fail)
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More than likely, yes. That is the plan.
Stephen Donnelly (Wicklow, Fianna Fail)
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As many as possible. When the HSE gets the self-assessments back it turns them around very quickly. We do not know how many of these organisations will have returned their assessments. The advice that I have from the HSE is that for those that are returning them the moneys are being paid out very quickly.
Róisín Shortall (Dublin North West, Social Democrats)
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There are 66,000 people still waiting and that is a very large number. Progress is very slow here because it is so hard to drag out figures and I ask the Chair to allow me ask one more question.
Seán Crowe (Dublin South West, Sinn Fein)
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Yes.
Róisín Shortall (Dublin North West, Social Democrats)
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On the issue of the State Claims Agency, there is €95 million additional funding and more than a 20% increase on what was estimated for the year. Bearing in mind that the point had been made at a meeting of the Committee of Public Accounts that during Covid there were a lot of out-of-court settlements, and that that was very cost effective as it were, then one would expect that the estimate would have been fairly close. What accounts for that more than 20% increase in State claims?
Stephen Donnelly (Wicklow, Fianna Fail)
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Does Mr. O'Grady have that information to hand?
Róisín Shortall (Dublin North West, Social Democrats)
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What is the main driver?
Stephen Donnelly (Wicklow, Fianna Fail)
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So the advice is, it is a function obviously of claims coming through but that we do not have line of sight of the individual claims.
Stephen Donnelly (Wicklow, Fianna Fail)
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No, not at this point.
Róisín Shortall (Dublin North West, Social Democrats)
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What is it? Is it a particular type of claim? What accounts for that level of increase?
Stephen Donnelly (Wicklow, Fianna Fail)
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Please answer, Mr. O'Grady.
Mr. John O'Grady:
Deputy, maternity is a big driver and I think represents about 45% of the overall claims history. It is important to bear in mind that the claims we are settling today are historical claims so actions that the system is taking to manage the claims portfolio will only have a benefit going forward as well. We can revert with a more detailed note, if that is useful.
Róisín Shortall (Dublin North West, Social Democrats)
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It would have been useful to have it this morning. A general point has been made about maternity claims. What has driven a more than 20% increase?
Róisín Shortall (Dublin North West, Social Democrats)
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The official has made my point for me and I thank the Chairman.
Stephen Donnelly (Wicklow, Fianna Fail)
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I thank Mr. O'Grady.
Colm Burke (Cork North Central, Fine Gael)
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My understanding, from the State Claims Agency, is that if it settled every claim in the morning, it would mean that from all Departments it would be between €4.2 billion and €4.3 billion, of which €3.8 billion concerns the healthcare sector. In view of the increase of €95 billion for this year, can we get an estimate of a breakdown over the next five years on the basis of present claims? I know that the number cannot be a comprehensive figure. If we increase the amount by €100 million per annum then surely we need to examine the matter now and see what it will cost us over the next five years. I know that we are only dealing with the budget for 2022 here but we must also forward plan. The State Claims Agency has said that the figure is €3.8 billion, which is health related; is it not time now to look at how we deal with this over the next four to five years?
Stephen Donnelly (Wicklow, Fianna Fail)
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Yes, it is. As Deputy Durkan and I discussed earlier, my belief is that we need to take a much more strategic approach to medical negligence claims for two reasons. First and foremost is patient safety because this is one of the ways where we can identify where things are going wrong, and where things are going badly wrong. We should take, to my mind, a root cause analysis approach right across the system to identifying where patient safety incidents happen, and minimising and, ideally, bringing those numbers down to zero. First, and foremost, this is about the patients.
Second, a knock-on impact of that would be lower claims going out. As well as that, I do not believe at this point in time that we have sufficient mechanisms available. Far too often it relies on legal actions or High Court actions where sometimes they get settled ahead of time and sometimes there are judgments made. I believe that we need non-judicial mechanisms available as well to people.
Colm Burke (Cork North Central, Fine Gael)
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We have reviewed the whole issue in terms of industrial accidents, and claims for industrial accidents and car accidents over the past ten years. The one area that we have parked and did nothing about, in fact, is medical negligence and we have let that roll on the way it is going. The biggest problem for the State is in fighting any of these claims, or trying to minimise the claims, there is a huge cost factor if it goes into a trial because a trial will last for anything up to four to five weeks. Do we now need to do an overall review about how we manage these claims and how we deal with the structure that is there at this stage? If so, has the Department started that process?
Stephen Donnelly (Wicklow, Fianna Fail)
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We have certainly started the thinking, Deputy, yes. I would agree with the Deputy that, yes, we need a review of the mechanisms for the claims. I would just add that we also need a system to stop the event happening in the first place. Ultimately, what matters is patient safety. Step one is to minimise and drive down as close to zero as possible any adverse incident for any patient.
Second, I fully agree with the Deputy. We need to take a broader view of what can be done to support patients harmed in adverse events associated with negligence. For what it is worth, my view is that, while everyone has the right to go to the courts, they should be a last resort. For too many patients, they are the only resort.
Colm Burke (Cork North Central, Fine Gael)
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Perhaps we could get a detailed memo from the Department on the current number of claims and the timeframes involved. Such a detailed note might be interesting because a very large amount of money is pending.
I will move onto a totally different issue. In the report the Minister gave us, he spoke about additional beds and so on. However, I notice that €1.46 billion was set aside for the nursing home support scheme and that there is going to be an underspend of €44 million. Is it not the case that, when someone is transferred from a hospital bed to a nursing home bed, the cost to the State is far lower? I am concerned that there is an underspend in respect of nursing homes when a number of nursing homes have closed down because they felt the amount of money they were getting was not sufficient for them to continue in business. Is this an issue that now needs to be reviewed? Nursing homes may be taking in patients or residents who are well able to move around and so on today but, as they get older, they will require a far higher level of support. There is no mechanism through which those nursing homes can get additional financial support. Is it not now time to review that whole process?
Mary Butler (Waterford, Fianna Fail)
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I thank the Deputy for his question on the nursing home sector, about which we have had many conversations. Some 80% of beds provided in the nursing home sector are operated by private and voluntary organisations. Just under 4% fall into the voluntary category so approximately 76% are private. The fair deal scheme supports 18,000 beds in the private sector. Last year, close to €1 billion was paid out under the fair deal scheme. On the Deputy's point regarding the underspend of €44 million, my job as Minister of State is to make sure that the fair deal budget is sufficient to run from 1 January to the very last day of any given year. We have seen fewer people present this year. Normally, we have approximately 22,500 people in nursing homes under the fair deal scheme during the year. This year, we have a slightly lower number. That is the first point.
Colm Burke (Cork North Central, Fine Gael)
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Is there not a problem in that there are people in hospital beds who could be discharged but who are not being discharged in a timely manner? I will give an example. The Taoiseach officially opened Heather House in Cork three or four months ago but it is not now being fully utilised.
Mary Butler (Waterford, Fianna Fail)
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I will give the Deputy an example from-----
Colm Burke (Cork North Central, Fine Gael)
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No. To deal with that specific issue, I know of people in Cork University Hospital, CUH, who are looking for a bed. This is not a private nursing home but a HSE facility. Beds in public nursing homes are costing €1,600 per week on average whereas the real cost in a hospital is approximately €8,000. Heather House has empty beds and does not have full staffing in place while beds are occupied in CUH that could be freed up for people waiting for elective surgery, surgery that is being cancelled. Is it not now time to look at this?
Mary Butler (Waterford, Fianna Fail)
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Deputy Burke makes a very valid point. It is working very well in University Hospital Waterford, where we do not have any people on trolleys because we have a service level agreement for up to 45 beds in nursing homes throughout the community as far as Dungarvan and into New Ross. There is no shortage of money to do that. These are what we call "transitional step-down beds". In some cases, a resident who no longer needs to be in an acute hospital can be transferred to a transitional bed for up to 11 weeks. I appeal to all acute level 4 hospitals to make more use of this. I know, for example, in-----
Colm Burke (Cork North Central, Fine Gael)
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In fairness, they are. What I am saying is that there is still a problem in that, when some hospitals right around the country try to find a bed to accommodate a person who needs more than normal nursing home care and a small bit of additional support, the nursing homes are not able to provide that because they do not feel they are getting sufficient funding.
Mary Butler (Waterford, Fianna Fail)
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The HSE community nursing units will always step in if a resident does not have an appropriate place to go. If a person needs to be discharged from an acute hospital and a private or voluntary nursing home is not in a position to take that person because of his or her complex care needs, the HSE will always step in. Under the fair deal scheme, we currently have 4,500 beds in community nursing units, the old county hospitals that we all know.
Colm Burke (Cork North Central, Fine Gael)
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They are costing us quite a lot of money, however. There is now an underspend of €44 million, which is great from the Department's point of view, but, in real terms, an additional cost is being incurred because people are in hospitals for longer. There needs to be a review of how to get people out of hospital beds and into a step-down facility that can provide the level of care they require far more quickly. It is not happening.
Mary Butler (Waterford, Fianna Fail)
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If I can come in there, that is a proposed underspend but, as of 2 November this year, there were Covid outbreaks in 72 nursing homes. We continue to pay temporary assistance payments to any nursing home in which there is an outbreak of Covid. As I have said, Covid is not gone completely. As of the start of this month, it was in 72 nursing homes. That budget will also be used in that way. We could also see a spike in people presenting to nursing homes in December. My job is to make sure the budget is sufficient to last until the very last day of the year. We will continue to support the private nursing homes. As the Deputy will know, only a couple of weeks ago, we announced a scheme worth €10 million for inflationary energy costs.
Colm Burke (Cork North Central, Fine Gael)
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Would the Minister accept that-----
Mary Butler (Waterford, Fianna Fail)
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May I also just come in on the issue of personal protective equipment, PPE, because it is important and I did not get to come in on it earlier? Since the outbreak of Covid, some €67.5 million worth of PPE and oxygen has been provided to private nursing homes. I do not have the specific breakdown for 2022 but, up to August this year, the spend on PPE and oxygen was €67 million.
Colm Burke (Cork North Central, Fine Gael)
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As we sit here, a large number, 300 to 400 people, are in hospital beds when care could be provided for them in a nursing home setting but that is not happening fast enough. Part of the problem is that nursing homes are not able to provide the support they will require because they feel they are not getting sufficient financial support to do so. I am just asking that this be reviewed in order to free up hospital beds to allow us to go ahead with elective surgery and all of the other things we need to do in hospitals. Is it not now time to have a look at that, particularly when we have an underspend in an area where we can save a great deal of money in real terms?
Stephen Donnelly (Wicklow, Fianna Fail)
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That is one of the top priority areas in the winter plan. As the Deputy quite rightly says, the level of delayed discharge from care is far too high. One of the ways to deal with that is to discharge patients to community nursing homes, in the case of more complex needs, or to private nursing homes. As the Minister of State, Deputy Butler, has said, some hospitals do this very well. However, other hospitals do not. This is partly down to a variance in operational effectiveness on the ground. As I have said, some hospitals are very good at it. They have very good relationships with the community and with the nursing homes. Other hospitals do not have as good relationships. It is a priority area for the HSE in the context of the winter plan.
Colm Burke (Cork North Central, Fine Gael)
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May I come back to the Minister regarding Heather House in Cork? There are 60 additional beds there in a brand new building. There were 50 beds but we added another 60, which are not yet fully occupied. All of the hospitals in Cork are under serious pressure and we cannot get patients out.
Stephen Donnelly (Wicklow, Fianna Fail)
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I will bring that specific issue back to the HSE in the context of discharge under the winter plan.
Colm Burke (Cork North Central, Fine Gael)
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In fairness to the HSE in the south and south west, it has acquired the golf links hotel, the Blarney, where it will provide an extra 50 beds. However, I am concerned that, when we finish the building work in March, we will again leave 50 beds unoccupied for a period of time. We could have anything up to 100 step-down beds available but not being utilised. I am a bit concerned about forward planning in that regard.
Stephen Donnelly (Wicklow, Fianna Fail)
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I will look into it but I do not share that characterisation. I was in CUH recently. I met with hospital representatives and with Michael Fitzgerald and the team in the community healthcare organisation, CHO. We went out to one of the new community nursing units, which is about to be opened up for dementia patients.
There is a very clear understanding in Cork that there is a problem with delayed discharges across the country. CUH has it, as do many other hospitals. I have asked the acute side and the community side to work closely together to address the exact issues the Deputy has raised. Any and all nursing home capacity that is available must be used. We obviously cannot pay any price-----
Colm Burke (Cork North Central, Fine Gael)
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I accept that.
Stephen Donnelly (Wicklow, Fianna Fail)
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-----but within reason, we must maximise the step-down options available for patients in hospitals, including CUH. I agree fully with the Deputy on that.
Seán Crowe (Dublin South West, Sinn Fein)
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I have a couple of questions. To follow on with regard to the community nursing beds and the acute beds, a lot of the hospitals are facing a big challenge at the moment and we are only starting the flu season. It is not uncommon to increasingly see a huge number of ambulances outside hospitals. There is additional money in the winter plan and so on, but most of the hospitals are saying it is due to lack of beds. A lot of the slow turnover is also down to a lack of beds within the system. I told the Minister's officials about the situation in Tallaght Hospital a number of weeks ago when there were 11 ambulances parked outside at one stage. A couple of weeks ago, there were six ambulances outside the Mater. There is clearly a problem there. One of my constituents was four hours watching her mother die on the floor while she waited for an ambulance to come. The journey would take maybe ten minutes in an ambulance. That woman's last memory of her mother is of her gasping for breath and dying on the floor. She died on the way to the hospital. There are many of those cases. Another woman from Wicklow was in contact with us. She had a broken hip and was waiting four hours for an ambulance. An ambulance ended up coming from St. James's and she was left lying on the floor with a broken hip. That is appalling. There are loads of those stories, as the Minister knows. There is a difficulty with bed capacity.
I will follow up on the questions about nursing home beds. The information we were given refers to 17 units closing and four reopening. Clearly, the scale is enormous. A lot of the homes that are closing are private facilities. The State needs to step up in that regard. Maybe some of the focus around this Supplementary Estimate should be on whether we are filling that gap. Clearly, what is happening in the hospitals is that those over 75 are taking longer to recover. If there are no step-down facilities, that creates blockages in the system. It is good that people are living longer, but there is a major challenge in this regard. There are 17 units closing and four coming into the system. I remember five years ago saying that we needed to be opening practically one nursing home a month to fill the gap that exists. There is clearly a gap. Is this Supplementary Estimate going to cover that?
Stephen Donnelly (Wicklow, Fianna Fail)
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The Minister of State, Deputy Butler, might answer specifically on the availability of nursing home beds. I will just give a view on the initial question around the acute beds and the ambulance response times. There are a few different things at play here. First, the National Ambulance Service needs significant additional funding. That is happening now. In the budget for 2021, the budget for this year and the budget for next year, the national ambulance strategy, which was launched in 2016 and has been refreshed this year, is getting a substantial amount of money. With that, the National Ambulance Service is rebuilding the bases. This is because many of the ambulance bases throughout the country are not fit for purpose. It is also building and modernising the fleet. Critically, it is hiring more paramedics and advanced paramedics. There are some very good things going on. It is also adding more and more capacity in the call base up in Tallaght. The National Ambulance Service knows the response times for high-priority calls are not where they need to be. We need to recognise that. They are missing some of them by far too much and there is also too much variability around the country. We are responding by significantly increasing the funding available to the service for that. I recognise that it is not yet where it needs to be and some parts of the country are worse than others.
The Chairman asked about beds and patient flow and making beds available so that when people come in they are not on a trolley and if admitted they can get a bed as quickly as possible. I will just say two things. In part, more beds are needed. As per the paper that was circulated, albeit too late - and I fully accept that - more beds have been added to the system since Covid than in any period in history. Members will see from the graph that we are now significantly ahead of the Sláintecare target. Looking at the investment profile for the coming years, our intention is to pull further and further ahead of the Sláintecare targets in terms of those extra 2,400 beds. At the same time, working practices within the hospitals need to change. When we look at the discharge rates across the seven days, we can see that on Saturdays and Sundays, a small fraction of the number of patients are discharged as during the week. That means there are people in hospital beds on Friday, Saturday, Sunday and Monday who should not be there and there are people on trolleys in the emergency department who should not be there and should be up in those beds. Similarly, there is quite a variance in hospitals in the number of senior decision-makers being on-site in and around the emergency departments, that is, people who can make discharge decisions and admissions decisions. Some hospitals are doing incredibly well. The Minister of State, Deputy Butler, referenced University Hospital Waterford. It probably has the highest performance of the emergency departments. I was in there recently and it is very impressive. There are other hospitals where we do not have decision-makers on the floor when we need them. Unfortunately, those decisions are being left to nursing staff and NCHDs. There needs to be movement right across the board both in terms of changes to working practices and the availability of senior decision-makers, while at the same time acknowledging that far more beds, diagnostics, theatres and ambulance infrastructure are required as well.
Mary Butler (Waterford, Fianna Fail)
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As we know, the nursing home sector has changed in recent decades from a predominantly State-led service to a situation today where approximately 80% of nursing home services are provided by the private sector and 4% by voluntary organisations. As I said earlier, private nursing homes provide vital residential care to over 18,000 people on behalf of the State. It is interesting to note that 15 private companies now control 10,700 beds in the sector. As of 28 November this year, 17 nursing homes have closed or officially notified HIQA that they are going to close. Currently, 11 have closed and six have notified HIQA and are starting to ask the residents to move on. According to legislation in place since 2007, they have to give families and residents six months to find other nursing homes. We are very concerned about the small family-run community nursing homes that are under extreme pressure. I have requested the HSE to work with any small nursing homes that are in trouble to see what we can do to help them. There is a scale with large nursing homes on one side of the sector and family-run or voluntary homes with a small number of beds, maybe 30 or 40, on the other. We have lost approximately 500 beds this year but four new nursing homes have also opened, which brought in 450 beds, so there has been a net loss so far of about 50 beds. In CHO 5, for example, where I am based, we have lost almost 120 beds, while there are other areas that can cope better. We are acutely aware of the situation. We continue to fund the nursing home sector to the tune of €1.4 billion a year, which is a massive amount of money. It is almost one twentieth of the health budget. We will continue to do that. We have schemes in place now for Covid outbreaks and a scheme to deal with inflationary measures. Nursing homes can claim up to €31,500 this year, backdated to 1 July.
The larger nursing homes are also eligible for the Government support scheme whereby up to €10,000 can be claimed per month. This may suit some of them better. They cannot use both schemes. I tailored this particular scheme to the smaller nursing homes. They can claim €31,500 for six months of the year.
Seán Crowe (Dublin South West, Sinn Fein)
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As with the acute beds, there is probably a lot being done. We need to do more, however, and that can be clearly seen.
I have one more question on something that has not been touched on. We know from the large-scale cyberattack that huge investment is needed in IT systems. In addition, the patient identifier number scheme is coming online. There is no mention of sufficient funding in the Supplementary Estimates for that. We were told the systems was in many cases near collapse and there were huge problems right across disability teams with a system unfit for purpose and so on. Is it within these figures? I do not see it. Is there sufficient funding there?
Stephen Donnelly (Wicklow, Fianna Fail)
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I thank the Chair. We will get the exact numbers from the officials now but I agree with him that Ireland is a laggard when it comes to e-health, and significantly so. It was quite rightly called out in the Sláintecare report. There is a substantial amount of money being invested. There is an additional €90 million being invested next year in the very points the Chair has raised. We all saw the very serious disruption to patient care caused by the cyberattack and that obviously had a significant follow-on financial impact. If we are going to solve this problem we must be honest about it and say we do not have the IT systems we should have. We do not have integrated systems. They are better in the hospitals than in the community. In some hospitals and specialties, they are good. Maternity is doing very well. The national imaging management system is good. There are other hospitals I have been in where NCHDs have told me of queuing for access to laptops in order access patient files. That is just not acceptable. In community, many areas are still working, as the Chair quite rightly says, on the basis of paper files. Some of the GP systems are very good.
There is a refresh of the e-health strategy taking place. Much more money is going to be invested into it. We are hiring for two very important roles, namely, a chief technology and transformation officer and a chief information security officer. This year with there was an additional €55 million allocated to respond to the cyberattack. We are taking it seriously. A great deal of money is being invested in it, but we just have to be honest and say that the current situation is not good enough. I speak to doctors, nurses and allied healthcare professionals all over the country. One of the things they always raise is how frustrating it is trying to do their jobs with the outdated systems. There is a plan being developed and money going in but I am not going to sit here and pretend it is where needs to be.
Seán Crowe (Dublin South West, Sinn Fein)
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It is not part of the Supplementary Estimate the Minister is looking for.
Stephen Donnelly (Wicklow, Fianna Fail)
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It is in the overall numbers but not in the Supplementary Estimate.
Seán Crowe (Dublin South West, Sinn Fein)
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I apologise to members for hogging the meeting but I have a last question on the national children's hospital. There is a story in some of the papers about additional funding there. Again, I do not see it under any subhead here. Significant money has been spent. The committee has visited the hospital and looked at ongoing progress. Is additional funding needed for that or is the existing funding sufficient?
Stephen Donnelly (Wicklow, Fianna Fail)
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I will get a note from the officials on that. As we know, it is going to cost more than the €1.4 billion. It will cost significantly more. Part of that is being driven by construction inflation and we are contracted to take a portion of the burden of that. There is also a very substantial amount in dispute. The reason the Government has not given an estimated final figure to date is we want the amount under dispute to be zero and the contractor will want it to be significantly higher. We are not in a position to give a figure because it would be harmful to the State to give an estimate of how much we think we might end up having to pay. We all know it is going to be higher than €1.4 billion. I have figures that may be useful on the drawdown so far this year. I can share them now or send them on.
Seán Crowe (Dublin South West, Sinn Fein)
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Do members want to hear them now? Okay. The Minister may go ahead.
Stephen Donnelly (Wicklow, Fianna Fail)
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The figure we are all aware of is €1.433 billion. That is the approved capital budget. The drawdown to date is about 80% of that, which is €1.148 billion. The capital allocation this year is €352 million and the drawdown of that to date is about 70% or €247 million.
Seán Crowe (Dublin South West, Sinn Fein)
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Okay. I thank the Minister. Deputy Gino Kenny is next.
Stephen Donnelly (Wicklow, Fianna Fail)
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I beg the Chair's pardon but I just want to say that the projected amount is nearly the full amount. The projection is €342 million of the €352 million will be drawn down this year.
Seán Crowe (Dublin South West, Sinn Fein)
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I thank the Minister.
Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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I am sorry I had to leave earlier. I will have to leave again in a few minutes. I hope I am not repeating any questions that other members have asked.
On the pandemic recognition payment, there was huge welcoming of it but the Government has made a dog's dinner of it, unfortunately. This relates especially to workers who are non-HSE, including private workers and those who work for section 39 organisations. Out of that €189 million, how much has been spent thus far?
Stephen Donnelly (Wicklow, Fianna Fail)
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We will get that for the Deputy. He may wish to continue while the officials are getting it.
Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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On clinical negligence, the Minister was saying in 2010 the figure was €81 million, I think.
Stephen Donnelly (Wicklow, Fianna Fail)
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That is right.
Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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The projected figure this year or even next year could be six times that amount, if I am reading this right.
Stephen Donnelly (Wicklow, Fianna Fail)
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Yes. It is nearly six times this year.
Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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That is up to €500 million.
Stephen Donnelly (Wicklow, Fianna Fail)
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It will be over €500 million.
Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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That is absolutely incredible.
Stephen Donnelly (Wicklow, Fianna Fail)
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Yes.
Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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What is pushing this? Why is it going up incrementally by that amount? It is an amazing amount of money for negligence. I am aware things happen in the health service but this is an incredible figure.
Stephen Donnelly (Wicklow, Fianna Fail)
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It is. To the Deputy's first point, 126,000 staff have been paid.
Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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Okay.
Stephen Donnelly (Wicklow, Fianna Fail)
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I respectfully disagree with the language he used. We would all have preferred it to have been paid within the first week after the Government decision was made. The HSE has been dealing with a lot, in fairness. The other thing is the financial management systems are being improved, which goes back to the Chair's point about e-infrastructure. The HSE was nervous about this, and I think legitimately so. It paid its own staff and paid many of them reasonably quickly. We would all have preferred it to be quicker but it was done reasonably quickly. However, the HSE was genuinely nervous about sending out moneys to private, for-profit companies like the home care companies and the nursing homes. Its officials were concerned if they sent out the wrong amounts, if they sent out too much, they would be hauled in here or before the Committee of Public Accounts and criticised for not taking sufficient care with public money. I have some sympathy with that. However, because it was taking so long to put in place safeguards they believed sufficient, I, as I was saying earlier, intervened and said I wanted a different process. That was to send out a self-assessment, let the private companies and the section 39 organisations do it, pay the money and then audit afterwards. That was a compromise to get moneys paid, but it is relevant 126,000 staff have been paid. Of course we want them all paid but that is relevant is well.
Returning to the State Claims Agency and medical negligence, there is a real issue here for many reasons.
I am sure members of the committee and the Deputy himself has spoken to clinicians who now talk of practising defensive medicine, such as over-referring and overuse of diagnostics, because in certain specialties they are scared of spending all of their time in court. In some areas I am aware they are finding it hard to hire people in because so much of their time is spent in, or preparing to go to, the High Court. That is not why they became healthcare professionals. It is an issue.
As the Deputy has quite rightly said, a jump from €80 million or €81 million in 2010 to an estimated €530 million this year and estimated to be higher next year is something to which we have to take a fundamentally new approach. We need to be very strategic about identifying where the patient safety issues are occurring and, first and foremost, stopping them, because what matters far more than any payouts from the State Claims Agency is minimising and eliminating harm to patients. We then need to have mechanisms available to patients who are not in the courts.
It turns out that 98% of clinical negligence cases handled by the State Claims Agency are resolved without court hearing. Nonetheless, there are mechanisms like no-fault compensation schemes, which are used in other countries, which we need to look at. The Deputy and the committee will be familiar with Mr. Justice Meenan’s report which contains many recommendations. The latest advice I have is that good progress is being made on those recommendations and there is more to be done.
Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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On clinical negligence, one could draw from it that people are either taking more litigation against the health service or there is an issue with the service. The figures are quite unbelievable. Is it the situation that doctors and medical professionals are under such pressure in respect of resources that they are making more mistakes? We understand mistakes happen in health services but there has to be a reason all this is happening where, over the past decade, this has shot up from €80 million €530 million. There has to be a reason.
Stephen Donnelly (Wicklow, Fianna Fail)
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There are many reasons. We need the data, the research and the cold hard information to say what exactly is driving all of these things in different ways. We also need a plan which we will be looking to put together to deal with this.
Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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This is obviously a great deal of money which could be better spent elsewhere in the health service.
Stephen Donnelly (Wicklow, Fianna Fail)
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It is a great deal of money and a lot of patient harm, and that is my biggest concern. Of course, we have to be cognisant of the money, but ultimately this money is simply reflecting harmed patients, and that is what we have to be ruthless in identifying and eliminating.
Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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The Minister said 126,000 people have been paid the pandemic recognition payment. How much of the €189 million has been spent?
Stephen Donnelly (Wicklow, Fianna Fail)
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I am going to hazard, if we are to assume the sum is broadly €1,000 each - some people are getting a little bit less than that - roughly €126 million has been spent.
Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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So there is €60 million left. Does the Minister know what percentage of section 39 bodies and those who are working in the private sector still have not received the pandemic payment?
Stephen Donnelly (Wicklow, Fianna Fail)
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I will get the Deputy those figures. We are getting weekly updates now from the HSE. I will send the committee a note afterwards, but a large volume of the private and section 39 organisations are now returning these forms. I have asked the HSE to turn this around into the payments very quickly, which I want and I understand it is doing so. I said to the HSE that anyone who has submitted a form within a reasonable time before Christmas needs to be paid, for all of the reasons we can understand.
Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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The Minister can understand why people who were working at the height of the pandemic in the private sector or in nursing homes could be very peed off in respect of this. Despite the goodwill, which was welcomed last January, these people have still not been paid.
Stephen Donnelly (Wicklow, Fianna Fail)
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Of course, and none of us want to be here. Can we just take a step back for a moment. First of all, let us acknowledge that these payments should have happened earlier this year and that, while 126,000 and more by the end of the week have been paid, there are still tens of thousands who have not been paid. Let us also reflect that one of the things I and the Government were determined on was that this was going to be a genuine recognition and that it would be good by international comparisons, which it is. Would I prefer that these workers had the €1,000 in June rather than in December? Yes, but it is still good that it is €1,000 being paid. Critically, credit is due to the Minister for Finance, Deputy Donohoe, in that, when I asked him if we could make this payment tax-free, and very little gets made tax-free, he agreed it could. I said we could not give people €1,000 and then take €500 or more back in tax. Normally, that is what would happen. I accept we would have all liked the payment to have been made earlier, but there is still approximately €190 million in tax-free money being paid out to approximately 190,000 men and women in our system and, ultimately, that is good thing.
Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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It is a very good thing, but it is just the way it was delivered. We all agree with it, but people not receiving this payment for a period of up to a year takes the goodwill out of it.
Stephen Donnelly (Wicklow, Fianna Fail)
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It will not be up to a year, to be clear. The decision was only made earlier this year and the vast majority of these payments should be made before Christmas, so that will still be within the same year.
Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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Hopefully, it is-----
Stephen Donnelly (Wicklow, Fianna Fail)
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Yes, I would have hoped it would have all happened in the first number of months, as do we all.
Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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I thank the Minister.
Seán Crowe (Dublin South West, Sinn Fein)
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The Minister might come back to the committee with information as I know one hospital which paid out the pandemic payment to all of its staff but the Department has not recouped this money to the hospital. Perhaps the Minister might come back to the committee with those figures also. The Minister is stating this money has been paid out. In this case, however, it has been paid out by employers, and they have not been recouped this money. This is funding which every hospital needs.
David Cullinane (Waterford, Sinn Fein)
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I want to take the Minister back to the Supplementary Estimates and to the total figure of €1.39 billion. Our job today is to ensure there is, at the very least, a basic and elementary level of scrutiny, oversight and accountability. For that to happen, we have to be satisfied as to the figures in two respects: what was originally allocated versus what will be allocated now and the difference between the two. That is essentially why we are here.
Regarding the Covid-19 expenditure, it took us a bit of time to get there because we were perhaps late in getting the breakdown and we had to work out some of the figures with the Minister’s officials to get to those, but we now know that the total Covid-19 expenditure was €1.878 billion. We also know the original Covid-19 expenditure, as in budget 2022, was €679 million. These figures are from page 19 of the Minister’s own document.
Stephen Donnelly (Wicklow, Fianna Fail)
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That is €697 million, Deputy.
David Cullinane (Waterford, Sinn Fein)
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Yes, that is €697 million. The difference between €697 million and €1.878 billion is €1.18 billion, which is €968 million new Covid-19 measures, funded programmes, and then the €213 million which is made up of the Covid-19 recognition payments and the therapeutics. That is basically it, is it not?
Stephen Donnelly (Wicklow, Fianna Fail)
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Yes.
David Cullinane (Waterford, Sinn Fein)
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Yes. The question then is, of that €697 million which was originally allocated, what was it allocated for? I went back over the Estimates and €200 million of that was allocated for the access to care fund and €497 million for Covid-19 programmes. We then need to work through now all of the different Covid-19 programmes and compare and contrast what was originally allocated for each of those programmes with what we are allocating now.
There are two figures. There is the €697 million, which is the original allocation, and then there is the €1.878 billion, which we now know is the total revised allocation for Covid-19. On personal protective equipment, PPE, on page 19 it says €118 million. The question then is to look at this through the lens of the €697 million figure. How much of that €697 million was allocated for PPE?
Stephen Donnelly (Wicklow, Fianna Fail)
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I thank the Deputy. My apologies if the Deputy was here because he may not have been.
David Cullinane (Waterford, Sinn Fein)
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I was and I heard-----
Stephen Donnelly (Wicklow, Fianna Fail)
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The Department has clarified that it does not have a table to compare in respect of the €697 million. My understanding is that when it comes to PPE, the €118 million is broadly what was provided for and what will be spent. However-----
David Cullinane (Waterford, Sinn Fein)
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Some €697 million was budgeted for.
Stephen Donnelly (Wicklow, Fianna Fail)
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If I could just finish this point, what the Deputy is asking for, very understandably, is how that €697 million breaks out. The Department does not have that here today.
David Cullinane (Waterford, Sinn Fein)
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Why?
Stephen Donnelly (Wicklow, Fianna Fail)
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It has agreed it will send it on in tabular form in order that the committee can have a look at it piece by piece.
David Cullinane (Waterford, Sinn Fein)
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Hang on a second. How can we sign off on this? What the Minister said to Deputy Shortall earlier was that the total allocation for PPE is €118 million. That is part of that additional spend. The Minister said it in his opening statement. I have a very loose breakdown of that €697 million. A total of €200 million is for the access to care fund and €497 million is for Covid programmes. Is the Minister telling me an allocation was not made with regard to that €497 million across all of the programmes, whether it is PPE, testing and tracing, vaccinations, access to care fund, acute hospital and community responses and so on? Is the Minister telling me the breakdown exists but that he has come here today without that breakdown as part of a Supplementary Estimate that involves that figure? Is that what the Minister is telling me?
Mr. John O'Grady:
The Minister is correct in saying the €697 million is broken into €200 million for the access to care fund and €497 million for other Covid responses. The allocation of €497 million was made against the overall Covid response. Administratively, the HSE has allocated that out into individual programmes, but it was left flexible on the basis it was not entirely clear. There were clearly going to be pressures. Those pressures have exceeded the level of funding provided, but where the pressures were to arise was not clear when the budget-----
David Cullinane (Waterford, Sinn Fein)
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Surely there would have been some breakdown. It is not possible for me to envisage we would provide €497 million - quite a precise figure rather than a rounded figure like €500 million - on the basis it came from somewhere but yet we cannot have the breakdown. Maybe I will move on to the access to care fund-----
David Cullinane (Waterford, Sinn Fein)
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I get there needs to be agility and flexibility, but we are being asked to sign off on additional spend. We should have had the €697 million figure and been told what was originally allocated and what it was intended the money would be spent on and then told what the new revised allocation of €1.878 billion would be spent on. How much of the €1.878 billion will be allocated to the access to care fund?
David Cullinane (Waterford, Sinn Fein)
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Look at page 19 of the document.
David Cullinane (Waterford, Sinn Fein)
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What is that for?
Mr. John O'Grady:
That is what the HSE has tracked as the spend against that budget. I do not necessarily think that is the full level-----
David Cullinane (Waterford, Sinn Fein)
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Hang on a second. Some €200 million is allocated. Is that not right?
David Cullinane (Waterford, Sinn Fein)
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The €1.878 billion is made up of all of those components, including the access to care fund. This is what the Department envisages will be spent across all of these programmes, unless we are saying we will spend more again. What the Department provided to us today is €6.9 million for an access to care fund, where in the budget, there was a provision of €200 million. Is Mr. O'Grady telling me we will only spend €6.9 million this year on the access to care fund?
Mr. John O'Grady:
That is the figure the HSE has reported as spend against the access to care fund. We believe the true figure is much higher and it is embedded-----
David Cullinane (Waterford, Sinn Fein)
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How can it be higher? The final revised allocation in front of me is €1.878 billion. It is made up of all of these components, part of which is the access to care fund of €6.9 million. If Mr. O'Grady is telling me the latter figure may be higher, the revised allocation will be higher than €1.878 billion. Where will that money come from?
Mr. John O'Grady:
The true spend against the access to care allocation of €200 million is more like €130 million but it is reflected by the HSE in how it returns information to the Department in core acute expenditure.
David Cullinane (Waterford, Sinn Fein)
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That makes no sense in how the Department is presenting this today. The fact that I even have to do this frustrates me. The Department is presenting figures to us of €118 million for PPE, €402 million for testing and tracing, €465.8 million for vaccinations, €6.9 million for the access to care fund, €396 million for Covid acute hospital responses, and €274 million for Covid community responses. That is gross expenditure on HSE Covid responses of €1.665 billion. We know €697 million of that is the figure that was allocated. The additional money the Department seeks is €968 million and there is €213 million of Covid recognition payments and therapeutics. The overall figure is €1.878 billion.
We are being asked to sign off on €1.878 billion of Covid expenditure. What is allocated for the access to care fund is €6.9 million, whereas what was actually provided in the budget is €200 million. The Department then says it is actually spending €130 million. The access to care fund was coming out of the Covid expenditure. I looked back over the budget.
Mr. John O'Grady:
That is correct. I will go back to what I said previously. The projected spend is approximately €130 million. Those are the data we have from the HSE-----
David Cullinane (Waterford, Sinn Fein)
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How can we only spend €130 million when it is €200 million and when we have a waiting list crisis, the Chair talking about the National Ambulance Service, we have people waiting far too long in hospitals, we have some patients waiting more than 24 hours, and we have all of the challenges and the pressures? The Minister announced, with great fanfare, €200 million of an access to care fund. It says here we will spend €6.9 million, which is what we are being asked to sign off on. We are actually being told it is €130 million. Does that mean the figure is coming from somewhere else? Why is it only €130 million? Why not the full €200 million? Maybe the Minister could answer that. How in God's name have we arrived at a situation where €200 million has been provided for an access to care fund at a time of considerable crisis in our healthcare system. It says here €6.9 million and we are being told it might be €130 million. What has gone wrong that we cannot spend the full €200 million?
Stephen Donnelly (Wicklow, Fianna Fail)
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I will ask the official to revert on the €6.9 million and the reporting from the HSE versus the €130 million. As the Deputy will be aware, the HSE has hired significantly fewer staff than was provisioned for-----
David Cullinane (Waterford, Sinn Fein)
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Is that separate from the access to care fund?
Stephen Donnelly (Wicklow, Fianna Fail)
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With respect, it is all part of an estimated increase in patient activity.
David Cullinane (Waterford, Sinn Fein)
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What the Minister is telling me is the access to care fund was really a combination of funding that was already announced as part of the 10,000 staffing.
Stephen Donnelly (Wicklow, Fianna Fail)
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I am not.
David Cullinane (Waterford, Sinn Fein)
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That is what the Minister just said.
Stephen Donnelly (Wicklow, Fianna Fail)
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I am not telling the Deputy that. It is stand-alone. What I am saying is that, while some of it has been used, there is a shortfall, as we are aware, because the total amount of hoped-for additional activity within the HSE, which includes overtime, weekend sessions, theatres working longer, all of the things the access to care fund is for, and the additional full-time staff will be less at the end of the year.
David Cullinane (Waterford, Sinn Fein)
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I just need to come back to a final point to the Minister's official. The smaller Covid allocation figure for 2022 of €697 million was what was budgeted for. We are agreeing on that.
David Cullinane (Waterford, Sinn Fein)
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Of that €697 million, €200 million was budgeted for the access to care fund. That is built in here. The €697 million figure is part of the €1.878 billion, is it not?
David Cullinane (Waterford, Sinn Fein)
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However, Mr. O'Grady is telling me the figure for the access to care fund is €6.9 million but may be €130 million. How is that possible? In other words, the access to care fund is now being funded from something else.
David Cullinane (Waterford, Sinn Fein)
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How are we meant to sign off on this stuff? The Department has not presented the information in any kind of comprehensive way which would give me satisfaction we are doing the right thing. I have to say that and that is just one area. We should have had a breakdown of what the figure of €697 million was to be spent on versus the €1.878 billion. We would have been in a better position for it. I find it astonishing that the Minister announced €200 million with great fanfare as part of a waiting list management strategy and we are now told he may only spend up to €130 million when we have a crisis in healthcare. I find it incredible. Today has been a shambles with regard to the presentation of Supplementary Estimates and it is no way to treat the Oireachtas Committee on Health. The Minister may respond if he wishes. I stand over the criticism I made at the very start of this session that it is no way to treat the Oireachtas Committee on Health.
Stephen Donnelly (Wicklow, Fianna Fail)
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We were asked to come here last Thursday. Today is only Wednesday. The officials stopped what they were doing and worked through the weekend to provide the notes. I offered previously to come back. I have been a member of committees for many years. Deputy Durkan and I sat on the Oireachtas Committee on Health for many years together and I have had exactly the frustrations the Deputy has now.
As a result of that, a genuine effort was made to get more accessible information together. I acknowledge his frustrations. There is a wider issue of the reporting along heads and subheads against what is programmatic activity. The management accounting and financial accounting do not match up. They lead and have led, for many years, to this kind of problem. The solution is an integrated financial management system within the HSE in order that the Oireachtas, the Minister and the Department can have confidence the money is being spent programmatically in the way it is allocated. Good progress has been made on that system but there is still a way to go. I share some of the Deputy's frustrations.
Seán Crowe (Dublin South West, Sinn Fein)
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Deputy Durkan is next, followed by Deputy Shortall.
Bernard Durkan (Kildare North, Fine Gael)
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I refer again to the State Claims Agency. It would be beneficial if we had an audit of the claims and their origins for the past ten years to date. The leakage in funds is sufficiently worrying that nothing else will show due diligence in respect of what is emerging. I saw files from two different patients during the week. One case involved a procedure that went wrong and had to be corrected with significant extra expenses. We need to know what procedures go wrong that result in negligence claims. How often do they happen and do they have a particular place of origin? What is the cause of the problem? As to the corrective measures and the amount of time and money spent and the impact on the patient, in one case the impact on the patient was lifelong. It cannot be reversed and that is just the way it is. If the procedure had been performed differently, there would have been a better outcome for the patient and the State.
I ask the Minister to provide this information as soon as possible. If he has those details today, that is good and well. I would like a detailed publication of the information. What was the prevalence of the cases that are coming up and what have been their subsequent cost to the State? This should include a breakdown of the costs, be they medical, legal or otherwise, as well as a comparison of what the patient received in direct compensation and what the costs were. We need to have that information as a matter of urgency.
I refer to the allocation of funding in relation to monkeypox, the incidence of which is rising from zero. Is adequate provision being made for that in the future? Since June, €2.6 million funding has been applied to subhead L1 to fund the revised contract and fee structure for GPs of the CervicalCheck programme. How is that proceeding and will there be ready access? We need to know if there are any delays incurred by patients as part of CervicalCheck, such as delays after the check, delays in gaining access to the check, or delays in accessing necessary treatment.
We have to look at hospital waiting lists again. I had occasion to join a person from my constituency who had to go to an accident and emergency department in the past six months. One was a successful visit. When the patient arrived in the morning, the department was full of people waiting but it cleared within two hours. It was a dramatic performance by this hospital. Whereas in the other hospital, there was a different situation altogether. There were only a few people in the department at the beginning of the day but the number grew as the day went by, which leads me to ask what was happening. Of course there were people coming in, but there had to be people being treated and moving on as well. Why do some hospitals have a quick and satisfactory turnaround time and provide a satisfactory experience for patients while others do not? They keep repeating this again and again on the same basis. I compliment those who are doing it well and ask whether it is possible to direct some of their expertise to those which are not doing it so well, to bring the standard up to where it should be. What experiences have we learned in the past year arising from unforeseen circumstances? Were they all unforeseen or were they obvious beforehand?
I refer to the national children's hospital. The Minister is absolutely right. Saying the cost is going to go up and advertising this to the public is crazy. The contractors and subcontractors will obviously be rubbing their hands in glee the more the Minister admits the costs will increase, such as saying how the costs may go to €1.4 billion, €1.8 billion, €2 billion or perhaps €3 billion. Why not tell them at the beginning it will cost €5 billion and have done with it, so they know they have a worthwhile objective for which to strive? It is very important that this is done at this stage. I refer to the children's hospital from the point of view of the patients and staff who will attend. I fully support the hospital. It is a huge boon for parents and children all over the country who have been waiting for a state-of-the-art health service that will meet their requirements, of which there are many. I ask that we look carefully at small details that could have a negative impact. I will not go through specific-----
Seán Crowe (Dublin South West, Sinn Fein)
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Such as parking.
Bernard Durkan (Kildare North, Fine Gael)
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Yes, and that as well. Parking is an issue I raised at the beginning of the meeting because I noticed it emerged as a concern again in recent weeks. Some of us raised this issue before work on the hospital started and before plans were finalised. You have to get staff and patients into the hospital. I know the Luas passes alongside the building and a good bus service also goes through the grounds but not everyone can get to hospital using such transport while in an emergency situation. We need to make certain that patients and staff are adequately catered for in respect of parking and transport. We must recognise that spending the minimum amount of time looking for a parking space is considered to be a major issue for parents bringing a child to hospital who needs urgent treatment.
The last point I want to make at this stage is-----
Seán Crowe (Dublin South West, Sinn Fein)
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This will be the Deputy's final point.
Bernard Durkan (Kildare North, Fine Gael)
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No. I am within my time. I was the only member who kept to his or her time in the first round.
The first point of contact between a patient and a hospital is very often the parking area. Is that not amazing? Therefore, it is hugely important. We need to be alert to the issue and make sure we do whatever can be done to make it easier for the patient. It is so simple and is of equal importance in the overall provision of services. Does the Chair want to make the last point?
Seán Crowe (Dublin South West, Sinn Fein)
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No.
Bernard Durkan (Kildare North, Fine Gael)
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I do not necessarily want to make an issue of it but-----
Seán Crowe (Dublin South West, Sinn Fein)
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The clock was not turned on.
Bernard Durkan (Kildare North, Fine Gael)
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The clock was not turned off; it was accidental. Was it turned off for anyone else? Anyway, it is important that we on this committee, Members of the Houses and the public are satisfied that everything possible is being done to address the issues that affect patients. We must try to make sure we overcome the obstacles, the snags and the whatabouts that have dogged the service for years. That is what is happening. If we want a good service that is reliable, we need to snag on a regular basis. I will make further comments later, if necessary, but if not, I will take answers to these questions.
Seán Crowe (Dublin South West, Sinn Fein)
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The Deputy has raised several issues with the Minister who, I am sure, is dying to respond.
Stephen Donnelly (Wicklow, Fianna Fail)
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First, the State Claims Agency is saying at this point that the costs relating to the damages payments are going up. The next question is what that means. It is identifying those as being the driver for this year and generally for previous years. It is saying that damages payments account for approximately two thirds of the total costs of the claims. Therefore, approximately two thirds is going to the patient and approximately one third would appear to be involved in legal fees, administration and everything else.
The actuaries for the State Claims Agency have referenced two things and we will be looking further into this. One is a reduction in the real rate of return. The second is that they are quoting considerable volatility in the damages being awarded with regard to catastrophic birth injury. Those are the two issues being referenced now. As we said a few times, and maybe it would be a good session for us to do with the committee, we need to take a rigorous approach to this to minimise and eliminate patient harm and the costs associated and to find non-judicial avenues wherever possible. As we said earlier, only one in 50 claims that are handled by the State Claims Agency end up in the courts.
I will get the Deputy a note on GPs and CervicalCheck. To their credit, the GPs have been doing a lot of additional work through Covid-19. They deserve great credit. Huge changes are happening in that regard. We will get Deputy Durkan a note on that.
I agree with the Deputy in terms of the turnaround time in emergency departments. I believe he was reflecting the fact that some hospitals are very good at this and other hospitals are not as good. First of all, I agree. Do we need more training in terms of patient flow and so forth? I think we do. I can also tell the Deputy that the improvements from the specialist team have been very encouraging. As he will be aware, I directed the HSE to send the specialist team into Limerick in the first instance and more recently into Galway University Hospital, GUH, and Cork University Hospital, CUH. The results from Limerick are promising. The big question is whether they can be sustained. One of the areas the team focused on was the number of patients who were in hospital for more than two weeks. The view going in was that alternatives were available for some of these patients and that was what it found. The average length of stay has gone down. The team did other things like take trolleys off the wards, which was very popular with the nursing staff and patients. As I said earlier, my clear view, which I expressed to the HSE and individual hospitals, is that senior decision-makers need to be on site longer than they are currently. My belief is that we need a combination of better patient discharge, better patient flow through the system and through the hospital, senior decision-makers being on site longer than they currently are and a more comprehensive avoidance approach. Really, it is all of those things.
The Deputy asked a question about whether there are learnings from unforeseen expenditure. Undoubtedly, there are and it is something on which we need to reflect further
. Access to the children's hospital is being looked at. We are all aware it is a congested site. We are all aware of where it is and that it has fewer parking opportunities than some hospitals. The Deputy is quite right about when someone is bringing in a child. I have on more than one occasion been driving around the back streets with a child of mine in the car in a bad way looking for somewhere to park around the estates. You cannot get into the car park in Crumlin and you drive around the estates trying to find somewhere, and then you carry your own kid sometimes quite a long way to bring them into an emergency department. That is the current situation and it must be addressed. Again, we need to acknowledge that it is a challenged site in that regard. It is something they are spending a lot of time looking at. It is a challenged site.
Finally, I concur completely with the Deputy's point around the difference this hospital will make. I do not know if the committee has had a chance to have a tour of the hospital recently. The difference it will make to care is mind-blowing. I can say that Children's Health Ireland, CHI, has been hiring up across its multiple hospitals. It is increasing its resources and getting a lot of extra money for staff so that when they go in, which we hope will be in the second half of 2024, many of the staff will have been hired in anticipation of that.
Bernard Durkan (Kildare North, Fine Gael)
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For further information, the closure of nursing homes is alarming. We need hospital beds in whatever way we find them and a number of facilities are closing. We need to identify the causes and remedy them as soon as possible. It is more we need of all, not less.
Mary Butler (Waterford, Fianna Fail)
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The Deputy makes a valid point. It is an area on which we are working hard. I asked the HSE to intervene with any nursing homes that inform HIQA they are going to deregister. This year, 17 nursing homes have issued deregistration numbers. To date, 11 have closed and six are currently open but are at the point of closing. Nursing homes close for a myriad of reasons, however. Unfortunately, we are seeing a lot of smaller community and voluntary nursing homes under pressure at the moment.
Bernard Durkan (Kildare North, Fine Gael)
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I thank the Minister and Minister of State.
Róisín Shortall (Dublin North West, Social Democrats)
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Getting back to the business of this meeting, then-----
Bernard Durkan (Kildare North, Fine Gael)
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That is the business of the meeting.
Róisín Shortall (Dublin North West, Social Democrats)
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I am concerned that the Minister repeated the misrepresentation about the calling of this meeting and the reason why it is taking place today. If the Minister checks with his Secretary General, he will realise that the circumstances are very different from what he is claiming. It was proposed up to two weeks ago that there would be a swap because the pressure is on to sign off on the Supplementary Estimate. I could not sign off on it today on the basis of the gaps in data and failure to answer various questions from all members of the committee. I do not think we would be doing our job if we signed off on the Supplementary Estimate today. We are going to have to look at circumstances for having another session. That can only happen once we get the data that have been requested today, however. We would be remiss in our responsibility to sign off on this in the absence of all that key information that has been requested.
I return to the issue of the Covid-19 recognition payment. I meet people on a regular basis, as, I am sure, everybody else does, who are really disappointed that having put in that big effort, they are now in a situation, ten and a half months after the Government announced this payment, where they have still not received it. The Minister of State indicated that there were delays in getting data back and all that kind of thing. Can the Minister clarify when he requested the staff data from the private providers?
Stephen Donnelly (Wicklow, Fianna Fail)
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It will not surprise the Deputy to hear that I disagree entirely with her representation of this meeting. I will state again clearly that the first I was aware, and the first the finance officials who prepare the documentation were aware, of an invite to appear before this committee was Thursday. That is not my view; that is just a fact. There may be more to it in terms of other conversations going on. I disagree entirely with the Deputy's representation that questions are not being answered. We have been here now for two and a half hours and every effort is being made to answer questions across a wide variety of issues. I acknowledge what the Deputy stated but I disagree entirely with it.
With regard to the recognition payment, to be clear, I have not asked for any returns. The HSE has written to the section 39 organisations and private providers with self-assessments asking them to please fill them in.
Róisín Shortall (Dublin North West, Social Democrats)
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When did that happen?
Stephen Donnelly (Wicklow, Fianna Fail)
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I will get the Deputy the exact dates. I raised it with the HSE initially several months ago.
Róisín Shortall (Dublin North West, Social Democrats)
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Does the Minister of State know? She answered the earlier question.
Mary Butler (Waterford, Fianna Fail)
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I am sorry; no. I was trying to be helpful when I said that 452 submissions had been received in the last couple of weeks from the various bodies and that to date, 23 nursing homes have been paid. It is very helpful that we have that information in now and we are going to pay out as quickly as possible. We are all frustrated by the number of people who are still waiting. Approximately 60,000 people are still waiting to be paid and we want to make sure they are paid before Christmas. I was just trying to be helpful in providing that number of 452 submissions from those who are entitled to be paid.
One of the issues we had during the height of the pandemic, especially in the nursing home sector, was that many workers initially worked across multiple sites. That was one of the reasons we were trying to verify the matter as much as possible.
Róisín Shortall (Dublin North West, Social Democrats)
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I am not saying it is straightforward. The Minister made a number of points about changes he made to improve the situation and so on. That is why I am asking when, over a ten-month period, did the authorities go about trying to collect the information. That is important. It seems there was quite a long delay. If the Minister cannot provide that information today, perhaps he will do so in the next few days.
The Minister is very good at describing problems, drawing from his experience as a health spokesperson for a couple of years. However, he has been in the job as Minister for two and a half years. Two of the major problems preventing a clear line of sight of the expenditure of the massive health budget are the absence of an integrated financial management system and the absence of a proper ehealth function. The Minister described very well the problems caused by the absence of those two things. What is being done about putting in place a proper, integrated financial management system and where are we in regard to the ehealth programme that was first established within the HSE in 2013?
Stephen Donnelly (Wicklow, Fianna Fail)
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Going back to the Covid recognition payment, the information I have is that at the start of November, funding application packs were sent to just over 750 organisations.
Róisín Shortall (Dublin North West, Social Democrats)
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To be clear, that was done in November.
Stephen Donnelly (Wicklow, Fianna Fail)
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It was done at the start of November.
Róisín Shortall (Dublin North West, Social Democrats)
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The payment was announced on 19 January.
Stephen Donnelly (Wicklow, Fianna Fail)
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As I said, I was not satisfied with the time it was taking for the payment to issue to staff in private facilities. I intervened and asked for a different approach.
Róisín Shortall (Dublin North West, Social Democrats)
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What was done about the private staff prior to November?
Stephen Donnelly (Wicklow, Fianna Fail)
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I intervened previously. As the Deputy will appreciate, the HSE took time to put this new process together and it then sent out the information packs to 440 nursing homes and hospices, 94 section 39 disability organisations, 87 agency organisations-----
Róisín Shortall (Dublin North West, Social Democrats)
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That happened ten months after the announcement.
Stephen Donnelly (Wicklow, Fianna Fail)
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-----and 133 home care organisations.
Ms Louise McGirr:
To be helpful, we will send on a timeline indicating when the payments started following the Government decision and the process we went through in that regard. There was a period initially following the Government decision in which the criteria and practical implementation of the decision had to be designed. There was a lot of consultation with unions and worker representatives, which added to the time taken to ensure everybody who should be paid was covered. The process was developed in consultation and working in partnership with worker representatives and there was significant feedback from unions. That definitely delayed implementation but we had to do it in order to get the input of staff as to who would receive the payment.
Róisín Shortall (Dublin North West, Social Democrats)
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I thank Ms McGirr. A timeline would be helpful.
Ms Louise McGirr:
We will come back to the committee with a clear timeline. A tender process was run for the private facility staff. The first thing that happened was the HSE paid its own staff in the section 38 organisations directly. That was significantly covered off by mid-year, with a substantial portion of those staff paid. The tender process then started for the private sector staff. That is a rough outline.
Róisín Shortall (Dublin North West, Social Democrats)
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We look forward to getting the timeline.
Stephen Donnelly (Wicklow, Fianna Fail)
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On the financial management system, significant resources have been allocated by the Government and are being applied. Good progress is now being made and the first area is due to go live next summer. For all areas of the HSE, the section 38 organisations and the large section 39 providers, the plan is that they will go live by 2025, which will represent 80% of total health spend.
Róisín Shortall (Dublin North West, Social Democrats)
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How much has been allocated for that this year?
Stephen Donnelly (Wicklow, Fianna Fail)
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We will get that figure for the Deputy.
Róisín Shortall (Dublin North West, Social Democrats)
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What about the ehealth system, which is a 2013 programme? Where does it stand? The Minister said €90 million has been allocated to it for next year.
Stephen Donnelly (Wicklow, Fianna Fail)
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An additional €90 million is allocated.
Róisín Shortall (Dublin North West, Social Democrats)
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Is that for next year?
Stephen Donnelly (Wicklow, Fianna Fail)
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A very large amount of money is allocated for it in this year's budget.
Róisín Shortall (Dublin North West, Social Democrats)
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The Minister said €90 million is allocated for next year.
Stephen Donnelly (Wicklow, Fianna Fail)
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That is specifically for cybersecurity, in response to the cyberattack.
Róisín Shortall (Dublin North West, Social Democrats)
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On the ehealth programme, is the 2013 programme still being implemented or is there a new one?
Stephen Donnelly (Wicklow, Fianna Fail)
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I might come back with a note on this. I am not trying to avoid the question but it is not something we prepared for as part of the discussion on the Supplementary Estimate. I will ask the Department to revert to the committee with a note.
Róisín Shortall (Dublin North West, Social Democrats)
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That is fine. However, the Minister made the point that things do not match up in the financial systems. That is a matter of real concern in a budget of €22 billion.
Stephen Donnelly (Wicklow, Fianna Fail)
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Yes, it is.
Róisín Shortall (Dublin North West, Social Democrats)
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I am asking what is being done to make things match up.
Stephen Donnelly (Wicklow, Fianna Fail)
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On ehealth, I am thinking more in terms of patients and so forth. Regarding the financial management system, we have given the figures. The HSE is planning to go live with that from the summer of next year and then continue the roll-out in order that, two years from then, 80% of health spend will be covered. It has been deeply frustrating for everyone for many years that this has not been in place.
On ehealth, it is not just a case of there being an ongoing roll-out of the 2013 strategy. The strategy is being updated and new work is going on for all the obvious reasons. The data are clear that Ireland is a laggard on ehealth. That was identified in the Sláintecare report.
Róisín Shortall (Dublin North West, Social Democrats)
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I am just wondering what is being done about it. When does the Minister expect to have a new strategy?
Stephen Donnelly (Wicklow, Fianna Fail)
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We will have a new strategy next year.
Róisín Shortall (Dublin North West, Social Democrats)
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What is being done in the meantime? Is the previous strategy being implemented?
Stephen Donnelly (Wicklow, Fianna Fail)
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In the meantime, there is ongoing roll-out in all sorts of areas. For example, lots of Sláintecare projects are funded that are looking at remote sensing for patients in the home and community. Electronic prescribing has been rolled out and video calling, which came about during the Covid period, continues to be used. There is a lot of activity going on but, in terms of a proper national approach, the strategy is being refreshed. The plan is to have a strategy for 2023 to 2027.
Róisín Shortall (Dublin North West, Social Democrats)
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That is ten years after the original strategy. It is very disappointing.
David Cullinane (Waterford, Sinn Fein)
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It looks like we may not sign off on the Supplementary Estimate today. That is the view of some members and I support it. We may need to meet again next week to discuss the Estimate because there are gaps in the information. The Minster referred to there being a lot of moving parts and mentioned that we do not have an integrated financial management system, which is, in some respects, leading to what might look like a situation whereby the figures are not adding up. It is obvious from everything we have heard that some expenditure was reprofiled. That is clear. We need to know exactly what was reprofiled because that is not clear from any of this. We need more information.
Going back to the access to care fund, we were told the €130 million will not come from the €1.8 billion of Covid expenditure but from the allocation for acute operations. Page 17 of the Estimates document breaks down the original €13.9 billion allocation for the HSE and shows the final allocation is now €14 billion. There is no mention anywhere in that of the access to care fund. I assume it is buried in there somewhere.
Mr. John O'Grady:
I understand the Deputy is referring to subhead J.1, which relates to the core expenditure of the HSE. There is not any budget indicated for the access to care fund but we understand from the HSE that the expenditure has been tracked there. That is why there is something of a mismatch.
David Cullinane (Waterford, Sinn Fein)
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I know that. However, the money was allocated as a part of a €697 million figure but that is no longer the case. If the figure is €130 million, it is not factored into the €1.8 million of Covid expenditure. That is clear. This means the €130 million must now be allocated or accounted for somewhere else. Where is it being accounted for?
David Cullinane (Waterford, Sinn Fein)
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That is what I said. It is buried in there somewhere but it is not stated.
It was not originally allocated under that; it was allocated under the Covid expenditure. However, now it will be accounted for somewhere else. That is only one example. There are many other examples. The point is being made for me that we need all of this information for us to sign off on it. How could we sign off on it when we have much reprofiling of spend that we have not had answers on? We have answers, but we do not have the detail and we need to get that detail.
By the way, on that €697 million breakdown, it was said there was a bit of fluidity and so on, but there has to be something more that can be given to us as well. There is much more information that can be given to us to be helpful. Obviously, the committee will work out now what we want to do.
Seán Crowe (Dublin South West, Sinn Fein)
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Just on that, people have expressed frustration. We have gone into it in detail and there is the delay in getting the document and so on. It is not satisfactory and I think the Minister accepts that. He said at the start the meeting he was willing to come back. Would he be able to come back at a later date in relation to this? I do not want to put it to a vote today. It will end up in a vote. If the Minister agrees-----
Stephen Donnelly (Wicklow, Fianna Fail)
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Ultimately, the Oireachtas holds the Government to account for money. I take these very seriously and I took them very seriously when I was a member of the committee. Of course, we will facilitate the committee. In order to try to be helpful, rather than the officials coming back with just more detail, I suggest that perhaps there would be a series of queries, questions and issues from members and the officials will then be able address exactly the questions asked - if that would be helpful.
David Cullinane (Waterford, Sinn Fein)
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I have already put some. I am looking for a breakdown of any money that was reprofiled – any money that was allocated under this heading, but it is actually now being spent over here so it is being accounted for over here. That is one area. The €697 million-----
David Cullinane (Waterford, Sinn Fein)
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We can go back over all of the questions. However, that is-----
Stephen Donnelly (Wicklow, Fianna Fail)
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It is, but I am suggesting that the other members of the committee may have questions. The Deputy may have more questions having reflected on today.
Seán Crowe (Dublin South West, Sinn Fein)
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I suggest perhaps an hour next week. Would that be sufficient if we the put the questions in beforehand? Is the Minister available for that hour?
Stephen Donnelly (Wicklow, Fianna Fail)
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We will find something, of course.
Bernard Durkan (Kildare North, Fine Gael)
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I would agree with that, as long as we do not delay any procedures or spending that is urgently required at the present time. It is a bit like the US, which is good at these kind of things toward the end of the year. I do not want to see any part of the service discontinued as a result of failure to pass the Supplementary Estimate. I would emphasise that in the first instance. I would ask that the Minister and his officials would do what they can to provide specific information on specific issues that have come up. Further information will not kill us or do any harm because of the nature of the service that is provided for thousands of patients all over the country, their friends and their families. In addition, on giving the amount of time, whatever amount of time, for example, an hour if an hour is necessary, is good. However, it will be much better if the specific questions could be raised with a view to deliberate answers on the day.
Seán Crowe (Dublin South West, Sinn Fein)
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Okay, so we will tic-tac on that-----
Stephen Donnelly (Wicklow, Fianna Fail)
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Sure.
Seán Crowe (Dublin South West, Sinn Fein)
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The difficulty is getting the room. That is the big challenge. If we go on the Tuesday, it means the subcommittee on mental health cannot have its meeting that it has already lined up speakers for. It is facilitating that. That is why I was suggesting Tuesday. Our meeting next week is not due to start until 10 a.m. because of prior engagements of the two individuals who are coming in. There is an hour there, if that suits the Minister. If not, we will try to come up with some other date. I am suggesting that we do not sign off on it today. Genuinely, people want to find out as much information on this and do the job that they have been asked to do.
Stephen Donnelly (Wicklow, Fianna Fail)
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Let us take a look. My diary is showing that Cabinet is meeting on Wednesday next week at 9 a.m.
Seán Crowe (Dublin South West, Sinn Fein)
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The Minister could miss one of them, could he not?
Stephen Donnelly (Wicklow, Fianna Fail)
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We will find something.
Seán Crowe (Dublin South West, Sinn Fein)
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Okay. Great. I will then adjourn the meeting. I appreciate the Minister and his officials coming in and answering the questions. The select committee is now adjourned.