Mr. Robert Watt:

I am pleased to be here to deal with the 2021 appropriation account and the issues raised by the committee. I am joined by my colleagues, whom the Cathaoirleach has already mentioned. I will now set out the main points of the 2021 accounts as they pertain to Vote 38.

The initial 2021 net provision, both current and capital, for Vote 38 was €21.765 billion, which consisted of a gross provision of €22.19 billion and appropriations-in-aid of €433 million. This represents a 21% increase in the allocation compared with the initial 2020 allocation and reflects the substantial investment made by the Government in combating the Covid-19 pandemic throughout that year. Some €1.66 billion was originally provided for Covid expenditure, but extra costs, including an earlier-than-anticipated roll-out of the vaccine programme, saw expenditure on Covid-related measures total €2.193 billion in that year.

Higher levels of Covid-related activity than projected in 2021 drove higher levels of expenditure. In particular, the budget of €200 million for the vaccination programme was an initial allocation to allow for purchase of the vaccines and did not factor in delivery of the vaccination programme, planning for which was concluded post the 2021 Estimates. Total expenditure on the highly successful vaccination programme totalled €530 million in 2021. The higher-than-projected incidence of infection throughout the year also drove a surge in test and trace activity, with a resulting higher level of expenditure than initially anticipated of €706 million.

The increased funding provided was not just for direct Covid responses such as those previously mentioned but also designed to develop extra permanent capacity within the public health system. Funding of €426 million was provided in 2021 for additional beds in line with the Health Service Capacity Review 2018. The additional beds funded included 1,146 acute beds, 66 critical care beds, 139 subacute beds and 1,250 community beds. While Covid had an impact on some expansion during 2021, most of the planned targets had been met by the end of 2022, and the plan to deliver on any remaining funded additional capacity is set out for this year.

A significant proportion of the extra funding secured in 2020 was to provide for the recruitment of extra staff across the health system. Since the beginning of the Covid-19 pandemic, the HSE has been committed to ensuring sufficient staffing levels to meet both Covid-related and long-term healthcare demand. The years 2020 and 2021 saw the largest annual increases in the workforce since the foundation of the HSE. A total of 12,506 whole-time equivalents, WTEs, were hired across those two years. The total number of HSE staff at the end of 2021 was estimated at 132,323 WTEs, an annual net increase of more than 6,100. It should be noted that these recruitment figures are additional and do not include the replacement of existing staff who retire or leave during a given year. Increases in staff numbers were seen across all categories in 2021. Nursing and midwifery staff increased by 1,660 WTEs, health and social care professionals by more than 1,100 and medical and dental staff by 352, with 150 of those additional staff at consultant level. While these increases in staff numbers were unprecedented, they fell short of meeting the ambitious recruitment targets for the year, with difficulties experienced due to both Covid and an overall shortage of healthcare workers. These recruitment underspends affected community settings in particular. The savings realised by not reaching these recruitment targets were used to offset the overruns in respect of Covid expenditure and, married to a strong opening cash position held by the HSE, saw no Supplementary Estimate required during the year. Indeed, the Vote was in a position to surrender €394 million to the Exchequer at the end of the year.

As well as responding to Covid - and you, Chair, and the Comptroller and Auditor General mentioned this - 2021 saw the Department deal with an unprecedented cyberattack on the HSE and the Department of Health itself. The Comptroller and Auditor General has referred to this attack in his special report on the matter. The impact on the Department was minimised due to the security measures already in place. However, a review of ICT controls and countermeasures led to an expenditure of just under €1 million. The HSE incurred additional costs of €51 million in its immediate response to the attack, which impacted the delivery of services for a time, as colleagues will be aware.

The Department has continued to discharge its functions. We continued to invest in Sláintecare reforms, with over €7 million disbursed in support of over 123 projects through the Sláintecare integration fund, for example. We also support the Minister and the Ministers of State in their work, including their legislative priorities and their public and parliamentary accountability. For example, in 2021 the Department processed over 15,000 parliamentary questions, a significant increase on the number for 2020. I look forward to continuing our work, including with the committee. I am very happy to take any questions colleagues may have.