Mr. Ciar?n Devane:

Heavily, I think. It is a topic at every single board meeting on both the financial side and the recruitment side. To give some context, we increased the headcount of the HSE last year by roughly 6,000, but, of course, another 10,000 people have to be recruited to replace those who retire and move on to other careers. We were trying to land on 16,000 but landed on roughly 17,000. I would not use the phrase “recruitment embargo”, although I know exactly what the Senator means. Part of what we were doing was saying you cannot recruit if you do not know where the money is coming from. It is a case of ensuring clear lines of sight between the roles that are approved and the roles that are delivered.

One of the things that caught us out – there is a combination – was that fewer left than we had anticipated. We had been expecting 11,000 people to leave, which would have been consistent with previous years, but fewer did. That caught us out partly. What also caught us out was people being recruited to roles that were approved from a clinical point of view but that had no money allocated for them. This is one of the areas where we would all say more grip is needed going forward. The REOs are under no illusion that they are accountable for bringing the numbers in where everybody thinks they should be landing.

On the wider point, there is a debate every single year between us, the Department of Health and the Department of Public Expenditure, National Development Plan Delivery and Reform on where the demand will land. The deficit in any year is made up of three things. The first of these is demand. There are always debates about whether it will be here or there, and it always ends up at the high end. The second is inflation, which is unfunded. That adds to it. The third concerns the mitigations we can put in place to bring the numbers down. The numbers we have been talking about since October and the higher demand, with 10% more people turning up at A and E departments and so on, will drive activity, and that will drive costs.