Stephen Donnelly (Wicklow, Fianna Fail)
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I thank the Deputy. The two big areas of underspend which we have shown in the document circulated to the committee are those the Chair and I have just discussed. They relate to the chief clinical officer and national support services. They are not really underspends. That is to the Chair's point. We call them underspends but, in fact, they are lump sums that are transferred across and, within the HSE, are released out to the service lines, such as hospitals, the cancer control programme and the national women and infants programme, as they roll out new services and hire new people. The big chunky amounts, which are in here as overspends, are, in fairness, not really underspends. Those are sums that gets released throughout the year, but there are individual service lines where that might be the case. In terms of the total HSE amount, that is then netted off overspends in terms of the money that the Oireachtas votes to the HSE.

Moving slightly away from the Deputy's question, we have obviously got a big focus now on productivity and cost containment. My preference is that where they can find savings, they should be able to reinvest the moneys locally. A quick example I will give the Deputy relates to the medicines budget. We started the latter for this year and are continuing it into next year. What we said to the various groups, Professor Barry and the others who are involved in that, is that any money saved can be reinvested in new medicines. In that context, they have aggressively gone after biosimilars and generics. They are well ahead of target for this year, and that money is beings reinvested. My view is that if an individual hospital can roll out a productivity programme and get better at cost containment in the context of its various spends within reason - it might not always be the case - it should have some ownership of the moneys saved and should be able to reinvest them locally. This lines up the incentives in a way that works.