Mary Harney (Dublin Mid West, Progressive Democrats)

Our democratic system means that, fundamentally, there is no public spending decision without a tax decision. The two cannot, and should not, be separated. That is why both expenditure Votes and taxes are set by the Oireachtas annually around the same time, and both have to be adhered to. The Oireachtas has voted a budget for the HSE for 2008 from resources provided by taxpayers. Excluding the long-stay repayment scheme, the gross current amount is €14.2 billion which equates to approximately €3,380 for every person in the country or €9,732 for every income taxpayer. This amount is more than a quarter of voted Government current expenditure. It is almost the equivalent of total estimated income tax receipts. This allocation is an increase of 8% on the 2007 outturn of the HSE. By any national or international standard, that is a high level of increase for a national health service. Few other countries maintain such levels of increases year after year. The OECD reported yesterday our rate of increase in public health spending was the second highest in the developed world between 1995 and 2005. Many people say recent levels of annual increases are unsustainable.

No health system in the world operates without implicit or explicit budget limits and benefit limits. It is also the case that every health system, including our own, needs to deliver the most effective services for given resources and to constantly improve, that is, to make value for money and efficiency gains. The HSE has incorporated value for money targets within its service plan. Those who support increased efficiency in public services will fully understand and support the fact that a 1% increase in efficiency for the HSE means, in financial terms, providing the same level of services at a cost of €142 million less; a 2% efficiency gain means providing the same level of services at a cost of €280 million less.

Additional information not given on the floor of the House.

The services and targets to be provided by the HSE in 2008 are set out in the national service plan, which I approved in November 2007 and the addendum to the service plan which I approved in February 2008. Both of these documents have been laid before this House and published. In its Exchequer issues return to end April, the HSE is reporting an overspend against profile of €95 million, excluding the long-stay repayments scheme. I have had discussions recently with the chairman and CEO of the HSE about these emerging budget pressures. The imperative for efficiency gains and more effective practices is all the greater to deliver services, consistent with Government priorities, and within the annual budget allocated by the Oireachtas and the profile of expenditure planned for each month. The HSE is considering the steps it should take in this regard. When I receive the HSE's proposals in this regard, I will report to Government as part of the normal expenditure management process.

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