Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein) | Oireachtas source

Looking back over my notes on the Bill, I challenged a section of it on Committee Stage and feel equally strongly at this time about the matter.

It could be argued that this Bill is a technicality in so far as it seeks to create a single budget for the Department of Health and the Health Service Executive, as against the position heretofore where we had two separate Votes. That is, in essence, a technical matter but as I have said previously, the critical point is that there is adequate funding to provide a health service that is fit for purpose and capable of responding to the needs of people when those needs arise. Quite clearly the significant cuts in the provision for health services over recent years, amounting to some €4 billion by the end of this year, have carved out a critical level of resourcing from the health structures, both in terms of the capacity of the health service to cope with all cases presenting and very especially with regard to the numbers of people employed. It has already been signalled that some 2,600 whole-time equivalent posts are to go in this current year on top of the 12,500 which have gone since 2007, almost 6,000 of which were front-line nursing posts.

It is not so much a question of whether the Minister has a single allocation or two budgets but that he has provided adequately and properly. I am afraid that the facts demonstrate that this is not the case. That is not to say that money thrown at the system is the way to do business either. We need to get value for money and there must be, at all times, a responsible evaluation of the return from public investment in our health services. We already know that many areas of the health service are under enormous strain, not least the acute hospital network. Many hospital sites are finding it very difficult, if not virtually impossible, to cope on the reduced budgets of recent years, yet section 10 of this Bill seeks to introduce what I can only describe as a piling, year on year, of any failure - in the language of the Department - of the health service to manage its affairs within the stated budget, that is, the allocated sum in any given year. What this will mean, in essence, is that if the HSE is unable to manage the health care needs of the population in any given year, it will have to carry forward any overspend as a further reduction in the following year's allocation. This would continue, year on year. That will work its way down into acute hospital sites and all of the other areas of health care delivery until we end up in an absolutely impossible situation. This is very worrying.

On Committee Stage the Minister introduced what I described as the "fantasy notion" that the executive might actually have a surplus, having underspent and he suggested we would have to get the approval of the Minister for Public Expenditure and Reform for those moneys to be carried forward and added to the subsequent year's allocation. If only that could be, but it is most unlikely indeed. This is a very worrying aspect of this legislation. While I was not overly exercised about whether we had two separate budgets or one, as the case might be, when I examined the body of the Bill and saw what is actually entailed in section 10, it was a cause of great worry to me. I did not support it on Committee Stage and wish to record again that I will not be supporting it unless the Minister indicates, in response, his willingness to revisit that particular section.

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