Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

It is important that when we discuss health budgets we put all of these things into their rightful context. We have this year the largest budget for the HSE and the health sector in the history of the State, at approximately €15 billion, an increase of €2 billion a year in the past three years. It is increasing much faster than the population is growing or ageing. We are now one of the top five spenders on health in the world, if we divide the health budget by the number of citizens in the State, notwithstanding the fact we have a young population. Even during the recession, our health spending per capitawas above average, so this idea we are only catching up on underspending during the recession does not support the facts.

The fundamental problem and crisis that affects our health service, in my view, is not solely lack of money or lack of resources. It is much more about how money is spent and how resources are deployed, and monetising all problems does not actually bring us any closer to a solution. There will, of course, be more money and more staff for the health service this year. We already have record numbers of doctors, almost 10,000, working in our public health service. In terms of nurses per patient per head per bed, we are very near the top of the league table. However, those extra staff and extra beds, and all of the extra money, will not make a difference unless we have better management, proper clinical leadership, real accountability and proper responsibility from those charged with running and managing our health service. I absolutely accept it is the Government's responsibility to make all of this happen.

If we take the entire spend of the entire Government, we spend approximately €60 billion a year. In a sustainable way, the most any responsible Government can increase spending is by approximately 4% or 5% a year. Anything more than this is unsustainable and we would be heading into another crisis quite soon. The most we can increase spending is by €2 billion or €3 billion a year. If we take all Government Departments and agencies together, they requested an extra €12 billion this year. Anyone will understand this is not sustainable. It is the normal process in the course of events for Departments and State agencies to request much more than they anticipate they will achieve from the Estimates process.

What is unique about the HSE is it estimates it needs €1.5 billion extra every year, that is an extra 10%, to do nothing to improve patient outcomes. That is not sustainable. If we are going to turn around our health service and make reforms and changes, and if we have any prospect of implementing reports such as the Sláintecare report, the starting point cannot be a 10% increase in the budget, an extra €1.5 billion a year, to do nothing in terms of improving outcomes for patients, improving patient experience or improving patient care. It is not credible or sustainable, and I accept it needs to change, because we cannot have this continual exchange of letters where all problems are monetised and then just passed on. We will need a lot of changes and a lot more accountability, and that will be driven by the Government.

See this speech in context