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

I do not accept the contention that the things set out in the HSE service plan will not be delivered. I think they will be because pretty much every year the level of activity has increased. At the same time, there is almost always a financial challenge during the year which we must work out and almost always it requires a Supplementary Estimate. It is hard to do it because the financial systems are so archaic and badly managed that it is March or April before we know how much the HSE spent in the previous year. That is atypical for public bodies. This goes on throughout the year and it would not be unusual to find a dramatic change in the estimated position from week to week; €100 million or €200 million can disappear or reappear in the space of a few weeks. That presents a real problem in planning. Last year there was a projected overrun in the primary care reimbursement service, PCRS, but it never materialised. However, another overrun by several hundred million euro appeared somewhere else. I would love the funding of the health service to be transparent and to know exactly where the money goes. We used to talk about money following the patient. I would like to be able to follow the money, but, unfortunately, we cannot do so. That is a big problem, one for which the Government takes responsibility.

The Public Service Pay Commission is examining the issue of pay for health care workers. It has been asked to examine the position for health care and Defence Forces staff first. In the meantime, public service pay restoration is well under way. Recruitment in the health service is now much easier than it was a year or two ago, which is encouraging. That is due, in part, to pay increasing again, but ironically it is also as a consequence of Brexit. Fewer overseas and EU workers are moving to the United Kingdom; they seem to be more willing to come here.

The European Health Consumer Index gives a mixed picture. It is poor on access. There is no point denying this, notwithstanding the fact that the numbers waiting for operations and procedures are falling, but they are not falling for outpatients. The index does point to good outcomes in some areas, which should be recognised. It gives us a green score based on the fact that Irish patients have access to novel drugs, as well as the cost of medicines. The Deputy will be aware that in Northern Ireland patients with cystic fibrosis do not have access to medicines such as Orkambi, but here patients do.

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