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

The HSE is overrunning its budget once again, as has been the case in almost every year that I have been in the Dáil, which is ten or 11 years at this stage. That is notwithstanding a substantial increase in the health budget, amounting to some €1.7 billion a year, since 2013. We are now spending more per head than almost any country in the world, and we have been spending more than the OECD average per head for 20 years now, including during the recession period. It should be obvious that the problems in our health service, which are real, are much deeper than finance and staffing numbers. Looking at nursing numbers, OECD statistics show that we have among the highest number of nurses per head and per bed in the world. However, nurses here are not deployed in the way they should be. Nurses spend too much time doing non-nursing tasks that could be done by people who have other qualifications and who do not have to be as highly qualified as are our nurses to do those jobs. There are major structural problems in our health service which have not been solved by extra staff and extra resources in the past number of years. We need to move on from that to much deeper levels of reform.

The Deputy is correct that agency spending is very high. However, in the broader context it must be noted that it counts for approximately 2% of the health budget as a whole. When one considers that payroll takes up approximately half of the health service budget, roughly 4% of the payroll budget is accounted for by agency staff. For every 25 people working in our health service it is likely that one is an agency worker. I contend that if one went into other workplaces, such as big companies, public bodies and perhaps even media organisations and saw 25 people working, there is a good chance that one of those 25 is working with an agency or is working on a temporary basis. That happens for many different reasons, including maternity leave cover, cover for temporary absences or extra staff taken on during periods when capacity has to be increased as part of a core-flex arrangement. In our health service there are many doctors who are no longer willing to commit to long-term careers in smaller hospitals. Those doctors want to work in big hospitals, where there are opportunities to do research and other things. That is a structural change we are just going to have to face up to in our health service in the future.

The Government has made many changes in this area. We have negotiated a new pay deal with public servants, including doctors, nurses, support staff, healthcare assistants and therapists, to restore pay. Pay restoration is well under way. There will be two pay increases this year, and another two next year, for all of our healthcare staff. We are also engaging with the unions on two other issues, namely, recruitment and retention of doctors and nurses and the two different pay scales for those who came into the public service after 2011 and 2012. As is always the case, the Government has to put the interests of patients and taxpayers first, which means ensuring that we do not deploy or spend more taxpayers' money than is necessary, as well as ensuring that any increase in the payroll bill actually results in better patient care and that the money goes to the patient and not just to the employee.

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