Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I thank Deputy Donnelly for the question. A number of areas within the HSE are contributing to the overspend in 2018. These include higher payouts under the State Claims Agency, a shortfall in private patient income, a higher level of spend in the acute and disability services sectors and, for example, the additional costs associated with Storm Emma, which amounted to about €40 million. The overspend in services is driven by the non-achievement of planned savings, higher levels and higher complexity of demand, costs associated with meeting national regulatory standards in the disability sector and the need for additional emergency placements for children and young people with disabilities. Finally and importantly, an amount of €280 million was provided in the 2018 Revised Estimates for appropriations-in-aid receipts from the UK in respect of healthcare provided under EU regulations. These receipts are now estimated at €225 million, leaving a shortfall of €55 million against the provision.

The HSE advises that the savings projected to be achieved by year end under the value improvement programme will be in the region of €80 million. The introduction of a savings programme into the HSE's 2018 national service plan reflects the commitment we must have in the health service to achieve greater value and efficiency across the totality of resources at its disposal. With major increases in public funding for our health services in recent years to a level which compares favourably with spending in other countries, it is important that the scope to develop services through the improved management of existing resources also receives ongoing attention.

In presenting its 2018 national service plan in late 2017, the HSE conveyed its view of what it saw as the significant financial challenge of implementing the plan within the allocated budget for 2018. This was not a secret; it was published on pages 2 and 3 of the national service plan. In response, I confirmed to the HSE that the plan was to be framed having regard to the funding available. The health sector was but one of several priority areas competing for additional funding in 2018 from the fiscal space available to the Government. I pointed out that over €600 million in additional funding was provided for the health sector in the 2018 budget and that the HSE’s allocation had increased by approximately 20% since 2015, or by an average of 6.6% per annum, which is ahead of both the programme for Government and the confidence and supply agreement level of increase. Taking the significant 2018 and prior year allocations into account, it is clear that issues of budgetary performance need to be addressed in certain areas and that the HSE should discharge its accountability in this regard under the performance and accountability framework.

Additional information not given on the floor of the House

As part of the monthly performance cycle, my Department holds the HSE to account for its expenditure and for the delivery of the services set out in the national service plan. Performance in respect of service delivery and finance is monitored monthly and, where services are experiencing significant performance issues, the HSE is required to submit an escalation report. Finally, the Government is committed to a significant programme of legislative and managerial reform to improve performance and accountability in the HSE. This includes the Health Service Executive (Governance) Bill 2018, which is currently before the Oireachtas. This legislation will establish an independent board governance structure for the HSE, and as one of its functions will support the chief executive officer and HSE executive team in developing a more effective performance management and accountability system.

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