Micheál Martin (Cork South Central, Fianna Fail) | Oireachtas source

The Taoiseach will be aware that the Minister for Finance has explicitly ruled out the possibility of any Supplementary Estimate for the Department of Health later this year but, in contrast, when pressed by Deputy Donnelly on this matter, the Minister for Health refused to rule out seeking a Supplementary Estimate. The Taoiseach might be able to explain the contradiction between the two Ministers in that regard. The Taoiseach might be able to indicate what he believes the full year outcome will be in relation to the health Estimate. Does the Taoiseach also believe that there will be no question of a Supplementary Estimate being required? He might clarify that for me.

I note that up to 2012 the HSE demonstrated a strong ability to deliver within budget but that changed due to a new political approach to service plans introduced by the Cabinet. The Irish Fiscal Advisory Council has said that ministerial and governmental decisions in demanding services but not providing the funding at the start of the year have directly added to the end of year Supplementary Estimates - in other words, at the beginning of the budget year every year the Government knew full well that what was provided for in the service plan could not have been met by the Estimate that was provided and that there would inevitably be a Supplementary Estimate. That has been an issue for quite a number of years. Does the Taoiseach accept this, or is that another recommendation of the Irish Fiscal Advisory Council which the Taoiseach will ignore?

I put it to the Taoiseach that whereas he talked about Sláintecare and some of the issues around thresholds, etc., that are doable, at the essence of the health service at the operational level are fundamental difficulties with access to the health service as manifested in overcrowding in accident and emergency departments and excessive deaths as a result. Much of that is contributed to by the deficiencies in step-down facilities, nursing home beds, rehabilitation beds and facilities, and facilitating efficient discharge from acute hospitals. In my view, the demographic realities of health have not been provided for in recent times. As a people, we are living longer. That is a good development but the numbers of people who attend the services, particularly emergency departments, for example, those over 65 years of age, is quite significant. The issue around care of the elderly, be it home care packages or, as I said, the various facilities required once discharge takes place, have not been provided for in budgetary terms by the Government and have been fudged year after year. Does the Taoiseach accept that basic proposition that the Government has not met the challenges arising out of demographic changes in terms of the health service?

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