Billy Kelleher (Cork North Central, Fianna Fail)
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Question 41: To ask the Minister for Health if he will provide an update on the crisis that a number of hospitals face in their budgets this year; the actions he will take to address the expected €320m overrun; and if he will make a statement on the matter. [33231/11]

James Reilly (Dublin North, Fine Gael)
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The figure of €320 million to which the Deputy refers is the overall projected overrun in the HSE Vote. The latest Vote data have reduced this forecast to €300 million. The HSE was required to make gross savings of €962 million in its national service plan this year. The plan which was approved in December 2010 requires the HSE to operate within the limits of its Voted allocation and has been framed to deliver service levels in 2011 broadly in line with 2010 levels, while reducing the cost of providing services.

In the acute hospital sector a significant variation in productivity between hospitals was identified, particularly in day case rates, same day admissions and length of stay. All hospitals have been advised that they must operate within their allocated budgets and meet the service level activity targets they agreed for 2011. It has been made clear that those hospitals which fail will face consequences.

Despite the fact that the hospital sector has managed to deliver some reductions in its cost base during the first nine months of the year, at the end of September there was an accumulated deficit of €145.6 million in hospitals. While some hospitals are on target to break even, having managed the reductions in their budgets, the deficit in the hospital sector grew again in September by €3 million. Although the rate of growth has slowed, demonstrating that the sector is now operating within a much more sustainable level of expenditure, there is still a significant deficit which falls to be addressed. The HSE is implementing measures to address its overall deficit, including measures to ensure that hospital activity levels, which are running over target in many cases, are brought back in line with the national service plan targets, and accelerating the collection of outstanding income due in respect of the treatment of private patients. I am on record as saying that every individual agency has responsibility for managing its budget and must take all necessary measures to stay within budget while delivering its planned level of service. Under its reform programme the Government has committed to achieving greater efficiency in patient care and service delivery. These efficiencies will not be easy to achieve but I am certain that over time they will help to ensure that more people get access to services within the resources available.

As the Deputy is aware, I established the special delivery unit earlier this year with the objective of addressing the obstacles that prevent patients being seen and treated quickly. In order to address the problems in emergency units, to date €2.3 million has been committed to 15 hospitals which represent 80% of trolley waits. Funding is approved on the strict understanding that it will be released only where the specific performance measures and specified conditions have been met, including the requirement that no patient will wait more than 23 hours in an emergency department.

In respect of the broader financial issues in the hospital sector, the HSE continues to work closely with all hospitals to ensure the service impact of cost containment is kept to a minimum and to ensure patient safety remains at the core of all decision making.

Billy Kelleher (Cork North Central, Fianna Fail)
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The fundamental issue is who is in charge of the health services. E-mails sent from Cathal Magee, the CEO of the HSE, to Michael Scanlan, the Secretary General of the Department of Health, state there is confusion and uncertainty about the governance of the system with regard to whether it is the Minister's advisers, the HSE, the Department of Health or the Minister who is in charge. There has been a substantial drift in dealing with the budgetary issues we now face. Decisions have not been made in recent months, other than on the PR exercises such as the special delivery units and the sacking of the board.

The substance of the issue is the clear problem with governance of the Health Service Executive because it does not know who are its masters. Is it the Minister's advisers, the Minister, the Secretary General or the board? Some of the e-mails being sent to and fro are quite disturbing because they deal with the very heart of the provision and delivery of health services. If there are to be changes in governance in the meantime, hospitals, hospital managers and HSE staff are unsure as to who is running the health services.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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May I ask the Minister to respond?

Billy Kelleher (Cork North Central, Fianna Fail)
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Will the Minister tell the House who is ultimately responsible?

James Reilly (Dublin North, Fine Gael)
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I made it very clear that I would be a far more hands-on Minister than my predecessor. The budgetary problems to which the Deputy alluded exist for the obvious reason I mentioned, namely, the performance of the Deputy's Government. Notwithstanding this, there is good news. Ultimate the buck stops with me; that is what I stated I would do and the Secretary General and the HSE report in. The board that was in place is gone and the current board will be gone by the end of this year. There will be a new plan for the supra-structure of the HSE until we come to the final solution later next year, hopefully by June.

Billy Kelleher (Cork North Central, Fianna Fail)
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The final solution.

Michael Healy-Rae (Kerry South, Independent)
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That is a bad phrase.

Billy Kelleher (Cork North Central, Fianna Fail)
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It rings a bell.

James Reilly (Dublin North, Fine Gael)
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Excuse me. I did not interrupt the Deputy. Perhaps he would like to hear some good news for the people of Cork and Cork University Hospital in particular. It has introduced new theatre practices, and their use in only five theatres, which is only 5% of all theatres in the country, has already yielded considerable savings. It uses its medical admissions unit in such a way that one quarter of patients who otherwise would have been admitted have been treated and sent home. This has resulted in approximately 22,000 bed days being saved. The savings are considerable and once it is spread throughout the system we will see even greater savings. We will seek to continue to transpose these good practices throughout the system. The failure in the past was that where excellence in care or process was identified it was not transposed throughout the rest of the system.