Stephen Donnelly (Wicklow, Independent)
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5. To ask the Minister for Public Expenditure and Reform if his Department has commissioned independent analysis on potential savings in the Irish health system since March 2011; if so, whether this analysis is available; if no independent analysis on potential savings has been undertaken whether he will consider commissioning such analysis; and if he will make a statement on the matter. [29667/14]

Stephen Donnelly (Wicklow, Independent)
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This question pertains to health care, in which the Department of Public Expenditure and Reform has become more involved. It really is an attempt to solve something that has puzzled me for many years. Members are aware there have been significant cuts in health care that have come at great pain to many people. While Ireland's health care expenditure per capitais approximately halfway up the OECD tables, we have one of the youngest populations and research by the National Competitiveness Council shows that when one adjusts for that young population, Ireland has the second-highest health care spend per capitain the OECD, next to the United States. However, as everyone is aware, Ireland's health care outcomes are not second highest. Consequently, in spite of all the pain that has been felt in trying to get on top of the health care budget, Ireland still is spending more per capita, when one adjusts for the young population, than anybody except the United States but is not getting the health care outcomes. There is plenty of external analysis from the OECD and others to suggest that a changed model of health care provision and expenditure could save billions, while improving the level of service delivery. My question is whether the Minister has commissioned an independent report that has gone into the wiring of the Health Service Executive, HSE, to ascertain whether things could be done fundamentally differently.

Brendan Howlin (Wexford, Labour)
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I have not commissioned any independent analysis on potential savings in the health sector since March 2011. That would be a matter for the Minister for Health, as the Government has line Departments with line Ministers responsible for their own areas. In terms of analysis, a comprehensive review of expenditure was carried out during 2011 and was published in December 2011 in conjunction with the 2012 budget. In my budget speech in October 2013, I announced a second comprehensive review of expenditure, the objective of which will be for each Minister and each Department to examine and propose measures that will contribute to the overall expenditure target set out by the Government for each of the next three years. This review also will expand on the existing analysis carried out by Departments and my Department since 2011. The Department of Public Expenditure and Reform will co-ordinate the review process and will produce the final comprehensive report alongside the budget documents for next year. In addition, a separate review of capital expenditure is under way that will set out the capital envelope for the next five years.

In January 2014, I published the Government's second Public Service Reform Plan 2014-2016. This sets out, at a high level, the key priorities and objectives in the main public services, including health. As set out in the reform plan, there are significant and administrative reforms such as usage of additional hours, as well as areas of reform of overtime pay, premium pay and all the rest.

On health expenditure, I note that at present there almost is a given that health expenditure is being reduced greatly. Consequently, I should tell the Deputy that in the budgets introduced by the Government since 2011, the money given to the HSE has not fallen. There is a general commentary about expenditure cuts but the facts are different. Net expenditure from 2011 to 2013 for the HSE has increased by €72 million, not reduced. Total non-pay funding given to the HSE has increased by €407 million, not reduced and I can provide the hospital details to the Deputy as well. Consequently, the Deputy is correct that the Government needs to drill down to make sure it gets value for the enormous effort it has made to maintain expenditure in the health area.

Stephen Donnelly (Wicklow, Independent)
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I thank the Minister for his reply. I would love to get those figures, as the numbers I received from the Government show a fall from approximately €16 billion to approximately €13 billion for this year but perhaps I can get the numbers at which the Minister was looking. I have looked at the comprehensive review of expenditure, which in the first instance is an internal document, that is, it is the HSE trying to fix itself from a health expenditure perspective, which-----

Brendan Howlin (Wexford, Labour)
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It has the knowledge.

Stephen Donnelly (Wicklow, Independent)
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Actually, I do not believe the HSE has the knowledge. I believe that what it has been asked to do and has tried to do is to make incremental savings, namely, to cut a bit here and there and to try to be a bit more efficient here and there. However, I do not believe the HSE has the knowledge to examine the current health care system and conclude that the manner in which health care in Ireland is delivered - which is a hospital-based system rather than a community-based system - is not the best for the patient and costs far more money than it needs to do. The Minister stated that his Department has not commissioned any report. He might know, because it is relevant to public expenditure, whether an external report has been commissioned that examines both health care delivery in Ireland and the HSE and concludes that in fact, a shed load of money can be saved by, for example, moving from acute to community-based care, while at the same time improving health care outcomes for the patient. I believe this would be a great opportunity and even if the Department of Public Expenditure and Reform has not done so, is the Minister aware of any report of this kind? If not, does the Minister think there might be a great opportunity to commission one?

Brendan Howlin (Wexford, Labour)
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Most of these questions would be more appropriately directed to the Minister for Health, because an enormous reform agenda is under way. This is because the structure that was put in place, which basically built the superstructure of the HSE on top of the old health boards, simply has not worked and has been extraordinarily top-heavy and to disentangle it involves a huge body of work. Were the Deputy to ask me for my personal view, there is an enormous amount of focus on structural change and the Deputy has suggested further structural change. However, I believe we must do what we were doing particularly well. There is a move from acute care to a greater focus on primary care and the Government is providing the resources for that. However, I will provide specific figures to the Deputy and might forward them to him in writing, rather than expecting him to take them down now. For clarity, total HSE expenditure fell by €19 million between 2011 and 2013. In 2011, it was €13.903 billion and at the end of 2013, it was €13.884 billion.

Stephen Donnelly (Wicklow, Independent)
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I thank the Minister. As I see it, having worked in health care abroad, there is an opportunity here. I have asked some of the most senior people in the HSE to show me the plan or document that sets out how health care delivery should be with regard to primary care centres, community-based teams, home care, respite care and all that good stuff, that sets out what it looks like today, which is an acute-based model, and which sets out how the transition will be made from the model that obtains today to the model we need. That document and thinking have not been done. While primary care centres are opening, which is welcome, and while some valuable things are being done, I put it to the Minister that there is an enormous opportunity for the country for someone to come along - such as the Minister alone or in conjunction with the Minister for Health because this is both a health care and an expenditure issue - to acknowledge we do not have a whole-Ireland strategic view. This was done in Northern Ireland three or four years ago, which now has a strategy that states this is what its desired health care system looks like and this is how it will get there. We do not have one of those and as a final point, I suggest the Minister might consult with the Minister for Health, because I believe this issue crosses both Departments, to ascertain whether experts should be brought in and whether that sort of strategic planning and thinking should be put together.

Brendan Howlin (Wexford, Labour)
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All these questions are appropriate for the Minister for Health and not for me. While I obviously must mind the money and make sure the Government gets value for money, specific policy issues regarding the Department of Health come to the Government from the Minister for Health. However, there is a Cabinet sub-committee on health at which these matters are thrashed out clearly. There is a strategic view and plan and the Government is moving from over-dependence on acute hospital provision to the development of effective primary care provision. However, all these matters can be spelt out by the Minister for Health and the best way to so do probably is at a committee, where one has time to interact and bring along officials from both the HSE and the Department of Health for the discussion.