Billy Kelleher (Cork North Central, Fianna Fail)
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4. To ask the Minister for Health if he will provide an update on the financial position of the Health Service Executive; his views on whether the executive has sufficient funding to deliver its 2015 service plan without recourse to a Supplementary Estimate; and if he will make a statement on the matter. [8306/15]

Billy Kelleher (Cork North Central, Fianna Fail)
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I am requesting an update on the HSE's financial position and asking whether the Minister is confident that the HSE has sufficient funding to deliver its 2015 service plan without recourse to a Supplementary Estimate.

Leo Varadkar (Dublin West, Fine Gael)
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The gross provision for the health Vote in 2015 is €12.677 billion, comprising €12.295 billion in current expenditure and €382 million in capital expenditure. Following restatement on a like-for-like basis consistent with the new Vote structure, the Exchequer funding provided in 2015 represents an increase of €564 million on the original 2014 provision. In addition to the Exchequer funding, increased non-Vote income of €130 million collected by the HSE will support expenditure in 2015. This contributes to a total increase of €694 million compared to the original 2014 Estimate. Savings of at least €130 million have also been identified, and this will be retained within the HSE to support services.

When adjusted for one-off issues, the January 2015 net Vote position is €16 million, or 1.3%, greater than the January 2014 position month-on-month. The 2015 net Estimate, compared on a like-for-like basis with the original 2014 net Estimate, is 4% higher, indicating that the January cash drawdown is not out of line with the available provision.

The Irish health services endured a seven-year period of significant retrenchment and funding constraint as a direct consequence of the financial crisis the Irish State had to address in the period 2008 to 2014. Improved 2015 budgetary parameters have allowed the HSE service plan to include a number of targeted enhancements to health and social care services, while providing generally for the delivery of existing levels of service. The 2015 HSE service plan represents a welcome turn of the tide in terms of the increased level of funding available.

In a welcome new development, any further savings that can be achieved over and above the target set in the national service plan will go back into the delivery of improved health and social care services.

It is not possible to address all of the issues and priorities in one year, and the operation of health services in 2015 will continue to demand very careful financial management. Nevertheless, we have made significant progress in putting the finances of the health system on a steadier and more sustainable path.

Billy Kelleher (Cork North Central, Fianna Fail)
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The Minister said his first aim was to draw up a realistic budget in the context of last year's Estimates and on the basis of negotiations with his Cabinet colleagues, the Minister for Finance and the Minister for Public Expenditure and Reform. Already, however, on 24 February, it is clear we do not have a realistic budget. The Minister repeatedly tells us things will get worse before they get better, which is an obvious statement of fact. We have huge problems with overcrowding in emergency departments throughout the country and a consistent problem with delayed discharges. We can already see that the fair deal funding for this year is wholly inadequate. We knew that already because Mr. Tony O'Brien, director general of the Health Service Executive, told us so at a recent Oireachtas committee hearing. The Minister must give his colleague, the Minister of State, Deputy Kathleen Lynch, additional funding for that scheme. The money must be found somewhere.

Pretending we have a realistic budget will not do. It is entirely unrealistic to claim the services can be delivered on the basis of the funding the Minister has set out. We are already, at this early stage in the year, in a situation where the health services are beginning to dismantle before our eyes.

Leo Varadkar (Dublin West, Fine Gael)
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We have a realistic budget in place. The Vote for 2015 represents the first increase in funding in seven years and a greater increase than was proposed by the Deputy's party in its alternative budget submission last November. The figures we have for January show spending is in line with projections. In other words, there is no evidence at this stage of any significant overspend. There are, of course, issues with delayed discharges. That figure is down since the start of the year but it remains a problem. We also have difficulties with waiting times and overcrowding in emergency departments. We need additional resources for the fair deal scheme, home care packages and home help provision.

As the Minister of State, Deputy Kathleen Lynch, and Mr. Tony O'Brien have outlined, there are three options for achieving these objectives. We could opt to reprioritise spending within the health Vote or we could bring forward a spending plan later in the year. The third option, pretending the problem will somehow go away in the summer, is not really an option. That is a total nonsense and fewer and fewer people believe it. When it comes to a decision on the three options, it is not one I can make on my own; it must be done in conjunction with the Cabinet committee on health and the Economic Management Council. All members of the Cabinet committee and the EMC are fully apprised of the situation and have been since November.

Billy Kelleher (Cork North Central, Fianna Fail)
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The Minister's response does not give us much comfort. He says we have a realistic budget which is on course and on target. If that is so, then my concern is that the Minister is saying that having 550 people on trolleys in emergency departments on a daily basis and people waiting 12 and 14 weeks for a bed under the fair deal scheme is acceptable. Surely these numbers do not represent a budget that is on target? In truth, it is a wholly inadequate service and the idea that it might get a little better at some stage and we should proceed on a wing and a prayer is not good enough.

There must be a sustained attempt to address the fundamental problems in our health service, including emergency department overcrowding. We must tackle delayed discharges if we are to address that issue, as acknowledged by the Minister and by the former national director of acute hospitals, Dr. Tony O'Connell, who resigned at the start of the year. The latter warned of the threats to patient safety as a consequence of overcrowding. The trundling acceptance that there is a difficulty without actually dealing with it is the major problem. The time for lethargy is past and we must now have a redoubling of effort.

Leo Varadkar (Dublin West, Fine Gael)
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At 8 a.m. this morning there were approximately 420 patients on trolleys across 28 acute hospitals. That number will fall dramatically during the day, as it always does, probably by half. Of course, it is still not acceptable that anybody should be on a trolley for more than nine hours. What was in Dr. Tony O'Connell's letter, which was not addressed to me but to others in the HSE, was nothing new. It is absolutely the case that older people who are in hospital longer than they have to be because they are waiting on a nursing home bed or home care package are at risk of falls, medication errors and infection. In addition, the fact they are not being discharged certainly does delay treatment for others, who are then put at risk. There is nothing new in what Mr. O'Connell pointed out in his letter. It is something that could be said about our health service for as long as I can remember, certainly going back to when I was a medical student.

We are taking action to alleviate the situation and that is why the number of delayed discharges has gone down and the number on trolleys is going down slightly week on week. It is one of the reasons the wait time for the fair deal scheme has gone down. I agree with the Deputy that it is necessary for us to press on with that, redouble our efforts and keep chipping away at the problem throughout the year. There are three options as to how we proceed, as I indicated, and a decision in that regard requires the approval of the EMC and the Cabinet committee on health.