Billy Kelleher (Cork North Central, Fianna Fail)
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1. To ask the Minister for Health the contingency plans his Department is putting in place in the event of a health budget overrun in 2016; and if he will make a statement on the matter. [36796/15]

Billy Kelleher (Cork North Central, Fianna Fail)
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What contingency plans are being put in place by the Minister for Health in the event of an overrun in the health budget in 2016 and will he make a statement on the matter? This leads from the point that next year there will be different fiscal rules applicable to Departments in the context of supplementary budgets. This year the Minister for Health has a €600 million budget deficit. Other than a sum of €280 million, no additional funding was allocated to the Minister for 2016 in last week's budget. The health service will be commencing 2016 under-resourced and underfunded. What contingency plans is the Minister putting in place in view of the fact that, as we know, he will have insufficient funding for the health services in 2016?

Leo Varadkar (Dublin West, Fine Gael)
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Since my appointment as Minister for Health, I have sought to put in place a realistic budget for health and social care. Improved budgetary parameters reflecting the growing strength of the economy have enabled me to secure additional funds for health and social care in 2015 and 2016. The gross current Estimate for the health sector for 2016 is €13.175 billion, an increase of €880 million on the Revised Estimate for 2015. In addition, potential savings of €125 million will be available to reinvest in maintaining and improving health services. While I welcome the increase in funding for the health services in 2016, I do not underestimate the challenges involved in the delivery of safe and efficient health services against a backdrop of growing needs. It is essential that we continue to focus on cost containment, productivity and efficiencies as there continues to be major cost pressures on the health service due to an increase in our aging population, the incidence of chronic conditions and the cost of new and expensive medicines, treatments and technologies.

I also recognise the need to strengthen accountability and good governance across the health service. The HSE has an accountability framework which makes explicit the responsibilities of all managers to achieve the performance targets set out in each year's service plan. Where areas of underperformance are identified, the matter is escalated according to an escalation and intervention process. The HSE’s 2016 national service plan will detail how the executive intends to develop and build on the accountability framework in 2016 to further enhance and strengthen accountability arrangements next year. The HSE will also engage in internal efforts to maximise savings and opportunities for cost containment and ensure that additional measures are identified and safely implemented to mitigate any projected deficits.

My Department will continue to work closely with the HSE to ensure that the greatest degree of budgetary control is exercised. Ongoing and intensive engagement each month between officials of my Department, the Department of Public Expenditure and Reform and the HSE, in the context of regular monitoring of expenditure, will continue to be enhanced as required in 2016.

New EU fiscal rules limit the amount of Government expenditure in any year. Therefore, any overruns need to be funded by new revenue measures, or reallocating funds from elsewhere. This is likely to mean, in practice, reduced scope to allocate additional money to Departments by way of a Supplementary Estimate at year end. Accordingly, the planning and management of health expenditure will be subject to particular attention in finalising the 2016 national service plan.

Billy Kelleher (Cork North Central, Fianna Fail)
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Straight away, the abdication of responsibility continues, because the Minister is saying his Department will work closely with the HSE. The bottom line is that it is the Minister who will present the Estimates and who is charged with seeking enough funding for the HSE national service plan that will be published in early 2016. The bottom line, to date, is that the Minister has said one of his overarching goals was to achieve a realistic budget for the health services. There is a €600 million hole in the budget for this year. That is hardly realistic. That is a massive deficit by any stretch of the imagination. It was foretold this time last year when everybody effectively said the Minister did not have enough money to run the health services in 2015. Form would indicate that what he has been allocated this year for next year simply is not a credible starting point. Therefore, he will have huge difficulties this time next year in trying to ensure he has enough money to maintain basic health services, bearing in mind the huge pressures on the health service at the moment.

Michael Kitt (Galway East, Fianna Fail)
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I thank the Deputy.

Billy Kelleher (Cork North Central, Fianna Fail)
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There are massive waiting lists, overcrowding in emergency departments and a lack of capital investment across many of our hospitals, so there are huge problems out there and the demographics on top of that. We already know we do not have enough.

Leo Varadkar (Dublin West, Fine Gael)
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I am not sure that in health there will ever be enough money to do everything one would like to do, but we have a very substantial budget and there should be enough to maintain the existing level of service and improve it in some instances. To clarify, the €600 million Supplementary Estimate this year does not fill a hole. The Minister of State, Deputy Kathleen Lynch, and I sought much of that money during the year to make particular policy decisions, including more community beds, more hospital beds, a reduction of the Fair Deal waiting list to four weeks, and the provision of GP care to everyone under six years and everyone over 70 years. I would not like people to be under the misapprehension that all of that is somehow an overrun. It is not. Policy decisions were made during the year, supported by Government, to do more than we had planned to do at the start of the year. In respect of the €600 million being carried over into next year, that is not all recurring expenses; some of it involves one-off payments that will not recur next year. For example, the symphysiotomy payments scheme would be part of that. Not all the €600 million has to be paid again next year.

Michael Kitt (Galway East, Fianna Fail)
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I thank the Minister.

Leo Varadkar (Dublin West, Fine Gael)
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There is the additional €280 million and the €125 million in savings. In the budget proposal from the party opposite, it proposed an additional €380 million for health but did not make any provision for the Lansdowne Road agreement. Assuming the party opposite does not intend to renege on that, it is providing €280 million, which is pretty much the same as we have provided, so obviously it must believe it is adequate.

Billy Kelleher (Cork North Central, Fianna Fail)
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The difficulty with all of this is that, as we stand here today raising issues and asking Dáil questions, there is overcrowding in emergency departments across the country and massive waiting lists. The Minister has changed the targets for inpatient and outpatient appointments to 18 months. There are cancellations on a continued basis for elective surgeries. Right across the health service there is huge pressure, which is having an impact on the quality of life of patients and putting the workforce under extreme and inordinate pressure. Last year, for example, the Minister said he would have €300 million in non-Exchequer income, but he will not have that income next year. That is not continuing income; much of it was one-off funding. Irrespective of what way the Minister wishes to put it, he will have a deficit this time next year again. If not, it will mean that services will have been cut back to remain within budget. The Minister should confront that reality now and accept that the budget for 2016 is unrealistic and simply will not sustain the health services of today, which are under-resourced and under-funded.

Leo Varadkar (Dublin West, Fine Gael)
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Almost entirely, the one-off income requirements are provided for. If the Deputy wishes to add €270 million to the €600 million and to the €280 million he can. We actually managed to have the one-off payments resolved this year. If one adds up the figures, they amount to more than €1 million. Elective surgery is cancelled more frequently than we would wish, but the cancellation rate is 1%. I pointed to the pre-budget submission from the Deputy's party which provides for an extra €380 million for health and, perhaps, knocking €100 million off that for the Lansdowne Road agreement. Is the Deputy telling me that in his party's pre-budget submission it provided inadequately for health, as the amount provided is pretty much the same as what we have provided?

Leo Varadkar (Dublin West, Fine Gael)
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Why would the Deputy's party provide an inadequate amount for health? The Deputy is accusing the Government of doing pretty much exactly what his party put in its own pre-budget submission.