Tommy Broughan (Dublin Bay North, Independent)
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72. To ask the Minister for Public Expenditure and Reform if he will report on his Department's invigilation of the relationship between Vote 38 and the HSE budget; the efforts being made to provide all necessary expenditures for primary and acute healthcare in view of repeated annual underforecasting of health expenditures; his views on the need for annual Supplementary Estimates; and if he will make a statement on the matter. [43865/18]

Tommy Broughan (Dublin Bay North, Independent)
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Early this year, following an interesting briefing from Fr. Seán Healy and Social Justice Ireland, the Committee on Budgetary Oversight identified the possibility of a serious discrepancy between voted health expenditure and what the HSE's national service plan was trying to achieve. That has turned out to be the case, with Supplementary Estimates required for the Departments of Health and Justice and Equality once again. The Minister was a member of the Government in 2015 when it effectively disestablished the HSE Vote by taking it back within the Department of Health. Since then, the Government has not been managing it.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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I thank the Deputy, but he had 30 seconds and has now spoken for over a minute.

Tommy Broughan (Dublin Bay North, Independent)
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The Considine report identified these problems ten years ago, but nothing has happened.

Paschal Donohoe (Dublin Central, Fine Gael)
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Managing expenditure within the overall budgetary parameters is a key factor in ensuring that our budgetary targets are delivered. As I said in reply to Deputy Durkan, the key responsibility sits with each Minister and Department.

Regarding the health budget, spending on our health services is at a record level. In 2017, OECD data placed Ireland fifth in terms of spend per capitaamong the EU 28. As Minister for Public Expenditure and Reform, I have made the resourcing of healthcare a key priority. This year, I will be allocating an additional €700 million by way of a Supplementary Estimate, bringing the total increase in investment in 2018 to €1.2 billion. In addition, I have announced a further increase of €1.05 billion in health funding for 2019, bringing the total allocation for 2019 to €17 billion. This brings the increased investment in health over the past two years to a total of €2.25 billion, or 15%.

The Government will continue to support the Minister for Health in managing one of the most important and complex sectors of our society and economy. As the Deputy will be aware, there are always key challenges to be addressed in the health sector. The Dáil has provided Supplementary Estimates in many years, with this year being no different, albeit of a high level.

We want to provide as much as possible for people who are sick and vulnerable, in particular elderly citizens. As our economic and budgetary circumstances allow, I will continue to invest more in our health services because it is the right thing to do. As the Taoiseach stated yesterday, we need to tie this higher level of investment to a higher level of return.

Tommy Broughan (Dublin Bay North, Independent)
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I disagreed with the Taoiseach. Reverting to our discussion about consultants, many of them have told me that they would be prepared to pay a higher personal tax rate if it was hypothecated to health spending. While we need more resources, the nub of the issue is that the Minister is not accounting to the House, as per his remit, for the difference between the national service plan and Vote 38. There has been serious criticism from our two key watchdogs. For example, Mr. Seamus Coffey of the Irish Fiscal Advisory Council has stated that the difference between the plan and the health Vote's spending drift is cumulative and long lasting. As the Minister stated, we are heading towards a figure of more than €2 billion in unplanned expenditure in respect of recent years. Even more damning is the report of our outstanding PBO entitled "The HSE National Service Plan and its Relationship with the Health Vote". While it acknowledges that the relationship is complex and there is a certain level of regular reporting, there seems to be a lack of seriousness in the Minister's Department about managing the health Vote.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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I thank the Deputy, but he will have another minute.

Paschal Donohoe (Dublin Central, Fine Gael)
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I am accountable to the House for this. I regularly answer health expenditure questions in the House and at the Deputy's committee. Had I not provided the additional funding required by the Department of Health this year and that then resulted in dramatic changes in our hospitals and primary care centres, the Deputy would be the first Member-----

Tommy Broughan (Dublin Bay North, Independent)
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I would.

Paschal Donohoe (Dublin Central, Fine Gael)
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-----to walk into the Chamber and condemn me for not taking action.

Tommy Broughan (Dublin Bay North, Independent)
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I want the Minister to be honest.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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Deputy, please.

Paschal Donohoe (Dublin Central, Fine Gael)
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The Deputy cannot have it both ways.

Tommy Broughan (Dublin Bay North, Independent)
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I do not want it both ways; I want it one way.

Paschal Donohoe (Dublin Central, Fine Gael)
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The Deputy cannot, on the one hand, raise concerns about me providing an additional level of investment and, on the other, be the first Member to walk into the Chamber and condemn me if I do not provide that investment.

Tommy Broughan (Dublin Bay North, Independent)
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I would, of course.

Paschal Donohoe (Dublin Central, Fine Gael)
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There we go.

Tommy Broughan (Dublin Bay North, Independent)
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What I am asking for is honesty. This Dáil's establishment of the Committee on Budgetary Oversight and the PBO will stand the test of time, as will the Sláintecare committee, which should probably be sitting continuously. We want the Government to implement Sláintecare and to be honest about it. I suggested a 43% top tax rate on salaries in excess of €120,000 or €130,000.

Paschal Donohoe (Dublin Central, Fine Gael)
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Yes.

Tommy Broughan (Dublin Bay North, Independent)
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Measures could be taken to get the Vote together. The conclusions in the PBO's report are damning of the Department of Public Expenditure and Reform's management of the health Vote. It seems that alignment of the national service plan and the Vote is impossible. The money that is voted and the plan's expenditure elements do not correspond. There is a lacuna, which the Minister should address on behalf of the people. Regardless of whether the health Vote needs to increase to €40 billion or whatever level is necessary, it should be accounted for to us properly.

Paschal Donohoe (Dublin Central, Fine Gael)
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It is accounted for properly. As we speak, the HSE officials are before the Joint Committee on Health dealing with this matter. The Minister, Deputy Harris, appears before the committee regularly to deal with related issues. I deal with questions on it regularly, principally from the Deputy.

It is only fair to acknowledge that his pre-budget submission addressed how additional resources would be generated.

I acknowledge that. As the Deputy knows, my view is that some of the measures he is looking to implement would have very damaging effects on jobs and incomes in our society. That in turn would affect our ability to put in place the kind of investment that is needed in our health services.

Particularly as we move into 2019, we need to put a structure in place to ensure that the kind of difficulty that developed this year does not happen in the same way next year. The Minister for Health and I are committed to doing that. In that regard, I particularly welcome the fact that we have appointed an executive chairperson for the HSE and I look forward to working with him on this issue.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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We will move to the next question, Question No. 78.

Tommy Broughan (Dublin Bay North, Independent)
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Is this me again?

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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Is this the same as Question No. 70? Then we will move on.

Tommy Broughan (Dublin Bay North, Independent)
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Does the Acting Chairman refer to Question No. 78?

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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I thought Question No. 78 was a different question.

Tommy Broughan (Dublin Bay North, Independent)
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No other Deputies are present.

Éamon Ó Cuív (Galway West, Fianna Fail)
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I am here for Question No. 80.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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I will allow the Deputy to raise it if he wishes.