Louise O'Reilly (Dublin Fingal, Sinn Fein)
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Some €346 million was targeted for savings in health in 2018. For a long time, I have been asking how that figure was reached, but I cannot get an answer. It is described as a targeted savings measure. It sounds as though a lot of work went into calculating the figure. However, I have asked very senior figures in the HSE, representatives of the Department of Health and a colleague of the Minister of State, Deputy Finian McGrath, to explain the calculation of the figure and I have not received an answer. The cynic in me thinks that somebody proposed a figure of €350 million but somebody else proposed €346 million because that would make it seem as though some targets had been identified or some work had been done in that regard.

Obviously, the Minister is aware that the target was missed. Why was it set in the first place? If we are to investigate that, perhaps we should begin by examining from where the targeted savings figure came. The phrase "targeted savings measure" brings to mind targets, savings, amounts and measures but all I see is a figure which nobody can explain.

The Minister of State, his Department and the HSE would do well to heed the very wise words of the Irish Fiscal Advisory Council.

The council said the health budget should be well founded and credible. It also spoke about the budgetary process within the health service the Government presides over and described it as suffering from weak planning and weak spending controls. Therefore, in saying this, I have the backing of the council.

The figure of €346 million was a savings target given to the HSE. I have been questioning a number of people on this. The more I question and the more the lack of answers becomes more apparent, the more worried I become that the figure was plucked from the air. I spoke to one of the Minister of State's colleagues about this. The conversation is on the record on the health committee. I must say again that I sincerely hope the Government does not get the figure from the same place as the lads we all heard on the telephone call. That is how it looks to me because nobody has been able to justify to me where the figure came from. Did the Department sit down with the HSE to come up with a figure? Was it just given to the HSE as a target to be achieved? Did the HSE come to the Department with the figure? Everyone I have asked has not been able to tell me how the figure was arrived at. I sincerely hope the Minister of State can tell me how it was arrived at. If so, perhaps he might be able to give me a list of the savings targets. What was targeted? What amount was targeted? By how much did it fall short? We know the target was not reached. That has been established and acknowledged and nobody will dispute that. If the target was not reached, have we any idea why such an overly ambitious target was established given that the health service is underfunded? We know it is underfunded because we were discussing the supplementary budget at a meeting of the health committee only this week. We know the health service is underfunded, yet somebody believes savings of €346 million can be made.

Finian McGrath (Dublin Bay North, Independent)
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I thank the Deputy for her important question. I hope we can get to the bottom of the issue.

The HSE national service plan set out in 2018 funding for health services totalling €14.556 billion. A sum of €14.411 billion was originally allocated to the HSE by the Department, with €145.9 million held back for new developments, most of which sum has since been released. The national service plan for 2018 included the establishment of a value improvement programme, VIP, which considered how to reduce the costs of delivering services without impacting negatively on either the level or quality of such services. The HSE prepares its annual service plan on the basis of a set of estimates and assumptions. In calculating the VIP target of €346 million in the 2018 plan, the HSE went through a process that considered the level of service it could currently provide with the available funding, the level of activity that could be tailored to fit the funding and what level of activity was almost entirely driven by demand.

The health service is very complex, as the Deputy knows. It is the provider of last resort, the provider of 24-7 services and a place of safety. There are a number of areas, including emergency departments in hospitals, disability, residential placements and similar areas, in which a activity of a certain level will happen even if there is not specific funding for it. I know this from disability crises. The HSE, through its planning process, determined a need for savings of about €346 million. A core national team was established to support the system in delivering the VIP, working as part of the performance improvement management unit. Despite an initial promising start, progress in identifying and advancing proposals, and actually securing the targeted savings, was slower than anticipated. Contributing factors to this were the significant operational management pressure due to the winter surge, an extensive flu season and storm emergencies, in addition to particular calls on the VIP senior team to support GDPR implementation.

The HSE is now putting in place appropriate resources across the system to ensure delivery of progress on the programme. There were three distinct themes within the overall programme. The HSE led on two themes, namely, focusing on a cost-reduction programme at service level and focusing on a corporate value programme. The service-level programme focused on cash-releasing initiatives in 2018, such as reductions in the use of agency services and conversion to full-time permanent posts, where the latter two are local and not linked to corporate-level initiatives, such as the nursing task force, and renegotiated supplies and utilities contracts. The HSE identified a €77 million savings target in this area.

In the corporate value programme, the HSE was tasked with identifying savings and cost reductions across its entire corporate operation. This might include better control of central administrative costs such as travel and better management of supplies. It was envisaged that this programme would identify savings of €119 million. A number of savings initiatives are in progress. Work is ongoing with respect to a number of corporate-level initiatives identified earlier in the year.

Additionally, within the overall VIP, the Department of Health was to work with the HSE within a shared governance and oversight framework on a strategic value programme. This would be a multi-year strategic initiative with the intention of achieving savings of €150 million in 2018 through identifying and implementing savings from productivity, improved models of care, policy implementation and delivery of service reform. To date, the most progress has occurred in VIP theme 1, which had an overall savings target of €77 million. The targeted savings were allocated over acute hospitals and community healthcare organisations, CHOs, and the HSE has indicated that the expected realisation in 2018 will be approximately €60 million, with the acute hospitals largely achieving their targets but the CHOs falling somewhat short.

VIP theme 2 savings are being assessed across all parts of the system, and this review will be reported at the end of the year. There was no progress made on VIP theme 3 in 2018, and this has contributed €150 million to the deficit in the HSE, which amount will be funded via the Supplementary Estimate. It is envisaged, however, that the groundwork undertaken during the year will support and promote the establishment of value-improvement measures in the context of 2019. I hope that goes some way towards answering the Deputy's question.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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I did not think anyone could confuse me even more; fair play to the Minister of State. What he is saying in his response is that the HSE, through its planning process, determined the need for savings. Therefore, it identified the need itself. The Minister of State will appreciate that is not exactly what the HSE said to me, but that is fine. It was stated the targets were not hit because of the winter surge. That happens every year, yet it surprised those responsible. They were also surprised by the flu and the storms. Perhaps it is fair enough to have been surprised by the storms but I really do not accept the other two reasons. Having made reference to the savings for 2018 and bearing in mind it is now December, the Minister of State said the HSE is now putting in place "appropriate resources across the system to ensure delivery of progress on the programme". I am not a big fan of having to speculate to accumulate but that is essentially what is being done. Money is being put in so the delivery of progress on the programme can be ensured.

This leads me to another question, namely, the question of how much money is involved. The health service did not reach the target of €346 million for reasons I do not accept as valid but those are the reasons given. Consequently, out of some other budget, money now will be provided to the HSE to facilitate it to put in place appropriate resources across the system to ensure delivery of progress on the programme. The end of the Minister of State's reply refers to a multi-year strategic initiative. As these are targeted savings for one year, a multi-year strategic initiative presumably will have multi-annual savings stacked into it. Does the Minister of State understand why I might be a little confused?

Finian McGrath (Dublin Bay North, Independent)
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I do. I am confused myself.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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Is he in a position to shed any light on it?

I am a lover of detective novels when I get the time to read them. I think Miss Marple would struggle with this. Can the Minister of State identify the amount the Department will now put in to achieve the process that will evaluate how the Department did not achieve the savings? People might be interested in that.

Bernard Durkan (Kildare North, Fine Gael)
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The pot of gold, Minister of State.

Finian McGrath (Dublin Bay North, Independent)
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I thank the Deputy for raising these very important questions. There are times when I get confused myself. My initial response is that the HSE said there was a need for savings, and the bottom line is that this involves a number of areas, including emergency departments in hospitals. I know from my work in the disability sector that sometimes an emergency case can go from a normal residential place of €80,000 or €90,000 up to perhaps €250,000 in a crisis. Regarding residential placements, there are certain activities for which there is no specific funding. Furthermore, the HSE has indicated to me a series of actions being undertaken to maximise the delivery of the value improvement targets while at the same time not impacting the HSE's ability to deliver on the planned activity levels set out in the national service plan, NSP, for 2018. Delivery of savings is in progress, which reflects the success of the service level initiatives undertaken. The HSE has indicated that the expected realisation in 2018 will be approximately €60 million. Work is ongoing in respect of the number of corporate level initiatives and will be reported by the end of the year. I will raise the other questions the Deputy has asked with the Minister, Deputy Harris, and try to come back to her with an accurate response.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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I thank the Minister of State.

Bernard Durkan (Kildare North, Fine Gael)
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The third Topical Issue matter is in the name of Deputy Joan Collins. It is to the Minister for Employment Affairs and Social Protection and is to discuss the delay in proceeding with implementation of the Children and Families Relationships (Amendment) Act 2018. The Deputy has four minutes to make an initial statement.

Joan Collins (Dublin South Central, Independent)
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The Minister is not in attendance, though. I was not informed she would not be able to make it.

Bernard Durkan (Kildare North, Fine Gael)
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The Minister of State-----

Finian McGrath (Dublin Bay North, Independent)
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The Minister is tied up.

Joan Collins (Dublin South Central, Independent)
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May I move the matter to next Tuesday?

Bernard Durkan (Kildare North, Fine Gael)
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You may.

Joan Collins (Dublin South Central, Independent)
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Then I request to do so because, while I mean no disrespect to the Minister of State, I wanted a reply from the Minister.

Bernard Durkan (Kildare North, Fine Gael)
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That is fine.

Finian McGrath (Dublin Bay North, Independent)
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The Minister is at a European Council meeting.

Joan Collins (Dublin South Central, Independent)
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Will she be back by next Tuesday?

Finian McGrath (Dublin Bay North, Independent)
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Yes. She will be back tomorrow.

Joan Collins (Dublin South Central, Independent)
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Next Tuesday, then. Is that okay?

Bernard Durkan (Kildare North, Fine Gael)
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That is agreed.

Finian McGrath (Dublin Bay North, Independent)
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It is agreed.