Róisín Shortall (Dublin North West, Social Democrats)
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4. To ask the Minister for Health to provide an update on the significant underfunding of the HSE national service plan; the current projected deficit to year-end; the reason his Department did not address this matter when its implications were highlighted by the HSE at the start of 2023; how he will address this deficit up to the end of 2023 in a way which ensures service capacity, activity volumes and access times are not adversely impacted for patients and service users; and if he will make a statement on the matter. [40910/23]

Róisín Shortall (Dublin North West, Social Democrats)
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We knew from early in the year that there was a black hole in the funding for the HSE national service plan, NSP. This was identified by a board member of the HSE, Mr. Brendan Lenihan, who is the chair of the audit and risk committee. He said he was not prepared to go along with this messaging, which was trying to cover over the fact that there was a serious shortfall in funding for the service plan. What is happening in that regard and where do we stand with the deficit?

Mary Butler (Waterford, Fianna Fail)
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Budget 2023 saw a record allocation of €24 billion to the health Vote. This increased funding reflects the Government's ongoing commitment to resourcing the HSE to deal with a range of pressures and includes a range of new investments to deliver on the Sláintecare reform agenda.

As part of the planning for service delivery for 2023, extensive engagements took place between the Department of Health and the HSE on managing the financial risks for 2023 and areas for savings and efficiencies were identified as part of that process. However, both demand and inflationary pressures have been high across the health sector and, in particular, in our acute hospitals. This combination of price and volume increases, reflecting demographic and post-Covid impacts, has led to increased costs in the provision of health services and contributed significantly to the HSE deficit, which was €642 million, or an overspend of approximately 6.8%, at the end of June.

Building on the areas identified in the NSP for savings, specific targeted measures have already been introduced to achieve reductions in the deficit. We are seeing increased levels of activity in comparison with the same period in 2019. Emergency department attendances are up 8%. Emergency department attendances by those aged 75 and older are up 21%. Admissions from emergency departments are up 7.5%. Admissions by those aged 75 and over from the emergency departments were up 15%.

Another cost driver is the significant impact of inflation across health in 2023. Core inflation is a reasonable general indicator for health, as it reflects products and services and removes energy and food. It has been increasing throughout 2023 and stood at 6.4% year on year in August, even as headline inflation began to decrease. The ESRI warned that core inflation may be harder to subdue and lead to upwards revisions in the inflation outlook for next year.

Róisín Shortall (Dublin North West, Social Democrats)
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I do not accept what the Minister of State has said. I know who writes this stuff and it is not true. It does not reflect reality. There is a three-month delay in approving the national service plan and we know why that was. It was because there were serious concerns about underfunding of the plan. We have known for a long time that the population is increasing and ageing and that there is growing demand for services. It was spelt out very clearly last March that the budget provided was not sufficient to meet demand for services. Stephen Mulvany of the HSE had heated exchanges with the Secretary General, as he was not prepared to engage in the pretence that there was enough money there. What he and Mr. Lenihan predicted has been borne out.

I asked if the Minister of State could tell me the current projected deficit to year end. What deficit is expected and how is it going to be met?

Mary Butler (Waterford, Fianna Fail)
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As I said, based on the figures that have been made available to me today, the current deficit was €642 million-----

Róisín Shortall (Dublin North West, Social Democrats)
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No. That is not what I asked.

Mary Butler (Waterford, Fianna Fail)
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I know that. I am answering the question. The current deficit was €642 million to the end of June. That is the publicly available figure at the moment.

I can tell Deputy Shortall what actions are being taken to address the HSE deficit. An initial minimum target reduction of 10% on agency costs has been brought in, with effect from August, across both the acute and community settings. There is a pause in the growth of management and administrative grades. A target has been set of reducing management consultancy costs by 30% by the end of 2023. Covid acute and community expenditure has reduced, from a high of €1.116 billion in 2021 to €701 million in 2022, with the 2023 equivalent forecast to be below €300 million.

Róisín Shortall (Dublin North West, Social Democrats)
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The Department got notice of this question. I asked what the projected deficit for the end of year was and the Minister of State has not been able to provide that figure. She should have been supplied with it. I ask her to go back to the Secretary General, get that figure and send it on to me. We should have had it today. Everybody's fear is that there will be a delay in recruitment and that that is how the deficit will be addressed and what the Department will propose. We know the implications of that. It is service cutbacks or planned service improvements not taking place. A projected 6,000 staff were due to be recruited this year. How many of them have been recruited at this stage? What are the other means by which the Department will close the black hole of €2 billion identified at the start of the year?

Mary Butler (Waterford, Fianna Fail)
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The black hole of €2 billion referred to by the Deputy has not been verified. As I stated, the figure up to the end of June-----

Róisín Shortall (Dublin North West, Social Democrats)
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I am sorry, but it is set out in the service plan. All of the shortfalls are identified in the service plan.

Catherine Connolly (Galway West, Independent)
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Will Deputy Shortall let the Minister of State finish?

Mary Butler (Waterford, Fianna Fail)
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Thank you, a Leas-Cheann Comhairle. The deficit has been verified at €642 million up to the end of June. As I stated, the HSE is taking significant actions to address this. For example, a State claims task force has been established to reduce the overall cost of claims.

Róisín Shortall (Dublin North West, Social Democrats)
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I heard that. What about recruitment?

Mary Butler (Waterford, Fianna Fail)
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I do not think this is a back-and-forth discussion. Deputy Shortall got her opportunity to ask a question.

Róisín Shortall (Dublin North West, Social Democrats)
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I did, but I want answers.

Catherine Connolly (Galway West, Independent)
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The Deputy should not interrupt.

Mary Butler (Waterford, Fianna Fail)
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Extensive efforts are being made to recruit across all sectors. Deputy Shortall needs to be fair as well. The main overrun is across acute services and emergency departments. Spending on disability services, mental health and older people is not over budget at all. The over budget spending is in the acute sector where the demand is overwhelming for many hospitals.

Róisín Shortall (Dublin North West, Social Democrats)
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How many of the 6,000 staff have been recruited?

Catherine Connolly (Galway West, Independent)
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Gabhaim buíochas leis an Teachta.