Bernard Durkan (Kildare North, Fine Gael)
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501. To ask the Minister for Health the degree to which various budgetary projections and targets have been missed in the services provided; the corrective measures taken or pending to address such issues; and if he will make a statement on the matter. [28239/19]

Simon Harris (Wicklow, Fine Gael)
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The HSE’s latest income and expenditure position at 30 April 2019 shows a revenue deficit of €116.2m which represents 2.3% of the available budget. The main drivers of the deficit are acute hospitals, PCRS and demand led schemes, disability services, and the treatment abroad scheme. Current gross expenditure on the Health Vote, year to date, is 8.8% higher than the same period in 2018. This percentage varies on a monthly basis during the year depending on spending under various headings but is, nonetheless, a matter of concern.

Significant savings are profiled later in the year in line with the targets set out in the National Service Plan. However, on present trends, taking account of the pressure in certain areas, the HSE would have a deficit at the end of 2019. This is a matter of concern for the Government. My Department is working with the HSE to gain further clarity on the projected year end position and working to mitigate the deficit in so far as is possible, in co-operation with the Department of Public Expenditure and Reform.

I have emphasised to the Executive the need to address health spending urgently by means of the following measures;

- Steps to ensure compliance with the staffing limits for 2019. The Executive has put in place controls around recruitment, pending receipt of finalised financial plans to manage the staffing levels back to affordable numbers;

- A reporting and monitoring structure around agreed savings targets in the National Service Plan, with responsible managers providing a monthly report from Quarter 1;

- A mid-year review of the Health Service Executives performance on savings and staffing limits, with further interventions as necessary.

The National Service Plan requires the HSE to protect and promote the health and well-being of the population, having regard to the resources available to it, and making the most efficient and effective use of those resources. Implementation of the Service Plan is ongoing, and my Department understands that the position of the HSE is that protection of front-line service delivery is its priority. I have emphasised the need for the Executive to meet its service targets in line with the National Service Plan.

Bernard Durkan (Kildare North, Fine Gael)
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502. To ask the Minister for Health the extent to which the delivery of health services here in terms of value for money compares with the most competitive overseas; and if he will make a statement on the matter. [28240/19]

Simon Harris (Wicklow, Fine Gael)
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Comparing health expenditure across countries is not straightforward, and there are a variety of ways of measuring health spend e.g. as a proportion of Gross Domestic Product (GDP), modified GNI* (a national indicator that excludes the globalisation effects that disproportionately affect the measurement of the size of the economy), or per capita; or the public versus private spend.

The System of Health Accounts (SHA) was devised by the Organisation for Economic Co-operation and Development (OECD) and has been adopted for joint reporting of health care expenditure by the OECD, Eurostat and the World Health Organisation. It provides a basis for uniform reporting by countries with a wide range of different models of organising their national health systems. Since the inception of the SHA methodology in 2013, Irish current expenditure has increased each year and this aligns with other OECD countries reflecting changes in demographics, macroeconomic growth and technological change.

The latest figures for Ireland according to the SHA methodology were included in the CSO statistical release, 20 June 2019. Overall there was a 5% increase in health expenditure in Ireland between 2016 and 2017. Ireland’s current health expenditure was €21.1 billion in 2017, which represents 7.2% of GDP or 11.7% of GNI* (Modified Gross National Income).

If modified GNI* us used, Ireland is above the OCED average and if GDP is used Ireland is below the OECD average.

From the most recent report, the majority of health expenditure (73%) was funded by government, with the balance funded by private sources including health insurance (14%) and household out-of-pocket expenditure (12%).

Even within a country, accurately measuring healthcare expenditure can be challenging due to uncertainty over what constitutes expenditure on health. A key feature of the SHA methodology is that it focuses solely on expenditure for health purposes which excludes expenditure on social care, and the implication of this is not insignificant for countries including Ireland where health and social care is delivered by the same providers. The Department has commissioned the Economic and Social Research Institute to examine this issue to assist the Department in a more forensic and more meaningful comparable examination of health expenditure and value for money.

The HSE National Service Plan (NSP) is an important accountability instrument in use by the Department in determining how the HSE is performing against its targets as it captures in a clear and quantified way the range of health and social care services to be provided by the HSE for the allocation it has received. It establishes links between funding, staffing and services and it incorporates activity measures, outcome-based performance indicators and deliverables in key service areas, which are matched with targets and timescales. In line with this, the NSP incorporates a value improvement programme with agreed savings to be achieved in 2019.

The Department provides oversight of the performance of the HSE in relation to the delivery of the services set out in the NSP, including the ongoing monthly performance management of the health system against the agreed activity and savings targets.