Leaders’ Questions July 4th

Deputy Micheál Martin: At a recent meeting of the Committee of Public Accounts the chief executive officer of the Health Service Executive admitted that it was facing a potential deficit of €500 million if corrective action were not taken.  He stated that to break even there would be a significant impact on services for the remainder of the year.  He added that the assumptions on which the HSE's 2012 service plan had been based were no longer valid.  According to Deputy Deasy who received an off-the-record reaction from the CEO, the HSE would have to close wards, beds and, possibly, hospitals.  There are hospital managers who are at the end of their tether and genuinely worried about the budgetary position, given the cuts already made to their allocations and their inability to make ends meet.  What is emerging clearly is that the health Estimate for 2012 was not an honest one. 

The CEO makes the point that in the plan which the Minister for Health, Deputy James Reilly, oversaw and approved the assumption was that there would be a saving of €124 million in drug payments via a new pricing agreement with the industry but "That has not come through."  The assumption was there would be additional income of €140 million, of which €75 million would come from charging private patients in public beds, but "That assumption is not yet deliverable."  Reducing agency costs by 50% was a further target.  Given that agency staff will cost €200 million this year, the CEO is now saying the 50% target was never realistic.

The failure to implement health measures announced in the budget in December is one matter, but it now seems clear that the figures were never achievable and what the Government, the Minister in particular, stands accused of, in essence, is that the books were cooked to give a false and dishonest health Estimate.  That is why on 8 June the Minister lashed out at workers in the health service, stating he wanted allowances, premium payments and everything else cut all of sudden and that people needed to get their act together.  The reality is he did not get his act together at the time of the budget, in that false figures that were completely unachievable were included in the health Estimate and now we are facing the prospect of ward and bed closures because of the failings of the Minister and the Government in this respect.

The Taoiseach: It is unbecoming of the Deputy to accuse the Minister for Health of being dishonest in the presentation of the Estimate for his Department for the budget for 2012.  That is not in keeping with the Deputy's normal behaviour.  Clearly, the HSE is facing a serious challenge this year.  Its performance report for April shows a net deficit of €200 million, of which hospitals account for €106 million, while community services have overspent by €57 million, of which some €13 million relates to child care services.  The primary care reimbursement service, including medical card services, is showing a deficit of €45 million.

The HSE has outlined possible approaches to dealing with the financial position, including reduced use of agency staff and implementing reforms under the Croke Park agreement to achieve more cost-effective use of human resources.  It has submitted a mid-year cost-containment proposal which the Department of Health and the Minister are considering.  As the Deputy will be aware, the Department has indicated that 70% of the HSE's €13 billion budget is accounted for by pay.  Of this, 18% is classified as non-core, including overtime and premium payments and allowances paid to staff.  In a health service that must run an effective 24-7 service, it is imperative that ways be found to address the growing deficit.

I do not accept the Deputy's assertion that the Minister was dishonest in presenting the Estimate for his Department for this year.  It is a fact of life that every Minister must work hard to ensure the ceilings and proposals for his or her Department's budget for 2012 are adhered to.  The Minister is working hard, both within the Department and with the HSE, to address the deficit.

Deputy Micheál Martin: The Taoiseach did not deal with the core issue.  Completely unrealistic and unachievable figures were included in the health Estimate.  Legislation to give effect to them has not even been brought before the House and it is only two or three weeks to the recess.  False figures were included in the Estimate: there was a figure of €143 million under the heading of income from private patients in public hospitals; a figure of €124 million for demand-led schemes and savings in respect of agency staff.  Mr. Cathal Magee states it was never realistic to state agency staff would be cut by 50% and the Taoiseach is now trotting out a reference to a cut in agency staff for the rest of the year.  The bottom line is that these were false figures and we need answers.

We need clarity on how the Estimate was submitted.  I accept there can be overruns in expenditure, but what is clear from this - anyone who knows anything on the ground is saying this - is that there was never a hope in hell that any of these figures would be realised.  They were false figures and will the Taoiseach correct them?  Can we have a realistic Estimate for the remainder of the year and can the Taoiseach give a guarantee that front-line services will not be affected because of the Minister's failings and incompetence and, perhaps, much more, in the Estimate?  We received no clarification from anybody in the Department of Health or the Minister.

The Taoiseach: When the Deputy had the privilege of serving as Minister for Health and Children, the answer on every occasion there was a difficulty was to throw millions into the maw of the public health service.

Deputy Micheál Martin: The Taoiseach should not listen to the prompts from the Minister; he should answer the questions asked.  The Minister for Public Expenditure and Reform, Deputy Brendan Howlin, has written to the Minister to tell him to get his act together.

The Taoiseach: The Deputy was not able to deal with the matter because he never had the courage to face up to what needed to be done.  That is the long and the short of it.

Deputy Micheál Martin: I do not need a lecture from the Taoiseach about my time in the Department of Health of Children.  I am quite happy about it.  What the people at the coalface want is answers.

The Taoiseach: In tackling the real problems the Minister has brought about a reduction of 20% in the numbers of patients on trolleys.  There were 10,000 fewer in the first five and a half months of the year.

Deputy Micheál Martin: I asked about the Estimate.

The Taoiseach: We are now in a situation where more people than ever before, 1.8 million, are covered by medical cards.  There has been an increase of 6% in respect of emergency department admissions and inpatient discharges have increased by 7%.

Deputy Micheál Martin: I referred to the Estimate.

The Taoiseach: We have an effective front-line service.  The catastrophic consequences about which the Deputy spoke at the end of February when significant numbers left the public service as part of the voluntary redundancy scheme did not materialise because clinical and medical teams and managers on the front line signed up for their individual programmes and plans.  These are being implemented.

Deputy Micheál Martin: Does the Taoiseach have any idea what is happening on the ground?

The Taoiseach: In so far as front-line services are concerned, the Deputy can take it that the Minister for Health is working with all his people.

Deputy Micheál Martin: Last week, Mr. Cathal Magee, the CEO of the Health Service Executive, referred to a €500 million overrun in the heath service at a committee meeting.

The Taoiseach: Cork University Hospital is now one of the best performing hospitals in the country because of the changes that have been made.

Deputy Micheál Martin: Of course it is, because a lot was put into Cork University Hospital in the last five years.  Could the Taoiseach answer the question?

The Taoiseach: I do not accept the Deputy's assertions regarding falsehoods, dishonesty or hard work on the part of the Minister.

Deputy Micheál Martin: They are the Government's figures.  The CEO of the HSE spoke about this last week at the committee.  The Taoiseach should ask Deputy John Deasy about it.