I will begin with health expenditure and then deal with the Deputy's points on pay policy. I will fully answer the question on staffing because it is important to put this on the record. In December 2013 there were 8,353 people working in the medical and dental sectors of our health service. That figure was 9,692 in November 2016, an increase of 16%. There were 34,169 nurses, there are now 35,795, an increase of 4.8%. The figure for health and social care professionals, such as social workers and people who work in the community, was 12,400; it is now 15,300. In management and administration there were 15,500 staff and there are now 16,700, an increase of 7.8%. For general support staff, who support the running of primary care centres and hospitals, there were 9,786 in December 2013, there are now 9,415, a decrease of 3.8%. In respect of patient and client care, there were 16,796 in December 2013 and at the end of November 2016 there were 19,874, an increase of 18%. There were 9,808 more people working in our health and social services in November 2016 than in December 2013, an increase of 10.1%. To paint a picture of numbers of people working in those services contracting is completely inconsistent with the figures for what has happened over the past three to four years. Those are the figures.
In response to the question do we have a grip on health expenditure, the management of the health Vote probably occupies a fifth of my time. I engage daily and constructively with the Minister for Health, Deputy Harris, on this. In respect of whether we have an assessment of this, after many years of difficulty in managing it and the Deputy will be well aware of those difficulties because she was party to some of them, I made an intervention last summer in advance of the health Estimate coming to the House and we absolutely expect that revised figure not to be overspent. I have the same expectation for this year, in contrast with the terrible difficulties my predecessors have had to face in the management of that Vote.
It is one that justifiably attracts a huge amount of my focus and time, given the anxiety and fear people experience when difficulties arise with regard to delivery of the services. However, to paint a picture of not being able to recruit or numbers decreasing is not the reality in terms of what is happening in those services.
Before I deal with the Deputy's specific points about where we are with public pay, and I will do my best to answer each of them, I want to again read into the record a section of the text we negotiated with the Irish Congress of Trade Unions. I will paraphrase it to get to this point. It states that this agreement is being offered by Government on the understanding that there will be continued adherence to the terms of the Lansdowne Road agreement and, in particular, its mechanisms to resolve disagreements before they escalate into industrial disputes over the remaining period of the agreement. It further states that the requirement to adhere to industrial peace will be fully observed in all sectors. That is a joint statement by the Government and the Irish Congress of Trade Unions. I need hardly tell the Deputy we were a long way away from that place in December. I am facing challenges on which she is justifiably questioning me now in terms of how we got to this point but as I have said on a number of occasions, it is my assessment that the challenges I face now are different from the position I would be in if our pay bill became completely unpredictable and uncertain in the second half of this year.
The Tánaiste and Minister for Justice and Equality has provided details to her counterpart in the Dáil on the detail of the question Deputy Burton put to me. I do not have the information with me. However, I will ensure that the Deputy receives an answer to her query.
In terms of how I will manage to deal with all of this across the entirety of 2017, I am not committing to tax buoyancy at this point. That is a decision for the Minister for Finance to make but I am making the point that the figure before us is less than the savings we accrued at the end of 2016 in respect of expenditure after I had met all the other commitments I had to meet. While the Deputy was not party to all of this, I want to make the point that the process was a very difficult one of ensuring we could pass a budget for this year and trying to reconcile all the demands we faced. What I will not wear, however, is being obliged to negotiate the passage of that budget through the Oireachtas in a way that is consistent with our fiscal rules and deficit targets for this year while - once I have secured the agreement to lead to it being passed - facing charges that the budget is in some way inconsistent with the fiscal requirements I must meet. I am responsible for this budget and I was responsible for negotiating its passage through the Oireachtas.
On the points the Deputy put to me in respect of outsourcing, she can rest assured that the level of enthusiasm I have for outsourcing is roughly the same as was the case when Deputy Howlin was running this Department. Whatever role I can see regarding outsourcing will not precipitate any rush to the bottom in terms of wage levels or service levels. I want efficiencies and value for the taxpayer but I am aware of my other obligations and I will do my best to meet those also. That is one of the reasons collective agreements matter. I have been at pains to say, both privately and publicly today, that collective agreements have benefits that flow both ways. That has been a factor in the agreement we have reached today.
In the context of our assessment of the demographics, a detailed paper on that, which I will share with the committee, was produced by my Department. We know that to fully meet the demographic pressures, particularly in education, our public service numbers would need to grow by approximately 3% per year until 2021, and education is a big part of that. As this Dáil develops and as we get into the passage of future budgets, which I am determined to see passed but everybody has a role to play in making sure that happens, that will become a far bigger factor. It will be a factor when the Government publishes its Estimates on the fiscal space for 2018, which we will do in the mid-term expenditure update in the middle of this year.
Brexit is absolutely a factor. In my capital review, in particular, and in the terms of reference I have agreed with my Department, Brexit is part of it. I make specific reference to it and to the regional consequences of Brexit because I am aware that the north-west of our country is facing particular pressure in terms of infrastructure, and that will be exacerbated if we see very negative consequences from Brexit materialise.
That leads on to the accusation that we are in some way anti-urban. I assure the Deputy, as somebody who lives a few minutes away from O'Connell Street and represents a constituency in the middle of Dublin adjacent to hers, that I see no evidence that this is a constituency that is in any way anti-urban. Many of the decisions we are making in the area of public transport, for example, are with a view to trying to serve larger urban centres. It is our larger cities, most notably Dublin, Cork, Limerick and Waterford, with their high concentrations of population, that will benefit from some of many decisions we have made in respect of housing.
With regard to the breakdown of expenditure for child care, we have made available an additional €86 million for the roll-out of the extended child care scheme that the Minister, Deputy Zappone, has announced. That forms part of an increase of €174 million for her Department, which, in percentage terms, was by some way the largest beneficiary of budget 2017. I do not believe they are underfunded in any way but the Deputy is correct that this is only for three months of that scheme. My understanding is that the target live date for that scheme was October 2016 and the full-year cost of that would then be taken into account in discussions I will have with the Department of Children and Youth Affairs for 2017. That will also feed into the expenditure report we will publish in the middle of this year.
Finally, I have already given my view on fiscal rules and how we take account of capital expenditure with regard to that but under the division of responsibilities that was carried forward into this Government, the Minister for Finance, Deputy Noonan, has overall responsibility for that area as the person who sets the overall expenditure ceilings for Government. He is leading the Government view on that matter but he is well aware of my views on it.