I propose to take Questions Nos. 429 to 431, inclusive, together.
As the Deputy is aware, the cumulative impact of this unprecedented period of financial and resource restraint has resulted in reductions in the health service budget of the order of €3.3 billion (over 20%) with numbers employed reduced by over 14,000 since 2008. On a comparative basis the OECD Report, Health at a Glance 2013, shows that recent reductions in public health expenditure per capita in Ireland are the highest experienced in any OECD country with the exception of Greece.
2014 is proving to be a particularly challenging year for the health services. Very difficult decisions were taken by Government in the context of the overall budgetary arithmetic. It is however, important to note that a substantial part of the savings required related to pay and pay related savings under Haddington Road, reductions in pharmaceutical prices and expenditures (including the introduction of reference pricing of interchangeable medicines and ongoing drug price reductions and drugs delisting from the Reimbursement List) and reductions in general practitioner fees. These adjustments, far from impacting negatively on the provision of services, can significantly enhance the capacity of the public health system to deliver quality, affordable care to the Irish public. That being said, certain savings targets required of the HSE at the time of the Budget were considered so challenging that it was agreed that a separate validation exercise to assess their achievability would be undertaken by the Departments of Health, Public Expenditure and Reform and An Taoiseach. While work continues in relation to the maximisation of the savings achievable under the Haddington Road Agreement, the initial savings targets under medical card probity were reduced by €110m in the context of the REV. Along with pay savings targets, and taking account of legislative issues around some of the savings measures identified, it is clear that the challenges facing the HSE in 2014 were hugely challenging from the outset.
There is ongoing and intensive engagement each month between officials of my Department, DPER and the HSE in the context of regular monitoring of expenditure. The HSE is proactively engaged in internal efforts to maximise savings and cost containment plans and to ensure that additional measures are identified and safely implemented to mitigate projected deficits.
It would be premature for me at this stage to estimate what carryover savings may be available in relation to current expenditure, as work is ongoing to validate and assess their achievability in the context of 2014, and such matters will be considered in the context of the budget discussions. It is not anticipated that there will be any carryover saving on capital expenditure in the current year, given the significant number of priority projects currently ongoing; should a small surplus emerge due to timing issues, it would be used to mitigate the emerging deficit on current expenditure.
