I propose to take Questions Nos. 373 and 424 together.
The Department is engaging closely with the HSE to ensure that every effort is made to maximise cost containment and cost avoidance measures and identify a series of mitigating actions that do not impact on the ability of the HSE to deliver on the planned activity levels set out in the NSP 2018. While it is anticipated that there may be some areas that will experience overruns in 2018, it is too early yet to be definitive in terms of the final out turn for the health services at year end.
A number of areas within the HSE are contributing to the overspend year to date.
1. A private patient income shortfall arising from the campaign by the private health insurers to dissuade their policyholders from using their insurance when admitted through an ED
2. Non achievement of the tranche 3 of the VIP programme
3. Higher level of State Claims Agency payouts than budgeted for
4. PCRS driven by costs and demand for drugs (in particular Hi Tech and LTI drugs)
5.Higher level of spend on national reform projects
6. Higher level of spend on service areas (Acute and social care)
7. Other smaller items, such as overseas treatment, winter response
The overspend in the service areas is driven by a number of factors, including non achievement of VIP tranche 2, higher levels and higher complexity of demand, costs associated with meeting national standards, emergency placement over level funded.
The actual overspend in these areas manifests as both overspend in pay and non pay.
A Supplementary Estimate will be provided in 2018 to the HSE, and this funding will carry forward into 2019.