The management of health services finances is always challenging, as we have seen since the HSE was set up. There is a range of supplementary figures going right back to the start of the HSE that I could put on the record of the House. The indications are that performance so far this year is better than last year and, as the Deputy has acknowledged, significant efforts are under way on the part of the HSE and the new CEO, Paul Reid, to manage available resources effectively. The HSE’s latest income and expenditure position at 30 April 2019 shows a revenue deficit of €116.2 million, which represents 2.3% of the available budget. The main drivers of the deficit are acute hospitals; the primary care reimbursement service, PCRS, in other words, the medical card and demand-led schemes; disability services; and the treatment abroad scheme. Current gross expenditure on the Health Vote, year to date, is 6.8% higher than the same period in 2018. This compares with an overall increase in the Health Estimate compared to the 2018 outturn of 5.8%. This House budgeted for the health service to spend roughly 5.8% more this year than last year and the health service bill is, I think, so far 6.8% more. It is within a percentage point of what this House has budgeted.
Encouragingly and importantly, significant savings are profiled later in the year in line with the targets set out in the national service plan.
I have heard this misrepresented on many occasions in recent weeks. When the service plan was being drawn up, the HSE was asked - and instructed - as is the norm in most health services, including the UK's NHS, to put a saving's plan in place. On the basis of current trends, however, there would still be a significant challenge. This is a matter of concern for the Government. My Department is working with the HSE to continue to obtain further clarity on the projected year-end position and to mitigate the deficit insofar as is possible. We are working closely with the Department of Public Expenditure and Reform. I do not yet have a projected year-end figure. I support Mr. Paul Reid, the new CEO of the executive, in his calls for people to live within their budgets and to come in on budget. I will share any further information with Deputy Donnelly when I have it.
I have emphasised to the HSE and its new board the need to address health spending urgently by means of the following measures: steps to ensure compliance with the staffing limits for 2019 - in other words, to hire more but only within budget; a reporting and monitoring structure around agreed savings targets in the national service plan, with responsible managers providing a monthly report; and a mid-year review of the HSE's performance on savings and staffing limits. In addition, the establishment on Friday last of a new HSE board governance structure with strong competencies across key areas will further contribute to strengthening the oversight and performance of the HSE pending its further reorganisation.