I welcome Mr. Gloster, Mr. Watt and the teams to the meeting. I want to start with the briefing that was published on budget day. According to the little booklet, €1.3 billion has been allocated to respond to Covid-19. How much of that is part of the Department’s funding health and is it included in the €22 billion budget? I know that money is being spent on vaccines. What exactly are we spending that funding on?

Ms Louise McGirr

The amount to which the Senator referred is just over €1 billion, or €1.032 billion. That is non-core funding. I will get the exact figures now, but some of that – around €200 million or €250 million – is for the Covid vaccination programme and test and trace. A significant amount of the funding is being used to deal with what we call the legacy of Covid, including the waiting list action plan and investment in a range of waiting list actions, because there is pent-up demand and a build-up of delayed assessment etc. from Covid. It is non-core funding and it is the second year we have received it. We have the additional temporary funding to deal with the waiting lists and urgent emergency care requirements over winter, in particular. We are seeing a really big increase in demand. Just over €400 million of it is for the resilience fund, which will help offset some of the increasing expenditure demands in our acute sector. It will also be used to increase our investment in areas, including the integrated financial management and procurement system, IFMS, and other digital initiatives, to try to build up resilience.

It covers a range of areas. It also includes Ukraine but most of that €1.3 billion has gone to health.

Senator Seán Kyne

That is fine. It is not for Covid per se but, rather, the legacy of Covid and catch-up.

Ms Louise McGirr

Yes, it is a legacy of Covid, which will be a number of years. That is recognised.

Senator Seán Kyne

Perfect. All hospitals do important work but some are better than others, as Mr. Gloster would attest to. Waterford hospital has been mentioned in that regard. Is there a matrix, if you like, between the number of patients seen and the cost of running the hospital? Can hospital budgets and outputs be measured in order that they can be ranked?

Mr. Bernard Gloster

I think we could be better at it. We have a lot of data that come out of hospitals from the hospital in-patient enquiry, HIPE, coding system of their activities, from their emergency department numbers and from their outpatients on the waiting list action plan. We need to get a more mature level of performance assurance, which I hope to do through the six regions. It is a matter of how we integrate all that data and what they tell us. We could do better in that regard. At the moment, it is very variable. I am sure the Senator knows that. As I said just before the Senator came in, Letterkenny hospital was the story last week. It was Limerick hospital yesterday, it will be Galway another day and so on. It is variable. Limerick hospital is on the news for trolleys all the time but it is one of the significant performers when it comes to managing outpatient waiting lists, for example. The picture is variable and we could do better.

Senator Seán Kyne

Mr. Watt, in his opening statement, stated “Focusing on the past three years, we have added an additional 22,000 healthcare staff…” He mentioned 6,700 nurses, 3,100 social care professionals and 2,500 doctors and dentists. There were 9,700 other staff. What is the breakdown of those? There is security and cleaning staff, for example. Do we have a breakdown of those?

Mr. Robert Watt

We could get a breakdown for the Senator. It would be the other groups he mentioned. Perhaps Ms Hoey has more details. There would be administrative-management grade staff, support staff and auxiliary staff as well. We can provide that breakdown to the Senator. We do not have it to hand but we can send it to him.

Senator Seán Kyne

Referring to his opening statement again, Mr. Watt stated about 42% of the expenditure is on pay, so that is about €9.45 billion. Some €3.2 billion will be spent on pharma by the end of the year. Those figures account for about €12 billion of the €22 billion. Is there a breakdown of the remainder, for example, for pensions, perhaps under large heads?

Mr. Robert Watt

Yes, we have a breakdown. It is mental health services, older persons services and the primary care reimbursement service, PCRS, which is a large part of the drugs costs that were mentioned. Perhaps Mr. Colman can give the headings. It would probably be best to send the information to the Senator rather than reading it out. It is all the other elements that go into health – community services and so on.

Mr. Kevin Colman

Aside from the HSE expenditure, pensions amount to about €700 million for next year. State claims would account for a big chunk, at about €440 million. There are grants to other bodies and agencies outside of the HSE, and the Department spend is about another €400 million there as well. The PCRS amounts to €4 billion, including local demand-led schemes. Those are the big areas.

Mr. Robert Watt

We can provide the Senator with the breakdown. Regarding the challenges of the expenditure overrun this year, it is overwhelmingly within the acute system. There are some in relation to pensions and the PCRS but it is overwhelmingly in the acute system.

Senator Seán Kyne

It has been said, and the witnesses can dispute this or not, that part of the problem is that if the HSE gets an allocation for 200 particular posts and cannot fill those posts, it still spends the money on other staff. Is that the case? Does that happen or does the HSE go back to the Department for approval?

Mr. Bernard Gloster

To put that in fairly simple terms, there was a period of time when we were challenged to recruit the numbers we were funded to recruit. There are two choices in that situation. One ends up with what are called “time-related savings”, that is, one has the money while the post is not filled. Usually, there is an agreement with the Department to spend that in a particular priority area to try to respond to some of the need. Sometimes it is then very hard to retract that back in when there are better times for recruitment.

This year was very different. This year our recruitment outcomes flipped completely. We have had very successful recruitment strategies, thanks to the work of Ms Hoey’s team. We are recruiting at a far faster rate than we experienced in other years. The retention profiles are changing and—–

Senator Seán Kyne

What does that mean in and of itself?

Mr. Bernard Gloster

When there are lots of developments going to post—–

Senator Seán Kyne

Does that mean retention is getting better?

Mr. Bernard Gloster

Yes, it is improving. We still have a way to go but the simple reality is that when we have a whole load of developments working together, we will get more staff in some grades than in others and that takes up the overall profile at the end of the year. That is the simple reality. It is not a question of us having funding for an occupational therapist but going back to the Secretary General and asking if we can switch that funding to a physiotherapist. We could not manage 150,000 jobs like that.

Senator Seán Kyne

Yes, I understand not getting down to that level of specifics but if the service has funding for 500 nurses and can only get 300, surely that money can be used for other staffing costs. I am trying to understand whether approval is sought or given in those circumstances or is it all kept within the HSE?

Ms Anne Marie Hoey

We produce a pay and numbers strategy each year as part of the service planning process and that strategy does allow for flexibility within certain staff categories. As Mr. Gloster said, we cannot get into the detail of a change in one post, for example, but there is flexibility within the pay and numbers strategy for certain clinical grades within the overall scheme of our needs and of affordability.

Senator Seán Kyne

Is that something Mr. Watt agrees with?

Mr. Robert Watt

Yes.

Ms Louise McGirr

I can respond to that. We agree the pay and numbers strategy or the broad parameters of same. We are really concerned about a couple of things, the first of which is affordability. Does the budget that the HSE has for pay equal what is in its pay and numbers strategy? Is there clear prioritisation around the grade groupings, as we call them, which are medical, dental, nursing and midwifery and so on, those big groups of staff? What do they look like in comparison with each other? As Ms Hoey said, there is flexibility within that in terms of re-prioritisation of medical and clinical posts or nursing and midwifery posts. Broadly, we are concerned to ensure that the HSE has a recruitment plan and that it sticks to it throughout the year. What has happened in the case of management and administration staff is that the affordability limit has been exceeded and so measures have had to be taken.

Senator Seán Kyne

Is there an actual strategy? Is there a physical document? The witnesses have used the term “pay and numbers strategy”. Can we get a copy of that? Is it available?

Ms Louise McGirr

Yes.

Mr. Bernard Gloster

Yes, we have a strategy for this year. The point I made in my opening statement is that going into next year, one of the things I have agreed with the Secretary General is that we have parsed up the employment too much. There are too many different ways to look at it. There are new developments, existing posts, replacement posts, agency, overtime and so on. We now have to give service units a total pay budget, a total numbers budget and policy guidance as to the distribution of those across areas like nursing, allied health professionals and so on. There will be a rule set and then areas can get on with that. One of the intentions of the six-regions system is that areas can get on with it and respond to local need. If, ultimately, the manager in the west of Ireland decides a physiotherapist is more appropriate to the needs of the population than an occupational therapist, I am not going to argue with him or her.