There were further revelations about the dysfunction at the heart of the health service in the Business Post at the weekend. Department of Health officials described a horror of waste in the HSE, criticised recruitment targets as incredulous, and expressed concern at their inability to hold the HSE to account.

Concerns about budgets in the HSE went all the way to the top. The Minister himself was said to have spoken directly to the Minister for Health, Deputy Donnelly, about the €514 million supplementary budget for 2020 and to have expressed doubt as to whether it was needed or indeed utilised as intended. When the Business Post sought confirmation on this from the Department, it was told those remarks were hearsay. I am pleased the Minister is in the Chamber today and in a position to confirm whether he had that conversation.

There is a great deal of detail on what has been reported in the past two weeks which raises serious concerns about monumental levels of waste, inefficiency and profligacy within the health service. I want to focus on just one area, which is cancer services. Recently, the Social Democrats introduced a motion calling for hospital charges for cancer patients to be waived and for hospitals to stop using debt collectors to pursue cancer patients for outstanding charges. The Government did not object to our motion but, crucially, it has not acted and it had the opportunity to do so. In advance of the Government’s publishing its measures to combat the cost of living crisis, the Department of Health submitted a proposal that would have seen those charges abolished for everyone. It said it would cost approximately €30 million. The cost for cancer patients would be only a fraction of that figure. The Government opted not to do this and instead made a conscious decision that cancer patients should continue to be charged for chemotherapy and radiotherapy.

How does the Minister think it must feel to be a cancer patient and read what has been revealed in recent weeks about the hundreds of millions of euro going into a black hole in the health service while debt collectors are hounding such patients to repay outstanding debts related to life-saving services?

Did the Minister raise concerns with the Minister, Deputy Donnelly, about the €514 million supplementary budget in 2020? Why is it there are hundreds of millions of euro in the HSE budget for fake recruitment targets but the Minister cannot find the relatively meagre amount that would be required to spare cancer patients the financial burden of paying for their care? Will the Minister commit to abolishing hospital charges, if not for everyone immediately, at least for cancer patients?

I thank the Deputy for her questions. First, to respond to the comments she made and the questions relating to the articles in the Business Post, the Minister, Deputy Stephen Donnelly, and I have a good working relationship. Officials of the two Departments engage on an ongoing basis. There is a health budget oversight group involving officials from both Departments that meets regularly and, as one would expect, we have occasional bilateral ministerial meetings as well, and sometimes on specific issues. For example, we had one in the middle of last year to review progress on the implementation of the budgetary measures for 2021.

The accounts for the HSE in 2021 are currently being finalised. The Minister gave an update to the Cabinet today that on a cash basis the health Vote was €469 million below profile. They are now calculating the level of accruals that relate to 2021 and it is expected there will be a deficit of perhaps up to €140 million for 2021. Those accounts are due to be finalised by the end of this month and any question of a prior year adjustment relating to 2020 will be dealt with in that context as well. There was a Supplementary Estimate of just over €500 million in 2020. The HSE ended 2020 with cash reserves of over €800 million and over €260 million was ultimately returned to the Exchequer in respect of 2020. The question of any prior year adjustment will be dealt with in the coming weeks as part of the finalisation of the 2020 accounts. The Comptroller and Auditor General has commented on that issue and has outlined what the process is in that regard.

On the issue of cancer care, the central tenet of Sláintecare, and the Deputy knows more about this than most, is that cost would not be a barrier to accessing healthcare. The Government is committed to meeting that goal. We recognise that any form of cost that people face to access vital healthcare is a barrier and must be addressed. We have made significant progress. Recently, we announced a further reduction from €100 to €80 in the drugs payment scheme threshold for medicine. That is an important reform. We have provided €300 million in respect of waiting list initiatives for this year as well. The Government is certainly of the view that when it comes to cancer and other acute conditions cost should never be a barrier to accessing the services people need in our acute hospital system. We are committed to achieving that goal.

I am puzzled by the Minister's last comment because, too often, cost is a barrier to people accessing care. For cancer patients, in particular, unless they have a medical card or private health insurance, they are faced with a bill of up to €800 per year just to get life-saving treatment. How can the Minister defend that? It is utterly indefensible. While, of course, Sláintecare calls for the removal of all inpatient charges, this is year five of the Sláintecare plan and no progress has been made on that. That is the reason we are asking the Minister to give a commitment, at least. The money involved is minuscule in the context of a €21 billion budget. We are asking the Government to honour the decision it made a couple of weeks ago on the Social Democrats' motion. The Government did not oppose it so, in effect, it is saying the motion was right. Will the Government honour that now and make provision for the removal or waiving of inpatient charges, at least for cancer patients, for the life-saving treatment and care that they must access? Will the Minister set out a clear timescale for that?

We are committed to tackling the general issue of costs in respect of access to healthcare. We will be extending the free GP care eligibility to children aged six and seven years across this year. As I said, we have reduced the drugs payment scheme threshold and, recently, there have been reductions in the monthly prescription costs that individuals and families face. We have provided dedicated funding of €30 million to ensure access for patients to new innovative medicines. The Minister, Deputy Stephen Donnelly, has been clear that he is committed to addressing any eligibility anomalies or barriers to ensure the health system cares for those who are in the greatest need first.

I do not believe there are people out there who need access to our public healthcare system for cancer care who are not getting it because they cannot afford it. That is not-----

That is not true. Listen to the Irish Cancer Society.

It is not a barrier.

It is absolutely a barrier. They are hounded by debt collectors.

The Minister without interruption.

As a practising politician for a number of years I have never encountered a situation-----

Okay.

-----where our public health system refuses to care for cancer patients because they cannot pay a bill. I have never seen that.

They hound them for the bills.

If the Deputy has any example please bring it to the attention of the Minister and the Government because access to cancer care in our public health system is not dependent on paying.