304. Deputy Holly Cairns asked the Minister for Public Expenditure, Infrastructure, Public Service Reform and Digitalisation the statutory grounds under which he has suspended autonomy for day to day spending from several HSE regions; to detail any consultation he had with the Minister for Health on this matter; and to detail the date and manner in which this decision was communicated to each of affected HSE regions. [67758/26]

As provided for in the Ministers and Secretaries (Amendment) Act 2013, the Government decides on an upper limit of Government expenditure and on the amount of Government expenditure to be apportioned to the area of responsibility of each Minister of the Government for a financial year. On a proposal of the Government, Dáil Éireann votes funds – the Estimates- every year for Government Departments and Offices and at the end of the year gives statutory effect to the Estimates by means of the Appropriation Act. Health expenditure is Vote 38 and is one of the largest spending allocations.

Managing the delivery of public services within budgetary allocations is a key responsibility of each Minister supported by the relevant Accounting Officer and Department. The Accounting Officer has ultimate responsibility for their Voted expenditure. The Secretary General of the Department of Health is the Accounting Officer for Vote 38.

The Ministers and Secretaries (Amendment) Act 2011 sets out the functions of the Minister for Public Expenditure, Infrastructure, Public Service Reform and Digitalisation including expenditure oversight and policy, responsibility for the central accountability, governance and value for money frameworks, procurement policy, pay and pension policy, and setting the public service reform agenda.

As set out in the Public Financial Procedures (A4.9), the issue of a formal sanction by the Minister for Public Expenditure, Infrastructure, Public Service Reform and Digitalisation in respect of voted expenditure is an essential element in the procedure for the management and control of public expenditure. It supports the sound management of public finances and promotion of value for money in public expenditure. As a matter of principle, the sanction of the Minister for Public Expenditure is required for all expenditure. Neither the voting of money by Dáil Éireann nor the inclusion of an allocation in an Estimate constitutes sanction.

There are two different types of sanction – delegated and specific sanctions. The delegated letter of sanction for current expenditure sets out the maximum gross current expenditure allocation, reporting requirements, general conditions, exclusions and specific guidance regarding virement, pay allocations, legislative and central requirements and pharmaceuticals.

The letter of delegated sanction for current 2026 expenditure for Vote 38 Health issued on 28 May 2026.  That letter reflected the provisions of Circular 21/2026 Expenditure Control and Escalation Process outlining that breaches of delegated sanction and persistent expenditure overruns may result in the deployment of an expenditure escalation pathway and the introduction of additional expenditure oversight mechanisms.

Given that the Health budget accounts for one fifth of total Government expenditure, my officials and I engage regularly with the Minister for Health and her officials through structured oversight mechanisms such as the Health Budget Oversight Group and bilateral engagement. Through these mechanisms, significant expenditure overruns on Vote 38 in 2026 were discussed and it was determined that action was required.  Additional conditions were added to the delegated sanction on 14th September 2026. I understand that the Minister for Health and her Department is working with the HSE to deploy those controls.