New HSE director general Paul Reid says a new model of health care will require investment.
The need for investment was explicit in Sláintecare, the 10-year programme to transform the country's health and social care services, he pointed out.
“I have never been involved in any major transformation that does not need investment,” he told a meeting of the Joint Committee on Health.
The HSE needed to strengthen trust and confidence in the health and social care services first and then invest funds in the future model.
Mr Reid also wants senior healthcare officials to change how they approached financial management processes, controls and reporting. “Any change in processes is always challenging in the early stages,” he wrote in a memorandum earlier this month.
“This change means that we will no longer spend money that we do not have. Breaching the budget can no longer be considered an option.”
In cases where they are faced with urgent demands that drove further costs other options had to be considered including providing less to a “lower priority service” to free up the budget for the “urgent demand.”
He wanted to ensure those most in need of services benefited from the service level that the budget would support.
“This is a very challenging process. But we must build a culture of delivering within the budget allocated to us by the State. When we do this, I believe that we will be in a stronger position to invest in the future.”
Mr Reid said the health service was continuing to deal with increased demands.
Fianna Fáil’s Stephen Donnelly said the number of people on long-term waiting lists to see a consultant had jumped by 800% in three years. More than 550,000 people had been waiting to see a consultant for over a year and a half.
Mr Donnelly said there was a “postcode lottery” with some patients waiting longer than others. “The number waiting for outpatients in Galway University Hospital is over 40,000; in Limerick University Hospital it is nearly 35,000; Waterford is at 40,000 and Tallaght (Dublin) is over 30,000,” he said. Given the unprecedented spending on healthcare, why was this happening, he asked.
Health Minister Simon Harris said around 3.3m people went to outpatient clinics every year. One million were first appointments but many of the rest could be treated in primary care.
Mr Harris said around half a million patients who were offered an appointment last year did not turn up and this needed to be investigated. He also said the nurses’ strike earlier this year had an impact on waiting lists.
Minister Harris told Fine Gael Senator Colm Burke that the chair of the South/South-West hospital group was asked to confirm membership of the project board to drive the new elective hospital in Cork.
It was expected that a decision would be reached on the make-up of the hospital and its location by year-end.
Mr Harris said the backlog in CervicalCheck had reduced to 71,361, down from more than 80,000 last month.