The recently published European health index, which is a consumer index for 2014, gives a very poor impression of our health service. We are ranked 21 but in 2013, we were ranked 14. We have dramatically fallen back seven places in those 12 months. This index is compiled from combination of statistics, including patient polls and a general survey carried out across European countries. We must take cognisance of this survey, which is certainly a wake-up call. Appropriate action must be taken to halt this downward slide and to ensure we come back up to our former rating in 2013. That is something we must achieve over the coming months. We must rectify this matter before the next poll is carried out.

The report also pointed out that our waiting list data were lacking credibility. This research is based on data from patient organisations because the data were found to be much more credible and accurate.

Health care inequity is also very evident. Public patients are often on never-ending waiting lists to be seen by consultants. Their cases are often deemed to be routine, although according to their GPs, they might be deemed otherwise. In most cases, a more urgent referral is required. Eventually when they are seen by a consultant, it is only then that they are placed on a waiting list as such. This is certainly very unfair treatment and it is unacceptable for our vulnerable population and those who cannot afford to access the health services directly. The fact is that when people eventually get a hospital bed, they are treated very well.

According to recently disclosed figures from the HSE, 382,000 people were on waiting lists at the end of the year while 55,733 of those were on waiting lists for more than 12 months. What appropriate action is the Tánaiste along with the Minister for Health and the Cabinet taking?

The most important development for 2015, and for 2014, was the allocation of significant additional resources for the Health Service Executive. I understand people would like it to have even more resources, as would I, but we were able to devote very significant additional resources last year in Supplementary Estimates, and for this year as well.

As the Deputy stated, the survey shows that for certain outcomes Ireland is performing well compared with other countries. For example, we score very well on patients' access to medications and to prevention services such as vaccinations and smoking cessation programmes. We also perform well on patient outcomes such as cancer survival and reducing deaths from strokes and heart attacks. Our infant mortality rate, thankfully, is one of the lowest of all the countries in the survey. However, the Deputy is correct that we have fallen from 14th to 22nd out of 37 countries this year, and it is a very concerning matter. The main reason given in the report for that is waiting times, health insurance status and Ireland's legal position on abortion because much of the report is compiled from a combination of statistics, patient polls, including of people who use the health services, and independent research. It is carried out by a private company, Health Consumer Powerhouse Ltd. The authors of the report acknowledge that this fall in ranking is mainly due to their decision to exclude any published official waiting list data in the analysis. They base their conclusions only on the result of their commissioned surveys of patient organisations.

I would expect to hear from the patient organisations that, in terms of experience and all the issues we have discussed in this House, waiting times are a major issue and concern. That is why in the HSE plan the Minister for Health has committed to addressing waiting lists-----

So did the previous Minister for Health.

-----with a focus on very long waiters such as people who have been waiting longer than certain periods-----

What is the certain period?

-----with nobody to wait longer than 18 months.

The outcome of this survey shows we are very good at certain things but we have difficulties in other areas, and the authors specifically reference the issue of the difficulties arising in respect of abortion in this country.

I certainly believe in the credibility of this report because it is like for like across the board with other countries in Europe. We have to take it seriously and as far as I am concerned, it is factual and credible.

With regard to the staffing and resourcing of our hospitals, it was very worrying to hear this morning that the representative of the consultants and doctors group has denied the report from the Minister for Health, Deputy Varadkar, that there has been an agreement on recruitment and salary scales. That issue must be addressed in the coming days and I ask the Tánaiste, the Taoiseach and the Minister for Health to get stuck into it because it is clear that we are not prioritising the appointment of medical staff. Our nurses are under severe pressure as a result of an exodus of very well-qualified people who have left this country to seek work abroad because of various anomalies. Recruitment of nurses is a priority.

We must also build up our community care systems. It is clear in the report that community care across Europe is top class and accessible to the public. We are falling down in that area. There were aspirations to build up our community services but we have not reached our targets and are falling far short in that regard.

The necessary funding should be made available for the fair deal scheme. It costs €700,000 a day to keep our patients in hospital beds who need to be discharged to nursing homes. That is a waste of money. We must make the appropriate money available for that scheme, and we must also make available the necessary home care packages. I ask that this matter be taken seriously in the coming weeks.

Before Christmas, I co-launched with the Minister of State, Deputy Kathleen Lynch, the dementia strategy for Ireland based on funding both from the HSE and from Atlantic Philanthropies, which would be centred on the precise points the Deputy is making to assist older people in particular to remain in their own homes for as long as possible. The Deputy will see that around the country there has been a significant capital investment in community care facilities, particularly the locally based community services, which in a reformed service will mean that where people previously had to go to hospitals for many services, and even remain in hospital, much more of those could be provided at local level. That is a trend not just in Ireland, but across the world.

The Deputy referenced the issue of a shortage of consultants. I understand agreement has been reached with the Irish Medical Organisation, IMO, about the new pay scales for new consultants coming into the system. Hopefully, that will be successful because as we know, many people who graduate from our medical schools go abroad, as they have always done, particularly to the United Kingdom and the United States, for further experience but we would like to see as many of those people as possible coming home to build their careers in Ireland. It is hoped that the new consultants pay deal which has been agreed will address those issues.

Above all else, across the health system, partly because of the numbers of people returning to work and the additional buoyancy in income tax and other tax revenue, we have been able to devote additional financial resources to the health service but it is critical that we do that in a well-managed way that gets the best value and the best attention. I agree with the Deputy that once people get past the waiting list problem in most Irish hospital institutions, their experience is very good simply because of the sheer quality, dedication and hard work of all the people who work in the hospitals - the nurses, the doctors and the other staff.