I understand that the Minister for Health went to the Cabinet yesterday to propose the HSE spending plan for 2016. From what we know about his proposals our health services will continue to be underfunded. One of the big ideas the Minister, Deputy Varadkar, proposed was based on the assumption that 125,000 medical cards will not be required next year. I do not know how the Government worked that out but I tried to picture the scene where the Ministers all sat around the Cabinet table, cogitated on this and obviously did not consider that there is a deserving citizen and a family behind every medical card. It was all a numbers game. Maybe one Minister said, "Well, 125,000 fewer medical cards, that sounds a wee bit high". Maybe somebody else said, "Let us go for 100,000 fewer medical cards". What was the Taoiseach’s preference? Was it 80,000 or 75,000 fewer medical cards? Did he pull numbers out of a hat?

It must have been a bingo game.

Did he do a version of “Winning Streak”?

Deputy Adams would know all about doing lotto numbers.

Is that how the Government came up with the figure of 50,000 fewer medical cards? It is little wonder that the head of the HSE recently acknowledged that there is no plan, no money and no vision for the health service. The Government’s stated intention is to maintain existing health service levels. Existing levels mean that, this morning, 331 citizens are lying on trolleys in accident and emergency departments. The Minister’s proposal, which is now the Government’s policy, envisages continued waiting lists, the capping of fair deal schemes, continued trolley waits and more waiting lists for home help hours and less money. Every day as we sit here, facing Christmas, staff and patients face appalling and chaotic conditions in our hospitals and the Government, the Taoiseach and the Minister for Health refuse to address these. The Government has no plan or vision for the health services and it is making life a misery for tens of thousands of patients and their families. Why does the Government persist in making a mockery of our health services, health workers, patients and their families by refusing to deal with the root cause of the crises in the health service?

Deputy Ó Caoláin is a decent man and Deputy Adams has forced on him a health policy that stipulates that it will provide everything and pay for nothing.

That is what the Government does.

That is nonsense. For the record, I am very proudly the Member who sent the Taoiseach these proposals.

Tell us where the money comes from.

The Taoiseach should be on the back of a lorry. The Government is really worried about them.

We can have one brought in.

Sinn Féin has come around to the view that we should have a universal health care system.

That is the universal answer.

No need for the chorus, thank you.

It intends to pay for that by nailing everybody earning over €80,000 with taxes.

Not at all and I look forward to the opportunity to implement it.

There will be less disposable income, fewer jobs and it will drive investment out of the country. That is what Sinn Féin stands for now.

There will be no taxes.

The Government has been very clear about this, as was the Minister for Health this morning in respect of medical cards. There will be no changes to income limits, no change in guidelines and therefore zero cuts in medical card numbers.

Does the Taoiseach believe that?

What we do stand for is the creation of more jobs that pay, fewer taxes on people and the abolition of the hated universal social charge brought in by the Fianna Fáil Government that drove this country onto the rocks.

American taxes and European public services. That is not going to work.

That sounds like an election broadcast.

This plan includes over €800 million extra with €100 million allocated for new initiatives, such as €13 million for acute services; the opening of a newly commissioned and built endoscopy unit in Roscommon; Wexford General Hospital, delivery suite; the acute floor, including emergency departments, in St. Luke’s Hospital in Kilkenny; the acute medical and oncology units in St. James’ Hospital, Dublin; Mercer’s institute for successful ageing-----

The Taoiseach should be on the back of a lorry.

What about Beaumont Hospital?

-----maternity services. We established the national women and infants health programme to lead the maternity strategy-----

What about the game-changing promissory bonds worth €25 billion?

Deputy Mathews should stay quiet.

-----the ongoing development of the national children’s hospital, and €10 million in new technologies in the implementation of the cancer strategy.

What about the €25 billion in promissory bonds?

Would Deputy Mathews stay quiet?

Burn the bondholders.

There is an investment of €7.25 million for investment in further disability services; an additional €2.5 million provided for the primary childhood immunisation programme; an extra €7 million for the ambulance service, which Deputy Adams has raised on many occasions; expansion of respite beds, palliative care; and-----

That does sound like an election broadcast.

-----and €35 million earmarked for mental health services.

The Government should cancel the €25 billion promissory bonds.

The Deputies opposite may laugh about it if they wish.

This sounds like an election broadcast.

It is part of the service plan. The Deputies may laugh about it if they wish.

Is the Taoiseach on the back of a lorry or is he in the Chamber?

He is on a low loader.

Cancel the €25 billion promissory bonds.

There is €35 million invested in health services which is so dear to Deputy Ó Caoláin's heart.

What about the promissory note?

Funding is provided for the continuing general practitioner contracts and developments and for speech and language therapy.

I know we are going on our holidays but the Members should not get too excited. It is tomorrow, not today.

The Ceann Comhairle should send a few of them on an early holiday.

Would they please allow Leaders' Questions to continue properly, with no smart remarks from the sidelines?

Speech and language therapy has been highlighted as needing a specific focus and it is getting that. These are new initiatives in the service plan, which has been approved by Government and which the HSE will publish today. This will maintain services and provide a targeted focus on particular services that I have outlined here, unlike Deputy Adams’ vision of having everything provided but with nobody paying for anything.

Will the Taoiseach expand on the universal health care policy?

That sounds familiar.

The only thing the Taoiseach gave me was his cold. He told us what he stands for: no plan, no vision, no money. He ignored entirely my question about people being taken off medical cards next year. People are sick and tired of his spoofing about all of this because they know the reality of what is happening in our health services. Does he remember in 2007 he pledged to end the scandal of patients on trolleys? In 2011 he promised to end the two-tier system of unequal access to health care. The Taoiseach should remember his five point plan. We can expect more promises from him as the election looms closer. A Fine Gael promise in January will be worth as much as a Fine Gael promise today or yesterday, it will be worthless, just like a Labour Party promise.

We did publish our strategy for health and we sent a copy to the Taoiseach. I commend it to him.

I read it.

It is also on our website because unlike the Government, Sinn Féin does have a vision for universal health care.

How is Sinn Féin going to pay for it?

On this Government’s watch our health service has gone from bad to worse. It is now completely chaotic and the Government’s Christmas gift to citizens who may be ill is 50,000 fewer medical cards next year.

It is a fairy tale.

New York, New York.

A "Fairytale of New York".

That is the year the Government will have the gall to commemorate the 1916 Rising. The Taoiseach should be ashamed of himself.

Our health service is good enough for everybody else.

The Deputy’s strategy for the health service is all rhetoric.

I did read the Sinn Féin health strategy. It is a wonder to behold.

The Government should implement it.

Deputy Adams promises to go around the country and have that decent man beside him, Deputy Ó Caoláin-----

Promising to keep hospitals open. Universal health care.

This is the start of the Fine Gael campaign.

-----stand up in public and say “This is a plan for the nation. We will provide every facility and you do not have to pay for anything.” Just like the boys and ladies on the Fianna Fáil and Independent benches, there will be higher taxes, fewer jobs, less investment and less disposable income.

If the Deputy thinks he can convince anybody of the health care programme he has there, well then fair enough.

It does not work.

He says we have no plan, no vision and no money.

Would you please stop?

This health service plan is costing almost €13 billion, which is €800 million more than last year, and guaranteed to maintain services. I read out a list of focused and targeted initiatives on new services and new investment.

Medical cards, Taoiseach.

As regards medical cards, the Deputy is clearly aware that 1,000 jobs per week have been created following the Action Plan for Jobs and confidence is returning to the economy. That means of course that somebody who has a medical card today and is unemployed, who then gets a job, will retain that medical card for three years.

How many?

The incomes of many people in employment will increase and they will be getting back some more in the USC in January. They may find themselves outside the income limit and become GP card holders, the number of whom will rise by 50,000 next year. As the Minister pointed out, with no change in the criteria and no review, 40,000 people moved out of the medical card sector last year. We expect that to be something of the order of 50,000 this year.

The Government's plan is to create more jobs, reduce taxes and therefore-----

No public services.

-----have more people able to invest in these kinds of services.

We are over time.

The latest figures, published on 7 December, show a reduction in the waiting lists across all categories.

Rubbish.

Therefore, unlike the Deputy's attack, the reality is actually different. We have not met all the challenges successfully, but the investment is now going in whereby that process can be continued and completed.

Delusional.