The single biggest failure of the Government has been its failure to reform the health system. In 2011 the Labour Party stated in its manifesto that in government it would deliver better, more effective care for every patient. The Fine Gael-Labour Party programme for Government described the coalition as the first in the history of the State that was committed to developing a universal health care system.

More lies.

The Government promised to create a single-tier health service, guaranteeing access to medical care based on need, not income. They were very big promises. Five years on, the hope it gave to hundreds of thousands of families has been cruelly dashed. Not only is the two-tier health system still in place, but the Government has, in fact, also made it worse, with 4,000 fewer nurses, 68,000 waiting for inpatient treatment and 400,000 for outpatient appointments.

As if all of this was not enough, the Government has now imposed a service plan on the HSE that is €150 million short of what it requires. Mr. Tony O'Brien, the man it put in charge of the HSE, has told the Government that the health service has been starved of resources since 2011. Other senior medics have warned openly that the lack of funding for 2016 will hurt patient care. Given the scale of the failure to reform the health system in the past five years and given the hardship and suffering the Government's decisions have imposed on families right across the State, will it now apologise for that failure? Will it now admit it has no plan or vision for the health care system? Will it finally commit to providing the level of funding and staffing required to provide people with the health care they so urgently need?

The health service and its staff have considerable achievements to show, particularly in the context of four or seven years ago when they were subject to the trials and difficulties of an economy crashed by Fianna Fáil through the bank guarantee and the collapse of the construction industry and resources were tight. Notwithstanding that, as patients throughout the country will verify, once people gain admittance to our health services, the level of attention and service from the doctors and nurses we employ in hospitals is world class and of a high standard.

If they manage to get in.

This does not mean the health service does not have problems or that it is not requesting additional funds. The scale of the challenge for the health service was acknowledged when, as part of the budget for next year, an extra €900 million was allocated to our health service. Performance reports indicate that waiting lists had reduced by the end of August. We are also developing a more responsive reporting structure for the HSE involving clinicians and consultants and we have a great deal of work done on the hospital groups. This means we now have reporting on hospitals on a regional basis. Furthermore, the Revised Estimate which is being published today provides an extra €20 million for mental health services. The provision of GP cards for children under six and for people over 70 has been warmly welcomed by parents and older people throughout the country. One of the biggest problems in our hospitals has been the issue of step-down facilities. Applications for the fair deal scheme are now being dealt with within a period of four weeks or less on average. These are significant achievements by our health services. We have also seen the development of more than 40 new primary care centres, where people can get a diagnosis and treatment for chronic illness without having to attend an acute hospital. They can also avail of ordinary GP services, after care services and other patient care services at these centres. Another 20 of these centres are in the process of construction. These facilities are changing the landscape of health care here. All of this is a tribute to those in the service, particularly to nurses, doctors and paramedical staff.

That was a truly amazing answer. The achievement of the Government is: 4,000 fewer nurses. Bualadh bos. There are 68,000 people waiting for inpatient treatment. Well done; good job. There are 400,000 people waiting for outpatient appointments. This is before we come to the absolute chaos in accident and emergency units. The Tánaiste should not attempt to hide behind the valiant efforts of staff within the health system to get the Government off the hook. In fact, the achievements of staff in the health service stand in stark contrast to the abject failure of the Government. The contrast could not be more dramatic. I have no doubt that if any of those workers watched this exchange and heard what the Tánaiste said, they would, to say the least, find it ironic that the Tánaiste would laud them for their efforts, having left them so badly in the lurch.

The Tánaiste's claims about new money for health are entirely bogus. She knows well that only €97 million of the money referred to is new money and that most of that was already committed. She knows that funding for hospitals - this is a matter of public record - is €100 million less than required. She knows that there is €1.5 billion less in the health budget now than there was in 2008. She may also know there are campaigners for medical cards for chronically sick children outside the Dáil today. They do not buy or believe for a minute the Tánaiste's attempt at propaganda that the Government has made the system better. That is manifestly not the case.

The 405 patients who are on trolleys in hospitals today are not convinced either. Who could blame them? Thousands of people with chronic conditions who cannot get access to the treatment they badly need do not believe the Tánaiste either.

Does the Deputy have a question, please?

In regard to the Government's largesse in respect of older citizens, let me tell the Tánaiste something. The greatest concern raised by older citizens in respect of health is the prescription charge because it puts them to the pins of their collars and forces them to make a decision on any prescription as to which medicines they will take and which to leave behind. In many cases, they take advice from their pharmacists on that. Did the Tánaiste know that?

It being Christmas time and the season of goodwill, I am going to give the Tánaiste the opportunity to apologise to all of those people she has failed.

Please, the Deputy has the floor.

Make no mistake, she has failed them.

The Deputy has almost got through her script now.

More importantly, the Tánaiste should do the decent thing and take the opportunity and accept the Government has got things badly wrong and should change course now. This means that it should provide resources, staff, a plan and a new beginning for the health service.

The Deputy may have sought to read her scripted remarks with some force, but she utterly lacked any sense of conviction, as if she would know, as a member of a party led by somebody who had to hop across to America for his private health treatment, or as if she would have any idea of what the health service in this country is about.

I will send the Tánaiste a copy of our plan for the health service for Christmas for her to read.

On a point of order------

I am sorry, Deputy, but there are no points of order during Leaders' Questions.

The Deputy's condescension and patronising remarks towards the hard-working staff of the health service-----

The Tánaiste is an absolutely disgraceful cynic. We are defending front-line staff. They have no sympathy for the Tánaiste and her nonsense today.

Order please. The Tánaiste has the floor.

The Deputy's condescending and patronising remarks-----

The only person who is condescending and patronising is the Tánaiste.

It is between condescension and cynicism.

The Deputy failed to recognise-----

Please, Deputies.

Are you able to keep them under control, a Leas-Cheann Comhairle?

I am not really.

Get on to the army council to keep them under control.

This is Leaders' Questions. Deputy Mary Lou McDonald asked a question and the Tánaiste is replying.

Notwithstanding the Deputy's remarks about Christmas being the season of goodwill, which I presume were thrown into the comments in order to make a joke of people wanting to have a happy Christmas and season of goodwill-----

Cop on to yourself.

The Tánaiste needs somebody to write a script for her.

The Deputies are so focused on aggression.

The Tánaiste is embarrassing herself.

This is a serious issue.

What is their policy for the health service?

It is here.

There it is.

Their policy for the health service-----

I have it.

Is that the man behind the wire?

The Deputy cannot display those documents.

The little red book.

The Deputy cannot display books.

In fairness, the Tánaiste asked and I have it here.

A question was asked by the Deputy.

That is a complete abuse of the Dáil.

Could we settle down, please?

It is fully costed for the terms-----

The Tánaiste asked about it.

The Tánaiste is giving a reply. Under Standing Orders, the Deputy is not meant to display those documents.

My apologies. It has been fully costed.

We are not buying it.

It is not. There are no costs in it at all.

It deals with bringing about proper universal access.

We are not buying it from the Deputy.

I can give it to the Tánaiste for Christmas. I insist.

This is like the "Antiques Roadshow" at this stage.

That is fantastic. I call on the Tánaiste to conclude.

That document has no costings in it at all.

It does.

Debate it.

It has no mechanism for paying.

What page is it on?

It is a bare document.

Deputy Mary Lou McDonald should resume her seat.

We can have a debate on it.

Let me conclude on this.

Perhaps those opposite would like to debate the costings.

It is fiction.

Please, Deputies.

Any place, any time.

Please, Deputy.

The Deputies are looking for cheap advertising.

That is no problem. We can make time to fully debate the costings.

Did the Deputies get approval for it?

The Tánaiste should conclude. There should be no more interruptions.

Insert it into the RTE Guide. It is a work of fiction.

Please, no more interruptions.

It is just as good as Brooklyn.

One of Sinn Féin's proposals, in a position where we are seeking to recruit hospital consultants, is to slash their wages.

No.

In how many extra hospital consultants-----

The Tánaiste has not read it.

-----would the Sinn Féin proposal result?

Would they have extra taxes if earning more than €100,000?

Go back to sleep, Dinny.

The Deputy-----

I am sorry, but I ask the Deputies-----

They would be chased out of the country if they were taxed like that.

Half of west Donegal is in Australia thanks to the Fine Gael policies.

Nonsense

At least the people would be here to pay taxes.

Please settle down. I want to call Deputy Mick Wallace.

After the Government's actions, people have left the country.

A Leas-Cheann Comhairle-----

Deputy Aengus Ó Snodaigh should sit down and stop being a bully.

Some 250,000 people have left the country. The dole was cut also.

Settle down. It is more than the dole that Sinn Féin would cut.

I ask the Deputies to, please, settle down. I must call Deputy Mick Wallace shortly.

Deputy Dinny McGinley-----

Hush.

The Deputy can put his name on the ballot paper to be elected again and see how he gets on.

When the Deputy is here in 35 years, he can-----

Put your name down.

The Tánaiste is going to conclude.

I challenge Deputy Dinny McGinley to put his name on the ballot paper.

Settle down, please.

We want to see more women in the Dáil precisely in order that we can avoid the kind of behaviour in which the Deputy opposite has just indulged.

Is the Tánaiste serious?

A bar room brawler. You are a disgrace.

I call Deputy Mick Wallace. May we, please, have some order?

Has she ever seen a tape of herself during Leaders' Questions?

I do not want any more disorder. Deputy Mick Wallace has the floor.

A sound man.