Our health service is under enormous pressure. Health care staff, nurses and doctors are literally at the end of their tether trying to keep things together and patients are suffering. Irrespective of what hospital one visits throughout the country - I was in Drogheda last week - one gets a clear illustration of this. Waiting lists for routine operations are spiralling out of control and have been for some years now. Waiting times are lengthening all the time and targets are being breached. Despite the fact the Government changed the goalposts to make such times and targets more manageable, they are getting worse. The Government undermined the National Treatment Purchase Fund which had been working very effectively to deal with elective surgeries and routine operations before it came into office.

Our emergency departments simply cannot cope. Talking to people in and outside of the hospital in Drogheda where I was last week, this was the number one topic of conversation. Waiting times for minor operations and CT scans are now the worst in Europe and the same is true of waiting times for emergency departments. There are 517 patients on trolleys in emergency departments today and operations are being cancelled in these hospitals as a result. Whether it is the Mater hospital, Beaumont Hospital or Cork University Hospital, they are under enormous pressure.

Most damning of all is that the Taoiseach and the Minister deliberately left the hospitals of this country short of at least €100 million in the health service plan. This is acknowledged by the HSE on page 90 of the 2016 service plan where it states there is a funding shortfall of €100 million. It had been €150 million but some cash management shaved off €50 million on a once-off basis, leaving €100 million of a shortfall. It uses the chilling phrase that one of the options which it can consider includes "aligning activity levels to the funding". That means cuts in capacity in our acute hospitals for 2016. It means fewer operations and more overcrowding in emergency departments, fewer discharges and so on. It is incredible that the Taoiseach and the Minister would have approved of this plan, knowing in advance it has left the hospitals short of €100 million. Why did the Taoiseach deliberately approve this plan knowing that, at a minimum, it leaves our hospitals short of €100 million for 2016?

I thank Deputy Martin for his question. He actually makes the case as to why it is critical that we are able to continue to grow the economy to deal with all these issues.

A total of €13.6 billion has been allocated for health this year. I have no intention of returning to a situation where endless money was thrown at a health system without reform and effective spend for the taxpayer and particularly for patients and securing the best outcome for patients.

The Taoiseach is going to leave them on trolleys.

I have said on many occasions that the position is not satisfactory in a number of areas, where elderly people are waiting on trolleys for a very long time or where incidents arise in overcrowded hospitals that should not arise. That is all the more reason that the impact of the spend that is in place should be examined and how capacity can be increased in an effective way to deal with the patients. While capacity is up by 5% this year, so too is the number of visits and calls to accident and emergency units.

The Deputy is aware that 1,000 beds were taken out of the system. There are 750 more nurses and 300 more consultants and doctors employed since 2011. There is an increase of €800 million in the spend for this year. I was talking to the Minister this morning. An increasing number of patients, both adults and children, are presenting with flu-like symptoms. The Health Protection Surveillance Centre has reported that influenza-like illness rates for the second week of 2016 are equivalent to the rates reported in mid-February last year and that influenza is expected to circulate for a number of weeks. There are 250,000 unused vaccines available at present. People aged over 65 years and people who are vulnerable or who work in the health service should avail of the opportunity to get the flu jab - the Deputy may shake his head if he thinks it is funny - and attend their local pharmacist or GP where it will be made available to them. There has been an increase of over 10% in the level of attendance by people over 65 years of age.

I also pointed out to the Deputy on the previous occasion he raised this matter that in December 2014, the Minister for Health convened the emergency department task force to ensure that where overcrowding began to occur in accident and emergency units, it would be addressed in a proper, integrated and system-wide way by the hospital groups dealing with the issue in the various hospitals. In April 2015, the HSE published the emergency department task force action plan with a range of actions that were time defined, such as getting the best out of the space available in hospitals and community capacity and developing internal extra capability and processes to deal with this. In addition, a sum of €170 million was allocated for that.

As Deputy Martin knows, without effective reform one can always say there is never enough money. He knows the process that applies here. When a budget is struck and agreed by the Cabinet, the HSE submits its programme to the Minister of the day. The Minister has 21 days to respond and either accepts it or makes amendments to it. Naturally, the HSE, in addressing the scale of the challenges, will always seek the maximum amount it can get. As I said, €13.6 billion has been allocated for this year, which is €800 million more than last year. Capacity is up by 5% but the increased number of attendances obviously creates pressures in accident and emergency units. This goes back to the point that to deal with these matters in a long-term way, the community and primary care system must be looked at as well as the capacity in hospitals, including the employment of consultants, doctors, nurses and other medical personnel down the line, and one must have the resources to be able to meet that.

The Taoiseach has great difficulty answering the question he was asked. Why did the Cabinet approve a plan that leaves acute hospitals short by €100 million? Pages 90 and 91 of the health service plan clearly lay out the position. Page 90 outlines the impact of demographics on hospitals and how demand for acute hospital services continues to increase. Demographic changes will see the population increase by 1% in 2016, an increase of 32,000 people. The over-65 age group is expected to increase by 3.1% or 19,400 people. This is setting the scene for its revelation that it is €100 million short. It is a €100 million shortfall before the plan even starts. The plan goes on to outline the implications of that on page 91, that is, providing inpatient services and inpatient activity at 2015 levels. This is at the start of 2016. It means real trouble ahead for hospitals in 2016. There will be no Supplementary Estimates, in accordance with EU rules. The Government had to allocate €666 million at the end of last year to cover a funding shortfall.

A question please, Deputy.

There were three fraudulent budgets for health over three years. The Government has now deliberately approved a budget that is €100 million short for acute hospitals. That will mean more overcrowding in hospitals, longer waiting times and higher waiting lists in 2016. The Taoiseach is not facing up to the reality that he is consistently underfunding health. He cannot come to the House and talk about the need for reform, because he promised reform for five years under the name of universal health insurance and ditched it at the 11th hour. The five-point plan has become a three-step plan because the Dutch model has been dropped unceremoniously from the Taoiseach's platform. He is afraid even to talk about health in public. All people will hear about for the next while is the strength of the economy.

The Deputy is way over time.

There is an onus to tell the truth to patients and the people. The HSE has laid out the position quite candidly in the health service plan. That was presented to the Taoiseach. Why did he decide to approve of it knowing it leaves the hospitals short of €100 million? Will he give a precise and specific answer? Why did he decide to leave the HSE €100 million short at the start of the year knowing it will cause incredible problems for 2016?

He is not so good at the sums.

Deputy Martin is well aware of the position from his experience in that Department and having served as a member of a Government. In this case, an extra €800 million was allocated by the Government to the HSE and the Department of Health, and responsibility resides in the Department of Health for that Vote. The HSE, in having more effective management, would be expected to deal with that. Obviously, improvements have been made with the money. The hospital groups were established, which is an important move towards having trusts which will examine the groups of hospitals and what they can specialise in for the future. There are 46 more primary care centres than existed in 2011. They are valuable with regard to people not being required to go to hospital for minor injuries. Families have free GP access for people over 70 years and children under six years of age. The next step is to extend that to children under 12 years. Since 2011, there are 300 additional consultants and since January last year there are 750 more nurses and 250 non-consultant hospital doctors, NCHDs. Mental health funding has been tripled and a suicide prevention strategy has been published to reduce the incidence of suicide, please God by 10% by 2020. We have also stabilised the private health insurance market which was facing collapse in 2011 and 2012.

Take a trip out to Beaumont Hospital.

I wish to make a final point. It is something I noted and I will put it to the Deputy again. In 2004, in respect of accident and emergency overcrowding, the Deputy said: "I think it's going to need sustained investment on the nursing home side. It also requires the development of home care packages ... because of the funding constraints of the last three years we haven't really been in a position to develop such a programme."

That was 12 years ago.

The year 2004 was a boom time-----

Fair deal.

-----when the Deputy had the same old way - fire money at it and hope it will work.

The Taoiseach is way over time.

The fair deal came in after that.

It is amnesia.

Giving €800 million without reform is no good. We must have a developing economy and in a planned way deal with the structures of community care and home packages-----

The Taoiseach cut them.

It is absolutely necessary then to deal effectively with the interests of the patients by employing medical personnel such as nurses, doctors and consultants and have the capacity to deal with that.

It is chaotic, and the Taoiseach knows it.