I was reading again the programme for Government in respect of health, which I have described as one of the great works of political fiction. Let me read the key passage:

This Government will introduce Universal Health Insurance with equal access to care for all. Under this system there will be no discrimination between patients on the grounds of income or insurance status. The two-tier system of unequal access to hospital care will end.

Yesterday, the Taoiseach admitted that his Government had failed in achieving that objective. Leaving aside that objective, I put a question to the Taoiseach yesterday on how he and his Government could have approved the HSE's health service plan for 2016 when the executive itself said it was €100 million short for hospitals. The Taoiseach approved funding for health knowing that the HSE is already, in January, €100 million short of what is required to meet the needs of acute hospitals. When I put the question to him, he refused to answer it and implied that the HSE requests every year more money than it gets. In other words, he is playing poker with people's lives.

I ask the Taoiseach to read again pages 90 and 91 of the health service plan. It outlines that there will be a growing and ageing population and greater demand on hospital services. There are overcrowded emergency departments. Cork and Beaumont hospitals are closed to elective admissions. Operations are not being carried out. St. Vincent's hospital was described by a public representative yesterday as being like a war zone, and it was stated the experience of patients there is unimaginable. That hospital had highest number of patients on trolleys in the country yesterday.

People are afraid to go to emergency departments and hospitals. A community nurse in Galway told me that elderly citizens were begging her not to send them into the emergency department in Galway. That is what is happening and there seems to be no realisation of it. Waiting times are getting longer and the numbers on the waiting lists are increasing because of the consistent neglect of health by the Government.

The Minister for Health, Deputy Leo Varadkar, said he will have to use private hospitals and overtime to try to deal with the problem now in the first weeks of January.

A question, please.

Does the Taoiseach believe the HSE when it says it is €100 million short for hospitals in 2016? Knowing that there can be no Supplementary Estimate next year, what will the Government do if there is any increase at all in the activity in hospitals in 2016?

Where is Leo?

Hiding.

I dealt with the question the Deputy asked yesterday. The Government has approved €13.6 billion for health services this year, which represents an increase of €800 million on last year. We are dealing with circumstances in which 1,000 beds were taken out of the system. We know the demographics and the fact the population is ageing. I pointed out to the Deputy yesterday the increase in the number of attendees with flu-like symptoms at accident and emergency departments and the fact there are 250,000 unused vaccines at present, of which people in vulnerable positions should avail. I also pointed out to the Deputy the importance of having an economy that is capable of dealing with the resources for investment in medical personnel, facilities and providing primary care centres, which are being built on an ongoing basis, and also in community facilities, increasing home care packages and the development of hospital groups evolving into trusts. This is to deal in a systematic way with providing health services of a much better kind for patients. The Deputy encountered all this himself. I am not going back. We can only go forward here.

The Deputy asked whether the Government had approved a budget that was inadequate in the eyes of the HSE. What the Government approved was the health service plan submitted by the HSE to the Minister. It includes an allocation of €13.6 billion for 2016, which is an increase of more than €800 million on last year's Estimate. We will not be in a position to provide all the services we need now - doctors, nurses, medical personnel, specialist facilities, the expansion of hospitals, including accident and emergency facilities, and all of those things - without having an economy that is capable of providing these resources. We had all of that before when an endless pot of money was thrown at a system that was not capable of dealing with it.

The Government has admitted that we have not been in a position to introduce universal health insurance. What it is committed to is a universal health care policy driven through primary care centres and communities and an expansion of facilities in hospitals. As the Deputy knows, 750 extra nurses and 300 consultants and specialists have been recruited in recent years. However, one must have the capacity and resources to employ these people. This means there are difficulties in many cases with patients and people who have to attend hospital for one reason or another. I understand the difficulties and the stress and pressure they cause, not only for front-line staff but also for patients.

People are afraid to attend accident and emergency departments.

I remind Deputy Martin that the allocation for 2016 is €13.6 billion, which is an increase of €800 million on last year. In the next number of years, I would like a multi-annual budget to be set out for the health system.

The Government cannot set out a budget for one year, not to speak of a multi-annual budget.

Such a budget would be much more structured than an annual budget and would allow the system to plan in a much better way for the treatment of patients in the home or in the community and hospital sectors.

The Government does not do any of that. The budget has not increased by €800 million, because the Supplementary Estimate introduced at the death of last year was €660 million. In other words, the Government left the health service short at the start of last year. The increase works out at less than €200 million if one adds it up. The HSE is stating simply that, in summary, when account is taken of the 2015 cost of services, the expected growth in costs and initial cost savings, there is a preliminary shortfall of €150 million. While it will do some cash management exercise to reduce this figure to €100 million, it is stating that it will be €100 million short and that one of the options will be cuts in health services.

The frightening thing about the report is the statement on page 91 that day case activity will be delivered at 100% of 2015 levels, while emergency inpatient activity will be delivered at 100% of 2015 levels.

The Deputy should ask a question, please.

The population is growing and demands on hospitals are predicted to increase next year, as we must all accept. As a result of an ageing and growing population, the population will increase by 1% and the number of people aged over 65 years will increase by 3.6%. However, the Estimate does not make any provision for additional activity, meaning that children with scoliosis who are already waiting too long for operations will wait longer next year, and other people, including cardiac patients and people with a range of conditions, will wait longer or may not even have operations next year if the Government's policy continues.

A question, please.

We need honesty in the debate about health and services. There is a medical manpower crisis. If one speaks to doctors, nurses and acute health care staff, one finds that they are under enormous pressure. What the Government is doing with the health budget is fraudulent and false.

Sorry, Deputy. Will you put a question, please? We are over time.

The Taoiseach is pretending enough money has been provided when he knows in his heart there is not enough money available. He will use language to camouflage this and get the Government over the next five or six weeks.

What is the Deputy's question?

What will happen in the rest of the year? I asked the Taoiseach a question about the supplementary health budget, which cannot be provided this year under European Union fiscal rules. How will the health service cope in 2016, given the degree to which the Government has under-provided for it? This is not my analysis-----

There will be more cuts after the election.

-----but the analysis of the Health Service Executive, whose plan the Government approved in the knowledge that it was short €100 million for hospitals.

The Deputy set up the Health Service Executive to provide world-class services. As he knows, the HSE has always had a difficulty in spending the money it received, although it may have claimed every year for more and more money. We cannot return to a position in which we continuously throw money at a system that is not reformed or capable of dealing with a situation that has evolved over very many years. It was created when the HSE was set up on top of the old health board system.

The taxpayer is putting up €13.6 billion for health this year, so of course there are requirements for reform and the effective expenditure of this money. The important point here is that one cannot employ the professionals who work on the front line - consultants, doctors, nurses and so on - and provide them with proper facilities unless one has the resources to do so. We have never had that, and we will not have it unless we can develop the economy to a point at which it can continuously do that.

That is my point. The Government is leaving the health service short.

The Deputy failed miserably in this regard and abdicated all responsibility.

He buried himself in reports.

In 2015, an extra €117 million was provided to the HSE to deal with overcrowding in emergency departments, and the waiting time for the fair deal scheme was reduced from 16 to four weeks. Even Deputy Martin will accept that this is reasonable and-----

Under this Government, the waiting time increased to 16 weeks.

The Deputy overlooks the minor matter of the economic crisis.

-----will allow people to be discharged from hospital.

Will Deputies listen, please? We are over time.