This week, the Health Service Executive service plan for 2017 was published. The introduction reads well as it references expanding services and improving the quality and safety of services but when one drills down through the figures, it does not read well at all. In fact, it is another work of fiction. We have highlighted consistently in recent years that the HSE service plans are not built on solid foundations. That has been more or less admitted by many people who have commentated on them. The headline increase is €459 million, but when the demographics and salary increases are taken into account, there is €61 million available to expand existing services or bring forward new services. That is €61 million across the entire health service, and of that €61 million, only €9 million has been made available for the acute hospital system.

Every day of the week, we hear people ringing in to radio stations to complain about the treatment meted out to their parent or other loved one in emergency departments. Waiting lists are at an all-time high. People are not able to access outpatient appointments for gynaecological, orthodontic or orthopaedic services. Across the board there are substantial increases in every area. This HSE service plan suggests it will address all of these issues with an additional €61 million for all services across the State.

We have to have an honest assessment of where we are going in terms of the provision of health care. We talk about improving the quality and safety of services but we are facing a crisis in every area of health. Our hospital system is not functioning. It is not capable of delivering even emergency care at this stage because consistently people are waiting in ambulances outside emergency departments. There is a lack of capacity and not enough consultants, midwives and nurses. In every aspect of the health service we are facing huge difficulties in providing basic care. To put that in context, Mr. Tony O'Brien, the director general of the HSE, stated recently at the health committee that within the next number of years, the health services will be unable to deliver any elective surgery. Effectively, only acute services and nothing else beyond that will be provided.

This HSE service plan is a work of fiction but, unfortunately, it is turning into a nightmare in emergency departments. Even at this late stage, will there be an acknowledgement from the Government that in talking about expanding services we have to fund those services? We cannot go on with this pretence and depend on a workforce of 105,000 to deliver health care in unsafe environments while being unable to deliver the basics across our hospital system.

The first point I would make in response to the Deputy is that next year will see the highest health budget that has ever been allocated and, thankfully, we have an economy that can deliver that increase. That should be acknowledged because without that increase, we would not be maintaining current services. With that increased budget we can maintain current services and deliver new services. The increases amount to more than €1 billion since last year. That is a significant increase.

In terms of what the HSE service plan looks to deliver, it is to maintain existing levels of service and some new service development while also providing for the increase in need that arises from a growing and ageing population. Clearly, we have to have targeted service improvements.

There is no doubt that we face a major challenge. Everybody across the House knows the challenging situation we are facing as a result of the increased population, higher numbers of elderly people and all the demands that arise from that. It is extremely dismissive of the Deputy to describe the service plan in the way he has done, given the level of detail contained in it, including the commitment to improve services and the increased budget. Of course the HSE has to manage that budget and ensure it is put to the most effective and efficient use.

I agree there are unmet needs. We must work continually to meet the current demands, but I want to point out to the Deputy some of the initiatives that will be delivered next year under the new service developments provided for in the service plan. They include disability services, including provision of places in day centres for school leavers with a disability, which have long been a source of concern; hospital service developments, including the new national children's hospital; the medical card for recipients of the domiciliary care allowance; improved access to and increased funding for older people to home care packages; improvements in the national ambulance service delivery; and better access to mental health services. All that is spelt out in the context, for example, of acute hospital day case numbers where the expected activity level in 2017, at well over 1 million, is 4.2% above the figure for last year.

As the Deputy is aware, additional funding has been provided to address waiting lists, and that will lead to improvements, including the reduction of the number of patients on trolleys. There will also be increased services in the community. For example, the activity level for home care packages, including the delayed discharge initiative, has shown huge improvements already this year, and the Deputy knows the waiting list for the fair deal scheme has been reduced to four weeks. This time last year we were very concerned because the waiting list was ten, 12 or 14 weeks. It is now down to four weeks, and the delayed discharge issue has been dealt with. It is on its way to improving.

I admire the Tánaiste's defence of this work of fiction but the reality is that the only thing this HSE service plan will deliver is longer waiting lists. The Tánaiste referred to additional funding of €61 million across the entire health care system over and above the headline figure, but she cannot stand up in this House and say with credibility that she will deliver on what is outlined in the HSE service plan. The point I am making is that this has been consistently the case in this House in recent years. The allocation of €61 million will not address the overcrowding or the shortage of consultants, midwives, nurses and other allied health professionals.

It is a bit late for that now.

It is simply not possible to sustain the activity that we are currently providing. The Tánaiste pointed out that there will be a 4.1% increase in activity across the acute hospital system, but an additional €9 million is being provided to fund that extra activity. That is simply not plausible. If the Tánaiste would accept, even at this late stage, that the funding in this HSE service plan will not deliver the health care we expect across our services next year, we could at least address some of the underlying problems.

I have acknowledged that given the increasing population, the increased numbers of elderly people and the increased demands on our acute hospitals, the HSE will have to manage the pressures on the system in the most efficient and best possible way. The point I am making is that the highest health budget ever will be allocated next year and so improvements will be made. There are particular pressures such as those the Deputy has mentioned, including in emergency departments.

The Deputy should know that the HSE special delivery unit team was on a site visit in Galway yesterday, working with University Hospital Galway, with a view to supporting the efforts to reduce the pressures on its crowded emergency department. As part of the winter initiative, the emergency department in Galway has been identified by the HSE as needing additional support. It is working in the areas still experiencing pressures such as Galway and Cork. Already, we have seen improvements where that kind of work has been undertaken, for example, in Beaumont Hospital where we have seen the numbers being reduced. We have to continue that sort of intensive work with emergency departments, and there are various management initiatives that can be undertaken to improve the situation. That is being done, despite the current pressures. Every effort is being made to deal with the particular issues. Under the winter initiative, extra money is being allocated for the Mercy hospital in Cork, with the provision of 18 step-down beds, which should improve patient flow in that hospital.

All of this work is being undertaken. Of course, the Deputy is correct in that the challenges faced by the health service are enormous. However, we can deal with them in a better way this year because of the increased funding.