The health system is in a terrible crisis right now. It is a human resource crisis, with nurses leaving the system on a consistent basis and up to 75% of graduates leaving the country. Accident and emergency departments are in continual crisis. There is a general human resource shortage across the board in respect of doctors, psychiatrists, therapists and many more.

The latest waiting list figures reveal a dramatically worsening situation in all the categories and in all the hospitals. There are now approximately 666,000 patients on a waiting list - a national record, and dare I say, a national scandal. The number of outpatients waiting for 12 months or longer is more than 109,000. The total outpatient waiting list has 473,000 people. The total number of inpatient and day cases is 85,000 plus. Then there is the pre-admit list of 26,000, plus the 61,000 on the planned procedures list, which do not get into the official lists. We have shocking waiting lists for diagnostics, for endoscopies, CT scans etc. and most shocking of all, there are 10,000 children who have been waiting for more than 12 months for an appointment in the Dublin hospitals.

If one goes through the categories by hospital, Waterford, for example, needs serious attention. The outpatient list in Waterford of those waiting over 12 months is up 443% since 2014. I do not know what is going on there but it is incredible. Its inpatient waiting list is up 159%.

Since the change and the downgrading and undermining of Waterford hospital, the waiting lists have soared in that hospital. For outpatient waiting lists, the Mater hospital is up 55%, St. Vincent's hospital is up 56%, Louth is up 96% and Limerick is up 108%.

A commitment was given that the National Treatment Purchase Fund, NTPF, would be given back responsibility for waiting lists. That has not happened yet. The NTPF has not started its work yet and I want to know why. In the last year when the NTPF was operating, it provided operations for approximately 33,000 patients. It facilitated approximately 200,000 patients in all up to 2010 and the median waiting time was down to 2.4 months. There seems to be an incredible inertia and lack of urgency attached to the crisis in waiting lists and the situation is getting worse. When will the Government show some urgency in tackling what is clearly an unacceptable crisis in terms of people waiting for urgent appointments and surgery?

The Government has shown priority in the funding it has allocated to the health area for 2017 which, as the Deputy will be aware, is €14.5 billion. The Government allocated €20 million to the National Treatment Purchase Fund for 2017, rising to €55 million in 2018. Last December the Minister, Deputy Harris, granted approval to the National Treatment Purchase Fund to dedicate €5 million of its funding to a day case waiting list initiative with the aim of ensuring that no patient would be waiting for more than 18 months for a day case procedure by 30 June 2017. In excess of 2,000 cases will be managed through the process and those patients are already receiving appointments.

In order to reduce the numbers of long-waiting patients, the HSE was asked to develop the waiting list action plans for 2017 in the areas of inpatient, day case, scoliosis, and outpatient services. Those plans have now been finalised and will be acted on shortly. The HSE and the INMO both agree that the time patients spend on trolleys waiting for beds has decreased. I acknowledge the work front-line staff have put into that initiative. Notwithstanding those improvements, the figures are too high and the Department continues to work with the HSE to identify further measures that can be taken.

In respect of Deputy Micheál Martin's comment about nursing and midwifery, management has committed to increasing the nursing and midwifery workforce in 2017 with 1,208 additional permanent posts; the conversion of agency-employed staff into HSE direct employees; maternity leave cover; offering all graduating nurses and midwives full-time contracts; a career break scheme; 130 additional undergraduate places this year and offering nurses and midwives improved educational opportunities and career pathways.

The HSE has developed an inpatient day case waiting list action plan with engagement from the Department and the NTPF. The plan focuses on reducing the number of patients. It is estimated that there are 39,000 patients to be treated by the end of October 2017 and the plan sets a target to remove approximately 75% of those patients from the waiting list, that is, 29,000 patients, through a combination of normal hospital national service plan-funded activity, as well as resourcing and outsourcing initiatives utilising the remaining €10 million of budget 2017 funding. That represents a 30% increase in activity, which demonstrates the priority attached to it.

Our hospitals are now carrying out four times more procedures on patients aged 65 and over, and twice as many in the under-65 age group since 2000.

I thank the Taoiseach.

This is my final point, a Cheann Comhairle. In 2016 alone there has been a 4% increase in inpatient and day case activity over 2015. Last year, almost 1.69 million patients received inpatient or day case treatment in hospitals, which is an increase of almost 40,000 on the previous year. That demonstrates the urgency and priority attached to the issue, while admitting that the waiting lists are too long. Serious action is being taken to address those problems.

Twelve months ago the Government agreed in the confidence and supply agreement to re-establish the remit of the National Treatment Purchase Fund to deal with waiting lists. Nothing has happened since then. The €20 million has not been spent by the NTPF and we are now into May 2017.

Those are the facts. There has been a lack of urgency. We all saw the scoliosis crisis but it should not have to have been revealed in such a telling and effective manner on RTE. There are still more than 4,500 children who have been waiting in excess of 18 months for an appointment in the three children's hospitals in Dublin. It is scandalous. We are talking about all-time records. The former Minister for Health, now Senator James Reilly, got rid of the National Treatment Purchase Fund. We are back to the same massaging of figures that he engaged in, widening the timelines and saying that the Government will concentrate on those waiting more than 18 months.

The National Treatment Purchase Fund should be restored. Rather than micromanaging it, we should get its systems back into play with the forensic way in which it tackled waiting lists in the past. Too many people, in particular too many children, are waiting far too long. The execution and delivery of a resolution to these crises is simply not happening in the health area. Waiting lists and times are getting longer every time the figures are published. There is no appreciable gain or sense that the Government is getting on top of the issue.

In the negotiations and discussions we had about the formation of a Government, it was agreed, indeed at the Deputy's own suggestion, that the National Treatment Purchase Fund would be restored. The restoration was costing €20 million for 2017, rising to €55 million for 2018. It is not true to say that nothing is happening. The NTPF has now commenced the initiative of €5 million for the day case waiting initiative which was approved last December. It is expected that in excess of 2,000 patients will receive treatment under this initiative. They will thus be off that waiting list.

In respect of the outpatient waiting list, it is estimated that there are more than 190,000 patients who fall into this category. The plan sets a target to remove over 50% of these from the waiting list, that is, in excess of 95,000 patients. That represents around 5,000 extra patients or a 5% increase in activity since last year in that particular patient cohort.

In respect of the NTPF and the inpatient day case waiting list action plan, we hope to have 39,000 persons treated by the end of October. The plan sets a target to remove 75% of these patients from the waiting lists, that is, more than 29,000 patients between the normal hospital service plan funded activity, as well as insourcing and outsourcing initiatives utilising the remaining €10 million of the budget for 2017. The money is being spent and is making serious inroads into the numbers, as I have already outlined, on the initiatives undertaken by it.