The revelations in yesterday's The Irish Times of the correspondence between the chief executive officer of the Health Service Executive and the Minister and the Department of Health demonstrate a very flawed and essentially opaque approach to the funding of our health services. At the very least, they show a very poor sticking plaster is being applied. There is a complete lack of transparency, substance and, most worryingly of all, credibility surrounding these figures. There is a bogus, spurious element to some of them and, indeed, a clear statement in the correspondence that they will not translate into reality. With all the talk of the implementation of Sláintecare, the crisis in accident and emergency services, overcrowding, and the bed capacity review, in essence these figures and the correspondence between the HSE and the Minister show that the health service will at the very best stand still if not face more cuts to vital services in 2018. Given that the pay agreements will absorb the bulk of the increased expenditure, there will be little for additional services. The elderly will continue to suffer, the disabled will still be shortchanged in respect of access to therapies and services, the acute hospitals will remain under intense pressure, notwithstanding the experiences of December and January, and primary and community care will remain neglected.

Specifically, according to the HSE's own internal assessment, there are "long waiting lists" in respect of gynaecology and "poor access to treatment [has] left thousands of women with a poor quality of life". Regarding anaesthesia, the HSE states that "Serious clinical risk exists because [there is only] one line of anaesthetic call" in most general hospitals and accident and emergency departments. The HSE states that there is "a national shortage of critical care beds" which is "impacting on access to scheduled and unscheduled care services". Ophthalmology theatre closures and waiting lists are "affecting preventable deterioration". Urgent targets will be missed in endoscopy and colonoscopy. There will be a staffing deficit in 2018 right across the spectrum of cancer care for child and adolescents and in geriatric oncology, radiation and surgical and medical services. The correspondence goes into other specifics, such as the need for 80 beds and five theatres in Our Lady of Lourdes Hospital, the dialysis unit in Galway and so on.

Most damning of all, the so-called value improvements or cost savings have not been identified and are extremely vague. The chief executive is stating large tranches of these savings will be very difficult to realise and, if we read the language, will not be realised.

Does the Taoiseach agree these Estimates lacked transparency in advance of the budget and have lacked it since and, in essence, they mask a deteriorating situation in the provision of services to our citizens in 2018?

Before calling the Taoiseach to respond, I ask Members to extend a warm welcome to our distinguished visitors, the Moderator of the Presbyterian Church in Ireland, Dr. Noble McNeely, who is accompanied by the Clerk of the General Assembly, the Rev. Trevor Gribben, and our friend from Lucan, the Rev. Trevor Morrow.

It is important that when we discuss health budgets we put all of these things into their rightful context. We have this year the largest budget for the HSE and the health sector in the history of the State, at approximately €15 billion, an increase of €2 billion a year in the past three years. It is increasing much faster than the population is growing or ageing. We are now one of the top five spenders on health in the world, if we divide the health budget by the number of citizens in the State, notwithstanding the fact we have a young population. Even during the recession, our health spending per capita was above average, so this idea we are only catching up on underspending during the recession is not supported by the facts.

The fundamental problem and crisis that affects our health service, in my view, is not solely lack of money or lack of resources. It is much more about how money is spent and how resources are deployed, and monetising all problems does not actually bring us any closer to a solution. There will, of course, be more money and more staff for the health service this year. We already have record numbers of doctors, almost 10,000, working in our public health service. In terms of nurses per head or per bed, we are very near the top of the league table. However, those extra staff and extra beds, and all of the extra money, will not make a difference unless we have better management, proper clinical leadership, real accountability and proper responsibility from those charged with running and managing our health service. I absolutely accept it is the Government's responsibility to make all of this happen.

If we take the entire spend of the entire Government, we spend approximately €60 billion a year. In a sustainable way, the most any responsible Government can increase spending is by approximately 4% or 5% a year. Anything more than this is unsustainable and we would be heading into another crisis quite soon. The most we can increase spending is by €2 billion or €3 billion a year. If we take all Government Departments and agencies together, they requested an extra €12 billion this year. Anyone will understand this is not sustainable. It is the normal process in the course of events for Departments and State agencies to request much more than they anticipate they will achieve from the Estimates process.

What is unique about the HSE is it estimates it needs €1.5 billion extra every year, that is, an extra 10% to do nothing to improve patient outcomes. That is not sustainable. If we are going to turn around our health service and make reforms and changes, and if we have any prospect of implementing reports such as the Sláintecare report, the starting point cannot be a 10% increase in the budget, an extra €1.5 billion a year, to do nothing to improve outcomes for patients, patient experience or patient care. It is not credible or sustainable, and I accept it needs to change, because we cannot have this continual exchange of letters where all problems are monetised and then just passed on. We will need a lot of changes and a lot more accountability, and that will be driven by the Government.

The Taoiseach did not answer the question. My question went to the heart of an issue of credibility and honesty in presenting the figures and challenges facing the health service. The Taoiseach has been commentating on the health service since he was Minister for Health, with little outcome. In 2014 and 2015, I identified dishonesty in the health service Estimates process and in the way things were working and operating in the Department and the HSE. Essentially, I am asking the Taoiseach whether the Estimate put before us in the national service plan, is acceptable. Irrespective of all of those issues about which the Taoiseach has spoken, one cannot put figures that cannot be realised into an Estimate.

That is what the chief executive of the HSE is telling the Government and the Oireachtas at this late stage, after the budget has been passed. In essence, the indication is that there is potentially a deficit of €800 million. Leaving that aside, there is a figure of €346 million for efficiency savings or value improvement. He is very clearly saying that the last element of that is almost beyond implementation in the figures. Essentially, he is saying that delivery of the €119 million in priority theme two, in addition to the €77 million from priority theme one, will be extremely challenging. We all know what that means; it means it is a false figure and it should not be in there.

Let us have an honest debate about this issue. The Taoiseach should stop coming in and saying that the Government will implement Sláintecare; it is not going to implement Sláintecare or anything in Sláintecare. That is the honest answer. Let us have an honest debate about the challenges facing health not just on funding, but on reforms. Let us not camouflage, mask and pretend while putting a sticking plaster over the figures for another year. That has been happening for the past four years. The Government realised hundreds of millions of euro in other savings last year while getting additional tax and so on but it has also prioritised where that goes. We want an honest debate on the figures not after the budget, but in advance of it.

I always welcome an honest debate and if we were to have an honest debate about health, one of the first elements the Deputy would accept is that it is not credible or sustainable to argue for an extra €1.5 billion per year for health care on the basis of it making absolutely no difference, with no improvements for patients.

We know that. That is not my question.

There is no chance of resolving our problems if they are all monetised and it takes an extra 10% per year to do nothing at all.

That is not the question I asked. Does the Taoiseach stand over the figures?

The position is not credible. With respect to the Deputy, it is fair to say he has been commentating on the health service for a very long time, since he became a Member of the Dáil almost 30 years ago, and including a period as a health Minister. He knows that during his period in government, there were service plans that included efficiency criteria and percentages for efficiency. There is nothing unusual about that.

In more general terms, there will not be cuts to the health service in 2018. The budget has increased and staffing levels have increased. All problems will certainly not be solved but there will be action in a number of very important areas. For example, there will be an increase in funding for home care, with an extra 75,000 hours for that care. It is very real. Surgical waiting lists have been falling for most of the past six months because of investment in elective hospitals and investment through the National Treatment Purchase Fund. That will continue. We are also adding more beds to the system, with 170 additional beds opening so far this winter across a number of hospitals. I would be happy to list them.