Last week I asked the Taoiseach some basic questions about the HSE's or the health service budget, but he did not answer the questions I asked. He went on a general tour of spending generally and within the context of health services. My fundamental point last week and this week is that we are essentially being misled by the Government and the HSE on the budget for the health service in 2018. The service plan was published, but the very fact that it was published in December after the budget was a problem in terms of transparency and honesty about the figures. I asked a very basic question as to why it had taken a freedom of information request to reveal that the bulk of approximately €346 million in savings identified in the service plan would not be realisable and that the CEO of the HSE was saying this was extremely challenging. That is not to mention the deficit of €172 million. There is no real understanding of how it will be provided for. I refer to what the HSE is stating about existing levels of service and the funding required.

The budget represents an increase of €413 million on the final figure, the outturn, for 2017, which is the crucial figure. It represents an increase of approximately 2.9%. Pay accounts for approximately €278 million of this sum and is part of public service pay agreements. Demographic costs constitute the big issue facing us all in terms of spending. In the light of these costs, the amount allocated is hardly adequate, but it is a significant factor. Basic health inflation, the incremental cost of developments in 2017 and so on must also be borne in mind. There is a figure of approximately €196 million for new service developments. One then has to factor in savings of €346 million. When one goes through the figures - it can be confusing to the public at large - one notes that, in essence, the HSE will find it extremely difficult to deliver services at the level they were provided last year, never mind expand services. That explains why those working in the health service cannot work out all of the general talk about global figures and increases when hospitals such as St. Finbarr's are being asked to accept a cut of up to 21 whole-time equivalent positions when ten beds lie unoccupied in Bandon, despite the fact that there are now considerable issues about elderly people finding placements in long-term care settings and when revenue funding was refused in Letterkenny, despite record levels of overcrowding. It explains the disconnect. There is a massive fudge in the presentation of the health figures.

Will the Taoiseach release all of the correspondence between the HSE and Minister leading up to the Estimates and the budgetary process? It is absolutely unacceptable that we must rely on freedom of information requests to find out the real story about the concerns of the chief executive officer of the HSE about this year's Estimate. Will the Taoiseach facilitate meetings between HSE directors and leaders and spokespersons of the various political parties in order that there can be a fully transparent assessment of the implications in 2018 and for the health budget in general? Does he accept that there is a fundamental credibility problem with the figures, as presented, for the health service Estimate for 2018?

The HSE service plan is credible, provided it is adhered to. It is always a struggle for the Health Service Executive, most public bodies and Government agencies to remain within budget every year. The funding they would like to have to do what they want to do will always be lower than what can be provided by the Government through the taxpayer.

As is always the case every year, the HSE will have to work very hard to stay within budget but the HSE service plan, which the Government approved and which was signed off on before we approved it, is credible if what is in it is adhered to. What is in it is that we will have - at the very least – the existing level of services we had last year plus a number of specific improvements that are funded. The funding is being held in the Department of Health to make sure those improvements actually happen and will be given to the HSE as they happen. That is what we expect to be done, but it will be a struggle. There will be plenty of engagement and over and back involving the HSE, the Department of Health and the Department of Public Expenditure and Reform and as the year goes on, as we sort this out, but the overriding objective is one that results in, at the very least, the existing level of service and on top of that the additional €200 million or so that is being provided for new services being spent on those new services and not being sucked into other costs.

As Deputy Martin said, it is an increase of €413 million on the outturn last year. That is a real increase and that is on top of a very high base. Let us not forget that our health budget is now the highest ever since the foundation of the State. On a per capita basis, we now spend more on health than almost any other country. We are in the top five. Even during the recession our health spending was above average per capita. The fundamental problem in the health service - there are problems - is not solely one of resources. It is about how resources are deployed, and they are not deployed as they should be. When one looks at something that has got a budget of €15 billion and we are talking about €450 million, €500 million or €800 million, we are talking about a variance of 6% or 7%. We are talking about the effect of 6% or 7% of the health budget. Why not look at how the 100% is spent? Let us imagine if the €15 billion was spent well and efficiently what kind of health service we could have. Instead, we only ever talk about the increment - the 1%, 2%, 4% or 5%. That is what is wrong. Fundamentally, what we have is a health service where all problems get monetised and then they get passed on. That is not working. It will not work as a system and it must change.

To answer Deputy Micheál Martin's specific questions, the service plan for the health service must be done after the budget. It cannot be done until the HSE knows what its budget is and that is in the health Act. I think Deputy Martin might have been the person who brought the health Act through the Oireachtas so that is where it comes from but it might have been the Minister who took over from him, Mary Harney.

In terms of the correspondence, the Minister for Health has advised me that it has all been released under freedom of information already. The HSE goes before the Oireachtas committee on a quarterly basis to account fully for its actions. Any Oireachtas Member, including those who are not members of the committee, is free to attend such meetings.

The starting point is honesty and full transparency in terms of the health budget and we did not get that this year either in the preparation and lead in to the budget or in the service plan. We only got elements of it following the release of freedom of information requests to a journalist in The Irish Times. If the Taoiseach reads The Sunday Business Post there was a very good article again last week highlighting a fundamental problem - a lack of honesty and a massive fudge going on in terms of the presentation of the budget.

It is interesting to note, for example, a project for renal services in Tallaght hospital. The tender was originally issued in December with the intention of awarding a contract in March. Now the HSE has extended the tender process until October. Why? It is so that the spending will not happen until perhaps January or February of the following year. That type of behaviour is becoming endemic because of the lack of honesty around the budget. The Taoiseach mentioned €200 million. A total of €48 million of that is for pensions - demand-led schemes. There is also increased funding for drugs.

The Taoiseach knows all of that so there is no point in trying to pretend. One of the more important admissions today is that the Taoiseach is now admitting that at the very least we will get existing levels of service. If that is all we are going to get in 2018 it will be a very rough ride for everybody working in the health service and more particularly those who avail of the health services, especially elderly people and those with dementia, where there is clearly not enough provision to cover the challenges that will undoubtedly come our way in 2018.

The sum of just under €200 million is for new service developments. It is not for pensions. That is separate funding. We are ring-fencing the money specially and holding it back in the Department of Health to make sure the money is spent on what it is intended for and not lost in some deficit elsewhere. I refer to things like, for example, the extra €10 million for respite funding, the additional 190 beds in acute hospitals that have already been opened this winter and also the additional €750 million for home care.

Of course we should set aside funding for new drugs and that is a service improvement.

There is one thing on which I will agree with Deputy Martin. I would like to see more transparency around the health budget. Deputy Martin mentioned in his question that the increase in our health funding is going to be €413 million ahead of the outturn last year. Even now, that is only a projection. We actually do not know how much the health service spent last year. We will not know until April how much the HSE spent last year. Even when a person is looking for transparency and that person is sitting where I or the Minister for Health, Deputy Harris, is sitting, the financial systems are so outdated and badly organised in our health service that it is April before the person knows how much was spent last year. We are going to need a major investment, first in information technology to have a proper financial system, and second in capacity to have people who are able to manage and follow budgets. That is something that is going to change.

Time is up.

If Deputy Martin submitted a freedom of information request on the correspondence between Ministers and Departments for every public body in the State, I guarantee him that every Department and agency asked for more money than they got. That is how the budgetary process works.

That is not the point about freedom of information requests. The Taoiseach is saying the €347 million figure is not credible. He knows this.

If we take all Departments and Government agencies together, they sought additional increases in spending of €12 billion last year.