I wish to question the Taoiseach on the issue of the dysfunctional health service, particularly where it fails to deliver timely care to patients. I will approach it differently from Deputy Micheál Martin who addressed budgets. I would like to question the Taoiseach about reforming the health service and would like him to look at doing so through a different lens. I ask him to look at it laterally rather than just in the context of budgetary measures. He should not look at hospital care as being the default method of supplying care to the population; rather community care services should be the default provider to keep people out of hospital and keep hospitals for those who need complex or emergency care. This does not in any way negate the need for increased hospital capacity, diagnostics or staffing.

The second way the Taoiseach should look at the health service is to look at anticipatory planning and reform rather than reactive planning and reform, which is what we have. The ten-year Sláintecare plan has been lying idle for the past eight months.

Third, integrated structural and cultural reform rather than emergency planning is needed in the health service. That will be key to demanding accountability and responsibility in the health service. It costs a lot of unnecessary money to run a disconnected and fragmented service and expanding an inefficient service will not make it more efficient. How we spend our money is more important than how much we spend.

Where are the political will and determination to reform the health service? We know that reform will be extremely difficult, but that does not mean that it should be seen as impossible. Proper structural reform should not frighten the Department of Health, the HSE, staff or patients, as proper reform of the health service would benefit everybody. It is an abuse of staff to expect them to work in unsafe conditions as they do. The circumstances to which patients are subjected in hospitals when trying to access timely care infringe on their human rights. It also leads to the recruitment difficulties which present a serious problem in the health service. Rationing health services because the Government is not willing to reform the health service is no longer acceptable. The trolley crisis is but the tip of the iceberg of the dysfunctionality. It grabs the headlines, but it tends to distract from and hide the fundamental structural deficiencies of the health service. Even if we were to eliminate the trolley crisis, we would still have not resolved the dysfunctionality issue. Is the Taoiseach satisfied to lead a Government which allows an inefficient Department of Health and HSE to continue working in the manner in which they have been? Will he outline the actions he will take to reform the health service?

When we talk about the health service, it is important to acknowledge the many difficulties we face, particularly in access. They include people waiting for outpatient appointments or surgery or waiting to be given a proper hospital bed. We have real problems in access to the health service, but we should not ignore the many good things which happen in it every day. Life expectancy in Ireland is among the highest in the western world and improving because of good personal health and the health service. When Irish people are asked to rate their own health, they rate it higher than people from any other country. More than 80% of patients who are asked about their experience of the health service say they have had a good experience. One would not think it, but when people are actually asked what they think about the health service, more than 80% say they have had a good experience. Notwithstanding the real problems in emergency departments, two thirds of patients are either seen and sent home or in a hospital bed within nine hours. As a country, our patient outcomes are average to good. That is reflected in increasing cancer survival rates, fewer deaths from stroke and cardiovascular disease and other things. Even in recent years there has been a big uptake of vaccinations and a big reduction in the number of patients who contract MRSA. The Deputy will remember what a big issue it was in the past.

As the Deputy knows, there are two parts to the issue of waiting lists: outpatient waiting lists for those waiting for a clinic appointment and lists for patients awaiting surgery or a procedure, for example, hip, knee or cataract operations. In recent months we have really focused on inpatient day case surgical waiting lists, that is to say, for those awaiting procedures. In four of the last five months the number waiting for a procedure has decreased and we expect the figure to continue to fall. That is one of the areas in which we are making real progress. There are fewer people waiting for such operations. I accept that we have not made any progress on outpatient lists yet, but that will come.

To pick up on the Deputy's question on anticipatory reform, he will have seen the capacity review which was published only last week. It is very much an example of anticipatory reform. We are setting out the capacity increases we will need between now and 2031. We are not waiting until 2031 to do it. For example, 190 additional hospital beds have already been put into the system this year and there are now almost 10,000 doctors working in the public health service, the highest figure ever. We will continue to do this in the coming years.

On structural reform, the position of executive director for Sláintecare has been advertised. The Minister for Health has permission to establish a HSE board to improve the accountability of the HSE. I accept that that is a reversal of a previous policy, but bringing back a HSE board to bring about some accountability is the right thing to do. The boards of the hospital groups will be appointed quite soon and we are working on the GP contract. It will be difficult to do, but we are very keen to have a new contract. Cultural reform will be more difficult because in the health service it means taking on vested and local interests. Everybody wants to do it until they actually start to do it. We will need to see more tangible progress in other areas before we really get stuck into it.

I thank the Taoiseach. As I stated, the fundamental question is one of reform.

There is a languid response to health reform from the Government as well as a lack of ambition and courage. There is also an amazing lack of curiosity concerning why we have an above average spend and a below average outcome in our health service. It is this lack of interest and ambition that concerns me.

Engaging in wrong policies with greater intensity will not bring about better patient care. The failure to have implemented any change eight months after the publication of Sláintecare means that it is too late to avert next winter's trolley crisis. When the HSE says that meeting its targets is challenging, it means virtually impossible. It is Holy Mary-type planning, where someone who knows that no miracle will appear is still hoping for one.

How could the Taoiseach go to Davos and say that our economic recovery is complete when there is a legacy of dysfunctionality in our health service, a housing crisis and pension and pay inequality and we at home know that our recovery is not complete and there are significant deficiencies in our public services? Where is the political will to reform our health service?

I think what I said in Davos, and the Minister, Deputy Donohoe, said it as well, was that our economic recovery was complete and that we were now expanding again as an economy, but that is not to say that our society has healed. We know the consequences of the lost decade - ten years in which virtually no houses were built, and ten years in which there was inadequate investment in the capital side of health care if not the current side. We are still trying to heal the society that was so damaged by that ten-year crisis, which was not caused by anyone on this side of the House.

I agree with Deputy Harty's fundamental comment. Fundamentally, the question is about reform. If we keep adding staff and adding resources, we will keep getting the same results, which are not good results. I do not agree that there is a lack of ambition or a lack of interest, but I accept that we are only going to be able to prove the Deputy wrong through results. I do not expect anyone to believe us until we start producing some real results.

On Sláintecare, I think we need to be realistic. It is an all-party committee report. It is a very good report. On the Deputy's advice, I have read it three or four times. It sets out what I think is a common vision that everyone shares in this House, for example, a commitment to public health, moving more of our health service into primary and community care, and separating or at least examining the separation of public and private practice. However, it is not true to say it is a comprehensive reform action plan or implementation plan for our health service. It is not that. The costings are evidently not correct and we need to get them done again. The report is silent on where the money should come from. It lists a million different options-----

I thank the Taoiseach.

-----including anything one can imagine. It does not deal with a lot of the issues like those the Deputy just mentioned. It does not address at all the whole issue of performance, efficiency and where the money goes. It proposes more and more money, but it does not ask the fundamental question as to why we do not get a good return from the €15 billion that we are spending already. It does not deal with very thorny issues like reconfiguring and reorganising our hospital service, for example.

Thank you, Taoiseach.

It is a really good report. It is the basis of a common vision as to where our health service should go that I think we can all sign up to, but to represent it as a comprehensive implementation plan to transform our health service just is not honest.

That means it is on the back burner.

That concludes Leaders' Questions. We have shown complete disregard for the allocation of time. I appeal to Members that, in future, they should please adhere to the times that the House has set down.