The revelations by Martin Wall on Monday in The Irish Times, following the release of correspondence between the Government and the HSE through a freedom of information request, confirms what I have said for some time, that, in essence, there was a fundamental lack of transparency at the heart of the process for providing money for health in 2018. There is a clear attempt by the Government to cover up the truth on the challenges facing the health services in 2018. The Government published a spending plan for health in the full knowledge that it will not be sufficient. I am not talking about the usual toing and froing or the arguments and counter arguments between the Government and the HSE but clearly there has been an attempt to paper over the gaps and to hide the truth from the public. The attempt to paper over the disagreement was made by putting in a figure of €346 million in value for money savings. We now know, however, that in the days after the publication of the plan, the HSE director general said that the targets will not be realised. This was subsequently revealed by The Irish Times also.

The correspondence shows that there was an understanding, or that assumptions were made, to keep off the books potentially hundreds of millions of euro in other risks. For example, there was no provision for pay pressures, €68 million of which was in the earlier draft. Was this a reference to the employees of hospices and disability organisations who had balloted for strike action and who have been denied their fair pay by the Government? The Government also instructed the HSE not to include any sum in the plan to deal with a carryover of its financial deficit from 2017. The director general of the HSE has estimated other significant challenges facing the HSE, but the Government clearly wanted the financial difficulties played down in the published service plan. Departmental correspondence states:

The financial challenges need to be addressed only once (in the financial section?). Details on the assumptions and arrangements to address financial challenge should be contained in the letter accompanying the NSP [national service plan] rather than included in the main document.

Decoded, the HSE is being told to bury the negative stuff as effectively as it can, and not to put it upfront because the public might see it too clearly.

There are also revelations about Sláintecare. The Taoiseach has repeatedly said that the Government is committed to Sláintecare but the HSE director general has said the plan is challenging because he would have to develop the service plan "in the absence of an agreed implementation plan and transition funding for Sláintecare". A sum of €3 billion was supposed to have been provided. The HSE director general was told by the Department that he was "overly focused" on a transition fund as it has not been approved yet. Clearly, this reveals a fundamental lack of commitment to the implementation of Sláintecare.

There is much more in this correspondence. The HSE pointed out that the plan would be challenging in terms of "performance and protecting patient safety". The Department's response was to warn the HSE that it was using "unacceptable language". Why has the Government gone to such lengths to prevent the truth from coming out and to prevent the HSE from telling it as it is with regard to the challenges facing the health services in 2018?

As I have said before in this House, the 2018 national service plan sets out a budget of almost €15 billion for the HSE. This is the largest budget for our public health service since the foundation of the State and it represents an increase of more than €600 million on 2017. This is a substantial increase in funding levels. This comes on top of a health service that was already well funded. When the total amount of health spend is divided by the number of people in the country, Ireland is among the top five countries in the world for health spend per head, and by some estimates Ireland is perhaps in the top one or two.

That comes after a period that included a recession and during which spending was above the average in the western world. The HSE produced its service plan in consultation with the Department of Health. The plan was approved by the HSE's leadership team in accordance with the law. It was noted by the Cabinet in December before publication. A number of measures and actions are under way to begin the process of turning the Sláintecare proposals into an implementation plan. As the Deputy is aware, the report of the all-party committee sets out a shared vision for our health service. It is a plan for a plan. It calls for an implementation plan and that is being worked on by the Minister for Health. We hope to have it ready in the next couple of months.

We have also completed the capacity review, which will feed into the ten-year infrastructure investment plan that is to be published in the next couple of weeks. A group has been established to look into the separation of public and private practice, as recommended in the Sláintecare report, and is meeting under the chairmanship of Dr. Donal de Buitléir. In addition, we have taken some steps towards the implementation of some of the things that are called for in the plan, such as the extension of the GP visit card scheme and reductions in prescription charges and in the cost of the drug payment scheme. All of these real and concrete actions are provided for in the budget.

I have often heard Deputy Micheál Martin calling for an honest debate about health care and health funding. I agree that we should have an honest debate. Fundamentally, if we are serious about facilitating real improvements in our health service, we all need to acknowledge the false proposition that is always put forward that there is somehow a direct connection between money and resources, on the one hand, and outcomes for patients, on the other. We know it is not the case that there is such a connection. The Irish Government Economic and Evaluation Service's report on the funding of our hospitals shows that in one year when there was no increase in funding for hospitals, activity increased by 7%, and that in another year when there was an increase in funding for hospitals, activity decreased.

If we want to have an honest debate about a health service that works and provides patients with the standard of care and the outcomes they deserve, we need to get away from the false analysis that there is a direct connection between money and resources, on the one hand, and patient outcomes and services, on the other. I would mention as evidence of my contention that it is a very indirect connection, at best, the fact that we spend so much but do not get the return we need. It seems to me that the difficulty we have had for many years with the running of our health service is that rather than trying to manage health services within an ever-expanding budget, as other agencies do, the HSE does something very different - it monetises every problem and passes it on to the Department of Health in the full knowledge that those documents will either be released under freedom of information or will be leaked, usually to the journalist Deputy Micheál Martin mentioned.

There was no greater leaker of information than the Taoiseach during his time as a Cabinet Minister.

WikiLeaks No. 2.

It ill behoves him to be lecturing anybody about leaking or revealing all sorts of information from the Government.

I object to that, a Leas-Cheann Comhairle.

Could I equally say-----

I would just caution that Deputy Micheál Martin that he is making an accusation against a Minister of the Government.

He has lots of evidence.

If it is true-----

The Taoiseach has made very serious allegations against the HSE.

If the cap fits, wear it.

He has accused the HSE of teeing up things for freedom of information and for leaking.

I can only warn the Deputy.

The point is that if the Taoiseach really wants an honest debate, he should stop trying to suppress organisations in terms of their annual reports and annual service plans. He did not answer the basic question I asked. Why did the Government edit the HSE's drafts of the service plan so heavily? Why did it say that the language was unacceptable and that the HSE was being too negative? The Government wanted to put a gloss and a spin on it to hide the truth from the public. In the weeks running up to Christmas, the Department had grave concern about what the HSE intended to say in the 2018 service plan. It was adamant that details of assumptions which underpin the health budget for 2018 - for example, no provision was being made in the financial figures for up to €68 million in potential pay pressures, or a potential charge of €170 million - would be left out of the publicly released plan and referred to in private correspondence only. The Government wanted to keep stuff private to hide it from the public.

The Taoiseach to respond.

The public knows this. The employees of hospices know this. The employees of disability organisations know this. They were denied fair treatment in the shape of an equivalent pay scale to HSE employees. The HSE was clearly saying that this was coming down the tracks, but the Government was saying "No, bury that, the public does not need to know that".

Deputy Martin, please.

If the Taoiseach wants honesty, he should stop trying to edit the news and prevent the truth from coming out.

Some co-operation, please.

I appreciate the Deputy's attachment to the HSE. As it is his creation, after all, he should know well what are the provisions of the Health Act 2004. The 2004 Act provides that the HSE service plan is not just written by the HSE; it is written by the HSE in consultation with the Minister for Health and the Minister for Children and Youth Affairs. That is what happens. When a draft is produced, a Minister may not be satisfied with it.

The Government hid the figures.

The legislation specifically provides for the Minister to seek an extension or to seek changes.

The Government hid figures that have been transparently verified.

That is what is set out in the 2004 Act.

It does not allow the Government to bury the truth.

As the creator of the HSE and the person who wrote the Health Act 2004, Deputy Micheál Martin should be well aware of that and should not be trying to misrepresent it.

The Government should have included the deficit and the carryover, but instead it buried them.

In terms of trying to cover up anything, everyone knows full well that correspondence is released under freedom of information. The idea that these things could never be kept out of the public domain is absurd. These things are always released under freedom of information if they are not leaked beforehand. Quite frankly, we have had years of this. Certainly, there are no secrets in the Department of Health or the HSE.

"LeoLeaks".

It is also the case that the HSE and the Minister come before the Oireachtas committee on a quarterly basis. Indeed, I think that is happening today.

You should not start fighting now because you are all the same.