Cuirim fáilte roimh Mr. Robin Newton. I also give a special welcome to Mr. Paddy Agnew, a former Deputy for Louth, who is in the Public Gallery. He was elected to the Dáil 37 years ago on an anti H-Blocks ticket. This is the first time he has been in Leinster House. I am sure everybody will extend a warm welcome to him. We are delighted he is here. It took him a while but he got here in the end.

It has been confirmed that in the first financial report of the year released by the Department of Health, the Health Service Executive, HSE, recorded a deficit of more than €100 million in January and February of this year. Based on that trend, it is likely that the half-year deficit will fall somewhere between €220 million and €300 million and it might be double that for the year as a whole. It is against that backdrop that I want to raise the scandalous spending on agency staff in our health service. Figures released to my colleague, Deputy Louise O'Reilly, show that every day in 2017 the HSE spent more than €800,000 on agency doctors, nurses and other staff to fill positions that have been left vacant. That is close to €300 million for the year as a whole. That is, as the Taoiseach will agree, a colossal amount to spend on the hiring of temporary staff, which is always more expensive than directly employing personnel. It is a big strain on the health budget.

When we look at the roles temporary staff are filling, the extent of the problem becomes apparent. A total of €105 million spent on hiring agency doctors and dentists and that figure has doubled since Fine Gael came into office in 2011. Some hospitals' dependency on agency staff is mind-boggling. Letterkenny University Hospital spent more than €9 million on agency doctors, Midland Regional Hospital Portlaoise spent €8 million and University Hospital Limerick spent more than €5 million.

There is also a severe crisis in nursing. More than €64 million has been spent on hiring agency nursing staff. There is no doubt that these staff perform a necessary function but the reason hospitals are reduced to relying on such costly agency staff is that the Government and the HSE have failed to address the recruitment and retention crisis. Health staff and the unions have consistently reported working conditions, facilities, supports, training opportunities and pay as the causes of the crisis and until these issues are addressed, we will continue to squander large amounts of public moneys in the way I have described. This is bad for workers. It is certainly bad for patients because it compromises continuity of care.

In April a Sinn Féin motion was passed in the Dáil which called for the introduction of recruitment and retention measures based on realistic proposals and which prioritised pay. It called on the Government to work with the unions to draw up a roadmap to full pay equality. Having done nothing thus far, will the Government now commit to acting on that motion in order that our nurses and other health professionals get a fair deal and we can end this ridiculous and excessive use of public money in the health service?

The HSE is overrunning its budget once again, as has been the case in almost every year that I have been in the Dáil, which is ten or 11 years at this stage. That is notwithstanding a substantial increase in the health budget, amounting to some €1.7 billion a year, since 2013. We are now spending more per head than almost any country in the world, and we have been spending more than the Organisation for Economic Co-operation and Development, OECD, average per head for 20 years now, including during the recession period. It should be obvious that the problems in our health service, which are real, are much deeper than finance and staffing numbers. Looking at nursing numbers, OECD statistics show that we have among the highest number of nurses per head and per bed in the world. However, nurses here are not deployed in the way they should be. Nurses spend too much time doing non-nursing tasks that could be done by people who have other qualifications and who do not have to be as highly qualified as are our nurses to do those jobs. There are major structural problems in our health service which have not been solved by extra staff and extra resources in the past number of years. We need to move on from that to much deeper levels of reform.

The Deputy is correct that agency spending is very high. However, in the broader context it must be noted that it counts for approximately 2% of the health budget as a whole. When one considers that payroll takes up approximately half of the health service budget, roughly 4% of the payroll budget is accounted for by agency staff. For every 25 people working in our health service it is likely that one is an agency worker. I contend that if one went into other workplaces, such as big companies, public bodies and perhaps even media organisations and saw 25 people working, there is a good chance that one of those 25 is working with an agency or is working on a temporary basis. That happens for many different reasons, including maternity leave cover, cover for temporary absences or extra staff taken on during periods when capacity has to be increased as part of a core-flex arrangement. In our health service there are many doctors who are no longer willing to commit to long-term careers in smaller hospitals. Those doctors want to work in big hospitals, where there are opportunities to do research and other things. That is a structural change we are just going to have to face up to in our health service in the future.

The Government has made many changes in this area. We have negotiated a new pay deal with public servants, including doctors, nurses, support staff, healthcare assistants and therapists, to restore pay. Pay restoration is well under way. There will be two pay increases this year, and another two next year, for all of our healthcare staff. We are also engaging with the unions on two other issues, namely, recruitment and retention of doctors and nurses and the two different pay scales for those who came into the public service after 2011 and 2012. As is always the case, the Government has to put the interests of patients and taxpayers first, which means ensuring that we do not deploy or spend more taxpayers' money than is necessary, as well as ensuring that any increase in the payroll bill actually results in better patient care and that the money goes to the patient and not just to the employee.

I am not asking the Taoiseach to do anything other than to engage in wise and prudent use of public moneys. If, however, it is his view that there is not a crisis in the recruitment and retention of medical staff, particularly nurses, I must inform him that there are lots of people working on the front line who would strongly disagree with him. I am putting the simple proposition to the Taoiseach that €300 million spent in a calendar year on the recruitment of agency staff does not represent good value for money. I am suggesting that there are things that need to be done to address that situation. This is a long-running problem. I have given the Taoiseach figures for 2017, but we could go back further and identify the same problem.

We have to decide that we are going to give our nurses, for example, a fair deal, that there will be full pay equalisation and that, having trained the best and brightest, we are not content any longer to allow them to emigrate, thereby losing all of their skill and expertise. Can the Taoiseach indicate in concrete terms how he proposes to address this situation? It is not just a case of how much money is spent. We could debate the overall resourcing of the health service on another occasion. I expect that we are on different sides of that argument. It is not just a case of how much money is spent, it is a question of how it is spent. Agency staffing is clearly not an optimum, desirable or prudent solution.

There are just over 10,000 doctors working in our public health service. That is the highest number ever. I accept that demand is higher than ever as well, but it is not the case that the number of doctors working in our public health service is falling. In fact, it is increasing and is at its highest point ever. Nursing numbers did go down considerably on foot of the cutbacks during the recession. We have approximately 1,000 more nurses than we had this time last year, so, again, we are going in the right direction. That is not to dismiss for a second the fact that posts are unfilled or that we have serious problems with recruitment and retention in different parts of the health service. However, it would be factually untrue to say that the number of doctors or nurses working in our health service is falling. The number of doctors working in our public health service is at an all-time high. The number of nurses working in our public health service is increasing. We must be able put it in that factual context. People are entitled to their own opinions; they are not entitled to their own facts.

I will describe what we are doing other than pay restoration, which is now very much under way, with two pay increases this year and two more next year - that is before increments. We have specifically given the Public Service Pay Commission the job of examining the issues of recruitment and retention, looking at where in the health service there genuinely is a recruitment and retention problem, where there is not, where it is the result of maldeployment and where particular incentives may need to be put in place for certain grades and professions. It is not an issue across the board. It applies in some places, some professions and some posts. If we really care about ensuring that taxpayers' money is well spent and goes toward patient care, we need to make sure that we have targeted recruitment and retention incentives, not blanket ones across the board whereby the money would not go to the patient.