I wish to question the Taoiseach on the lack of meaningful health reform in our health service. The consequences of not changing our model of care are plain to see. Fine Gael has been in power for eight years and this Government has been in power for the past three years. In those past three years, we have seen little or no health reform. In fact, the situation has deteriorated. The Taoiseach talks about health reform but he fails to implement what is glaringly obvious. Time is not in our side as demand for our health service continues to grow with our ageing population.

Sláintecare is now two years old. It still awaits transitional funding to trigger meaningful roll-out and delivery of better care to our patients. Sláintecare is stranded in the doldrums of inertia. There is much talk about implementation but no implementation. We cannot reform the health service from current spend. It is not possible. Specific independent, targeted funding is needed. Without this, Sláintecare will be just another report. Transitional funding is needed to shift the balance of care towards community care while at the same time delivering on unmet need. New models of data gathering, digital healthcare records and individual patient identifiers are essential so that we can gather data which will make meaningful progress in informing how we reform our health service.

The HSE service plan for 2019 indicates the HSE will struggle to maintain services at 2018 levels, which in themselves were inadequate, and will not deliver services as we require them in 2019. We still do not have multi-annual budgets. Without this, long-term planning is impossible. Unmet need will continue to grow as elective care will be limited by necessity. We will be providing only essential and urgent care in our hospitals. The expected increase in emergency admissions this year will diminish the ability to provide elective care.

Meeting current and future challenges within our service as it is currently designed is not sustainable. The service is facing extraordinary challenges and will need an extraordinary response. The capacity of our service is at maximum, with ever-increasing unmet need. Our hospitals are operating at 100% capacity which, internationally, is recognised as unsafe. We have a shortage of intensive care unit, ICU, beds, which limits elective care. We need 8,000 extra beds over the next ten years unless we engage in extraordinary health reform. Opening 200 beds this year is wholly inadequate. We educate our graduate nurses, doctors, consultants and general practitioners, GPs, for export. This feeds into inadequate quality in the services that we provide. The affect of this on our population is clear, with 100,000 people on trolleys, 70,000 awaiting elective care and 500,000 on waiting lists.

Will this be the legacy that this Government leaves behind? When will the Government deliver the extraordinary response that is needed to reform our health service?

I agree with the Deputy on the point that we need more health reform. I do not agree with his contention that health reform is not happening at all. I will give a few examples in response to some of the questions the Deputy raised. At the heart of Sláintecare is the view that health care should be affordable and that we should extend free GP care to more people and reduce the cost of accessing medicines.

That is happening. We have extended free GP care to all children under the age of six and all citizens over the age of 70, as well as to an extra 100,000 people based on income from April.

That was all done by previous Governments.

In addition, we have reduced prescription charges and will do so again in the next couple of weeks. Sláintecare, which the Deputy advocates for and supports, recommends that we extend free GP care to an extra 500,000 people a year, that is, 500,000 this year, 1 million next year and 1.5 million the year after. I think that the Deputy's recommendation is a mistake because it is too fast. I do not think the capacity to increase free GP care as quickly as he advocates, that is, an extra 1 million in two years and an extra 2 million in four years, exists in our GP surgeries. I think he is mistaken in that regard, although I recognise that he is a strong advocate of the Sláintecare report.

We are also investing in primary care centres. There are now 120 primary care centres open throughout the country, while there were only 40 a few years ago. We have set aside a ten-year capital budget envelope for health, which is a multi-annual budget if ever there was one. It provides for €11 billion, which is double what it was for the past ten years. As a result, three new national hospitals are under construction, with one to go to tender quite soon.

There is investment in ICT. The medical laboratory information system, MedLIS, is now available almost across the board, allowing people to see blood results all over the place. There is also the picture archiving and communication system, PACS, and what replaced it in radiology, and there is the maternal health record, where women who attend maternity hospital now have electronic records which they did not in the past. We are introducing reforms such as a commissioning model, where the National Treatment Purchase Fund is used to commission operations and procedures, which is why the waiting times for those waiting more than three months for an operation or procedure has fallen for months.

We are increasing bed capacity, by 200 last year and approximately another 200 this year. I visited Clonmel the other day, where there is a new 40-bed unit under construction, while the Minister for Health recently gave approval for an extra 60 beds in Limerick. As a result, the number of patients on trolleys thus far this year, while still far too high, is at its lowest in four years, and let us hope that will continue.

The next large step is contractual reforms for GPs and we are in negotiations with the Irish Medical Organisation, having concluded talks with the nurses on a new contract for them. We are keen to get that done to provide additional resources for general practice, that is, not just additional money for doing the same things but rather for change, embracing medicines management and ICT, giving information that we need to plan our health services and providing new services, particularly in the field of chronic care.

The Taoiseach referred to his and my discipline of general practice in respect of Sláintecare. As he will know, the continuation of financial emergency measures in the public interest, FEMPI, has devastated general practice and it will take years for general practice to recover. He referred to the expansion of primary care, which is an essential component of Sláintecare, and he was quite right that we cannot expand eligibility or services unless there is the manpower to do so. That is the very issue: we do not have the manpower in general practice to underpin Sláintecare. We do not have the capacity in general practice to supply the increased eligibility that the Taoiseach proposes and to expand the range of services if GPs are not available. We are losing GPs from our urban practices, not to mention from our rural practices, and we cannot recruit GPs to supply the extra services.

The Taoiseach has put the cart before the horse. If our health service is to be reformed, manpower in general practice needs to be expanded, which is the underpinning of Sláintecare. Unless we have an expansion of primary care, Sláintecare cannot progress. The Government is damaging general practice by the continuation of FEMPI and the failure to reverse it.

I followed with interest in recent days the debate about how moving towards multi-annual budgets would help us to improve our health services. I am broadly a supporter of multi-annual budgets, not just in the health service but across the board. Before there can be multi-annual budgets, however, one must demonstrate that one is able to keep within annual budgets. We already have a multi-annual budget in health, namely, a ten-year envelope for capital, but have the HSE and the health service managed to keep within that budget? Is there anyone in the House who believes that if there was multi-annual budgeting for current spending, the HSE, which has gone over budget every year for any number of years, would not also go over budget on its multi-annual budget?

I believe it would. It may burn up the money quicker than it does now and we have to take those concerns into account. We are training more general practitioners, GPs, have increased the number of training places and, thankfully, those training places are being filled. We are in negotiations with the Irish Medical Organisation, IMO, to restore funding for general practice and to link that to important reforms, including extending eligibility, moving to greater chronic care, medicines management and use of IT. Where I disagree with Deputy Harty in his strong advocacy for Sláintecare is that it is pretty unequivocal that it wants, as well as the 1 million people who already have free GP care, to have an extra 500,000 next year and 500,000 more after that. I think the Deputy is mistaken on that and that we need to do the other thing first.