I raise the issue of a perfect storm facing the health services, into which the Government has sleepwalked over the past eight years. I refer to the recruitment and retention of consultants in the hospital system. This results from years of accumulated neglect in reforming models of care and developing the health services to maintain critical service delivery to patients. With a booming economy and almost full employment, we still have a dysfunctional health service, which affects many specialties. Fiscal prudence is as much about how we spend our money as how much money we spend and we need to get maximum value for the money we spend. Throwing money at a failed health system will not solve the problem. The Government's lack of curiosity in this regard is astounding. We are speaking not about additional funding but about spending money which has already been allocated.

I will highlight a number of issues. Vacant consultant posts are caused by pay disparity and intolerable working conditions. Employing locums and non-qualified consultants in a vain attempt to plug the gaps in consultant numbers is compromising the quality of care. There was an accepted maxim that there was a bottleneck when entering the system but that once one did so, one was guaranteed quality of care. That is no longer the case. Approximately 500 consultant posts are vacant: 54 in general medicine, 34 in anaesthesiology, 25 in emergency consultants, five in intensive care, 17 in obstetrics, 34 in paediatrics, 56 in pathology, 101 in psychiatry, 37 in radiology, 57 in general surgery, four in medical oncology and three in cardiology at least. This will not be news to the Taoiseach or the Minister for Health as it has been highlighted in many reports. The consequences are that more than 500,000 people are waiting for a first appointment to see a consultant, 150,000 of whom have waited for more than one year and 96,000 of whom have waited for more than 18 months. Some 10,000 children are waiting to see a consultant for the first time, before they ever go on an inpatient waiting list if they require ongoing treatment.

In addition, the Taoiseach showed a great lack of understanding of home help services last week, when he said that in spite of a 50% increase in the funding allocation to home help services, he saw no tangible benefit in the reduction of people attending hospital services. That is to misunderstand completely the purpose of home help. Provision of home help is the right thing to do. It is not about saving money or reducing attendances at hospitals.

When will the Taoiseach understand that the manner in which we spend money, rather than the amount we spend, is critical to the health service?

I agree with the Deputy on one point, namely, that providing home help is the right thing to do, which is why the Government has increased funding for home help by 50% in the past three or four years. On the occasion to which the Deputy referred, I was responding to an argument I often hear made, namely, that not funding home help is some sort of false economy because it then leads to higher costs up the line through longer hospital admissions and so on. Unfortunately, while that seems logical on the face of it, it never seems to stack up when looking at the finances. I agree home help is the right thing to do, but it does not save hospitals money. That is unproven at the least. The point I was making is that some people say it is a false economy but it is not.

On recruiting consultants, the Government absolutely acknowledges the enormous difficulties and challenges we face. Notwithstanding that, the number of consultants in the health service is at an all-time high, as is the number of doctors. This year, for example, 10,500 doctors and dentists work in the health service, whereas ten years ago, there were only 8,000 and three years ago, there were 9,300. Many new posts are being created all the time and there is difficulty filling them. The figures change and vary from area to area. There are many vacancies in psychiatry, for example, but one will often meet registrars or young doctors waiting for a post in their specialty to be advertised because there is none. There is variation across the specialties and regions. Unfortunately, more peripheral hospitals are often not able to recruit consultants, whereas those attached to universities in the cities receive many applications, which we need to be realistic and honest with people about.

I am not sure where the figure of 500 posts comes from. When the Public Service Pay Commission examined the issue, it was not able to verify the claims of the Irish Hospital Consultants Association or the Irish Medical Organisation, or even the HSE's numbers in that regard. Many of the posts that are described as vacant are not. They are filled with locums or temps or, in some cases, they are in recruitment.

We acknowledge that this is a difficult issue but it is one that we will have to manage. We will do so in consultation with the representative bodies and the HSE.

The Taoiseach ignored the main point I was making, namely, that understaffing in the context of consultant posts is reducing not only the quantity but also the quality of the care being provided. There are hospital departments where consultants are burning out because of the dysfunctional service they work in and where agency locums fill gaps. The cost of employing an agency locum is twice that of employing someone in a permanent post. While the remaining consultants are holding departments together against the odds and struggling to get access to diagnostics and facilities to carry out their work, the system is chewing them up and repelling those who might wish to work in the health service.

Hospital departments are losing their accreditation because the accrediting bodies are looking at the volume of consultants in departments and the fact junior hospital doctors are not being supervised. The level of training the latter are receiving is insufficient to allow for accreditation to be given. This means that a particular hospital department will not only experience difficulty in recruiting consultants, it will also have difficulty recruiting non-consultant hospital doctors. Not only has the Government a casual approach to increasing bed capacity, a matter to which we have referred on many occasions, but there is also a recruitment paralysis when it comes to filling vacant posts. Urgent action is required. We cannot reform our health service if it does not have a proper complement of consultant staff.

My basic point was different. Nobody doubts that we have real challenges when it comes to recruitment and retention across the health service. However, one would think from what is said in this Chamber and from the common narrative that this meant there are fewer doctors, nurses and therapists than was the case one year ago or three years ago. The reverse is true. Notwithstanding the difficulties involved, we have had a recruitment surge in our health service. There are 117,000 people now working in our health service. Three years ago, the figure stood at 107,000. This means that there 10,000 more staff than was the case three years ago. In the past three years, 1,132 more doctors and dentists have been employed and there are also 1,291 more nurses and midwives. That gives the Deputy an example of the success we are having in terms of recruitment. The impression created is that these real challenges, which I acknowledge, are resulting in an outflow of doctors, nurses, therapists and midwives, but that is not the case. We have more every year. We have been successful in increasing the number of front-line staff in the health service over the past three years. There is more to be done. We have made some good progress in recent months in the context of concluding new contracts with GPs, which the Deputy welcomed, and staff nurses. The next step is to engage with the representative organisations of consultants to see if we can agree something there as well. However, it has to be realistic and affordable.