I will move on to a topic that the Taoiseach does have some control over, since he seems to have no control over childcare facilities. In one of the last Leaders' Questions put to the Taoiseach in 2019 before the Christmas holidays, it is apt to mention the deplorable state of the health service. In particular, I refer to Letterkenny University Hospital and the legacy of this Government to date.

This week the HSE published its national service plan for 2020, following approval from the Government. While it includes several measures, the plan will not specifically address bed capacity or staffing issues at Letterkenny University Hospital and it does nothing to end the current HSE embargo. The plan for 2020 has been allocated a budget of €17.4 billion by the Government. This is a record-breaking budget, the largest in the history of the State. While this represents a 6.3% increase in funding compared with 2019, it is clear that the plan will do nothing to alleviate the effect of the current HSE embargo on the quality of healthcare in Letterkenny University Hospital and across Donegal.

The embargo, or, as the Taoiseach continues to call it, the interim control measures, was introduced in April and was supposed to last for only three months. As we enter 2020 with the HSE service plan in place for next year, this embargo is no longer a so-called interim measure. It has been reported that as part of the Government's official directions to the HSE when drawing up its service plan, the Department of Health sought to maintain the employment restrictions. That means hospital overcrowding at Letterkenny University Hospital will continue, as will the staffing crisis at that hospital and the resulting decline in patient safety. Letterkenny University Hospital has some of the highest numbers of patients on trolleys this year, with 47 people waiting when I last raised this issue with the Taoiseach in November. This problem is not confined to Letterkenny University Hospital but also applies to community services right across the county. In Donegal alone, more than 100 posts lay vacant despite being approved by the national recruitment service. The embargo is here to stay, and if this Government returns after the next election, it will continue.

What is worrying is that the HSE has indicated that it will need an additional €420 million to address demographic, technological and other pressures and to tackle unmet need. An extended and more intense recruitment embargo will continue as a result. This vicious cycle will remain in place if Fine Gael and Fianna Fáil continue with it. It is up to the Taoiseach to break this cycle. Will the Taoiseach signal an end to the HSE embargo or interim control measures in 2020?

I thank the Deputy. Following Government approval, the HSE published its service plan for 2020 yesterday. The budget for the HSE next year is €17 billion, the biggest ever budget for our health service, and an increase of more than 6%. While the Deputy rightly points out that we have a growing and ageing population, a 6% increase is more than what is required to meet the resultant demographic demand. A lot of that money, roughly half, will go into additional pay and pensions for our healthcare staff. We stand over that. We want to be able to pay our staff better and pay them more, and that is why so much of next year's budget will go into pay and pensions. Roughly half of the increase will go directly to staff in pay increases, pensions and the hiring of additional staff. I thank the HSE, the new board and the new CEO for the professional and collaborative manner in which the service plan was drawn up this year. It was so much more professional and collaborative than in previous years. We have seen a dramatic improvement in financial planning and management under the new CEO and board, and I am grateful to all of them for that.

Regarding the Deputy's question about the embargo, I know he has read the service plan and knows it provides for an increase of 3,000 in the total number of staff in our health service. Increasing staff numbers by 3,000 does not constitute an embargo. This time next year 3,000 more staff will work in our health service than today. However, managers are no longer permitted to hire staff for positions that are not funded. That is the norm across the public service. It was not the norm in the health service for a very long time. Now it is, as it should be. Because normal public service rules now apply and staff cannot be hired for positions that are not funded, the deficit for the HSE is dramatically lower than in previous years. Principals cannot hire teachers that are not funded and Garda inspectors cannot hire gardaí that are not funded. We now have a normal set of rules in our public service and health service when it comes to the hiring of staff. There will be 3,000 more staff in our health service next year.

There will also be additional funding for community services and extra home care hours. For the first time, the budget for disability will exceed €2 billion in one year, which will mean more places for school leavers with disabilities, more autism services, additional respite care, more personal assistant hours and more residential places for people with disabilities who are no longer able to live at home.

Often they have ageing parents who cannot look after them anymore. There are additional palliative care beds: 55 in Kildare, Mayo, Waterford and Wicklow following the opening of the new hospices. I do not think so many hospices have ever been opened in one year. There is additional funding for the primary care reimbursement service, PCRS, to widen eligibility and reduce prescription charges, to extend free GP care to six year olds and seven year olds and make it easier for people over 70 to get a medical card. There is funding for the maternity strategy, the cancer strategy and the trauma strategy. There is €1 billion for mental health for the first time, additional funding for the fair deal scheme to make sure that waiting times do not exceed four weeks, or at least stand at an average of four weeks, additional funding for the voluntary hospices such as Marymount Hospice, St. Francis's Hospice and others, to begin to equalise their funding with the statutory hospices and additional funding for winter capacity. By no means will the extra staff and extra money solve all our problems in the health service, but it does give us a fighting chance of making some real improvements next year.

The Taoiseach gave a great rundown of the HSE's proposals for next year but the HSE will still be €420 million short of addressing what it calls demographic, technological and other pressures. Even with what the Government is doing, we will still be here next year talking about a deficit in the HSE.

Why did we not get the service plan before budget 2020 so that we could see what it was intended to do? The reality is that we will still be in crisis early in the new year, as the winter bug hits, and right throughout next year. While the Taoiseach says there will be extra funding, the Cleary Centre will still not have a new building. Seaview House respite home, Lifford hospital, iCARE and the Bluestacks centre will still be looking for funding. St. Joseph's in Stranorlar and all those other hospitals right across Donegal will all be in need because of the Government's inaction and its lack of recognition of the fact that health services need more than just money and highlighting the extra money the Government is spending on health.

The reason we do not see the service plan before the budget is that it is not written until the budget is known. One cannot put the cart before the horse.

That is the problem.

Everyone writes the service plan after it is known how much funding is available for it. However, I do not disagree with Deputy Pringle. Of course we will have problems and challenges in the health service next year, just as we have had in every previous year, and just as every other country does too.

As Deputy Pringle pointed out some of the difficulties we will face next year, it would be remiss of me not to point out some of the positive things that will happen next year. We will see two new hospitals open in Ireland next year: the National Rehabilitation Hospital in Dún Laoghaire and the national forensic mental health campus in Portrane. We will see three major extensions open: the Dunmore wing in Waterford, the new wing in Limerick and the new wing in Clonmel as well. We will see healthcare become more affordable for many more people. Seven and eight year olds will get free GP care. More people over 70 will get a medical card and prescription charges will go down for everyone. We will see patient outcomes continue to improve. More people will survive stroke next year. More people will survive a heart attack next year, and we will continue to see improvements in cancer survival, which are already better now than in the NHS, and I believe in the next couple of years will exceed the European average.

We will also see waiting lists continue to fall. We have seen the waiting lists for outpatient appointments fall for four months in a row. It took years of investment and effort to get there but we have got there. The waiting times for people waiting for operations have been falling for approximately two years. The number of people waiting more than 12 weeks for a hip replacement or a knee replacement, or for cataract, angiogram, vein and tonsil appointments is half what it was when I became Taoiseach. We will have lots of problems and we will deal with them, but we will also see lots of improvements too. Let us acknowledge them because at the very least we should be respectful to the staff in our health service who work so hard to deliver those improvements.