As I stand here, people have been waiting three and a half years in acute pain for an orthopaedic appointment and a whopping four and a half years for a respiratory appointment. That is a 54-month waiting list for respiratory appointments and we are about to face into a potential avalanche of respiratory cases as a result of long Covid. According to research by the Oireachtas Library & Research Service, which I commissioned, an estimated 114,500 people and rising in Ireland have long Covid. It is rapidly becoming a hidden iceberg of long-term chronic illness for our struggling health service. In December, analysis from the Royal College of Physicians of Ireland showed that the shortfall in cancer diagnoses equates to a delayed diagnosis for invasive cancers of between seven and ten every day in 2020 alone. That is someone's mother, father, wife, husband, sister, brother, daughter or son. Last year, while still dealing with Covid, the HSE had to grapple with the cyberattack. On top of that, GP attendances are also down significantly due to a mixture of reasons, including cost, private patients unable to access any GP and those lucky enough to have a GP finding it difficult to get appointments. All these delays are leading to cancer being diagnosed at a later stage of the disease, when treatment options are limited and, tragically, the prognosis is poor. We urgently need to do things differently if we are to address these appalling waiting lists once and for all. There is no doubt that recruitment of staff is key but we have already seen from the Department of Health disclosure on Sunday, which was subsequently backed up by the HSE's chief executive, that we will be at least 4,500 staff short in the health service recruitment drive this year.

I accept that we cannot magically make staff appear but we could sponsor students in training today on the basis that they commit to working within the health service for a period after graduating.

Second, we need to look at the way the health system works now and how we can speed it up. For example, we could maximise the use of the existing health infrastructure by extending the operational hours so that we get more scans done on the same machine, including on Saturdays and Sundays, as well as using the spare diagnostic capacity within our smaller hospitals.

First, I thank Deputy Naughten for raising this very important issue. I also thank the Deputy for the research that he has commissioned. It is an interesting analysis, maybe I would suggest a preliminary analysis, in respect of long Covid that certainly will be part and parcel of the health service for quite some time to come and will be a significant challenge for clinicians for some time to come. It needs to be monitored. Steps are being taken also, from a research perspective, to analyse and monitor this rigorously to make sure that we can look after people and also see the more medium to long-term impacts of Covid-19 on a certain cohort of people.

In respect of waiting lists more generally, they were too long before Covid-19. That is the first point. The base was high coming into Covid-19. They have got worse because of Covid-19 and the two lockdowns in particular - the first lockdown in 2020 and the second lockdown because of the Alpha variant in 2021. The short-term plan in the autumn worked well - it reduced waiting lists by approximately 6% - but, unfortunately, then we had the restrictions coming into the end of December and January where the health service and hospitals were told to focus almost exclusively on Covid and the Omicron issue.

The Minister will shortly be announcing and bringing to Government a waiting list initiative for 2022, but coupled with that a multi-annual waiting list initiative in terms of getting those waiting times and the numbers on the lists significantly down from outpatient to inpatient to day case, including, of course, diagnostics etc. That needs a comprehensive plan. The overall sum of money is approximately €350 million. That will be made available in 2022 to deal with the waiting lists, including, obviously, the public health system, the National Treatment Purchase Fund and the utilisation of private sector capacity in an all-out effort to get these lists significantly down. Emerging from Covid, this is a key target and challenge.

The Deputy is correct also to identify room for efficiencies, particularly the utilisation of equipment and facilities over the weekend period etc. Every available opportunity to do that will be taken in the context of this plan. The task force is jointly chaired by the Secretary General of the Department of Health with the chief executive officer of the HSE, and with the senior HSE team on that task force as well with other key officials to make sure that there is a relentless focus on getting the waiting times and the waiting lists down because it is important in terms of people's individual health and the overall health of the country.

I am not disputing that the Government is spending money - this year we will spend €40,000 every single minute on the health service - but just throwing money at our waiting lists does not work within the health service. We need to see structural reform. For example, take the rapid access haematuria clinic - the blood and urine clinic - at Roscommon University Hospital, where 10% of referred patients have been diagnosed with cancer. It treats 70% of patients in one visit and 100% of patients are seen within the 28-day target time for urgent cases, yet this service has not been rolled out anywhere else. There are many cases of good practice in the health service but these never get main-streamed because it clashes with someone else's agenda. This has to stop.

There is something fundamentally wrong when it is easier to spend money on treating patients in private hospitals than on supporting innovation in public hospitals, which could make a real difference in the long term to waiting lists.

We do need reform. In the progress report on Sláintecare that will be released later today, we can see all of the work in terms of more and more primary care centres opening, GP chronic disease management improving all the time and GP access to diagnostics. Some 135,000 radiology tests were delivered in the community in 2021. There is now national coverage of community intervention teams. Approximately 18.7 million hours of home supports were delivered in 2021. That is helping more than 5,521 people who are receiving the service. That is 2.7 million hours more than in 2020. Significant progress is being made in that area by the Minister of State, Deputy Butler. Much more needs to be done. We must roll out elective care facilities. Proposals have come in for Cork, Galway and Dublin and people from the mid-west are now making submissions in that regard. They are very important as well.

I am delighted Deputy Naughten raised Roscommon hospital. Perhaps others across the country would take note, so that when we say we are going to do different types of services in hospitals it does not mean a downgrading but rather an enhancement of services.

It would be nice to have the sterilisation facilities in the empty room there that the Minister went to see a couple of weeks ago.

The Minister met the team in Roscommon on the issue the Deputy referenced earlier. The point I am making is that I have heard nothing but positives about the manner in which the reconfiguration of Roscommon hospital has happened, as opposed to people just chasing the latest electoral stunt.

That is because of the helicopter service.

It has happened for more than 30 years.

That was because of Deputy Frankie Feighan.

The time is up.

Twelve months later Frankie gave-----

I am just saying it should inform debates as well across the country in other locations.

I thank the Taoiseach. The time is up.

A lot can happen.

That concludes Leaders' Questions for today.