We have had a lot of questions this week about the national maternity hospital but I want to ask about Letterkenny General Hospital. As the Tánaiste knows, Letterkenny is part of the Saolta group of hospitals. This group has seen waiting lists increase by over 45,000 people in the past seven years. Letterkenny has seen an increase of 19% in that time, maybe not as high as other hospitals in the group but that is because we were starting from a higher base and a longer ongoing problem.

More than 2,800 people in Letterkenny have been waiting for ear, nose and throat, ENT, orthopaedics and cardiology appointments for over 18 months. There are over 1,000 patients on the three largest lists for inpatient treatment at the hospital. Indeed, we even have a situation where a consultant surgeon has been appointed but has not done any surgery because he cannot get theatre time. That is the crazy kind of situation with which we are now dealing. If it was in the film "Catch-22" we would say it was unbelievable but this is everyday life in Donegal.

Figures have shown that of 806 beds added nationally to the hospital services, only 36, or 4%, have been in the Saolta group. Sadly, I think that the Saolta group is focused on Galway and Letterkenny is at the end of it thoughts. All told, Letterkenny and Donegal are at the end of the line as far as the Saolta group is concerned and the Saolta group is at the end of the line as far as the national picture is concerned. That does not augur well for the people of Donegal who depend on Letterkenny for their healthcare needs.

Some 33% of approved consultant posts are either vacant or filled on an agency basis in Letterkenny General Hospital. The recruitment campaigns for two geriatric medicine posts were extended four times and the positions remain unfilled. A consultant microbiologist post is unfilled despite the campaign being extended seven times. The campaign for a new ENT surgeon has been extended three times. That position remains unfilled. Even if those posts are filled, we end up with surgeons who do not do surgery because they cannot get theatre time because there are not any staff to run the theatres.

What are the Tánaiste and the Government going to do about this situation? Are they simply going to continue to move patients to private hospitals or are they going to come up with ideas to sort this situation out? The people of Donegal deserve better and deserve solutions that will deal with recruitment problems. Surely the Tánaiste would agree that there is something badly wrong with a health system that does not even seem to be trying to address these problems or is it simply about forcing people onto private hospital lists?

I thank the Deputy. I appreciate that the issue he is raising is that of waiting lists at Letterkenny hospital and the waiting times for people who live in Donegal. He is also raising the wider issue of hospital overcrowding. I do not have updated information on Letterkenny with me so I do not want to give the Deputy information that may be incorrect.

However, I can speak about the general picture in relation to what the Government is doing to reduce waiting lists. We do acknowledge that there are far too many people waiting on healthcare for far too long. Even before the pandemic this was an issue but of course, it has become a much more serious issue because so much care was delayed, and had to be delayed, as a consequence of the Covid-19 pandemic. That was further affected by the cyberattack on the HSE. The Government has a plan to reduce waiting times considerably. We have set aside a dedicated budget for this plan of €350 million per year. It is a huge budget to implement the waiting list plan and that will go to public hospitals and also to private hospitals, where appropriate. We need to use whatever capacity we have to get people the treatment they need. If the waiting list plan works then by the end of 2022 the number of patients on active waiting lists will be at its lowest point in five years. I cannot guarantee that is going to happen but that is the plan we are working on. If it does happen, it will be a minor achievement, at the least, to have waiting lists at their lowest in five years by the end of this year. That is the Government's objective and of course, that applies to Donegal and Letterkenny as well.

We will offer treatment to all 75,000 patients on the active inpatient and day case waiting lists at the end of 2021 by the end of 2022 and will ensure that 1.7 million people are removed from waiting lists for scheduled care in 2022. In addition, we are expanding the capacity in our existing hospitals. There are between 800 and 1,000 more beds in the system than before the pandemic and we are continuing to add to that. We need to do that because we have a population that is increasing and aging all of the time, with the additional healthcare needs that come with that.

There is no need for the Tánaiste to provide up-to-date figures on Letterkenny. I gave the up-to-date figures in my opening remarks and they show the seriousness of the situation. Unfortunately, even if the Government's plan works, it will not solve any problems in Letterkenny because what needs to be addressed there is the recruitment and retention of consultants and of ancillary staff to allow those consultants actually to do their jobs. That is the reality.

The Irish Hospital Consultants Association, IHCA, has said that the maintenance of the FEMPI wage cuts is causing the problem of the recruitment of consultants. Reversing those cuts might go some way towards alleviating the problem. I also suggest that there is an alternative, which is to do a deal to recruit Cuban doctors into the Irish medical system. This has been working in Portugal and Sweden, both of which are in the EU. Cuban doctors are working in both countries and are alleviating some of their recruitment problems. We should do that now, as another step to try to deal with this issue.

For years to come, the pandemic and the cyberattack are going to be used to explain why we have not delivered but that is not good enough any more. Even if we deal with these issues, Letterkenny will be back in the same situation it was in prior to the pandemic.

It is an enormous challenge to recruit and retain healthcare staff, including doctors and that is not unique to Ireland. That is very much a global phenomenon. There is not a health service that I am aware of, certainly not in Europe, that does not have a difficulty recruiting and retaining staff. There is much more demand for healthcare than there are qualified doctors, nurses and midwives in the world. That is why, just like lots of other countries, we rely so much on people coming from overseas to help to staff our health service. We are very grateful that they come here and do that. I do not have exact details on Cuba but I certainly do not see any reason why somebody in Cuba could not apply for a work visa to come here and work in our health service.

We should acknowledge, and this is not often acknowledged, that we have more doctors working in our public health service than ever before. One would get the impression sometimes that the number of doctors in our health service was going down and that more people were leaving than were coming in but that is not the case. We have never had more doctors working in our health service than we do now. We have never had more staff in our health service than we do now. We are up to about 40,000 nurses and midwives in our public health service now, which is more per head and more per bed than almost any country in the western world. That is part of the story and it should be acknowledged. Yes, we do have a recruitment and retention problem and it is a big one. We are struggling in that area, as are lots of other countries but we do have record numbers of doctors, nurses and midwives now working in our health service.