Given that the Government Front Bench looks like a Christmas reunion of health Ministers, I am going to focus on that topic. Various people have held the position of Minister for Health and there have been various CEOs of the HSE. When the HSE was established and CEOs were drafted in, there were many promises that it would make a big difference. More recent appointees have been on a very significant salary scale. There was a promise that such a structure would bring a new order to our health service. The current Secretary General of the Department of Health has a special pay arrangement to bring his expertise to the matter. Notwithstanding all of that, our health system seems to be in a permanent state of crisis. We have learned that some people have waited 116 hours for a trolley. Others have waited for three hours and 15 minutes for triage, when that should be carried out within 15 minutes. Eighty people are on trolleys today in University Hospital Limerick, UHL. On the same day last year, there were also 80 people on trolleys in that facility. This year, we have been told that respiratory syncytial virus, RSV, is the issue. Last year, it was Covid-19. This year, there are only 15 people in intensive care units across the country because of Covid-19. Last year, we were told that the health service was facing existential collapse because of the threat posed by Covid. There were 105 people in intensive care units because of Covid last year. This year, the problem is RSV.

Essentially, the problem seems to be that people are getting sick. If people stopped getting sick, our health service would work perfectly. People pay taxes in the hope that when they become sick or need care, they will receive it. Our tax burden in Ireland is not very high by international standards but nor is it very low by international standards. Our health spend in Ireland is pretty average by OECD standards. However, I do not think that anybody in this Chamber or in the community thinks that our health system is adequate in return for that tax spend. When is our health system going to move beyond crisis into something that provides the service for which people pay their taxes? When is there going to be a value-for-money audit across the HSE and our health system? When is it going to move beyond crisis and towards something that resembles a First World healthcare system for which people pay First World taxes?

I thank the Deputy for his questions. At the outset, we should acknowledge that there are some very good things about our health service. Life expectancy continues to rise in Ireland. It is at 83 now and that is, in part, because of the improvements that have been made to our health service in recent years. Stroke survival rates are improving all the time. When I was working as a doctor, a stroke unit was very rare and there is now one in nearly every hospital. Cancer survival rates are improving every year and there has also been an improvement in the treatment for heart attacks. Many of the patient outcomes in Ireland are as good as, if not better than, our European peers and are better than those in the National Health Service, NHS, which is often used as an example that we should follow. We have also seen great improvements in chronic disease management. People with diabetes, for example, are managed at community level by their GPs in a way that was unthinkable only ten years ago. There is some evidence that waiting lists, having risen dramatically in part as a consequence of Covid and the cyberattack, are now starting to level off and, if anything, are perhaps going to fall a little. The word for that may not be "encouraging" because waiting lists should not be as long as they are, but levelling off is perhaps the first step before improvement.

I acknowledge that we face real barriers to access. Most people would acknowledge that when a patient gets into the health service, the treatment, generally speaking, is very good. That is what most people say when they are asked in patient experience surveys. However, we have a real problem with access. People are waiting far too long to see a consultant or to get an operation or investigation that they need. People are also experiencing unacceptable conditions in most of our emergency departments, including in UHL, which Deputy McNamara has mentioned many times.

We are pouring resources into the health service as the Deputy himself noted. In the past two years alone we have added over 1,000 beds to the system, 930 in the acute hospitals and 340 in the community. There are 15,000 extra staff now compared with two years ago including 4,500 extra nurses and midwives. There is a narrative to the contrary but the facts speak otherwise. We have 4,500 more nurses and midwives working in our health services than we had two years ago, 1,400 more doctors and dentists than was the case two years ago, and more than 2,000 additional health and social care professionals. That is happening against a backdrop of a rising population and an aging population with much more complex needs. That is the situation with which we are dealing. We will continue to strive to make further improvements in the years ahead and turn the tide on waiting lists which I think is achievable.

Can we have some detail on how that target is going to be met? We have a GP crisis which has been going on for a very long time. My predecessor from County Clare, Michael Harty, was elected to this House on the basis of the GP crisis and the fact that the number of rural GPs, in particular, was reducing. It would not be unfair to suggest that his experience here was somewhat frustrating and through no fault of his or no lack of effort on his part the situation was not any better when he left than it is now. We still regularly read in the newspapers of a GP crisis. We learn that one in three consultant positions is either unfilled or filled from an agency. There are 59,000 people waiting for healthcare across the mid-west. Resources are being poured into it but of course the population is aging due to a number of factors including dietary and health outcomes. I also learned that more than 200,000 PPS numbers were issued this year in Ireland. While we are pouring resources in, our population is also growing. I struggle to have confidence in how the Government is going to meet these targets it repeatedly issues.

I should add to my comments earlier that a waiting list initiative is under way and we are seeing substantial falls in the number of people who are waiting a long time to see a consultant or to have an operation. The number of people who are waiting more than six, 12 or 18 months is now falling. That is a result of the additional resources being put in. The target should really be 11 or 12 weeks, not six months or a year. We are at least seeing some progress in regard to the long waiters.

In regard to GPs there is a big shortage. On Friday I met some GPs in east Galway. They are offering positions in their practice at €120,000 for a four-day week with a practice nurse and with a manager yet cannot get any applicants. That shows the kind of challenge we face. In response to that we have doubled the number of trainees but we need to do much more work with them to encourage them to stay in Ireland because there is an exodus of GP trainees from the country and they are not coming back. In regard to consultants, ten years ago there were 2,500 consultants. There are now 4,200. There has been a very significant increase in the number of consultants in Ireland. However, we have vacancies and many positions filled by locums, as the Deputy mentioned. We think the new consultant contract is very attractive with a salary of over €250,000 a year. Anyone would agree that is a very good offer for a 37-hour week. However, we are asking in return that those consultants who take up that contract commit to public practice and work those 37 hours in a public hospital and only do private practice on their own time in a private hospital.