I wish to revert to the issue of overcrowding in hospitals across the country, in particular, the hospital closest to me, which is University Hospital Limerick, UHL, in Limerick. I wish to put it in context as well because, on 14 January 2014, then Deputy Micheál Martin raised the spectre of overcrowding in hospitals. He stated that the Minister had neglected it as a priority in government and that is why there were record numbers last week, and the Minister tried to get away with it but got caught. The then Minister for Health, now Taoiseach, Deputy Varadkar, responded that Deputy Micheál Martin wasted money when there were billions of euro sloshing around. He also stated that the overcrowding in hospitals went back to the Tánaiste's time as Minister for Health and that he would solve it as Minister for Health. At this stage, I suppose we are much less concerned with when it started and whose fault it is than when it will end and who will solve the problem.

The Tánaiste has repeatedly said that the Government is a victim of its own success because of the rise in life expectancy. There has been a rise in life expectancy but not a hugely dramatic one. In 2014, life expectancy was 80.56 years in Ireland. It is now 82.81 years. It is an increase, but not one that would explain overcrowding levels. In January 2014, in the middle of winter, when Deputy Micheál Martin raised this issue, there were 359 people on hospital trolleys, 34 of whom were in Limerick. Today, in the middle of summer - everybody knows it will get much worse when we enter into the winter period again - there are 390 people on trolleys across the country, 97 of whom are in UHL.

We spend a lot of money on health in Ireland. We did then and we do now. We spent €19 billion on health in 2014 in the midst of an economic crisis. The country was on its knees and the Government still found €19 billion to spend on health. We spend more than that now. We spend almost €24 billion on health. By OECD levels, we spend almost as any other country on health but it seems, from my perspective, and maybe the Tánaiste will differ with me, that our outcomes are not as good as those of other countries. Trolleys are, of course, in every hospital but the large numbers on trolleys seem to be a particular Irish problem. There is money sloshing around us, as Sinn Féin already pointed out with regard specifically to the national children's hospital. Is money being wasted? I do not know the answer to that. We have seen much wastage of money in other Government areas. Does that carry across to the HSE, because, like RTÉ, there is a new chief executive officer, CEO, in the HSE who seems intent on reforming practices and getting value for money?

I thank the Deputy for raising the issue. In terms of lifespan generally, the last 20 or 30 years have seen a dramatic improvements in lifespan. Over the history of the State, we have gained 25 years in lifespan. In terms of health outcomes, there have been fairly dramatic improved outcomes on cancer care and survival rates and cardiovascular in terms of survival from cardiac issues. Heart disease was a huge killer in Ireland. It still remains a killer, but less so than it would have heretofore been. Stroke has been dramatically improved. The outcomes from stroke now are much better and it is all about early intervention. If one looks at the area of pre-ambulance emergency care, the professionalisation of that has been transformative over 20 years. Sometimes when we talk about health spending - it is exponentially growing - we also have to acknowledge that in a lot of areas there have been a lot of good outcomes because of that investment.

The focus on the emergency departments and the overcrowding is valid in regard to whether we are getting the outcomes that we should be getting by now in terms of the investment, both in human resources and in physical capacity. We have to add the population growth, which is a significant factor which was probably under provided for in some respects over a period, because we have gone from 3.5 million people in the 1990s to 5.2 million today and in the last two years alone the population has significantly increased for a variety of reasons. That is set to continue in Ireland because historically the population was probably lower than it should have been if one looks back to the Famine period and right through. The population growth is a key factor.

On University Hospital Limerick, the trolleys are down 20% compared to 2019 but that is not enough. The outpatient list is down 30%. There are an additional 730 staff, 100 additional beds and 200 more under construction. There is a surgical hub on the way. However, we need reform as well. The seven-day week roster idea is important in terms of getting better use of the asset that a hospital represents and out of the equipment and the facilities, etc., to get better value for money, to get more productivity and to get greater volumes done.

With all the investment, the volume of activity is increasing all of the time as well. That gets lost in all of the figures. To be fair to the health service, sometimes we do not give recognition of the fact that the extra spending has meant extra activity, operations and diagnostics. We have to continue to invest in community and primary care to take the pressure off the acute service and make sure people get the right care, at the time and in the right and most appropriate location.

I welcome the emphasis on primary care. There is a great new primary care centre in Ennis. The Minister for Health, Deputy Stephen Donnelly, opened it. I welcome that, but there is a shortage of GPs right across Clare and right across the country. It is increasingly difficult, as I highlighted to the Taoiseach, to get an appointment to see a GP in Scarriff. That will be exacerbated by the new arrivals of persons seeking international protection and persons with temporary protection because no additional resources are being provided. There are difficulties in Newmarket-on-Fergus. We had a meeting about it last night.

That all means that I was getting phone calls from constituents during Christmas last year saying they could not get a GP anywhere, they had been told not to go to hospital, they had nowhere to go and they had a sick child, and asking what should they do. There was nothing I could say to them. I suppose what I am looking for is an assurance that this will be solved and that in eight years' time we will not be blaming the Government or the Minister for Health of the day for not solving the problem. Is it resources? Is it organisation? Is it a waste of resources because we can predict rises in population, rises in birth rates and rises in life expectancy?

It is all of the above. It will need more resources, if one looks at the trajectory of health expenditure. Much of that is on the human resource because the human capital in health has increased. The numbers of people working in the health service have continued to increase but more and more services have come on stream with it.

It means more investment of capital, in equipment and in additional capacity in hospitals. It should and has to mean more investment in primary care. In that respect, there is a significant increase in training places for GP and for allied health professionals and an increase in medical places in the training colleges. That will be essential, as will the recruitment of internationally qualified primary care practitioners or GPs.

There is greater accessibility now to GPs, from the income threshold perspective. There has been a very dramatic increase in access, from a financial point of view, where more people now have access to a GP card.

However, the point is well made in terms of the need to increase the number of GPs. Training places have been significantly increased, and attracting people from overseas to work in Ireland will also be a necessary part of filling the current gaps in primary care need.