I will begin by expressing my solidarity with the people of Cork and west Waterford who have been impacted so severely by the flooding yesterday. I will return to this later. I want to raise the issue of healthcare spending. Last Tuesday the Government presented a "Once upon a time, in a land far, far away" sort of budget that was full of gaps with dodgy estimates. It has been exposed in many ways as a work of fiction. Nowhere is this clearer than in the health spend. The Government announced a health budget with a €2 billion hole in it. Bernard Gloster, the CEO of the HSE, has said the moneys allocated to the health service in the budget are inadequate and the funding is not sufficient to meet the expected demand for health services. This is very serious.

The front page of today's edition of the Irish Independent reveals that Government Deputies are apparently less worried about the substance of Mr. Gloster's concerns than they are about the very fact he stated them at all. These concerns are very real. It is extremely serious that the Minister for Health has announced a recruitment freeze during an acknowledged staffing crisis. This is a hammer blow to all those who work in the HSE who tell us how under-resourced they are. It is a hammer blow to Bernard Gloster who says that patients will be harmed without the recruitment of additional staff. Most of all, it is a hammer blow to the people of Ireland and those who are now wondering whether they will have access to health services if and when they need them.

The freeze on recruitment is outrageous. Having begged doctors, nurses and healthcare workers not to leave us for Australia and other places, the Government has effectively turned around and said never mind that. This week HIQA reported that staffing in hospitals such as St. James's Hospital and Mercy University Hospital is at a critically low level. The Irish Nurses and Midwives Organisation, INMO, is warning us that the recruitment freeze will send the healthcare system into freefall. Adding insult to injury were the comments of the Taoiseach in the Dáil on Tuesday, when he played down what he termed "talk" of a recruitment and retention crisis, one that we all hear about all the time in our constituencies.

The Tánaiste's Government's refusal to return to the rest of us here on Earth is evident throughout the budget on health. More than 4,000 patients may be unable to access potentially life-saving treatments next year due to the decision not to provide dedicated funding for new drugs. We know that more than 6,000 people throughout the country are desperate for access to home care due to a lack of carers available. Almost 900,000 people languish on some form of health waiting list, more than 100,000 of whom are children and young people.

Today we heard at the Committee on Public Accounts, under questioning from Deputy Kelly, that the new children's hospital is drifting further and further out of reach with a projected spend now of €2 billion. The blame lies squarely at the feet of the Government. Most galling of all is that we do not know who is responsible for the shortfall in funding. Is it the Minister for Health or the Minister for Public Expenditure, National Development Plan Delivery and Reform? Will the Tánaiste explain whether the Government can ensure safe staffing levels through the winter? What plan is there for the health service to ensure that sick people who present at hospital will not be left on trolleys or sitting on chairs?

It is the entire Government that produces the budget and delivers the budget across the board. In terms of any report, I fully respect the right of the chief executive officer of the HSE to comment on the budget, to brief Deputies - and he would not be the first CEO to brief parliamentary representatives in the House - and to engage with the Government in respect of issues pertaining to the budget. I have no issue with the new CEO engaging with public representatives or doing interviews. He is a very experienced public servant. He has been in public service for 34 years. He was very involved with Tusla and its reform. We look forward to working with him. He is only six months in the job.

The Irish healthcare system has received significant investment in recent years since the Government came into office. The health sector has been prioritised, with increasing budget allocations of more than €7.4 billion since 2019. This excludes funding for disability services. By any yardstick this is a significant increase in funding over a relatively short space of time. In this context, my view is that we need to do a deeper analysis of healthcare expenditure, parallel with analysis of future trends and ageing demographics more specifically. I noticed, leading into the budget, that the amount allocated in some Opposition budgets was very similar to what the Government has allocated. Sinn Féin's budget was the very same.

You are hilarious.

You will get on well so.

You are getting very nervous now when responding. It is the Labour Party that has an opportunity now and I am just making this point.

This analysis needs to happen in my view. I will come to the recruitment issue. Cost management is very important. When I was Taoiseach in 2020 we were presented with information that the 2019 budget would have a €1 billion structural deficit. We dealt with it and we added more. Lo and behold, there will be a substantial deficit again this year. It needs examination given the scale of increase that occurs on an annual basis. This applies to all parties in the House. Some of this is societal demands, such as ageing demographics and inflation. By the way, the expenditure overall in the past two or three decades has worked because our survival rates for cancer, stroke and infant mortality have really improved.

The time is up.

This year's budget will facilitate significant developments. I want to make a point on recruitment.

The time is up.

Many posts that have been funded have not been recruited. A lot of the recruitment issues we have experienced in the past year are not funding related but are human resource issues.

The Tánaiste's replies just do not pass muster. He spoke of a need for analysis and for examination but the reality is that the Tánaiste and Fianna Fáil are in government-----

Since the foundation of the State.

-----and the party has the Minister of Health portfolio.

Yes.

We need to hear from the Tánaiste what the plans and the figures are that are going to work in the budget. I say this because clearly, the Government's figures in last week's budget simply do not add up. This is acknowledged. Where are the plans to help those struggling people working in the health service who are so under-resourced and overstretched? Where are the plans to help patients? I refer to patients like the woman who contacted me and told me she had developed blood poisoning and was left in a chair overnight, propped up against the wall, due to a lack of beds. All of us are hearing from people who are telling us they were turned away from scheduled appointments because of a lack of staff. This happened after they had booked time off work and fasted for their procedures. This sort of thing does not happen in a properly resourced health service. The Tánaiste is in government and it is simply not good enough to hear him speaking as if he were a commentator and saying there is a need for analysis and examination. He should do something about this situation, ensure the health service is properly resourced-----

I thank the Deputy. The time is up.

-----and ensure that the appropriate Minister, namely, the Minister for Health, is in charge of the budget. What we are hearing makes it unclear to us whether it is the Minister, Deputy Stephen Donnelly, or the Minister for Public Expenditure, National Development Plan Delivery and Reform, Deputy Donohoe, who is calling the shots.

The time is up, please.

Either way, there is not enough money for healthcare and it is the patients and staff who are going to suffer.

Deputy Bacik should talk to her colleague, Deputy Brendan Howlin, who was both a Minister for Health and a Minister for Public Expenditure and Reform. He might fill in Deputy Bacik and give her some insights into how the process works.

That was years ago. It was two governments ago.

What I can say is that-----

That is so patronising.

-----we have cut costs across the board for patients. We have removed inpatient hospital charges.

The Government has cut services.

We have had the biggest expansion of access to free GP care in the history of the State. Up to 60% of our population now hold a GP or medical card.

If there is no problem, then give a card to every child.

There have been record patient-----

We have reduced the drug payment scheme costs.

-----and 1 million people waiting for care.

There are record-----

So, there is nothing to see here and everything is okay.

We have funded diagnostic scans for patients. We have introduced free contraception for women up to the age of 31. We have publicly funded assisted human reproduction, including IVF, for the first time. We have agreed a new contract for consultants and up to 700 have signed up to it. We have added more than 22,000 staff since 2020. Funding has been provided for 22,000 staff since then.

Is the recruitment freeze on the Tánaiste's list?

And child and adolescent mental health services, CAMHS?

We have increased our hospital bed capacity by more than 1,000 beds at the same time, and we have also expanded our ICU capacity.

The Minister of State, Deputy Butler, has said she-----

We are increasing college and training places. For every GP who retires, between one and a half and three new GPs are working. We also expended huge funding in the context of the pandemic.

Everything is fine.

We are doing the actions.

I thank the Tánaiste. The time is up.

Having said all that, and with there having been €7.5 billion in additional funding since 2020, I am making the point and there is nothing wrong in saying there is a need for further analysis in this regard in terms of our growing population-----

We need further money.

Analysis that is logical and informed-----

Old habits die hard.

That is enough now, thank you.

-----and not just sort of-----

Another report so.

Could we have a little less heckling, please? I call Deputy Mick Barry.