Why did the Taoiseach's Government take the decision to drastically underfund the health service in budget 2024? It is a health service that is already under enormous pressure, with record treatment waiting lists, a year-round trolley emergency and an ever-worsening recruitment and retention crisis. Against that backdrop, the Government chose, with its eyes wide open, to blow a massive €1.3 billion hole in funding for the health services people rely on. At the Joint Committee on Health yesterday, the head of the HSE, Bernard Gloster, described the Government's underfunding of the health service as highly unusual. I think Mr. Gloster was being very diplomatic. I would describe the Government's decision as mind-boggling. Incredibly, at a time of record hospital overcrowding, the Government's budget does not provide one additional red cent to fund even one additional hospital bed. Perhaps the most shocking thing is what its decision means for major clinical programmes and national health strategies.

How much new money has been given to the new national stroke strategy? The answer is zero. How much new money has been given to fund new medicines for patients fighting cancer? Zero. How much money has been given to improve our maternity services? Zero. ADHD clinics that were promised two years ago still have not been opened. How are they going to be funded, and what does the Taoiseach say to those who are waiting for those clinics to open? The Government’s decision will have a real impact on families who face some of the biggest challenges of their lives, families who need the Government to fund major improvements in the health service. Instead, it chooses to make things even worse. The recruitment embargo means thousands of vital front-line posts that were supposed to come online will not be filled - junior doctors, healthcare assistants, home help workers. Seven thousand vital posts that are needed for the winter ahead have already been scrapped and the consequences for people will be very real. Make no mistake: the Taoiseach makes this choice in full knowledge of the consequences, guaranteeing that the crisis in our health service will continue, that chronic waiting lists will continue and that overcrowding will continue. People see very clearly now a Government that has thrown in the towel on health.

So, when a child with scoliosis is told they have to wait even longer in pain for surgery, when a sick grandmother is left even longer on a hospital trolley, when a cancer patient cannot get the new drug that could change their lives, people will then remember the Taoiseach's catastrophic decision. Tá an Taoiseach tar éis éirí as an tseirbhís sláinte a shocrú. Is tubaiste é cinneadh an Rialtais gan mhaoiniú a dhéanamh ar an seirbhís sláinte agus caithfear é sin a réiteach. The Government delivered its budget two weeks ago, and now a health service plan will be presented with a deficit of €1.3 billion built in. It is now widely accepted it underfunded the health service, so we need clarity now as to who made this decision. Whose bright idea was this? Was it the Taoiseach’s? Was it the idea of the Minister for Health, of the Minister for Finance or, perhaps, of the man sitting next to the Taoiseach, the Minister for Public Expenditure, National Development Plan Delivery and Reform? Somebody in government pushed for this, and patients and people who will suffer as a result have a right to know whose decision it was. Will the Taoiseach tell us, please, who made this disastrous call?

The answer to the Deputy's question is that the Government makes these decisions. The Government acts collectively, signed off on the budget as a collective and accepts collective responsibility for the budget, including the health dimension of it, and ultimately, of course, it is a decision of the Dáil because it is the Dáil that votes on Estimates and it is the only body that allocates money to the health service, at least from a political point of view.

The health budget is always a challenge and that is not something that is unique to Ireland by any means. Health services all over the world struggle to come in on budget, and in Ireland that is no different. It has always been a challenge. Long before I was a TD, the health budget was a challenge for governments. No matter how much is allocated, there will always be calls for more. Whether the increase on an annual basis is a big one or a small one, there will almost always be a requirement for a supplementary. The years 2023 and 2024 are not going to be any different, but I do need to set out some of the facts because a lot of what the Deputy said was, characteristically, misleading.

First, the budget for 2024 is the biggest ever, at €22.5 billion. To put that in perspective, it is more than €4,000 for every man, woman and child in the State going to the HSE. It is a considerable amount of money. The waiting list initiative is fully funded, the emergency department programme is fully funded and, far from there being a recruitment embargo, the HSE will be allowed to hire 2,000 extra staff, in addition to replacements, throughout the course of 2024. When I was Minister for Health, not all that long ago, the budget for health was €14 billion or €15 billion, and an increase in any one year of €500 million would have been something I would have given my left hand for, quite frankly. Since then, we have seen the health budget increase by somewhere between 60% and 70%. Yes, our population has grown, it has got older and there is medical inflation, but not to that extent.

These are real increases and they have made a real difference, by the way. Our life expectancy is now one of the best in the entire world. Despite the Deputy's misleading comment, waiting lists peaked after Covid and have fallen by about 20% since then, which is not the case in most European countries, where waiting lists are still rising. That is not to say people are not waiting too long - they are, in their hundreds of thousands - but waiting lists have peaked and fallen 20% from the peak. Patient outcomes are better than ever before, particularly in areas like stroke, cancer and cardiovascular disease, and at the moment, while we experience overcrowding in too many of our hospitals too much of the time, generally speaking, if we take any day this week, roughly 100 or 120 fewer patients are waiting for a bed than would have been the case this time last year. Medicines are less expensive, free GP care has been extended to the majority of the population, we have abolished hospital charges, we are ending the public-private mix in our public hospitals with the new Sláintecare contract, contraception is free for women under 31 and State-funded IVF is now available. These are real changes for the better, done by this Government, done under the leadership of the Minister, Deputy Stephen Donnelly, and that extra money is making a difference.

In terms of recruitment, as I said, while we do have recruitment and retention challenges in some parts of the health service, what we have actually seen in the past three years is a recruitment surge. More than 22,000 extra staff are working in our health service, roughly the equivalent of the entire population of Longford. That is how many people have been hired and added to our health service in the past three years, and it includes 6,000 more nurses and midwives and 2,000 more doctors. There is capacity for the HSE to hire another 2,000 people next year, in addition to replacing everyone who retires or resigns, but it cannot just hire without approval and that has to change.

Not alone is there a recruitment embargo but industrial action is under way on foot of that. Those who actually run the health service have confirmed for everybody that there is a recruitment embargo and that is going to have real effects in terms of junior doctors, home help workers and so on. There are also 200,000 people on diagnostics waiting lists, 200,000 people on community waiting lists and 600,000 on the acute waiting lists. That is 1 million people, or just shy of it. I do not know what form of delusion the Taoiseach is labouring under but, I have to tell him, nobody else is.

What I want to know is this: did the Minister for Health ask for adequate funding? I have to imagine he did. I do not believe for one second that the Minister, Deputy Donnelly, came up with the bright idea to underfund the HSE to the tune of €1.3 billion. I have my criticisms of the Minister, but I do not believe he did anything as reckless as that. I would like to know whose bright idea that was, within Government. Was it the Minister for Finance? Was it the Minister for Public Expenditure, National Development Plan Delivery and Reform? The least the Taoiseach owes the House and the people is clarity on that point.

Every Minister around the Cabinet table looked for more in the budget package - whether on the tax side or the spending side. The Head of the Government - the Taoiseach - looked for more in the budget package than was possible. That is the reality of putting a budget together. Every agency, every Department and every Minister including the Department of the Taoiseach and the Taoiseach-----

I am asking about health.

The answer is "Yes." The answer is that was the case for every agency, every Department, every Minister and every Minister of State in the entire Government. That has always been the case. That is how budgets are done. People make a bid for a large amount of money, and they only get a fraction of what they ask for.

So the Minister asked for sufficient funding and got nothing.

That is how budgets are done. The Deputy's use of the words "recruitment embargo" is deliberately misleading. As always, she is misleading the public.

Absolutely.

It is a fact.

An embargo is a ban on recruitment. There is no ban on recruitment.

There is.

You said there was.

The HSE will be allowed to increase its total number of staff next year by 2,000. Where there is a restriction it is only where the HSE has already hired the number of people it is allowed to hire for a grade.

The reps are getting that.

When we allocate money for therapists, psychologists and consultants I do not want to see that money being diverted to hire extra managers, administrators and doctors who are underqualified. That has to stop.

I am talking about genuine doctors. We are not talking about managers.

That is misleading.

We are talking about front-line workers.