For years it has been widely acknowledged that there are fundamental problems and problems of an administrative nature with the HSE. Successive Governments have tried and failed to rectify core issues relating to the delivery of healthcare. Newly ordained senior executives arrived with great ambition and left disheartened. Some of those executives are now sideline commentators who seem to know it all but who have little progress to show for their time in authority. Ministers have been scapegoated in the past. No doubt, the Minister for Health, Deputy Donnelly, will shortly be threatened with the sword. I believe in ministerial and governmental responsibility.

The Tánaiste and his Government colleagues have a duty of care to countless men, women and children who suffer daily because of a totally inadequate service. Clarity must be brought to the financial and budgetary situation of the HSE. Uncertainty is creating widespread fear and trepidation to those who work within the service and the countless people in Tipperary and across the country who rely on the HSE for lifesaving interventions. Also, there are many people afflicted with illness who require ongoing support to sustain a reasonable quality of life. Planned changes by the CEO, Bernard Gloster, to establish six health regions across the country are being viewed as a positive move. This sounds reminiscent of the era of the health boards, when obtaining healthcare was easier and far less traumatic for people. It was a time when people did not languish on hospital trolleys for hours or even days or find themselves on waiting lists for months or even years. A more localised management structure would be better equipped to serve the needs of each region and would be easier and more efficient to navigate. Regional management of health provision is one of the key reforms contained in Sláintecare. Urgent and effective change is crucial.

The Ireland of today is a very different place. There has been a population explosion. Demands for all levels of healthcare have multiplied. Standards in medicine and diagnostics have advanced enormously. People are more knowledgeable and diligent about their health requirements. Each of these factors has increased pressure on an already dysfunctional system. The CEO of the HSE has stridently stated that the health allocation for the coming year is insufficient to meet needs. It is already apparent that a supplementary budget of €1.5 billion will be required to bridge the gap. This has become an established, alarming budgetary pattern. There is major and understandable concern that throwing money into the existing bottomless pit that is the health service, is difficult. It does not address the problem; it simply bridges the gap year after year. Bridging that gap will become insurmountable and our health service will eventually eat into funding required for other crucial sectors of our economy. In the future, it will be difficult for the Government to justify reduced spending on housing, infrastructure, education or business in order to cater for health. Year after year, however, this scenario seems more and more inevitable.

I thank the Deputy for the question and the issues that he raised. This year's overall health budget is about €22.5 billion. Allowing for the €2 billion that has been removed and transferred to the Department of Children, Equality, Disability, Integration and Youth for disability services, that is the highest ever allocation for health. Since this Government came to office in June 2020, there have been increased budget allocations of approximately €7.4 billion. That is since 2019, and does not include the funding for disability services. It is important to point out that there has been a lot of increased activity as a result of that spending and people have benefited greatly from it. We removed inpatient hospital charges, for example. We had the biggest expansion of access to free GP care in the history of the State when we made an additional 500,000 people eligible. Therefore, 60% of our population now hold a GP card or medical card. We reduced costs relating to the drug payment scheme costs. Diagnostic scans for patients have been funded. Free contraception up to the age of 31 was introduced. For the first time ever, we are publicly funding assisted human reproduction. There is a new consultant contract to which up to 700 consultants having already signed up. There has been a reduction in waiting times and waiting lists following the build-up that occurred during Covid-19.

The community health service has expanded, with an entirely new programme, particularly in the areas of chronic disease management and primary care, older persons and ambulance services. The community care piece is very important because it was always hit by ongoing increased expenditure on the acute side.

Some 22,000 staff have been added since 2020 and about 1,000 extra beds have been put in, significantly also in ICU. That said, it is worth pointing out that life expectancy improved over a 20-year period. We now have one of the highest life expectancies in the EU. That is positive and not disconnected to significant increases in health expenditure. Also, the way we live our lives has changed. I welcome all the young people and children who are here visiting us. Lifestyle matters and eating a good diet matters - seriously. Healthy behaviour matters in terms of lifespan. We have dramatically changed our cancer outcomes. Our heart disease and stroke outcomes have dramatically improved. That has led to better longevity.

The Deputy's point is valid, namely, that there be an evaluation of the funding and the amount of money that goes into the health service in order to improve efficiency in terms of the spending of that money.

The Minister has commissioned a detailed study on the future costs of healthcare-----

I thank the Tánaiste. The time is up.

-----but also value for money, efficiencies and looking at the drug budget, for example, of €3.3 billion. He will bring in independent experts to analyse that. I will come back to the Deputy on regionalisation at the end.

Very good.

The greatest issue facing our health service is the retention of staff. This is partly due to younger people choosing to emigrate as they find it difficult to purchase or afford a place to live in Ireland and due to our more mature and highly experienced staff quitting their jobs prematurely. Their love for their work has not changed, but the conditions they work under are intolerable. The mental and physical pressure they endure is unending and unsustainable. After Covid, the country came to a standstill to applaud our nurses and healthcare staff for their extraordinary work during the pandemic. We need to remember their work every day is no less extraordinary. The work of our health teams is highly pressurised and unrelenting. It is work that is physically and emotionally exhausting. If we do not lighten the burden and increase the staffing numbers and resources, these jobs will become untenable for many people.

The Deputy is correct to say recruitment and retention have been a very significant issue, notwithstanding the fact we have recruited 22,000 in three years. In home care, for example, 53,000 people receive that every day now and there have been huge improvements and expansion. Eventually, we were expanding so much in home care that recruitment became an issue towards the latter part of that expansion. The work environment and the whole human resources practice within the HSE needs to improve and focus more on retention and the work environment for high-quality people who are working in our health service, because it is very stressful. It is never-ending. If we consider the acute side in particular, most people going into hospitals today need to go into hospital. The level of acuity is much increased. That means greater stress and burden on people who are working within the service. It is 24-7 with seriously ill people coming into hospitals, especially our acute tertiary hospitals, requiring the attention of our teams of staff. I acknowledge the point the Deputy has made in respect of really working hard on making the work environment better for those who work in the health service.