Last Friday, the CEO of the HSE directed a severe escalation in the recruitment embargo caused by this Government’s mismanagement of the health budget. Job offers were withdrawn and recruitment has been halted for thousands of vital front-line posts. More than 7,000 essential posts have now been scrapped. The disastrous consequences of this Government's decision to deliberately underfund the health services for next year become clearer by the day and by the week. In his memo last week, the HSE CEO, Bernard Gloster, wrote, "I know this will create difficulties for many of you", as the health service "faces an enormous increase in demand". On budget week, he wrote to the Minister for Health outlining that "circa three quarters of the deficit cannot be achieved by way of reduction without significant and punitive risks to the public".

Yesterday, the Irish Nurses and Midwives Organisation recorded 595 patients on hospital trolleys. As we head into what we all want to avoid but what I think is unavoidable, namely, an extremely difficult winter in our health services, the Government in that context has decided to deliberately underfund the health service. In plain terms, it means no more experienced nurses and healthcare assistants can be hired, despite hundreds of patients on trolleys and hundreds of thousands of people on waiting lists. It means no more psychologists for child and adolescent mental health services, CAMHS, even though the number of children on waiting lists has doubled under the Government’s watch. It means no more home care workers, even though 5,000 older people are waiting for home support; no more therapists for specialist discharge teams; and no more radiographers or clerical staff for radiology departments, despite nearly 250,000 people waiting for a diagnostic scan. It means no more porters, hygienists or cleaners to keep patients safe from infections, and no more investment in community care to deliver early intervention, chronic disease management or local rehabilitation services. The Minister, Deputy Harris, knows, as I do, that without all those supports, people will not get the right care in the right place at the right time. That is not to mention the extreme reputational damage this recruitment freeze has caused for the health service. The only exemptions here are approved consultant posts, a small number of doctor training posts and nurses and midwives who are graduating this year.

What about all the Irish nurses who are working abroad, whom we want to come home and some of whom want to come home? What about all the other healthcare professionals who are graduating this year? What message has the Government sent them? I will tell the Minister. It has told them to leave, if they are thinking about it; and that if they have left, we do not want them and they can stay where they are. It has said to Australia, Canada, Britain and New Zealand to come and take our healthcare graduates. What message does that send at a time of great crisis in the health service, when hundreds of patients are on hospital trolleys every single day and hundreds of thousands of people cannot get access to basic care? The Minister promised that children with scoliosis would be seen within four months - another broken promise from the Minister and this Government - but they have been left without any clarity on when they will get the life-changing care they deserve. It was quite obvious from the budget that the Government has thrown in the towel on health. It has condemned tens of thousands of patients and staff to extreme risk in hospitals this winter.

Will the Government wake up, see sense and undo its disastrous decision to underfund the health service? Will it immediately revise the health budget for the rest of this year and 2024? Will it reverse the recruitment embargo and the scrapping of essential front-line posts that will do enormous damage to patients?

I thank Deputy Cullinane for raising the important issue of how we ensure we continue to grow our health service by hiring more nurses and doctors and people to work at the front line. It is important when talking about the health service and recruitment levels that we bring a bit of context and honesty to the discussion. The first thing to say is that as of September, there were 143,075 staff working in the health service, an increase of 5,330 this year to date. Sometimes when you hear Sinn Féin and others, you get the impression that we are contracting or reducing the size of the health service. Some 5,330 more people are working in the health service this year, so far, compared with last year. There are 23,263 more people working in the health service since the beginning of 2020, just before this Government came into office. Included in that are 6,808 more nurses and midwives; 3,388 more health and social care professionals, including therapists; and 2,633 more doctors and dentists. The last three years - 2020, 2021 and 2022 - saw the largest-ever increase in the workforce of the HSE since its foundation. We need a little bit of context. Similarly, in the budget only a month ago, the Minister for Health secured funding to further grow the size of the health service workforce in 2024. He has funding to increase the number of people working in the Irish health service by 2,268 next year as well. Deputy Cullinane is right when he says that on 10 November, the HSE's CEO issued a pause on recruitment. There are a number of exemptions, some of which Deputy Cullinane glossed over, for example in relation to consultants, graduate nurses, midwives and doctors in formal training programmes.

I did not gloss over it at all.

The Minister for Health is supportive of this because there needs to be some link between the budget we allocate in this House and what happens in relation to a public service. The reality is that the HSE is now on course to exceed the 2023 funded workforce target. To be clear, this is for 2023. Budget 2024 will come in on 1 January, which is weeks away. In 2024, the Minister for Health will have more money for the HSE to hire more nurses and doctors in addition to the exemptions already secured. Honesty is important in politics and the health service. I have two documents. One is the budget book. On pages 104 and 105, the Government outlined its allocation of funding for the health service for 2024 of €2 billion, broken down between core funding, non-core funding and capital. I also have the Sinn Féin alternative budget for health 2024. Deputy Cullinane will be glad to know I read it. Presumably, what Deputy Cullinane would do if he was Minister for Health would be to allocate a budget of €1.5 billion. When he asked me to revise the health budget, was he asking me to cut it by a further €500 million to reflect Sinn Féin's policy plans?

The Minister can raise issues about Sinn Féin all he likes.

I will.

He did not include that we would have provided for existing levels of service above that €1.5 billion. First of all, the Minister is wrong, as usual. People do not need bluster. I want the Minister to talk to patients and healthcare professionals, the older person or grandmother lying on a hospital trolley, the person with scoliosis waiting for a procedure or the child waiting for a speech or language or occupational therapy. All will get worse because there is a recruitment freeze. The Minister called it a "pause." Some 7,000 people have had the rug pulled from under them because the posts they were offered have been scrapped because of a decision by the Minister and his colleagues to underfund the health service. What about people working in healthcare services in New Zealand, Australia, Britain and Canada who want to come home? That pause means they cannot come home. He is telling them to stay where they are when we need them most. I ask the Minister again to stop making this about Sinn Féin. He and his Government made the decision. I urge him to reverse the decision to introduce a disastrous recruitment embargo and do what is right for the patients I spoke about and the people who want to come home and work in the public system.

Deputy Cullinane needs to get over himself. I am not making this about Sinn Féin at all. I am making it about the choices Irish people have between this Government versus that government. Those choices are clear.

The Deputy does not have to take my word for it on what the Sinn Féin alternative health budget was. His leader said it on RTÉ on "This Week" on Sunday. Now, do not sue me, but she did say it.

That is additional.

She is hardly wrong.

It does not include the ELS.

Please let the Minister answer.

The Minister is misleading the Dáil.

They tend to shout at you or sue you, so stop. Elections, politics and accountability are about making choices and the people of Ireland will have a choice. They will have a choice of a Government that is continuing to grow the size of the health service. What I say to those patients is very clear. We are offering €2 billion in additional health spending. I ask the Deputy, as somebody who wishes to be the Minister for Health, from somebody who was the Minister for Health, whether it is his position that he can just spend and recruit regardless of budget or does what we or he produces on budget day matter. If it does, it is time to be honest. We are increasing the size of the health service and the budget. We are going to make more progress on patient outcomes in 2024.

The HSE said it is not adequate. Do not take my word for it.