If the Minister for housing had been here, I would have asked a different question but since it is the Minister for Health, I will ask what is a very relevant question for many people. I recognise that a lot more people have GP cards now than was the case previously. I also recognise that with the abolition of hospital charges, the increase in the GP card threshold and the lowering of the drug refund threshold, the Minister has narrowed the financial difference for those who do not have a card. However, there is a major problem at the moment that I keep coming across which is that people who have had medical cards for years are, on review, losing those cards for a very simple reason. As has been pointed out earlier, social welfare payments, including pensions, have gone up and the minimum wage has gone up. Some might say there is not much difference, that it is only €80 but for people with young families, there are other things attached to the medical card. For older people, it is fair to say that the medical card is gold dust. Are there proposals to change the income thresholds for the medical card?

It is something we have to keep under constant review for the very reasons the Deputy has outlined. We have substantially reduced the cost of healthcare right across the board. Approximately 1.6 million people now have GP or GMS cards. For the first time ever, over half of our population is entitled to free GP care. However, as the Deputy rightly points out, notwithstanding increases in the over-70 medial card thresholds in 2021, we have not moved the other thresholds in some time and increases in income are inevitably pushing some people just short of where they were previously. The Deputy will also be aware that a very considerable number of discretionary medical cards have been issued as well. The point he raises about those who move to the wrong side of the threshold because of quite marginal changes to social welfare payments, among other things, is certainly something we need to keep under review. We are aware that a number of people are being affected by that.

Over the past six to seven years we have increased the number of staff in our hospitals and the health service generally by over 40%. We have moved from 103,000 whole-time equivalents working in the health service to over 143,000. However, we have not increased the infrastructure available to them. For instance, a lot of consultants are finding that they have only one half day per week in theatres. There is a proposal to put surgical hubs in place in a number of centres and hospitals around the country. One issue that came up at the Oireachtas health committee yesterday was that of elective hospitals for Cork and Galway. We learned that the design team has not even been appointed yet. I am concerned about this in the context of our growing population, which is up by over 40% in the last 23 years. Last year there were over 100,000 more people in the country and if that continues every year there will be 6 million people here by 2030. We will have all of the people we need employed in the health service but will not have the infrastructural capacity to deal with the work that is required to be done. Can we do something on the elective hospital issue, in terms of both structure and delivery?

The short answer is "Yes". The Deputy will be aware that a painstakingly slow process must be gone through for hospitals. We are in the middle of that process for the national maternity hospital and are dealing with it to some extent for the elective hospitals. To try to deal with this, we have got agreement from the Department of Public Expenditure, NDP Delivery and Reform to reduce the number of stage gates, which is helpful and we are doing various things in parallel on the electives, including looking at similar design for the different hospitals across the country. In the meantime, I have one note of good news. The Deputy will be aware that the enabling works have now started in CUH for the surgical hub, which is the shorter-term solution while we wait for the elective hospitals to be developed.