A lot of change is taking place in the health services, as the Minister knows. Of the most recent changes taking place, the new health regions are a key to the future health of citizens. However, according to the Royal College of Surgeons and the national doctors training and planning board, the model 3 hospitals are critical in delivering the new model of healthcare. Model 3 hospitals, such as Letterkenny University Hospital, have a crisis in general-surgeon consultant workforces. In Letterkenny, 27% of consultants are non-permanent, 31% are aged between 56 and 65 and 7% are over 66. The Minister will agree those shocking statistics are a basis on which to assess hospital staffing. In Letterkenny's case, it is particularly bad when we consider it is more than 250 km to the model 4 hospital within the Saolta group, which leaves huge numbers of people in Donegal dependent on Letterkenny for services.

The model 3 hospitals report, compiled by the HSE, the Royal College of Surgeons and the national doctors training and planning board, lays out a process to counter the change needed, and as Colm Henry, chief clinical officer of the HSE, states in its introduction, it lays out "in stark terms for the first time, the challenges facing Model 3 hospitals in the successful recruitment and retention of consultants." The report states, "The public is entitled to the same high standard of medical care across Ireland, regardless of their location." I definitely agree with that, as I am sure the Minister does as well. With 24% of consultants in model 3 hospitals on non-permanent contracts, that is twice the level in model 4 hospitals. The report recommends a model 3 implementation project is established as soon as possible, with a timeframe of 18 months for completion. This action would optimise the chances of achieving improvements for patients and staff in model 3 hospitals.

I believe that, as one of the busiest hospitals and the one that is the farthest from a model 4 hospital, Letterkenny University Hospital should be one of the pilot sites for the implementation of this project. It seems the Department of Health does not share this view about the implementation group or the pilot sites. It seems to favour a more scattergun approach that might not provide clear directions on where to progress the development of model 3 hospitals.

Will the Government make sure an implementation group is formed and that Letterkenny University Hospital will be one of the hospitals to model the roll-out of the study to improve retention and ensure everyone has access to vital health services?

I thank the Deputy for raising this important point relating to Letterkenny general hospital. He asked about an implementation group to make sure the resourcing that is required there will be put in place, and I will certainly raise that matter directly with the Minister for Health and relay that to him. It is important we look at the overall context of where we are with health delivery and with regard to resourcing our health service. The Deputy will know that this year, we have a health budget of just short of €23 billion, an increase of €7.7 billion from 2019, and that has seen a very significant impact on the achievements Ireland has made in health outcomes across the country. Life expectancy is above 82 and our mortality rate fell by 10% in just over one decade, and all across the health service we are looking at additional resources that are needed and are being put in place. A total of 28,480 more staff are working in our health service than there were at the beginning of 2020. There are 9,600 additional nurses, 4,200 health and social care professionals and more than 3,000 new doctors, and about 45% of consultant contracts now are the new public health contracts where consultants have signed up to them.

The Deputy has raised in some detail some of the challenges in Letterkenny general hospital and other model 3 hospitals. We want to make sure our health system is resourced across the Twenty-six Counties of the Republic. Funding this year has been made available for an additional 3,000 staff and the HSE has been instructed to start hiring those staff. The Deputy has briefly outlined some of the deficiencies with regard to staffing in Letterkenny, and I am quite happy to bring those matters directly to the Minister for Health. We are recruiting an additional 3,000 staff this year and we have done many other things to help patients, such as removing inpatient hospital charges and carrying out the biggest expansion of access to GP care, which is really important in order that people can get health services at the initial point through their GPs. Up to 60% of our population are now eligible for GP cards or medical cards. We have also reduced the threshold of the drug payment scheme. With regard to health, we are investing more than ever and we are getting better health outcomes. There is certainly more to be done in that space, but we have got approval for 3,000 additional staff this year and we have instructed the HSE to do that. On the specific matters the Deputy has raised with regard to Letterkenny general hospital, I am quite happy to raise them directly with the Minister, Deputy Donnelly.

I thank the Minister for his response. Letterkenny general hospital is one of the hospitals that face these issues but this report, which was compiled by the HSE, the Royal College of Surgeons and the training bodies within them, states that for level 3 hospitals, this has to be done. The statistics I outlined apply to all level 3 hospitals, relating to non-permanency, the age profile of consultants and so on. If we are to deliver a proper health service, we have to address this. The report specifically calls for a targeted response to be put in place for the small number of hospitals where the measures can be tried out to see how they work, but the Department has not recognised that. In response to a parliamentary question I submitted, the Minister for Health stated the Department is basically going to take a scattergun approach, such that we are not going to learn anything from it or see any real changes, and that is the problem because we need to see changes in our health services. Everything the Minister, Deputy O'Brien, outlined about throwing money at the issue and so on is not going to work. We have to accept the population is growing and that the health services have to develop and improve, and to do that, the Government has to take on board the report that is there.

I will raise the matter directly with the Minister for Health. It is not a question of just throwing money at it but is about getting improved health outcomes for our people, and I have given the Deputy just some examples of that where life expectancy and other rates have improved over the course of a few years.

In respect of Letterkenny, since January 2020, there has been an increase in staffing of about 25%. In 2020, the hospital had a budget of €157 million and its budget has now grown by €39 million, an increase of 25% in just over four years. Twenty-two new beds have also been opened in the hospital and capital investment is in place too.

I do take the Deputy's point with regard to the implementation group. I commit to him that I will raise those matters directly with the Minister for Health and ensure he responds to the Deputy directly on the matters he has raised.