I thank the Tánaiste. We move now to People Before Profit-Solidarity and Deputy Mick Barry.

I thank the Ceann Comhairle. What a cowardly and craven performance by the Taoiseach in Washington last night, by the way.

I wish to address what has happened in our health services on the Tánaiste's watch. Ten minutes from now, trade unionists will assemble at the gates of the Midland Regional Hospital, Tullamore and at Our Lady of Lourdes Hospital, Drogheda to protest against the recruitment cap imposed on the HSE and their hospitals by the Tánaiste's Government. Yesterday, workers protested at St. Luke's Hospital in Kilkenny and Connolly Hospital in Blanchardstown, where they were joined by my colleague, Councillor Ruth Coppinger.

Last Thursday, I joined with workers protesting at the gates of Cork University Hospital, CUH. I spoke to workers from the medical records department. They have just ten full-time staff where they should have had 24. I spoke to workers from the housekeeping team. Earlier this year, hospital management tried to stop members of this team from taking their annual leave but had to back down after an outcry. Nevertheless, the pay and numbers strategy still means that some members of this team have to clean three wards in a day. That is backbreaking. Outsourcing has to be stopped and these workers should get their grade 3. I spoke to nurses who pointed out that there are more than 2,000 nursing and midwifery vacancies being suppressed across the HSE. God knows how many posts are being suppressed across all grades. Perhaps the Tánaiste could tell us. I spoke to porters who told me that, in 20 years, they had not seen the workforce so burnt out and stressed out.

On Tuesday, there were an incredible 98 patients on trolleys or chairs at CUH, the highest number since the INMO started collecting trolley numbers 18 years ago. If there are 98 patients on trolleys in CUH at the start of October, how many await us in the depths of winter? One of the hospitals that could take some of the pressure off CUH is Mallow General Hospital but Mallow hospital now has 34.5 full-time vacancies. Staff shortages in its lab services recently forced the cancellation of some surgical procedures. The gap has been plugged for now, with staff members from CUH who live in or near Mallow coming to the rescue. Once again, the picture we see is of a health service really struggling to get by and a workforce that is severely overstretched.

Mallow was just one of the towns that were threatened recently with a cut to their ambulance cover. I congratulate the ambulance staff, the people of Mallow and people across the Cork and Kerry region for pushing back against that cut. The threatened cut to ambulance cover was withdrawn under pressure but the original cutback by the HSE to National Ambulance Service funding remains in place. People are suspicious, rightly so in my opinion, that the cut in ambulance cover will remain withdrawn until after the general election but will be reintroduced then. I urge the people of Mallow to elect politicians who will fight ambulance cuts all the way, not politicians who would have them postponed rather than cancelled.

The Government's pay and numbers strategy is a disaster. It is a recruitment ban by another name. Will the Government lift it before the winter comes or will it just allow this dire situation to go from bad to worse?

First of all I must point out to the Deputy that there are 28,000 more people working in our health service than there were at the beginning of 2020. That is a 23% increase. This includes some 9,375 nurses and midwives, 4,000 health and social care professionals and 3,330 additional doctors and dentists. At the moment, we are looking at 129,750 - approximately 130,000 -people now working within the HSE. This is excluding disability services, which have moved over to the Department of children. The budget is in and around €25.8 billion. We need perspective here. The Deputy creates a picture of cuts and pull back but that this does not stack up. The agreement reached by the Minister for public expenditure and the Minister for Health allowed for €1.5 billion in 2024, into the base, and €1.3 billion into the base for 2025. These are huge sums of resources allocated to our health services. That agreement allowed for the regularisation of 2,000 posts, for which the HSE had recruited but up to then had not been funded, and then a further 2,000 posts that were recruited temporarily to support services during the Covid-19 pandemic and which were still in place. The HSE had basically recruited 4,000 staff without funding being provided and that is all sorted now. In addition, provision has been made to recruit a further 4,200 staff in 2024, with 3,310 funded by the Department of Health and 900 by the Department of children. There is no ceiling. There is the provision now whereby decisions can be taken regionally on prioritisation and the allocation of resources. I do not believe it merits industrial action, but certainly engagement and dialogue.

We also have to raise the issue of working on outcomes, reforms and governance. We cannot keep on ignoring that. The resources are exponentially growing within health. We are committed not just to further recruitment, but also doubling the numbers in training in nursing and allied healthcare professions. The Minister for higher education and the Minister for Health have already announced significant funding for the colleges to increase the number of those in training. The argument being put forward by the Deputy is that the recruitment ceiling is a freeze by another name.

That could not be further from the truth. The health service has been funded to expand its numbers, both this year and next year. Funding has been allocated to enable that to happen.

The Tánaiste gave out a lot of statistics but he did not point to the fact that services have had to increase, and rightly so. He also did not point to the fact that there are big increases in the population. He also did not indicate how much of the new staffing is on the basis of hire of agency workers. These workers are more expensive and often have considerably less skill and experience in the particular hospital. The Tánaiste says he does not believe that it merits industrial action. He should listen to the nurses, porters, the staff in the medical records' offices and the housekeeping staff. In many cases, these people are the Tánaiste's constituents and they are telling me and they are telling the Tánaiste that they are over stretched, burnt out, stressed out and demoralised. A blanket of statistics cannot be placed over that to deny the real human experience.

The Government will ignore this issue at its peril. These protests are gaining strength around the country. This is a snowball effect that is happening in the hospitals among the health service workers. Whether the election takes place in February or in November it looks to me like the Government is running smack into that mood among the health service workers. This will be a general election issue.

I am not providing an umbrella of statistics. There is a fundamental issue here. The statistical data from the OECD shows that Ireland now has the second-highest rate of practising nurses per 1,000 of population, among reported EU countries. However, let us put all that to one side. There is no doubt that health expenditure has increased exponentially. Yes, the population has grown as well and there is pressure on hospitals. I accept that. There are organisational and reform issues that we have to look at as well. We are more or less increasing health expenditure every year by €1.5 billion. We have to evaluate that spending. There has been a tremendous increase in life span over the past 20 years. There has been fantastic work done on cancer, cardiology, stroke treatment - where outcomes and survival rates have really improved. Equally, we have to look at some of the outcomes in terms of numbers of people treated and so on over the last number of years and the correlation of that with the inputs. This is a legitimate issue that we should put on the table. By this I am not referring to the people on the ground. HR management in the HSE needs to be looked at. A concern I have is that work has been delegated to regional executives in terms of the prioritisation of resources but that could lead to a post-code-lottery type of situation, which is something we must avoid.