Fine Gael has been in government now for nearly 14 years, joined at the hip with Fianna Fáil for the last eight. We are on the eve of a general election and we still have a very serious crisis in our hospitals and across the wider health service. On the Taoiseach's watch, accident and emergency departments are dangerously overcrowded, the trolley crisis has become a year-round problem, more than 1 million people are waiting for treatment and care on waiting lists, while children with scoliosis and spina bifida wait and wait in agony for their operations. All the soundbites and spin in the world cannot hide that this persisting crisis is a result of bad policy and bad decisions by the Fine Gael-Fianna Fáil partnership.

One of these bad decisions was the Government's damaging recruitment embargo, or the pay and numbers strategy, as the Government now calls it. You can call it what you will but it means the same thing. In the midst of this crisis, hospitals and other services across the system cannot hire the front-line staff they so desperately need.

The story gets worse because, while the Government prevents the recruitment of permanent staff into the health service, its spending on agency staff has gone through the roof. New figures provided to my colleague David Cullinane this morning show that Government spending on agency staff has nearly doubled, ballooning from €350 million in 2019 to €650 million in 2023. Staggering stuff, Taoiseach. During that time, the Government abolished 2,000 permanent nursing and midwifery posts, and all the while the Government spends €146 million on agency nurses, money that would have, in fact, delivered more than the 2,000 permanent nurses into the system. The Government chose temporary staffing even when hiring nurses into permanent positions was cheaper. Think about that for a second because the mind boggles - more expensive temporary staff instead of less expensive permanent staffing at a time when our services desperately need permanent staff. How incompetent is that. How does the Taoiseach defend that use of public money? There is more, because this morning's figures also show that the Government's spending on outsourcing of administration and management in the HSE has trebled in the past five years, shooting up from €29 million in 2019 to €86 million.

The Government's spending on agency staff is a runaway train, making a mockery of public spending controls. It is not only a massive waste, it further destabilises our health service already in crisis. It shows again that Fine Gael and Fianna Fáil cannot be trusted to spend public money wisely, competently or in the best interests of the people.

Mar thoradh ar an méid as cuimse atá caite ag an Rialtas ar fhoirne áisíneachta sa tseirbhís sláinte, rachaidh an ghéarchéim in olcas. The Government's actions are, in fact, prolonging the crisis in our health service. How does the Taoiseach explain this ballooning in costs for agency staff? How does he defend the runaway costs for agency staff, leaving the health system with an ongoing staffing crisis and making private companies very rich?

I thank Deputy McDonald for raising important issues in our health service and recruitment into our health service. Of course, the reason we talk about numbers of people working in our health service is because we all want to see improved patient outcomes and improved patient wait times. I will dwell on that in a moment.

A bit of context that is important when we are discussing health services is health recruitment and the health budget. The Government recently announced €25.8 billion of a budget for the delivery of health services next year, the highest budget for health ever in the history of the State. It represents an increase of more than 43% from when this Government came to office. When this Government came to office, we were spending €18.1 billion on health; we are now spending €25.8 billion. It is important we have some context in terms of the huge levels of investment of public money we are putting in. As a result, as of August of this year, there were 27,901 more staff working in the Irish public health service - it has nothing to do with private - than there were at the beginning of 2020. As for what this means in reality, it means 9,375 additional nurses and midwives, 4,092 additional health and social care professionals, and 3,330 more doctors and dentists. These are factual figures. I presume the Deputy accepts them. There are now nearly 28,000 more people working in the health service than when this Government came to office. By any measure or means or any fair discussion, that is a very significant increase.

In fact, last year, despite what we hear in this House, we saw the largest recruitment ever into the HSE since its foundation. The largest level of increased recruitment ever in the history of the HSE took place last year, something that the Deputy forgot to mention in her earlier comments.

Where are they? In offices.

She does not need any help. Deputy McDonald is right that there is an importance to the whole issue of safe staffing and the safe staffing framework. Indeed, I would have worked on this when I was in the Department of Health. The Minister, Deputy Donnelly, has done huge work on this. I am pleased to tell the House and, more importantly, people watching at home that the safe nursing staffing framework has now been fully funded. That involves approximately 2,000 posts. My understanding is approximately 1,500 of those people are now in place, working in our hospitals today, and the remaining 500, which are being recruited, are fully funded. Every post, because the Deputy mentioned safe staffing, in the safe staffing framework of 2,000 is now fully funded. Fifteen hundred of them work in the health service today and the money is absolutely in place for the final 500.

When we talk about the health service on a macro level, let us look at it at a hospital by hospital level. In St. Vincent's University Hospital, which is not too far from here, there has been a 49% increase in the number of nurses and midwifes working in that hospital now since the Government came to office. Percentages can be misleading. That is 498 extra nurses working in St. Vincent's now than before this Government came to office. Tallaght Hospital, also not too far from here, has seen a 53% in nurse numbers. That is 521 more nurses. Cork University Hospital has 599 more nurses. The Mater, which is in the Deputy's constituency, has 488 more nurses working there since this Government came to office than before. In Waterford, in the south east, there has been a 51% increase or 381 more nurses. This is having a positive impact.

I accept wait times can still be too long; so does the Minister. We are driving them down.

What about Kerry? The Taoiseach did not mention it at all.

I will get you a figure for Kerry but that has gone up, too, Deputy.

The figure has gone down.

Wait now, please.

No, it has not. It has gone way up.

Let me tell the Deputy this, because it is too important to shout and interrupt here. In terms of waiting times, it means that we are seeing waiting times fall. They are not falling in the North, they are not falling in the UK, they are not falling in most of Europe but they are falling here in Ireland. Wait times for outpatient services have reduced from 13.2 months in July 2021 to seven months today. We have seen huge progress in our Sláintecare targets, including 17% fewer patients waiting more than 12 months. That equates to 23,970 more people.

We have much more to do in health, of that there is no doubt, but there is really increased investment and increased levels of staff.

Here is the context for you, Taoiseach. When the Government came to office there was a crisis in healthcare, and as it leaves office there is a crisis in healthcare, and everybody knows it. Those are the facts.

Says you.

According to you, staffing is safe and sufficient. Why then are people waiting for care? How is it then that cardiac rehabilitation equipment lies idle? How is that can cancer patients are left waiting for treatment - 120 per day, it is reckoned by SIPTU - due to a lack of radiation therapists? How is it that you cannot walk the length of yourself anywhere without meeting people who are frantic with worry waiting because of staffing shortages?

The Taoiseach quoted his budgetary figures there. It is not only a question of the money; it is how it is spent. Notably, the Taoiseach did not address the core of my question, which is a runaway train on agency spending, which is inefficient and which means the permanent need within the system is never properly addressed, even though it is more cost-effective to take on permanent staff. When you take to your feet, Taoiseach, defend for us, if you can, how it is that €650 million is the figure on agency spend, and agency temporary staff are hired instead of permanent staff, even though that is a more cost-effective option.

It is simply not true to say we are not hiring permanent staff.

It is true.

I just went through in quite a lot of detail the fact that there are 27,901 more people working in the Irish public health service now than when this Government came into office.

Pen pushers.

With the cacophony of noise it is hard to concentrate. Including in respect of the Deputy's own local hospital, the Mater Hospital, I went through the material difference that has made in terms of hundreds of additional nurses working on the ground, thousands of extra doctors, thousands of extra healthcare professionals. The Deputy can say all that and she can acknowledge that to be true, while also saying that there are still pinch-points and there is still more to do.

Agency.

In relation to agency, I guarantee you if the Minister for Health said tomorrow that we are not doing any more agency, despite all this recruitment, your Deputies would be writing to me saying "what about this?" and "what about that?".

Hear, hear.

There is always a need for flexibility and agility when it is hard to fill posts. We are recruiting record levels, more than ever. We have set a target of a two-thirds reduction in agency staff in 2025. The Deputy made a very important point that I want to deal with directly about radiation therapists and cancer treatment. This is a real issue and I thank her for raising it. There are vacancies when it comes to radiation therapists in our radiation oncology centres. These vacant posts are still available to be recruited; in other words, they are funded posts. There has been a recent independent review of radiation therapy professionals which published recommendations. We are working very closely because these posts are funded and we want to fill them quickly.