Sympathies from this side of the House also to those affected by the terrorist attack in Sydney.

There was an outstanding piece of journalism, which I keep referring to, in the Limerick Leader two weeks ago. I have in my hand the front page of the newspaper, which shows the faces of four young women who lost their lives because of the health issues in acute care in the mid-west and University Hospital Limerick. They were Aoife Johnston, 16; Niamh McNally, 16; Eve Cleary, 21; and Leona Cusack, 33. It was an outstanding piece of journalism by Sandra Quinn.

The issues in relation to acute care in the mid-west is the topic I have spoken about the most in my political career. It is probably the reason I got into politics. I have had to tell personal stories in the Chamber in relation to my dad, my mother, even my wife and my neighbours. I have spoken about how care is thought of in the mid-west and the discrimination that has happened to all of us in Tipperary, Clare and Limerick over the past 20 years since the Government made the decisions on downgrading hospitals without the infrastructure being put in place.

In the south east, they have four model 3 or model 4 hospitals, in south Tipperary, Wexford, Waterford and Kilkenny. We have one. We have one accident and emergency department for 450,000 people. It is shocking. It is discriminatory.

Along with my colleague, Deputy Sheehan, and all our representatives, I very much welcome what the Minister has announced today. It is very rare that somebody in opposition will stand up in Leaders' Questions and say that but it needs to be said. In principle, what has been announced today is very welcome, and the engagement the Minister has had with us, particularly in the last two weeks, is also something different and very welcome. There always is a "however", and the "however" here is the detail. We will support the Minister on this decision. The reality is that we need close on 600 beds in the mid-west by 2040. However, the capital envelope for this is too small. It is €9.2 billion up to 2030. Our capacity as a country to deliver on this is not there. My question to the Taoiseach, the Minister for Health and the Minister for public expenditure, if he is going to be still there, is this: will the Government give the financial capacity to deliver on this plan? Without that financial capacity, this plan, with all the goodwill of the Minister and everyone else, cannot be delivered on. It is impossible. It just does not add up. Will changes be made to the capital plan of the HSE in order to deliver this for the mid-west and end the discrimination that has been happening to us?

I thank the Deputy for raising this issue. It is very serious. The Deputy rightly referred to the shocking deaths of Niamh McNally, Leona Cusack, Aoife Johnston, and Eve Cleary. From that, there is no question that the mid-west needs additional investment but also reform. The reform dimension started two years or more ago now and has had impact, but the investment also has had impact. The level of increase in investment over the last five years in the mid-west is quite substantial, which gives prospects for significant investment in the next five years and even beyond that. Investment in the hospitals in the region went from about €370 million to €689 million. The UHL budget has gone from €265 million to €507 million, and then on the current side there are additional doctors, nurses, allied healthcare professionals and so forth. In that period, about 420 additional beds will be delivered across the mid-west region, including 48 additional beds. The Deputy has the details of that in Ennis, St. John's and so on, and for Nenagh.

There are additional needs. In the context of options A, B and C in the HIQA report, the Minister brought to the Government this morning a proposal to progress all three, first in terms of additional capacity in the existing site. It is interesting that the average number of people waiting on trolleys at University Hospital Limerick has almost halved in the weeks since the new 96-bed block opened compared to the weeks prior to it. Enabling works are under way, as the Deputy knows, for a second 96-bed block at UHL. The Minister is mandating the HSE to acquire a site as close as possible to the existing site. In terms of option C, which is model 3 reconfiguration across the mid-west, the Government has agreed to develop a model 3 hospital in the HSE mid-west that will provide a second emergency department for the region. All three options will be pursued by the Minister.

The Deputy has experience as a former Minister and he knows the important decision is the one that has been taken. A lot does depend on implementation and progression.

The acquisition of a site will be very important. The speed of consideration in terms of option C will also be very important. The Minister will develop a strategic plan for option C for the commencement of reconfiguration. I do think it is possible.

I thank the Taoiseach for that, but he has to answer the question. Will the capital allocation for the Department of Health - HSE capital spending - be increased dramatically to deliver the project? It cannot be delivered at the moment. This decision cannot be executed. It is impossible. There is not enough money there, particularly if we look at the existing commitments relating to elective hospitals and everything else.

In reality, option B should become option C. That is the quickest and best solution for the people of the mid-west. I respect that the Minister will never want to discuss sites, and rightly so. What we should do is acquire a site and deliver option B and then wrap option C around it in stages in future years. That is what the mid-west really needs. I encourage the Government to provide a capital plan to deliver that, along with the upgrades to Nenagh and Ennis, including pathway changes, diagnostics being moved and everything else. Ultimately, unless there is an increase from the Department of public expenditure in relation to the capital provision for the HSE, with the best will in the world, the Minister cannot deliver this without the money being given by the Government.

The amount of capital being allocated for projects across health and education is enormous.

This is new.

Unprecedented levels of capital investment are being allocated. The Deputy knows that very often there is a parallel between the speed of acquisition of sites, speed of delivery, design and planning. There are a load of variables before we get to the drawdown of substantial capital in relation to a number of projects. The enabling works are happening in terms of the second site. There is an acknowledgement that there are capacity limits to the existing site in UHL. The acquisition of a site is extremely important. At that point, it will be necessary to incrementally build up and then free up and decant services from the main hospital site. Equally, there is no reason, given population growth and everything else, why we should not be incrementally reconfiguring and moving to a model 3 in the wider mid-west region. If we took the view at the start of every capital programme that we just do not have enough capital, very little would have been built in the country.