Mr. Robert Watt:

I will kick off, and my colleagues from the HSE will come in, no doubt, on specific aspects. I will try to give a comment on each of the points made by Deputy Durkan.

There has been a significant recruitment over the past two years. We have had a record increase in numbers. This year, we are below the target we had forecast. That relates to the availability of people with the skills, capacity and experience to fill vacancies. It also relates to our processes. Ms Hoey may speak about this. We are trying to improve the processes. As ever, there is a balance to be struck between having an open and transparent process to ensure that we have properly qualified candidates and the best candidates competing for posts and meeting the need for efficiency and speed when it comes to recruiting people. I accept what the Deputy is saying. The Minister expresses frustration to us on a regular basis about posts that have been earmarked to be filled and that cannot be filled for whatever reason. Sometimes we cannot find a person or it takes too long to find a person and there are issues in our process. We are addressing the issues relating to process. We are increasing significantly the number of places available across the different specialties in order that, over time, we will have more graduates coming through and more qualified people who are in a position to fill posts.

On GP replacement, there is a specific issue in communities when GPs retire. There might be a gap. We have to ensure that the next generation comes in to take over practices. There has been a significant increase in the number of GPs who are in training. There is now a flow of newly trained GPs to start filling the gaps as their older colleagues retire. This is an ongoing issue. Again, HSE colleagues might touch on some of those matters.

Early in the year, we set out a plan in respect of waiting lists. Some €350 million was invested. Much of that money has been spent. Some moneys have not been spent because we could not access additional capacity in either the public system or in the private system through the National Treatment Purchase Fund, NTPF. We have delivered a lot. We were knocked off track by Covid for the first four or five months of the year but since then we have started to accelerate activity. We are making significant progress, especially in respect of those who have been on waiting lists for a long time. We focused on people who had been waiting for excessively long periods. I have set out the numbers in that regard. Approximately 80,000 or 81,000 people are waiting for procedures and slightly more than 600,000 - it may be starting to dip below that mark - are awaiting outpatient consultations. We are starting to see significant reductions in the number of people waiting for outpatient consultations. That has required significant focus by our HSE colleagues across the different centres and hospitals in the system. The big issue for next year is to continue to ramp up capacity and increase activity. If we see the end of Covid as a significant disrupter of the health system, we hope we will get a free run that will allow us to continue to ramp up scheduled care and have a big impact on outpatient consultations.

There are a series of reforms and measures to reform pathways and how we help people to access care and avoid the choke points. Dr. Henry is leading on reforming those clinical pathways and he may touch on some of that work, which is interesting in the potential impact it could have next year in ramping up in the context of overall volumes.

We will spend all our budget for capital projects this year. We are spending the capital allocated to us. There are issues around planning and getting projects to the stage when they can be approved by the Government. Three major projects that were stuck in the system have been approved this year, namely, the move from Holles Street to Elm Park and the elective hospitals for Galway and Cork. The two latter projects are with the Government since this morning, and the Minister will make an announcement about them later. We got those three projects through the various approval hoops and assessment processes that are part of the public spending code and are moving to the next stage. There are issues in how quickly we can plan and get projects approved and then there is the planning process and issues around construction which we are all aware of. The system is striving to be more effective.

I will stop there and ask my colleagues to respond, as appropriate.