Ms Phil Ní Sheaghdha:

My colleagues and I will address some of the staffing issues first. Ms Leahy works in Our Lady of Lourdes Hospital and will give an overview of its nurse-led unit and audit mechanism.

On recruitment and retention in general, Deputy Margaret Murphy O'Mahony asked what would fix the problems. The measurement we have used in our submission to the Public Service Pay Commission is purchasing power parity, in respect of which we took into account the cost of living and earning potential. For example, the average staff nurse earns between €28,900 and €42,000 over a timespan of nearly 20 years, which is very modest pay. Student nurses do not earn an income; they only receive the minimum wage of just over €9 an hour during their 36 weeks of training. In some cases, they must pay for two units of accommodation because their clinical placement is completed in two separate locations. These aspects must be corrected to make nursing an attractive proposition and counteract the reduction in the number of applicants. Of course, the cost of living has got a lot to do with the reduction in the number of applicants.

On purchasing power parity, we know that health services in the United Kingdom have always been a huge fan of the Irish trained midwife and nurse.

That is going to become increasingly attractive. Our market is going to become increasingly attractive. Weighting in London adds about 21%. That is not confined to London, however. It applies in any major city, including Manchester and Bristol. Great Ormond Street Hospital comes to recruit our paediatric nurses immediately on qualification, and it succeeds.

We know all of this, as do the Government and the party of Deputy O'Connell and Deputy Durkan. We have made numerous submissions to them. I would argue that it is now within those Deputies' gift to correct it, and I urge them to do so. Paying people €28,900 and expecting them to be exposed to what Dr. Boylan described cannot continue. There will never be a developed maternity strategy unless the Government bites the bullet and corrects the salary of low-paid women. I emphasise that they are predominantly women. There are four male midwives in the country according to the last count. Nursing is not very different. We can talk around it, but the simple fact of the matter is that we have overcrowding to such an extent that there were 640 patients on trolleys on Monday of this week, for whom there are no beds. Absolutely every non-urgent elective case must then be cancelled. We are not dealing with the reasons the beds are closed.

Yesterday I spoke to somebody in the HSE who says that the Minister has announced 540 new acute beds. We welcome that. Several of them will be opened based on the beds that have been closed. Where will the health service get the staff to open them? It cannot open beds and not recruit staff. It all goes back to the same central point. People must be paid properly for what they are expected to do and what they are exposed to. The levels of burnout and the levels of assault in midwifery have increased. These issues are all related and come back to the same circle of recruitment and retention. We have provided the figures. They are the HSE's figures. There are 16 fewer midwives working in the front line today than there were on 16 December. That is despite recruitment measures, including recruitment from Portugal and Italy. We are battling in recruitment, entry and retention. Somebody has to do something about it, and we urge the Government parties to do something about it. It is within their gift.

In respect of the inquiries, it is important to emphasise what happens when an adverse incident happens, particularly in the HSE. The first thing that happens is an oversight investigative process is put in place by the employer. The practitioner is called to that as a witness. Senator Burke asked what supports are available. More often than not, the practitioner is then subjected to a Health Information and Quality Authority, HIQA, investigation. The oversight investigative process which the HSE conducts usually looks at the learning outcomes. It is not supposed to apportion blame, but we know that there have been incidents where blame has been apportioned. The practitioner is then subjected to a HIQA inquiry. In the case of nurses, midwives and medical staff, a statutory body becomes involved. This is a separate process. In many instances, a disciplinary procedure is instigated by the employer in addition. For instance, there may be a coroner's inquiry, which involves An Garda Síochána

A speaker was absolutely right to note that the employer does not support any staff member going through that. In the main, it is their trade union that supports them. We have specific insurance policies for our members who go through this. We pay their legal fees and the cost of their counselling services, and we are constantly saying to the employer that this situation is not good enough. We are happy to do it and happy that our membership covers that cost. However, without their trade union they would have absolutely no support in many instances.

I am glad to have been asked the question as it gives me the opportunity to set the record straight. It is one of the respects in which our midwives in particular, who have been through a number of inquiries in this country of late, are very critical of their employer. Some of them have been followed to their homes by journalists. This should be anticipated. When a practitioner is undergoing an inquiry, there should be a separate room for them, with a separate exit by which they can leave, so that they are not identified. We should not have to go before the Nursing and Midwifery Board of Ireland to argue for an in camera hearing. The employer should be quite willing to agree that this takes place. Ultimately the staff member will be found not to have been professionally questionable, but it will not matter, because the media has destroyed their name in the process. It is a very serious issue, and one that is readily rectifiable.

Dr. Boylan referenced the Australian system. We have had years of Ministers talking about other services. When he was the Minister for Health, Senator James Reilly said that we need the system of health care that they have in the Netherlands. We have had years of this. We cannot transplant another system into our own when we have absolutely no primary care development and our outreach maternity services do not exist. In particular, we cannot transplant a system into ours until we develop the community services in the first instance. That is one of the areas where nurse advancement and midwifery advancement have particularly helped in other jurisdictions. I refer to advanced midwifery practice in smaller units. There is a very important place for the advanced midwife practitioner. This practitioner would be a constant staff member in a certain location, very well-practiced and very skilled in the area of infant and mother care.

I want to make a point in respect of the clinical nurse specialists, CNSs, referred to by Mr. Kilian McGrane. I refer to the numbers mentioned and the funding for the posts, the sum of approximately €4 million. I have calculated that 82 posts are at issue. Each one of those clinical specialists will come from the pool of midwives that are currently working. They are not new posts. Most of them are uplifts from the current posts. That means we will lose 82 current posts unless we agree to backfill each one of the clinical nurse specialist posts.

We have spent the last two weeks talking to the HSE about the funded workforce plan for 2018. There is no mention of backfill for maternity posts in that strategy. We urge both the HSE, which is represented here, and the representatives of the Government party to carry our message to the Department of Health and to the Minister. There is absolutely no hope that this strategy will be implemented unless each CNS is backfilled and we have a plan for the development of advanced practice in midwifery. We know that the latter works, because in jurisdictions where it is in place, it contributes massively to the service provided for women across gynaecology and obstetrics.