Louise O'Reilly (Dublin Fingal, Sinn Fein) | Oireachtas source

I welcome the witnesses and thank them for their presentations and all the work they do representing their members. I wish to clarify one point. It is fair to say that GPs are represented here, although that is not necessarily the subject we are discussing.

Their representatives are in the room. Perhaps representatives from the IMO might like to say something about GPs.

The HSE appeared before us last week. I am sure the witnesses will have looked back on it but in case they did not, it had a wonderful idea for increasing the number of staff. It is just going to change how it counts them so student nurses that were previously counted as 0.5 WTEs at one minute to midnight on 31 December turned into full WTEs on the stroke of midnight. If it was able to do that with all of its staff, it could indeed double the number overnight. I do not think that is a very productive thing to do. It did not have any explanation as to why it had done it - merely that it was on the recommendation of some person who did not happen to be in the room.

On the Public Service Pay Commission, pay for front-line healthcare workers is an issue I have raised virtually all of my working life but certainly since I be came a Deputy. The latest reason for not answering our question is that the Public Service Pay Commission will deal with that. The commission's report is due at the end of this month. I think it is pretty much irrelevant where someone's profession is positioned on a table, particularly as we are haemorrhaging staff to countries that pay more. However, let us imagine that the Public Service Pay Commission does not adequately address the pay issues outlined by the witnesses. Could they provide a picture of what our service will look like come winter? My contention would be that we are not well prepared for winter. Indeed, we managed to be surprised by the flu last winter. In the event that the pay issue is not addressed, are we looking at hiring more agency staff or closing more beds? What will be the implications of this? My estimation is that the Government is putting a lot of emphasis on the Public Service Pay Commission. If the latter does not deliver, we will find ourselves in a very difficult position. I would welcome the witnesses' views on that matter.

When representatives from the HSE appeared before us last week, they also put it to us that people do not want permanent jobs. They referred to nurses in particular. Dr. Durcan is smiling. I also smiled because it struck me that people did want permanent jobs. It cannot just be my mother who raised me to want a permanent job. I am sure everybody's mother wants him or her to have a permanent job. People themselves want the stability of a permanent job. Senior people in the HSE told us that new and prospective entrants to the health service are actually running away from the notion of a permanent job so could the witnesses comment on that?

In the context of the funded workforce plan, which I know relates specifically to nursing, could Ms Ní Sheaghdha bring us up to speed? When is the plan likely to be published? What would be the likely implications if it was, for example, published in the morning? If there is a six-month lead-in time for the recruitment of staff, where does that leave our graduates now? Are they actively involved in a recruitment process? I know it is warmer in Australia and other countries and that some places have sun and snow, but they had that ten years ago and temperatures have not changed dramatically. That is not me denying climate change. I just do not think it has changed dramatically. Yet we did not have those sort of problems ten years ago. My understanding is that young people with portable qualifications went abroad, worked for a year or two and came back. Why would they not do so? They are not coming back, however.

Those are some of the issues on which I would like the witnesses to comment. Retention is a bit of a chicken-and-egg thing. We are losing staff because it is an unattractive place to work, which means we are not recruiting staff, which makes it a more unattractive place to work, which means we are losing staff. In terms of initiatives to retain staff, is there anything at the moment that might be working in one hospital? Let us say there is a particular hospital that is managing to keep its staff. Is there anything that one hospital is doing that could be modelled across the health service? I am not convinced that there is but if there is, we would welcome that information because it strikes me that this is a double-edged sword. The failure to recruit is leading to pressure on retention. There is a lot of talk about new entrant pay and how poorly new entrants' pay compares with that of other jurisdictions but, equally, we have an issue with retention. Is that purely pay-based? I know it has to do with the conditions. One feeds the other. Are there initiatives that could be taken which would improve retention?

I would also like to hear the witnesses' view on the actual number of beds. If we clicked our fingers or used the magic formula the HSE used and doubled our staff overnight, are there sufficient beds in the system? My estimation is that there is anything from 500 to 1,000 beds that could be opened relatively quickly if we had the staff. I would welcome the witnesses' views on that.

Regarding the conversion from agency staff, I am sure the witnesses are aware, through the media, that Sinn Féin recently published figures in respect of the spend on agency staff and the manner in which it is increasing. When I raise this, the Minister then tells me that a whole raft of wonderful initiatives is in play. There is a heavy focus on converting from agency staff to directly employed staff. Can the witnesses give us some estimation of what, if anything, is happening with that and what could be happening? Clearly, these people are available to the system but they are choosing to either remain registered and work with agencies, work on a half-and-half basis or work full-time for the HSE and then part-time for an agency in order to supplement their wages. it could also be the case that there is not much effort, from a managerial perspective, regarding how the process of conversion is going.

Obviously, the people who are here represent a large cohort of the workforce within the health service, although not the full cohort and not every worker. It is proposed that at later date, and I say this for the benefit of anyone who might be looking in and thinking "Hang on a second, I am not one of those grades. Why am I not represented there?", we will come back to this issue and there will be an opportunity for all of the grades to make a presentation.