Ms Phil Ní Sheaghdha:

I actually disagree with the Deputy's fundamental premise. Irish nurses are not well paid by comparison. We have international comparisons that are compiled not by us but by the International Council of Nurses, affiliated to the World Health Organization. They clearly indicate that, out of the nine main countries that are English-speaking with western medical styles, Ireland's pay is the lowest. I do not know what figures the Deputy is looking at but they are clearly not the figures that have been accepted by the World Health Organization and the International Council of Nurses. A nurse's starting salary is €28,700. We do not even have to go outside Ireland. Even when we compare with other grades working in the public sector, such as teachers and gardaí, we note nurses' starting point is approximately €4,000 to €7,000 lower. That continues throughout their career.

I would like to address the issue of the benchmark with the private sector because I heard Deputy Stephen S. Donnelly say this before. When a nurse starts on a ward, on his or her first night on duty not long after qualifying, the responsibility he or she holds does not bear any comparison to what newly qualified accountants or engineers hold. They will not be building bridges and will certainly not be doing the final accounts. A nurse, however, will be looking after patients and will be in charge because that is how bad the system has become. A newly qualified nurse will rapidly be in charge of a ward once he or she is employed in the public health service. He or she will also be subjected to a fitness to practise inquiry if he or she makes any omission or mistake. Engineers' starting salary is not much lower than €28,700 and they quickly arrive at a salary that will get much higher during their career; therefore, they have aspirations. They will stick it for six months to a year because they know that it will get much better. Nurses are still on a low salary after 14 years. The point the Deputy is making does not make any material sense when one makes a comparison with the private sector because one cannot compare. In 2007, when the benchmarking body looked at this issue, it found that there was no relevant comparator with a nurse bearing the responsibility he or she carries in the private sector.

I have addressed the fiscal space and given some ideas that the committee has probably heard already. They are about decisions governments face. The fiscal space is a concept that is manipulated by decisions that must be made now. The reason we are here advocating on behalf of the health service is the decisions must favour the health service above all else, immediately and in the budget. To answer Deputy Louise O'Reilly's question about the consequences of the Public Service Pay Commission not dealing with the issue of pay, it will undoubtedly worsen a situation that is already a catastrophic crisis. This year we asked the HSE to tell us how many of the acute and closed beds it would be able to fund and open. It cannot tell us how many beds are closed and estimates that there are approximately 200 in the acute sector, which cannot be opened because of staffing issues or refurbishment. Health Information and Quality Authority regulations state capacity and design have to change. That will reduce the number of beds available. The HSE estimates that at the end of 2018 its target will be to have fewer than 100 beds opened. That is incredible. They are modest targets and the HSE is hampered by the fact that recruitment and retention of staff to facilitate the opening of these beds are not possible. Modular build is what it is under consideration at some sites. It states there is capacity in South Tipperary General Hospital for a 30-bed modular build, but that argument has been on the go for nearly two years. There are difficulties in recruitment and retention of staff in that respect.

The one thing that has been proved to help the conversion of the agency is the framework for nurse staffing. When staffing levels are correct, the agency's spend will drop, as was shown and demonstrated in Beaumont Hospital, where it fell to below 0.1%. It works, but the problem is that it is not funded for implementation.

I was asked about the HSE's issues in people not wanting permanent posts. That is simply not the case. To pay a mortgage and meet childcare costs, our members tell us that they require permanent jobs, as well as flexibility in rostering and hours of work, which are not always available to them. In a female-dominated profession, that can have serious consequences, to the extent that some women are forced out of the workforce and to accept agency posts to have flexibility. It is true, however, that there are no conversion criteria. The HSE states that last year it converted 712 agency nurses. Its bill is still just over €1.2 million a week in the statutory services alone, not including voluntary services. The HSE does not, for example, make provision for the replacement of nurses on maternity leave who are still counted in its census. There 37,200 nurses, of whom 2% on any given day are on maternity leave, but they are still funded and counted. Therefore, the roster has to be supplemented. We are not building or growing and are barely supplementing the roster. In many instances, the shift post goes unfilled.