Ms Phil Ní Sheaghdha:

I thank the Chairman for the invitation. The INMO is delighted to present to the committee today. I will briefly go through our opening statement, which members will already have received. It is broken down into three main parts. The first part relates to the additional beds that have been announced in the budget as well as the winter plan. We welcome these beds. However, we ask members of the committee to be conscious that each time they hear the word "bed" they must think the word "nurse" because without the nursing staff to staff the beds, unfortunately we are not going to make progress in expanding the much-needed capacity in the health service. In Limerick, for example, we are balloting our members because there is an acute shortage of nursing posts. We are attempting to open 90 additional beds but we are running with 125 vacancies before we start. The legacy of the moratorium still stands. We have to work very hard to recruit and we have to make sure pressure is not put on the system to open beds if there are not sufficient nurses to provide safe care.

At our conference last Friday week, the Minister for Health confirmed that the framework on nurse staffing, which is Government policy, will now be used to determine how many nurses and healthcare assistants are needed to provide care to patients in beds. This is important and welcome. It is a scientific method to determine how many nurses are needed. We understand this is funded for the incoming year. The settlement of our strike in 2019 stipulated that this funding would be made available for the three years following the dispute, with the staffing to be completed by the end of 2021. Multiannual funding is required. Funding for this year is welcome but it will only extend to model 4 hospitals. We have to be assured that when nurses are looking to their future in the public service, they understand there are commitments behind the correct staffing from a financial perspective. Otherwise they will leave and go elsewhere. That has been the practice.

We have set out the staffing levels at which we are running in our submission. The most recent census produced by the HSE tells us that in the staff nurse grade, which is the main grade of nurse working in the health service, there has been an increase of just under 300 whole-time equivalents since December last year. There have been significant reductions in our community services. We have 40 fewer public health nurses and five fewer midwives. Our midwifery workforce is very important because in order to implement the maternity strategy, we have to meet the ratio of one midwife per 29.5 births and we are far away from that. That means we are providing unsafe care in sections of the public health service because in some of our maternity units we are now at a rate of one midwife per 40 births, which has been proven internationally to be unsafe and dangerous. Nurse and midwife staffing is very important. The good news is that there is a scientific tool to determine staffing levels.

In our submission, we are advocating that in the medium and long term we should look at increasing our undergraduate places in order to ensure we are training sufficient numbers and have room. The good news is that 5,000 school leavers applied for nursing courses as their first preference in 2019 and we provided 1,700 places to them. There is room there to increase the number of undergraduate places. We need to do it fast and we need to be cleverer about retention because it is a big problem. We are still heavily reliant on overseas recruitment, particularly non-EU recruitment. We have put those figures in our submission. More than half the nurses who registered in Ireland in 2019 were from outside the EU, mainly from India and the Philippines. We are hugely reliant on recruitment from overseas and we have to make sure that continues in the current climate. It is continuing. It is slower, but it is continuing.

The children's hospital requires 300 additional nurses just to open and we are already short and are down below that 300. This means that when the children's hospital begins to operate its services, it will not be able to open all of its beds. It simply will not have the nursing numbers. We need to ensure we are training sufficient numbers at undergraduate level to make that timeframe. Unfortunately, we are two years behind on that already.

Right now, there is a crisis in the health service because of the high number of healthcare workers infected with Covid-19. Of those, we know that up to 34% are nurses. We have a high level of absence. Many of our members are reporting absences stretching into 16 and 17 weeks, particularly in areas where they have been directly caring for Covid patients. We need a fresh look at the occupational health policies of the HSE, particularly the policy that dictates that workers come back to work even if they have been close contacts of a Covid case. We believe that is wrong and is not aligned with the testing regime. There is no routine testing in our acute hospitals. We have surveyed our members and they want routine testing in acute hospitals. There is also the added difficulty of childcare. This committee has heard from us on this matter before. If there are any changes in Government policy on the closure of schools, we have to make sure that for the female-dominated workforce that is our nursing workforce, thought is put into how their childcare needs will be looked after in that circumstance.

We cannot have a repeat of what happened earlier in the pandemic, in March and April, when that was basically left to chance. We must ensure that, prior to any decisions regarding schools, provision is made for childcare for the 91% female workforce that is leading on providing care against this terrible virus in acute hospitals and communities.

I bring the attention of the committee to the fifth recommendation of the Special Committee on Covid-19 Response. It states that Covid-19 as an infection should be made an occupational illness. The INMO previously called for that to be done and the committee recommended that it should be catered for in the health and safety legislation. We need stronger input into the health and safety of the workforce that is meeting the virus head-on daily and nightly. The INMO has been and remains critical of the supports available to members of the workforce when they are infected, as well as of their protections at work. The quality and supply of personal protective equipment, PPE, has improved but, each week for the past two weeks, 50 nurses have been infected with Covid-19 while at work. That is a very high figure. I am happy to take questions from committee members.