Ms Phil Ní Sheaghdha:

In point 5 of our submission, we set out the statistics that we received from the Nursing and Midwifery Board of Ireland in 2019, which advised that 62% of newly-registered nurses and midwives trained outside Ireland. That is the figure as we know it. There are approximately 1,700 in training every year, which is the number of Irish graduates.

In addition, we also have nurses coming back to Ireland to register. However, of those who registered, 62% had trained outside Ireland. That will give the committee an idea of the numbers.

With regard to the increase in the numbers of undergraduates, we make the point simply because we will have a greater focus on the need for education. We know the Minister with responsibility for higher education, in his new brief, is looking to expand opportunities for school leavers as Covid-19 will bring its own problems with employment. If there are 5,000 people putting nursing or midwifery first on the Central Applications Office form, they should be accommodated, encouraged and funded to undertake the course. There is a very real shortage and this is about supply and demand. There is a request from school-leavers and we should accommodate it, encourage and applaud them. We do not have to reinvent much but we must make a provision for them and ensure they can do it.

There are absolutely retention difficulties. As Professor Irvine mentioned, if we remember as far back as 2012, nurses who graduated not only got the 10% pay reduction that all public servants got but they also got a further 20% reduction in their graduating pay scale. In total they got a 30% pay cut and to a person they took that personally and emigrated. We are now looking overseas to that group and saying "Sure come home and we will treat you fine and better now". If they return, we give agency contracts rather than employment in the health service. There are many fixable problems that currently make no sense.

Our recruitment practice is bureaucratic. If I resign as a nurse today in hospital A, it will take a minimum of eight weeks for the director of nursing to get approval to go to advertisement and it would probably take approximately six months to fill the post. It is pure bureaucracy at work but such tasks must be delegated to the director of nursing. If there is a job and a person can continue to work, it should be up to that director to put that person on the payroll. It must be that simple or otherwise we will continually fight against ourselves in order to recruit.

In 2012 and 2013, all the austerity measures were introduced and on 1 October public servants got the last of those cuts to pay restored, aside from the hours aspect. Nurses in this country work a 39-hour week, a longer week than any other healthcare professional. As a result, 1.5 hours per week is owed to them each week by their employer, which they currently work for nothing. That is how they view it and it must be corrected in order to retain those staff. I hope that answers the Deputy's questions.

On the broader matter of what can be done, we cannot provide both of these services into this winter. We had over 100,000 people on trolleys last winter. If we face that again while trying to provide care for people with Covid-19, we will fail. It is simple enough. The people who work in the health services are doing their best, from doctors to nurses to porters to cleaners and everybody else. They are doing their best but they are human and exhausted. We did a very intensive survey last week and the main message is that people are exhausted. The citizens of this country understand the health service has limits but these are being reached and it will not be possible to provide both services.