Ms Phil Ní Sheaghdha:

I thank the Chairman and members of the committee for the opportunity to make a presentation on behalf of the Irish Nurses and Midwives Organisation. We set out in our submission to cover the matters that we were asked to deal with, namely, issues to do with Covid infections and healthcare workers. The first issue to which we draw attention is the rate of infections among healthcare workers. This week, the International Council of Nurses confirmed that the rate of infection among Ireland's healthcare worker population, at 12%, is the highest it has recorded. This is a worrying trend which we have raised previously with the committee. We believe that the delay in the introduction of protection for workers by ensuring that the Health and Safety Authority, HSA, has a role to play in examining workplaces has certainly contributed to this high rate of infections. The INMO and the Irish Congress of Trade Unions, ICTU, sought for the HSA to amend regulations and that the Government would insist that they be regulated from the time that the pandemic was declared on 11 March last year. Unfortunately, that did not happen until the biological hazard directive was introduced by the European Union on 24 November. That interim period led to a lack of focus on the principle of preventing infections among healthcare workers. These workers are in the eye of the storm. The settings in which they work are workplaces and the HSA must conduct inspections where we know there are continuing clusters of Covid-19 infections in workplaces.

The data show that the prevalence of infection among females is highest in the health service because the number of female worker is higher than in other sectors. The reports from the HSA confirm that if one is a woman working in the health service, one is at the highest risk of contracting Covid-19. The issue is huge for us because a large portion of our members are women. Stress levels and mental health issues surrounding the provision of childcare and the difficulties in attempting to secure childcare, when decisions have been made, for example, to close schools, are combined with the difficulties of going to work in a high-risk environment and fighting to have personal protective equipment, PPE, provided that is adequate. That equipment is continually being assessed for its efficacy. We had to do so again in January, unfortunately, having previously, last April, sought a policy change to allow all healthcare workers to wear surgical masks. We had to repeat that process and seek the upgrade of those masks as what we know about the virus showed there was a higher risk. We were tracking the numbers of infections rates and this demonstrated that the new variant was far more infectious than existing variants. It took almost three weeks for the HSE policy to change to allow healthcare workers the right to wear the higher-grade mask.

Many other issues in our submission point to the fact of the precautionary principle and healthcare worker protection not being to the forefront. We are and have been very critical of this. It is a real issue for our members, who are putting themselves at risk on a daily basis in moving past all the obstacles to get to work, including incurring additional personal costs for the provision of childcare, in order to provide a service. We believe that their health and safety has not been protected to the level that it should and must be.

In regard to the vaccine roll-out, we point out in our submission that the trajectory and statistics we have from the HSE show that some counties, including, for example, the Border counties of Louth, Donegal, Cavan and Sligo, had very high population incidences, yet vaccine administration was not concentrated in, and prioritised for, those areas.

Our members in those areas were absolutely devastated when they were not prioritised for the vaccine roll-out. Today the HSE portal to allow healthcare workers register for vaccination opened and we are very worried that the same thing might happen again. We hope it will not. We have worked hard with the HSE on a sequencing document, which was issued on 19 January, to ensure that front-line, patient-facing healthcare workers are prioritised for the vaccine that is available because clearly this is their line of defence.

The long-term Covid effects are another issue on which we believe the committee must comment. The long-term Covid effects are real. Many of our members report to us that they have not recovered, that they continue to fight Covid at home, that they have long-term fatigue or long-term neurological or cardiac presentations post infection at work. There is simply no fast-tracking or clinical pathway for them, despite numerous requests for same. We believe that, as an employer, the health service has to do better and that there must be real precautionary and preventative measures in place. There must also be very real measures now to deal with the long Covid effects.

In addition, we know from all the studies we have done or which other health services across the globe have looked at that the mental health effects post pandemic will be of huge significance. More than 80% of our members have said their mental health has been affected by working in these conditions. Now we have to prepare for that and make sure we are putting in place supports to allow recuperation and to allow the healthcare workers who have been working at 120%, 140% and 150% to recuperate when, it is to be hoped, the vaccine is fully rolled out and we have a reprieve.