Ms Angela Fitzgerald:

The question about staffing is really important. Having adequate staffing means that people can go beyond doing the tasks and they can do all the caring. When there is not enough staff, people are stretched and we saw some evidence of that. We very much advocate for the staffing framework. Currently, our role says we can comment on what we observe on a site in terms of adequate staffing. Having a staffing framework, as the Senator said, requires that providers in the first instance ensure those minimum staffing numbers are there and then we can regulate that they are doing that. That is coming. The Chief Nursing Officer in the Department is working on that. When it is available it will really strengthen our ability to address what the Senator said.

The Senator is right on culture. As Senator Ryan also pointed out, culture cannot be changed in a day. We know that as an organisation ourselves.

We have talked to a number of providers about what they rely on to tell them all is well from a culture point of view. There are some important statistics. What staff say about working in a place and what they say to their employer which they might not say outside is really rich information. Some more enlightened providers are now doing that. It is something we want them to give us as part of their frame of reference, so we can get that information in addition to the information we receive directly from staff. The Senator is right that it is critical.

My mam had dementia. I minded her for ten years at home. My father-in-law had a stroke and has very limited speech. They are very difficult jobs. They are not easy to do and we as a society have to give recognition to those jobs. A young person with a degree will not look at these jobs when he or she can look at other things. It is about how we remunerate and reward people for these difficult jobs, particularly at the level below nursing. Nursing is a challenging job in any setting. The minimum qualifications and staffing requirements are essential. They are coming and we are happy about that. They will allow us to intervene more objectively and less subjectively in this space.

Culture is at the heart of the human condition. It is how we see the other person. You cannot teach that but you can give leadership and guidance. As leaders in organisations, that is the role of the board of directors, the board of management and the nurse manager on the floor. They need to be on the floor. Some of our systems, collectively, have required people to move away from the floor and they have to get back to that. The Senator has raised really important issues.