Oireachtas Joint and Select Committees

Tuesday, 23 June 2020

Special Committee on Covid-19 Response

Childcare: Impact of Covid-19

Photo of Michael McNamaraMichael McNamara (Clare, Independent)
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I want to introduce our witnesses on childcare from committee room 1. From the Irish Nurses and Midwives Organisation, I welcome Ms Phil Ní Sheaghdha, general secretary, Mr. Tony Fitzpatrick, director of industrial relations, and Ms Niamh Adams, head of library services. I also welcome Mr. Paul Bell from SIPTU, and I see Mr. Patrick Cole is with him.

I wish to advise our guests that by virtue of section 17(2)(l) of the Defamation Act 2009, witnesses are protected by absolute privilege in respect of their evidence to this committee. If they are directed by the committee to cease giving evidence on a particular matter and they continue to so do, they are entitled thereafter only to a qualified privilege in respect of their evidence. They are directed that only evidence connected with the subject matter of these proceedings is to be given and they are asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against any person, persons or entity by name or in such a manner as to make him, her or it identifiable. We expect witnesses to answer questions asked by the committee clearly and with candour. However, witnesses can and should expect to be treated fairly and with respect and consideration at all times in accordance with the witness protocol. If any witnesses have any concerns in that regard I ask that they raise them immediately with me, as Chair.

I ask Ms Ní Sheaghdha to make her opening statement. As is customary, I ask that she limit her statement to five minutes and deliver it as circulated in advance to members.

Ms Phil Ní Sheaghdha:

Niamh Adams is not attending today. Ms Kimberly Clarke is with us instead. She is a member of our organisation who works in north county Dublin and currently has great difficulty in obtaining childcare in order to allow her to work as a front-line worker in addiction services.

I will briefly discuss our submission. We will concentrate on the effect on our members, including front line nurses and midwives, of the restrictions on childcare. Members will see from our submission that in the background we set out the problem we had, namely, that the HSE has implemented a moratorium on recruitment since last May. Therefore, our staffing levels were particularly compromised. We have a significant reliance on overseas recruitment, particularly from non-EU countries. Statistics provided by the nursing registration board which demonstrate that last year 1,819 of the nurses who registered in Ireland were from non-EU countries, predominantly the Philippines and India, are listed on page 2 of our submission. Given the travel restrictions imposed since Covid-19, they are obviously not in a position to travel and help us to maintain staffing in our health service.

The second major issue that has affected staffing levels has been the infection rate among healthcare workers. At present, Ireland is top of the league and has the highest infection rate of healthcare workers globally. That is an absolute scandal. We have sought figures and the Minister for Health, Deputy Harris, instructed that figures be issued on a weekly basis when he met us two weeks ago.

We have now got the second set of figures, following on from that meeting with the Minister for Health. These again confirm that 88% of those infected who work in the health service got the virus at work. In other words, this is an occupationally acquired illness or injury and they, therefore, have to absent themselves for 14 days to self-isolate. We know from the figures that we received last Friday that 4,823 healthcare workers remain out sick, and "still ill" is the category that is stated. We know that 1,600 of those are categorised in the category of nurse or midwife. We have asked the HSE for the workplace settings but it has not been able to supply them to us as yet.

This obviously puts enormous pressure on rosters. As the committee will be aware, nursing and midwifery provide a service across the 24-hour cycle, so childcare has always been very difficult and requires a lot of juggling and preplanning. Some 92% of nurses and midwives are women and in order for them to continue in the workplace, they need to have a very robust childcare service available to them. That is often formal and informal, and it also relies heavily on partners and on the school system being open. What we have found is that, since the restrictions began on 13 March, when schools, crèches and registered childminders were closed, this has become a huge issue for our members.

As to what we have done, page 4 of our submission notes that we surveyed our members to see exactly what arrangements they had in place pre-Covid-19. We found, as I have just set out, that 27% of all of those who responded, and we had a very large response rate, were reliant on crèche, childminder and childminder in the childminder’s home. If members look at the column that shows the position during Covid-19, they can see the drop in that figure, for obvious reasons. Crèche was completely removed from the equation, childminder in childminder’s home dropped from 29.7% to 7.8% and childminder in the person's own home went from 11% to 13%, which is a slight increase. Many of our members rely on grandparents to provide an out-of-hours service and pickup from school when the shift pattern has not concluded. The figure for grandparents in the survey went from 32% to 10%. Obviously, preschool, primary school and secondary school were no longer available.

This was a huge problem, therefore, for the nursing and midwifery workforce, many of whom had to rely on taking annual leave or extending and changing their pattern of taking parental leave, which is unpaid, to maintain the employment contract. Ms Kimberly Clarke is here as one of those people who had to use eight weeks of her leave to ensure she could maintain the employment relationship.

The big issue, of course, is that a majority of our members are female, and 96% of those who responded to the survey stated they were female. Many of our members are lone parents and the problem was particularly more problematic for them. One of the lone parents responding to our survey said one-parent households cannot afford extra childcare since the schools closed, and another stated there is no thought for single parents who are front-line workers. Some 60% of those who identified as lone parents responded that Covid-19 restrictions caused additional expenditure for them in order for them to be able to attend work on the front line, where they wanted to be.

Photo of Michael McNamaraMichael McNamara (Clare, Independent)
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I ask Ms Ní Sheaghdha to conclude. She may make some concluding remarks but I want to leave time for members to ask questions of both herself and Mr. Bell.

Ms Phil Ní Sheaghdha:

The actions we believe are now required are that the costs to nurses and midwives of attending work and other additional costs should be repaid to them, and that, when we have a reopening of crèches and early childhood services, there has to be preferential treatment for healthcare workers in order for them to continue to maintain their employment contract. Overall, what we have set out at appendix 1 is the list of representations we have made since very early on in March, right through to last Friday, to the Minister for Health, all the HSE officials, and the Departments of Children and Youth Affairs and Public Expenditure and Reform.

We are still not satisfied that proper consultation has taken place with front-line workers who are reliant on the State for part of their childcare requirements. Indeed, in their words they feel they have been abandoned - while they have been applauded, they have also been abandoned because it is now at their cost that they are attending work.

Mr. Paul Bell:

I will read our submission into the record and the members and you, Chairman, are free to put questions to us. To start, I wish to note that a worker who was nominated to appear before the committee today was not available due to staff shortages in the area of operation.

On behalf of my union SIPTU, I am honoured to meet the committee today to discuss childcare for healthcare workers during the pandemic. At the outset, I will briefly introduce the SIPTU health division. It is a multi-grade representative health division with more than 42,000 members. Our membership covers a variety of settings, including nursing, midwifery, healthcare assistants, diagnostic and therapy health professionals, phlebotomists, the national ambulance service and support grades. Our division covers all areas of the health service including acute care, mental health, care of the older person, community care and intellectual disability.

While we note childcare is not an issue solely related to the gender of the parent, it must be stated that the contacts SIPTU received were overwhelmingly from working mothers who were desperately trying to secure childcare so they could go to work as essential healthcare workers in all the grades SIPTU represents. The following average applies to female gender balance within the relevant workforce: nursing and midwifery is 90.6%; health science and diagnostics is 78%; household is 80.2%; catering is 69.1%; healthcare assistants is 76%; home helps, who are also referred to as healthcare support assistants, is 96.4% and ambulance control is 50%. It should also be noted that SIPTU membership was represented within the following family demographics: co-parenting where both are essential workers, co-parenting where both are essential health workers and lone parent healthcare workers.

In reference to the issue of childcare for healthcare workers during the pandemic, it is not an exaggeration to confirm that this has been a leading issue for our members since the lockdown was enforced in mid-March 2020. The issue stands alongside several other key challenges which arose, such as lack of provision of personal protective equipment, PPE, lack of testing capacity, clusters in nursing homes and infection rates of healthcare workers who were becoming sick due to their work on the front line. Publicly, the HSE announced a survey had been undertaken to ascertain the number of healthcare workers who required childcare support. The HSE stated that the figure was 7,000. It is important to advise the committee that SIPTU representatives are unaware of any survey being undertaken and, if it was, how it was advanced given the challenges arising during the lockdown. To date, no member has advised SIPTU that he or she was offered or requested to participate, or participated, in the HSE survey to establish the childcare needs for essential healthcare workers.

SIPTU representatives suggest that the experience our members have had over the last number of months in seeking to secure childcare for their small children has been deeply frustrating, challenging and emotionally distressing as they have striven to meet the balance of ensuring the safety of their children while also ensuring that they were able to go to work and provide essential healthcare to their local community. In order to afford appropriate consideration of the challenges arising for healthcare workers securing childcare we must remember the environment within which these needs were arising. First, all childcare facilities were closed. Second, grandparents were cocooning. Third, childcare workers were reluctant to provide care in a healthcare worker's home due to concerns of infection risk given the role of the parent in the health service. Fourth, where childcare was able to be sourced members frequently conveyed their frustration at the increase in costs and their inability to fund this. Fifth, rosters within the health service are atypical and cover a 24-7 and 365 day service.

Given the combination of the deficit of childcare facilities and grandparents cocooning, the usual means of meeting roster challenges outside of Monday to Friday, 9 a.m. to 5 p.m. were not achievable.

Unfortunately, other factors also arose due to the rules which were put in place concerning general public health and the specific instructions which were given to public service employers which could not be departed from. Throughout the pandemic, the Department of Public Expenditure and Reform issued regular updates and instructions through documents on frequently asked questions. These were designed to achieve uniformity across the public service in the instructions concerning application of Covid-19 leave and other matters. SIPTU argues the focus of the Government Department was to achieve uniformity rather than to find a fit which would assist parties in developing suitable arrangements to meet workplace and home life needs.

Photo of Michael McNamaraMichael McNamara (Clare, Independent)
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I will ask Mr. Bell to conclude.

Mr. Paul Bell:

As the opening statement has been submitted for the record, I will just summarise. SIPTU contends the challenge of childcare for healthcare workers could have been managed more effectively by Government by focusing on securing support through measures which would have been approved by public health officials. An example would have been the provision of childcare in a safe environment explicitly for healthcare workers. This model was used in other countries to ensure essential healthcare workers could get to work in the safe knowledge their children were being cared for. Instead, the focus was on uniformity with rigid options only being approved which resulted in the loss of essential healthcare workers to the service and loss of annual leave or financial loss to the healthcare worker. We thank the committee for the opportunity to meet with it today.

Photo of Colm BurkeColm Burke (Cork North Central, Fine Gael)
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I thank the SIPTU and INMO representatives for coming in this morning and for their detailed submissions, which we appreciate. I also thank their members for all the work they have done over the past three or four months in a very difficult situation. I will touch on one or two items. One relates to the number of people in the healthcare sector who have been affected. Is there a breakdown of the number affected between hospitals, nursing homes and mental health facilities? I believe more than 8,000 people in the healthcare sector have been affected. Is there a breakdown of that number? It is interesting but I know of two mental health facilities and in one of them many staff and residents were affected while in the other everyone tested negative. They are very similar settings but the results were totally different. Is there a breakdown of the figure which would show from where cases were drawn?

Ms Phil Ní Sheaghdha:

Is the Deputy referencing the number infected or the number absent due to coronavirus?

Photo of Colm BurkeColm Burke (Cork North Central, Fine Gael)
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I am asking about the number affected. More than 8,000 healthcare workers have been affected. Is there a breakdown of the settings in which the more than 8,000 who have been affected work, whether in hospitals, nursing homes or mental health facilities?

Ms Phil Ní Sheaghdha:

The figure provided by the HSE as to the number of healthcare workers infected is 8,180. The figures are broken down by geographic area but do not set out the workplace locations.

With regard to childcare, in our survey in respect of those for whom childcare was a difficulty we asked those who responded to identify where they worked. Some 61% said they worked in public acute services, including acute hospitals, 3.8% worked in private acute hospitals, 1.5% in private care services for older persons, 5.9% in public care services for older persons, 15.6% in public community care and 7.5% in disability services.

Photo of Colm BurkeColm Burke (Cork North Central, Fine Gael)
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I will return to the issue of childcare facilities.

Obviously, in a lot of cases, the staff of those facilities were facing a huge problem. The breakdown of the figures shows that where grandparents were looking after children, that more or less stopped once the lockdown came. In terms of the numbers affected, do the witnesses have any information about how people were able to resource alternatives, or was it the case that people were not able to locate an alternative to the arrangements they had in place?

Ms Phil Ní Sheaghdha:

The trade unions and the health service negotiated that working from home would be a facility available to staff. The information supplied in our survey of members shows that 34% availed of that. However, the majority relied on a partner taking annual leave or a relative coming to live in their home. Some moved their children to relatives' homes and did not see those children for eight weeks. Many responses to our survey attested to that. The sacrifice they made in coming to work was extraordinary. In fact, I do not think it can be matched by any public service representatives in the midst of this Covid-19 crisis.

The feeling our staff have right now is that the annual leave that is scheduled for the rest of this year has already been completely used up. We do not believe the health service is going to quieten down. We believe, in fact, that now that we have two services, namely, a Covid service and a non-Covid service, the pressure on the health service is going to increase dramatically. We see from our own daily count of trolley figures that the numbers are already going the wrong way. We are up to more than 130 people on trolleys today. The health service will continue to be busy and healthcare workers, including the nurses and midwives we are representing today, are very clearly saying that a better plan must be arrived at to make sure they are not financially at a loss and having to pay for their ability to come to work.

Photo of Colm BurkeColm Burke (Cork North Central, Fine Gael)
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Mr. Bell spoke about the lack of flexibility in regard to accommodating healthcare workers. Going forward, what does he suggest should be done to deal with that issue? We may have challenges in this regard in the future. How can we introduce the flexibility that is needed and how can management work with staff to ensure they are accommodated?

Mr. Paul Bell:

First of all, I do believe that the Government and authorities responsible for health services should at least look at other models in other jurisdictions. The United Kingdom might seem strange as an example but, nevertheless, it did provide childcare and school provision for the children of health workers and workers in essential services in other areas of the economy. That type of provision needs to be planned because, if it is not, we are going to end up in the same position again. We also understand that the health service, going forward, must start ramping back up in order to take care of patients who may not have been able to access hospital services during the lockdown. We are going to see very serious pressures there because some health workers will either be due to take annual leave or there may be issues concerning exhaustion where all annual leave has been taken up. At that stage, we think other problems may present.

Photo of Michael McNamaraMichael McNamara (Clare, Independent)
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Thank you, Mr. Bell.

Mr. Paul Bell:

If I may, the Deputy requested some data from my colleague. The Health Protection Surveillance Centre had been producing some information that was incomplete about the level of Covid-19 infections and where they might be. At one stage, approximately 7,800 workers were infected. Of that number, 1,577 were in nursing homes settings, which accounted for 19.8% of the total.

Photo of Michael McNamaraMichael McNamara (Clare, Independent)
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My apologies, Mr. Bell. I hope we can return to that point but I must move on now to the next speaker.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I thank the witnesses for coming here today and for their very detailed statements. I pay tribute to the extraordinary work nurses and midwives have done during the pandemic. We all applauded the front-line workers, including healthcare workers, in the Dáil but the testimony we have heard here this morning, as well as the anecdotal testimony we have all heard in recent months, suggests that those public expressions of support were not necessarily always matched by support where it mattered for nurses and midwives.

The testimony we have heard here this morning and the anecdotal testimony I am sure we have all heard in recent months suggests those public expressions of support were not necessarily always matched by support where it mattered for nurses and midwives.

I will come to childcare in a moment but, if I could, I would like to go back to the infection rates for nurses raised by Ms Ní Sheaghdha. She stated that the infection rate for Covid cases among nurses and midwives in Ireland is the highest on earth. That is an absolute disgrace in anybody's book. Why does Ms Ní Sheaghdha believe this infection rate is so high? Why did we have such a high infection rate, as an island on the edge of Europe with an advanced healthcare system that had more time to prepare than most European countries? Was enough done to protect Ms Ní Sheaghdha's members?

Ms Phil Ní Sheaghdha:

First, we had a call last Friday with the International Council of Nurses and our figures were the highest. That is not something we are proud of. We strongly believe that there were two policies that directly influenced the situation. The first is that a shortage of PPE created a situation where supply was more important than protection. In other words, we were having meetings with the HSE about decisions, for example, on the wearing of face masks. We had to lobby and cajole the HSE. I think I wrote six letters in all, seeking to introduce a policy whereby the wearing of face masks would be mandatory and they would be provided for all healthcare workers. We had a situation where one of our members was sent off duty because she attended duty with a face mask. She was advised by her management that it was against HSE policy and she was actually sent home. That became an industrial relations matter which we then resolved. On 22 April the HSE's policy for the mandatory wearing of face masks by all healthcare workers was introduced. We saw a dramatic drop in the number of infections of healthcare workers from that date onwards. When we raised that with the HSE it stated that at the same time there was a coincidental drop in the general infection rate of the population. We do not accept that. We believe that face masks should have been mandatory from the very beginning in every single healthcare setting because our testing and tracing was not, and still is not, sophisticated enough to determine who is infected and who is not. We have also learnt that asymptomatic presentation, in other words, people with no symptoms, can still be infectious. Therefore, waiting for somebody to develop a temperature before he or she started wearing PPE was a mistake. That is particularly relevant in the community sector.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I thank Ms Ní Sheaghdha very much for her reply. It is something that will have to be looked at in an awful lot more detail. It sounds absolutely extraordinary that we would have let that happen to healthcare workers.

Ms Ní Sheaghdha's members were put in an impossible situationvis-à-vischildcare. Schools were closed, grandparents were isolating, childcare facilities were closed, home childcare was very hard to find and expensive, and Ms Ní Sheaghdha's members needed to be at work. As per her data, many of them were also living with front-line workers, many of them also healthcare workers, making it absolutely impossible in many cases. The promised childcare scheme for healthcare workers never really happened. Were any supports put in place for childcare for Ms Ní Sheaghdha's members? Were any costs covered? Was any tax relief offered? Were any dedicated facilities opened for healthcare workers? Was there any flexibility on rosters?

What happened when Ms Ní Sheaghdha's members simply could not get to work because of childcare issues? Were any sanctions taken against them? Were any of them docked pay? Were they told that they would have to take annual leave and what happened if they ran out of annual leave? Are some of these issues still at play for her members?

Ms Phil Ní Sheaghdha:

Yes, as Deputy Stephen Donnelly rightly stated, 69% of the nurses and midwives we surveyed indicated that they were either co-parenting with a healthcare worker, co-parenting with another essential worker or a single parent. In other words, they had no other options. That is a very high percentage. What did the State do? Through freedom of information, we had to seek the dialogue that took place between five Departments. At one point there were five Departments discussing the issue: the Department of Finance, the Department of Public Expenditure and Reform, the Department of Health, the Department of the Taoiseach and the Department of Children and Youth Affairs.

When we obtained the information through freedom of information last week, we discovered in the HSE and Department of Health releases that there is no database of the family status of healthcare workers. They stated that their estimate was largely based on CSO, Central Statistics Office, and Revenue information. In other words, they did not know the family status of their workforce or how it would be affected.

This workforce was the most essential to be at work during the first global pandemic. They did not have the database and still do not have it. All of the figures they produced around who would be affected and the numbers were conjecture. The figures they estimated for came to 8,898. When we met the Minister for Health, we stated it was a gross exaggeration and the figure was too high. However, all of the policies that were then sought to be introduced were costed at that level. We do not believe it was that high. We believe-----

Photo of Michael McNamaraMichael McNamara (Clare, Independent)
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Thank you, Ms Ní Sheaghdha. I am sorry to cut across you.

Ms Phil Ní Sheaghdha:

-----it was more likely in the region, as we stated, of just over 200 a week.

Photo of Michael McNamaraMichael McNamara (Clare, Independent)
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I am sorry but I just have to try get everybody in. I call Deputy O'Reilly. Are you taking ten minutes?

Photo of Louise O'ReillyLouise O'Reilly (Dublin Fingal, Sinn Fein)
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Yes. I assume the Chairman is taking a note of those who went over to ensure that time is given to the rest of us.

Photo of Michael McNamaraMichael McNamara (Clare, Independent)
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I have noted it. I am taking a note of all speakers' time.

Photo of Louise O'ReillyLouise O'Reilly (Dublin Fingal, Sinn Fein)
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I welcome our witnesses. We thank their members for all of the work they have done and the work they continue to do in this extremely trying time.

I received an email from a nurse on 18 June in which she stated:

I have just been notified that the crèche will not take my child back. I am a full-time nurse who has gone over and above in the last few months. I now face the decision of quitting my job due to a lack of childcare options. What will the Government do for me and everyone else in this situation?

To date the evidence suggests not very much, unfortunately. We know the implications up to this point because we know that people have had to take time out of their annual leave and take unpaid leave and suffer a financial loss, as well as the loss of their annual leave. This is not just the case for nurses but for all front-line healthcare workers. What are the likely implications of the resumption of childcare on a reduced level as we go forward and start to open up with the resumption of healthcare?

I just remind Ms Ní Sheaghdha I have ten minutes which includes me and her talking. I would be grateful if she could be as brief as she could.

Ms Phil Ní Sheaghdha:

Again, we have exactly the same testimony from some of our members saying that they are meeting resistance in respect of their children being accepted into childcare facilities. That is very unfortunate. We believe this requires a public information campaign that the children of healthcare workers are not infectious and that healthcare workers are fully compliant with infection control when they leave their hospital. There needs to be a more regular testing and tracing system in place for all healthcare workers. Currently, it is only in place as a routine for the private and community sector. Acute hospital workers are not included in that. We believe that-----

Photo of Louise O'ReillyLouise O'Reilly (Dublin Fingal, Sinn Fein)
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I am sorry to cut across. Is it correct that they are not testing and trace healthcare workers to the extent that they should be? Should that be an important element as we roll out non-Covid related healthcare?

Ms Phil Ní Sheaghdha:

Absolutely.

Photo of Louise O'ReillyLouise O'Reilly (Dublin Fingal, Sinn Fein)
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It is not happening, however.

Ms Phil Ní Sheaghdha:

In our submission we point to the good examples. The best example in this country so far has been the prison service where there has not been one infection among the prisoner population. There was a very tight regime of testing and tracing of prison officers and of all other attendees to prisons, combined with visitor restrictions, etc. Worldwide, it is known that testing and tracing is imperative in ensuring the safety of both the population that one serves but also those who go to work and who then acquire this terrible virus as an occupational illness.

Photo of Louise O'ReillyLouise O'Reilly (Dublin Fingal, Sinn Fein)
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That is exactly what it is. It is a hazard of the job.

On 26 March in this Chamber, we stood and applauded front-line healthcare workers. I have been contacted by healthcare workers who believed that it was something of an empty gesture because what followed were no firm commitments on childcare. I note from Ms Ní Sheaghdha's submission that one of her members stated childcare was the most stressful aspect of this pandemic, that it is a huge issue and they need help now.

What arrangements are in place for front-line healthcare workers who have taken annual leave to look after their children?

Are they getting any of that time back?

Ms Phil Ní Sheaghdha:

No. The issue is still outstanding and will be a matter before the Workplace Relations Commission as a dispute on behalf of healthcare workers in the next week.

Photo of Louise O'ReillyLouise O'Reilly (Dublin Fingal, Sinn Fein)
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The Government announced a plan on 18 May. In the run-up to that and all through April, the Taoiseach said the Government was ready to "push the button", which is the phrase he used, on childcare. Is it correct to say there were no feasible childcare arrangements in place at that time?

Ms Phil Ní Sheaghdha:

In fairness, the Taoiseach did state at the time that the announcement was not going to assist lone parents or healthcare workers who are married to healthcare workers. At the time the Irish Nurses and Midwives Organisation was very critical of that announcement on the basis that these are the very people who need the assistance. Currently, this is still the situation. It may very well become exacerbated because normally, during the summer months when schools are closed, healthcare workers would keep some of their annual leave to facilitate staying at home. Unfortunately, that has now already been used. They are really facing into a dilemma. We know they will be needed to attend work. The health services are getting busier.

Photo of Louise O'ReillyLouise O'Reilly (Dublin Fingal, Sinn Fein)
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They are, and the waiting lists have not gone away. When work resumes to tackle the waiting lists, which I believe are hovering close to 1 million people, every single healthcare worker will be absolutely needed. Am I right in saying there is a link and that low staffing levels inhibit infection control measures?

Ms Phil Ní Sheaghdha:

Absolutely. Also, the most significant issue that causes healthcare workers to become infected is fatigue. Our members tell us that when they have the dual responsibility of working night duty to facilitate continuing at work while also attending to childcare needs during the day, it is a huge issue. Many of them have had to change their rosters to continue to work.

Photo of Louise O'ReillyLouise O'Reilly (Dublin Fingal, Sinn Fein)
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So they are working all night and looking after their kids all day-----

Ms Phil Ní Sheaghdha:

Fatigue is a huge problem.

Photo of Louise O'ReillyLouise O'Reilly (Dublin Fingal, Sinn Fein)
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-----and keep that up. Nobody can keep that up. This is absolutely disrespectful and it is impossible to work all night and look after kids all day. It is a long time since I had to look after kids at home but it is a hard job to do that all day, particularly for people who are not getting any support at all. For them then to go into dangerous and potentially infectious and hazardous situations during their work, where they spend all their day making up for failed promises in relation to childcare, is absolutely disgraceful.

Ms Phil Ní Sheaghdha:

It is very important because one has to be sharp when dealing with an infection of this nature. One has to be sharp with regard to donning and doffing the personal protection equipment, PPE, which we know is tiresome. Many nurses and midwives tell us they are exhausted when they finish their shift because it is a different way of working. The list at appendix No. 1 of our submission sets out all the correspondence. We emphasise that this issue has not gone away. A solution needs to be focused on the healthcare worker, the great healthcare worker who has gone right in there and faced this pandemic head on. They now need a solution focused on them to ensure they are not spending more money to come to work to provide the service, which they are happy and very proud to provide. They did get a boost when they were applauded. They felt it was warranted and they felt it was right. They are now saying that the Government has to go further than that because it becomes hypocritical unless the issue we now face is actually resolved, which is the need for assistance with childcare when we want to go to work. We cannot abandon our children and leave them at home. Many healthcare workers felt they were being forced to do this. It is simply not right.

Photo of Louise O'ReillyLouise O'Reilly (Dublin Fingal, Sinn Fein)
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It is very wrong for a worker to feel that one must leave kids at home to be able to, or to be forced to, go to work. It is absolutely disgraceful. I joined others standing here in the Chamber in applauding the front-line healthcare workers. I felt at the time it was the right thing to do. I have been contacted by large numbers of front-line healthcare workers who at the time, as Ms Ní Sheaghdha has rightly pointed out, were happy to receive that level of recognition, but there was no follow-up. As we head into the summer and into the reopening and restarting of non-Covid-19 related care, there are no facilities in place for specific arrangements for front-line healthcare workers.

More and more people will contact Deputies through their constituency offices in the coming weeks to state that crèches simply will not take their children. Mr. Bell is correct that we need an information campaign, but we also need a bit of action from the Government on this issue. That does not seem to have happened up to this point.

Mr. Bell referred to his members being excluded from the survey. The survey was undertaken but his union and members were not consulted or involved in it.

Mr. Paul Bell:

That is correct. We have no knowledge of any survey interaction with any of our membership cohorts, which is very peculiar because the HSE made great play of the fact that it had consulted its employees.

The high rate of infection also applies to allied health professionals and healthcare assistants. The grades of a large cohort of healthcare workers who have contracted Covid-19 have not yet been identified.

The special annual leave credit is the proposal SIPTU is putting forward to assist our trade unions as well as employers. Many healthcare workers have taken special leave at their own cost or they have exhausted their parental or annual leave. Those workers will be missed in the health service going forward. As Ms Ní Sheaghda stated, these issues will impact on the health of the nation. We need to address those concerns now.

Photo of Louise O'ReillyLouise O'Reilly (Dublin Fingal, Sinn Fein)
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I agree that they will have a serious impact.

Patrick Costello (Dublin South Central, Green Party)
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I wish to jump in on the latter point regarding leave. How many members of the witnesses' organisations have used up all of their leave entitlement? How many have no annual leave left? What are they doing to manage that? Let me know if I am wrong, but it strikes me that once healthcare workers and other staff have used up their annual leave and are taking parental leave or looking at unpaid leave, the reality is that many of them will have no leave left for the rest of the year. It is not just a question of leaving children at home, they may be forced to give up their jobs in order to maintain decent childcare. This is putting massive further undue pressure on the health service. How many the workers have used up their leave entitlement? If nothing changes, what do those workers plan to do when all of their leave has been used up?

Ms Phil Ní Sheaghdha:

In our survey of members, 62% responded that they have used the majority of their annual leave. They stated that 48% of spouses and partners had also been forced to use annual leave in order to allow the healthcare workers to attend work.

Mr. Paul Bell:

Most of the information we have received is anecdotal. Members have communicated to us as their trade union their issues concerning childcare and the ability to attend work. A significant number of healthcare workers are in that category. The HSE has more up-to-date data in that regard. It is a vicious circle. If this issue is not corrected, the professional and other healthcare workers who are essential to the health service will be affected and the health service will not able to operate as it ought if there is a resurgence in the pandemic or if serious clusters emerge. We have major concerns in that regard. We also have concerns about the impact of fatigue, anxiety and stress on health workers across the spectrum and how that may affect them going forward. When the emergency is declared to be at an end, if it ever is, these issues will start to materialise more frequently.

Patrick Costello (Dublin South Central, Green Party)
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If 62% of the workers use up the majority of their leave and are faced with a choice of taking unpaid leave or leaving their children in a precarious situation and dealing with the stress that goes with doing so, many of those people may consider remaining in their current employment to be unfeasible unless something changes. We need to address this issue or we will be left with a health service that is even more understaffed than is currently the case.

Photo of Seán SherlockSeán Sherlock (Cork East, Labour)
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I welcome the contributors here this morning. I want to start with the 18 May deadline. That was the deadline that was fixed in the minds of all of us here in terms of the expectation that childcare for healthcare workers would be provided at that point. I am talking about the roadmap. That deadline was missed. What I find extraordinary, and this what I would like to get a view on from both SIPTU and the INMO, is the litany of correspondence between the INMO, in particular, and the various line Departments. I have the dates here in the INMO's submission: 6 April; 16 April; freedom of information requests in respect of 8 April and 9 April; again two more on 9 April; on 27 April; and even on 6 May. There seems to me to have been a very proactive and progressive attempt by the INMO to engage with the HSE and through the ambit of NPHET and the line Departments in respect of putting in place something to meet the deadline of 18 May.

If I look at the evidence base here, based on the litany of correspondence, I would have to conclude objectively that there was never going to be a serious attempt on the part of the HSE, NPHET or even any of the line Departments to provide any kind of childcare for healthcare workers. I would like to get the reaction of the witnesses to that. It seems to me that there was no concerted effort. There was maybe a bit of pageantry being gone through, a bit of choreography, or a pretence that they were going to deal with that issue. I would like to get the perspective of the witnesses on whether they felt they were taken seriously as healthcare workers in respect of whether the Government was actually going to come up with a scheme that was fit for purpose and to which everybody would subscribe.

Looking at the scheme up to 18 May, it was going to be devised along the lines of childcare professionals going into the homes of healthcare workers. In my opinion, for what it is worth, and I would love to hear the witnesses' opinion, they had never fully worked through what the protocols around that would be. It seems to me that what we are at here is the Government is going through a charade in respect of taking the issue seriously. That is the first point. I would love to get the reaction of the witnesses to that in the short time that I have.

Ms Phil Ní Sheaghdha:

Go raibh maith agat. The Deputy is right. We did not leave any week go by when we did not raise this issue with both the HSE and the Department of Health. We then made contact with the Department of Public Expenditure and Reform. Every single Department's answer was that it depended on what NPHET said.

We believe that an employer has a broader responsibility than waiting for the very right and very correct public health advice. We now believe that the employer has an opportunity to do the right thing, and that is to restore the annual leave that these workers had to take and to restore the parental leave, which is unpaid, that they also had to take to ensure that their contract of employment was maintained. It is absolutely disgraceful that the workers who were at the front line, right central and bang in the middle - they did not hesitate or blink but went right in there - are the ones who now will have suffered the biggest loss and will have no annual leave for the remainder of the year, which potentially exposes them to being more vulnerable to infection. We believe that is completely incorrect.

We believe that the employer did have choices. There was much they could have done in respect of rosters, reducing hours or allowing people to come to work for some of their week if they could make arrangements. There was none of that. It was a very rigid approach. Frankly, as we say in our submission, they have an opportunity now to correct the wrong.

Photo of Seán SherlockSeán Sherlock (Cork East, Labour)
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I appreciate that. The message to take away for us, as public representatives and Teachtaí Dála, is that the issue of the clawback of parental leave needs to be addressed. There has to be recognition of healthcare workers in respect of the amount of parental leave and other leave that they have taken to meet their childcare needs. The State owes them a service or favour in that respect in terms of seeking to claw that back.

Is Ms Ní Sheaghdha confident that all of her colleagues will have access to childcare on 29 June?

Ms Phil Ní Sheaghdha:

No. Ms Clarke, who is here with us today, has already has some issues arising in respect of it. This is going to be an issue and we believe that there has to be preferential treatment. We have to have a Government statement that provides for positive reinforcement of the need for preferential treatment for healthcare workers, who are essential and on the front line. If places are available at a reduced rate, they have to be prioritised for healthcare workers. In addition, the Government has to ensure the annual leave and parental leave of healthcare workers and those with whom they co-parent is made good. Since 13 March, they have been changing rosters and moving, bending and trying in every way possible to ensure that they can go to work and provide the service they want to provide, and which they are very proud of providing, while ensuring that their children are safe.

Photo of Jennifer WhitmoreJennifer Whitmore (Wicklow, Social Democrats)
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I thank the witnesses for attending. I acknowledge the sacrifice and work of their staff over recent months. I also acknowledge and thank their families because the sacrifice was not just made by those staff but by their children and by the members of their extended families who stepped in and assisted. I am aware of a nurse in Wicklow whose sister took her child for eight full weeks. She did not see her own child for eight weeks when she worked in the Covid unit. That is a huge sacrifice not only for her but for her child.

I have a number of questions and I ask the witnesses to answer them briefly because we are very limited in terms of time. I refer to the appendix on the consultation that took place. It seems the majority of the consultation was between the witnesses' organisations and the HSE. At what stage was there consultation with the Department of Children and Youth Affairs, specifically in the context of the front-line workers' childcare scheme? That scheme was meant to start in May and I would have anticipated the Department was heavily involved in discussing the options for a scheme set up specifically for the workers represented by the witnesses. What level of consultation happened in April and May on this?

Ms Phil Ní Sheaghdha:

We did not have consultation with the Department of Children and Youth Affairs until the scheme was announced. We then had a meeting at which the scheme was explained to us. Our criticism was that we should have been involved when the scheme was being thought up and developed. We were trying to find a solution that would assist healthcare workers and, as previously stated, it was clear when it was announced that lone parents and those co-parenting with healthcare workers were the very groups that would not be assisted by the scheme. We were very critical of this when we met the Minister for Health. He arranged for a meeting involving the Department of Children and Youth Affairs, ourselves and other trade unions, at which the scheme was set out and explained as opposed to consultation on the scheme prior to its development.

Photo of Jennifer WhitmoreJennifer Whitmore (Wicklow, Social Democrats)
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Ms Ní Sheaghdha was not involved in the development of the scheme. Does she feel there is now sufficient consultation between the unions and the Department to develop childcare solutions that will work for the workers?

Ms Phil Ní Sheaghdha:

Absolutely not.

Photo of Jennifer WhitmoreJennifer Whitmore (Wicklow, Social Democrats)
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It seems that we are taking a wait-and-see approach. There does not seem to be a huge amount of proactive addressing the needs that will exist after 29 June. We do not know exactly how many staff will not have the childcare they will require. Have the witnesses carried out an analysis in respect of what the impact would be if the schools do not open on a full-time basis? If they do not reopen fully, not only will children under the age of four or five require childcare, those aged up to 12 will also need it. Have the witnesses looked at the impact of this on their members?

Ms Phil Ní Sheaghdha:

The figures are on page 4 of our survey of our members. Some 10% were using preschools, 37% were using primary schools and another 10% were using secondary schools. Almost 60% of those surveyed, therefore, were reliant on schools to allow them to have some element of their working days covered. That is pretty big. We would look to other countries in Europe that have prioritised schools, when they reopen, for the children of healthcare workers.

Photo of Jennifer WhitmoreJennifer Whitmore (Wicklow, Social Democrats)
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Ms Ní Sheaghdha referred to the mental health impacts of this on INMO workers. I imagine there were significant mental health impacts on the children of front-line workers as well. Has anyone done any analysis or a review on that?

Ms Phil Ní Sheaghdha:

We have not but, as the Deputy said, our members are reporting separation anxiety among their children to us, particularly for the parents who had to live separately from their children, and that was not just in one or two cases but it was quite frequent for periods and blocks of time. That is an issue that will require a lot of analysis after this period. When we look back, we will ask what we could have done better and we are saying that the health service, including both HSE and the Department of Health, and the Government have an opportunity to correct what was done wrong and to make sure it does not continue.

Photo of Michael McNamaraMichael McNamara (Clare, Independent)
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I call Deputy Bríd Smith.

Mr. Paul Bell:

Can I make an observation please? We have not had an opportunity to respond to the questions of the latest three Deputies.

Photo of Michael McNamaraMichael McNamara (Clare, Independent)
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I apologise for that.

Mr. Paul Bell:

I would like to answer those questions with the Chairman's indulgence. A number of questions were put forward that I wanted to respond to.

Photo of Michael McNamaraMichael McNamara (Clare, Independent)
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I ask Mr. Bell to give brief answers. I am sorry it is just that we are in different rooms. I ask him to just take two minutes. I am sorry to limit him like this.

Mr. Paul Bell:

On the HSE and the Department of Health, it needs to be made clear that both of those organisations never saw childcare as being within their control or as being their responsibility. As we understand it, their conversations were taking place with the Department of Public Expenditure and Reform. Our submission makes it quite clear that the Department of Public Expenditure and Reform wanted uniformity. It did not respond to the special needs of health workers who are working predominantly unsocial hours. This is a seven day a week operation. SIPTU and our members hold the Department responsible for basically winding down the clock. In other words, the Department held the attitude that this issue would disappear by the end of the emergency and it would not have to be dealt with. The Department of Children and Youth Affairs only engaged with us and with the group of unions in recent weeks, and there is a further engagement due to take place today. No succour was offered to our members about how any of these issues will be addressed, including the issue of the funding of childcare.

Photo of Bríd SmithBríd Smith (Dublin South Central, People Before Profit Alliance)
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I thank all of those who have presented here today. I speak on behalf of everybody when I say - and most of the population will agree - that the evidence presented today is probably the most astonishing we have heard in this committee. The hairs were standing on the back of my neck when Ms Ní Sheaghdha said that INMO members were both applauded and abandoned because that is exactly what happened. This is astonishing evidence on what happened to our front-line workers and to those to whom we are extraordinarily grateful. We face a huge challenge because we have a backlog of non-Covid-19 treatment that has to be met and we also face the possibility of another resurgence of the virus.

I ask Ms Ní Sheaghdha to state again to us that until 22 April, until the HSE removed from its website the guideline that face masks are not advisable unless one is symptomatic, face masks were not issued to healthcare workers in settings where Covid was known to be present and where they were dealing with it. Could Ms Ní Sheaghdha confirm that for me?

Ms Phil Ní Sheaghdha:

No. What I am saying is that in circumstances in which the status of the patient was not Covid-positive, face masks were not recommended. If the patient had status-positive Covid-19, yes, face masks were recommended at varying degrees and depending on the procedure in which one was engaged. For example, if one was performing an aerosol-generating procedure, face masks were mandatory. There were, however, many circumstances in which the status of the patient was not known and in which face masks were therefore not recommended. There were many areas of healthcare where testing had not been conducted and face masks were not recommended. For example, public health nurses attending clients in their own homes were not advised, and it was not mandatory for them, to wear face masks at that time. Subsequently, we know they should have been mandatory, and from 22 April-----

Photo of Bríd SmithBríd Smith (Dublin South Central, People Before Profit Alliance)
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Absolutely, and at that stage we knew that the infection could be passed on while one was asymptomatic.

Ms Phil Ní Sheaghdha:

Yes. The evidence that has now come to light is that asymptomatic transmission is a feature of this virus. In other words, one can have no symptoms, temperature, etc., and still be infectious.

Photo of Bríd SmithBríd Smith (Dublin South Central, People Before Profit Alliance)
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Our figures for infection among healthcare workers are the highest globally, and a third of them were nurses and midwives. That is quite shocking. I have no doubt but that this must make the people Ms Ní Sheaghdha represents feel very angry. It is over a year ago since I met Ms Ní Sheaghdha on picket lines when nurses were striking for their pay increase. In a yes-no answer, have all nurses received that pay increase as a result of that strike?

Ms Phil Ní Sheaghdha:

No.

Photo of Bríd SmithBríd Smith (Dublin South Central, People Before Profit Alliance)
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Ms Ní Sheaghdha said she was dealing with five different Departments at one stage. Did she feel she was being passed from Billy to Jack, that there was a parcel being passed around the place and nobody was taking responsibility for answers to the queries and the proposals she was making?

Ms Phil Ní Sheaghdha:

I think they were looking at it from a very singular point of view, that is, public health concern, and not looking at their responsibility as employer. I might add we are now dealing with another Department, the Department of Business, Enterprise and Innovation. Covid-19 is not classified as an occupationally acquired illness under our health and safety legislation, and it must be. Under the umbrella of the Irish Congress of Trade Unions, we have written to the Minister with responsibility in this regard, Deputy Humphreys. I was circulated with a response from her Department last Friday which advises that the regulations will not be altered to include Covid-19 as an occupationally acquired illness. We believe that is wrong and a mistake. For every worker in this country, not just in the health service, who acquires Covid-19 because he or she is at work, that is an occupational illness and an occupationally acquired illness, and the Health and Safety Authority must amend its regulations in order to allow it to investigate why it was acquired. We are looking for the reasons behind these figures. We do not have the regulations that would require the Health and Safety Authority to come in as an independent statutory body and examine them. It must have that authority.

Photo of Bríd SmithBríd Smith (Dublin South Central, People Before Profit Alliance)
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I have to interrupt Ms Ní Sheaghdha. That is more astonishing evidence she has given us, but I wish to ask her one final question. We received an answer to a parliamentary question to the effect that fewer than 180 staff were recruited under the call to Ireland. We know that doctors and nurses are very angry about how they have been treated, and when they have been recruited they have been recruited under agencies which treat them very differently from the way they are treated by the HSE. Facing into the current crisis, does Ms Ní Sheaghdha think the State is missing out on a huge opportunity not just to deal with Covid but also to increase the capacity of the health service overall, which is urgently required?

Ms Phil Ní Sheaghdha:

I thank the Deputy for that question. In our submission we have set out the figures. Before Covid, we were operating with more than 1,000 fewer nurses and midwives than we had in 2007. We now have a big problem because, as we have set out in the figures, we are very reliant on recruitment of nurses and midwives from non-EU countries. We recruit from EU countries as well, but non-EU countries were our biggest single registration bloc last year. We know that, due to travel restrictions, these nurses and midwives will not travel to Ireland to work here. We also know that the UK has made specific travel arrangements that allow Irish workers to travel to the UK, and the UK is very aggressively recruiting our graduates. We have promised our graduates in nursing and medicine posts on graduation, but they have had that promise for the past three years. It is always a battle, particularly when one has a health service that is funded on an annual basis and then implements a moratorium on recruitment in the first quarter of the year, as it did last year.

The health service denied it and said there was no moratorium but there was one. The first thing we have to ensure is that there is no moratorium on essential healthcare workers ever again because when the chips are down we need every single healthcare worker who is available and willing to work in this country. There is no point in asking them to come back from Australia in the middle of a pandemic. They should not be forced to go to Australia in the first place. We have a problem.

We have set out a number of points on this very issue to the parties which are now looking to form a Government and those are: increase undergraduate places; never again introduce a moratorium; and make sure to treat those who work in the public health service, nurses and midwives, in an equitable manner with all other professionally qualified healthcare workers.

Matt Shanahan (Waterford, Independent)
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I thank our guests for attending here today. I wish to make a comment with respect to Mr. Bell's statement on the survey. The committee should write to the Department to understand the basis of that survey and whether SIPTU members were excluded from it. If that proves to be the case, we should bring it back to the committee for further review.

I would say to Ms Ní Sheaghdha that we are at a little bit of a crossroads here. She highlighted a number of issues in her statement today. First, I would say, and I think most people in the room would agree, that parental leave and annual leave should be restored to front-line healthcare workers who have had to take that leave. We know that schools are opening up and, therefore, the childcare issue for some front-line healthcare workers will be, we hope, sorted from here on in. I think Ms Ní Sheaghdha is asking for some kind of State-supported childcare initiatives, which will be very difficult to do in terms of the 24-7 rostering, which she outlined. Has her organisation developed or costed any concrete proposals around that or had any discussion with the Department on that?

Ms Phil Ní Sheaghdha:

We have and we have made a submission to the Department of Health and through freedom of information we see that it was considered but not agreed to in its internal correspondence. Essentially, we said that healthcare workers will do their best, they will change their rosters and they will minimise the requirement on the State, as they have been doing. However, there will be a residual cost that the State must look to cover. Healthcare workers went to work when most other citizens were asked to cocoon and stay at home. Healthcare workers were singled out as being essential, for the right reasons. It is not at all appropriate that they faced a cost in addition to that. They demonstrated bravery throughout this. They did not flinch. They should not have had to pay for that as well as being that brave.

Matt Shanahan (Waterford, Independent)
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I hope Ms Ní Sheaghdha will be able to provide those costings to the committee and we will be able to bring them to Government. Ms Ní Sheaghdha said that some 4,823 healthcare workers remain out sick. Does she have a timeframe on their return to work? For instance, we know that some people suffer extreme fatigue after Covid. Does she have any timeframe on when those people might return to work and how many will return?

Ms Phil Ní Sheaghdha:

We do not. These are the figures we have sought. This is the information we have sought from the HSE and that is why we believe it is so centrally important that the Health and Safety Authority, HSA, is involved in this conversation and has a formal function.

Matt Shanahan (Waterford, Independent)
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Ms Ní Sheaghdha highlighted the difference in infection rates in healthcare workers between the public and private sectors. I think much of that can probably be explained by the fact that Covid patients were not being directed to the private care facilities. However, we can expect outbreaks of Covid in the future when I imagine there will be a different streamlining of Covid patients. In terms of PPE, Ms Ní Sheaghdha mentioned donning and doffing, an issue I brought to the attention of the Minister for Health some months ago, which is a significant aspect of the risk of infection.

With the newer standards with the understanding that the rate of infection of healthcare workers should drop, as I assume it would, does Ms Ní Sheaghdha believe it will drop in the area of Covid treatment in the future?

Ms Phil Ní Sheaghdha:

That is our aim. I was asked earlier what we thought caused it to be so high. I think some policies were introduced that we believe should not have been introduced, one being the non-wearing of face masks. A policy was introduced when the workforce was under pressure to give a derogation to essential healthcare workers allowing them to return to work if they had been close contacts of Covid-positive people in the community or through their workplace unless they developed a temperature. Again, we believe that was a mistake considering that we now know that asymptomatic people also could transmit. Therefore, we believe those policies should obviously be removed - the face mask one is; the derogation one is still there. We believe the HSE should very definitely issue a retraction of that policy. It simply cannot say that a health worker who does not have a temperature, even though he or she has been a close contact, should not isolate for 14 days like everybody else. Of course, they should. Fourteen days should be mandatory for healthcare workers, as it is for ordinary members of the public.

Photo of Michael McNamaraMichael McNamara (Clare, Independent)
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The next speaker is Deputy Michael Collins.

Mr. Paul Bell:

A Chathaoirligh, I wish to make a contribution in response to the Deputy's question.

Photo of Michael McNamaraMichael McNamara (Clare, Independent)
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I am sorry. Because Mr. Bell is in another room I cannot see when he wants to speak. I ask him to go ahead.

Mr. Paul Bell:

The HSE is now working on a return to work protocol and yet Covid-19 will still exist in the community and in the health service. Some big challenges will present in regard to the protocol. Because of underlying issues, some health workers may be told there is no work for them to return to. This is a big question we will need to consider for all grades, including nursing, midwifery, the ambulance service, support service and healthcare assistants. That is the complex conversation we will need to get into. At the end of the day if Covid-19 still exists, health workers with underlying health issues must be facilitated and protected. It may not be as easy as reassigning them to another post. The policymakers need to grapple with this matter.

On occupational health, some EU states already see Covid-19 as an occupational disease. Given that 35% of all cases of Covid-19 in our country relate to health workers, we do not know why there is such resistance and why it is not seen as an occupational disease.

To assist those working in the community, home care support assistants and home helps, my union, SIPTU, got to the stage where we had to source face masks for our members to try to shake up the system so that the HSE would respond to those workers in particular because some colleagues going to the homes of service users were being granted PPE while people in support staff or health care assistant grades were finding it much more difficult to procure that particular type of safety equipment. We had to take those steps to protect our members. At this stage, it seems that members are receiving PPE even though there have been issues with the availability and obviously the quality of the equipment, an issue the HSE has been trying to correct.

Photo of Michael McNamaraMichael McNamara (Clare, Independent)
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I again apologise to Mr. Bell. It is difficult for me to see when he is indicating he wishes to speak because he is in another room.

Photo of Michael CollinsMichael Collins (Cork South West, Independent)
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I thank Ms Ní Sheaghdha and Mr. Bell for appearing before the committee today. Shortly after the beginning of the Covid crisis, the Taoiseach and other Ministers made announcement after announcement that the childcare issue for front-line health workers was to be resolved. No matter how often the promise was publicly announced - in some cases the public were told it would be resolved in days - nothing happened.

Nurses and front-line staff were ringing me asking what they could do with their very young children. This was highly frustrating, challenging and deeply stressful for each and every parent. I sincerely sympathise with the front-line workers for the way they were treated. They were putting their lives on the line for their country while also having the stress and worry of wondering how they could resolve their childcare crisis at home, bearing in mind most of these had grandparents who were often cocooning.

It is clear from talking to many of these front-line workers that they felt they were left on their own. In many cases there were couples who were both front-line workers and the inability of the Government to resolve the childcare crisis for them meant that in a few situations one of them had to pull out of work and stay at home, which in itself was a huge loss for the front line. Many others had to send their children to relatives and friends many miles away and went without seeing their children for weeks on end. How did we get this so wrong, in Ms Ní Sheaghdha's view?

Ms Phil Ní Sheaghdha:

Again, it was due to a lack of consultation. We have always had to battle for conditions of employment for our members, nurses and midwives. We have to examine how we view female workers, particularly those who have childcaring responsibilities. On the one hand we are a State that says we completely embrace women who go to work, but we still have a gender pay gap and issues with real childcare provided by the State that would allow women to really participate in the workforce. This is a reflection of our overall position in respect of the provision of childcare, because women want to work. Our members wanted to contribute during the pandemic and they did. Many of the sacrifices they made, particularly around childcare, have been set out in our submission. They went above and beyond what would be expected and that has to be compensated in the first instance. They cannot be at a loss. In the next number of months to the end of this year we have to make sure that any annual leave they have spent is repaid to them. The same should apply to parental leave and any costs over and above what they normally would have paid should be reimbursed. That is very simple and the Government can do that immediately. We also have to start treating women who go to work with respect. That involves making sure that when they go to work they have absolutely secure childcare available to them that is appropriate for the hours they work. We need to do that if we are serious about full engagement of women in the workplace.

Photo of Michael CollinsMichael Collins (Cork South West, Independent)
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There is also a worry that Covid-19 may strike again. If that happens, does Ms Ní Sheaghdha think we are prepared for a childcare service for front-line workers?

Ms Phil Ní Sheaghdha:

Covid-19 has not gone away. It is still here, it still poses a risk to our members at work and the infection of healthcare workers continues. We want the HSA to be on the pitch with the regulated authority to look at what has happened. This should not be the HSE or the Department of Health looking at themselves. We have a statutory body with this responsibility and we call on the Minister for Business, Enterprise and Innovation to change the position and make sure it has statutory powers to investigate what happened, why it happened and what we can do to prevent it. That is imperative and has to be done now.

Photo of Michael CollinsMichael Collins (Cork South West, Independent)
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Does Mr. Bell think a package should be put together for front-line workers who have had to use all their annual leave?

Mr. Paul Bell:

That is a very simplistic way of addressing the hurt that has affected healthcare workers. The Deputy's previous question was more relevant. If we were to have this issue again, the same things would happen because the Government failed to join the dots. We want healthcare workers, who are predominantly female in certain sectors of the health service, to be in the service and yet we did not help them. For the life of me I cannot understand this because we said that childcare is essential to support health workers but maybe the Government did not understand what it needed to do to provide that childcare cover.

The other point I want to make is that when the informal care, such as grandparents, relations or friends caring for children, was taken away there was no offer to fund or subvent the cost of childcare. It is a complex issue but was made more complex by a lack of political will.

Photo of Michael McNamaraMichael McNamara (Clare, Independent)
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I thank Deputy Michael Collins. I call Deputy Carroll MacNeill.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I thank the witnesses for coming in and thank the members of their organisations for the extraordinary work they have done. Ms Ní Sheaghdha's description of the role of women in work and women's participation in the workforce is about as eloquent as I have heard in my time in this Chamber.

It is succinct and perfect, and I want to thank her for putting it on the record. I completely agree with every word she said on women's participation in the workforce and the role of childcare. If I may say so, this pandemic has shown up how we have all come to think about it in an overly casual way. As Mr. Bell said, we are reliant on the informality of help, whether it is an hour here or a pickup there, to deal with all of the additional things families require to be able to get through their working week and support and manage their children at every stage and children at different ages with different needs. What healthcare workers have done in terms of their commitment to their work is simply without parallel in this period. I feel very strongly that, at a minimum, they need to be reimbursed. It is not the correct word and I ask the witnesses to forgive me. Their work needs to be acknowledged, at a minimum, in terms of repaying them for this period with annual and parental leave.

With that as a background, I ask Ms Ní Sheaghdha and Mr. Bell for some practical details on their submissions. I refer to page 3 of the INMO's submission. I cannot quite follow the numbers and I want to ask Ms Ní Sheaghdha about them. The submission states there are 38,000 whole-time equivalent nurses working in the State while Mr. Bell's submission states there are 40,000. I am trying to get the number of people to whom this applied at the time. There are conflicting numbers and I know they came from the CSO and a HR estimate. It was stated that 8,898 was too high. I ask Ms Ní Sheaghdha to talk me through what she said. She thought the figure was 200 per week. That figure seems too low to me. I ask her to help me with that as I cannot follow it.

Ms Phil Ní Sheaghdha:

The point we are making is that the HSE does not collate data based on family status and does not know how many of its workforce have schoolgoing or younger children. In other words, it could not know how much of a problem this was going to be.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Yes.

Ms Phil Ní Sheaghdha:

We surveyed our members and had a fairly high response rate. It is our view, based on our experience, that this affected about 200 of our members per week at various points. In other words, some people were able to come to work for some but not all of the time. That was about the figure and was the figure we-----

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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About 200 per week are affected. It impacts different people in different ways. Depending on those who work a week on-week off system or roster arrangements, different people are affected.

Ms Phil Ní Sheaghdha:

Exactly.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Ms Ní Sheaghdha said the HSE does not have that data. Is the INMO now going to begin to collate it so that it has data on its membership? This information is crucial and the HSE should have it, although I can see the data protection issues inherent in that. Does the INMO have that information?

Ms Phil Ní Sheaghdha:

We have the results of the survey, but we are saying that the HSE must now collate figures in respect of family status because that is clearly important given that its workforce is predominantly female.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I understand the logic. Nobody has this information and it is important that it is obtained in a data protection appropriate way. I want to understand the application of the circular. Ms Ní Sheaghdha referred to circular 33/2020, which I have read. It is about trying to deliver as much flexibility as possible. The particular problem concerned lone parents and co-parents who are both healthcare workers. Even when that did not apply, it was still difficult in certain circumstances. Could Mr. Bell provide an alternative comment on the difficulties involved or the practical issues that arose? Where was the block in providing the flexibility that had been directed?

Mr. Paul Bell:

I thank the Deputy. I will assist her in regard to the term "reimbursement", which is a fair enough word, but we want to have a conversation about a special annual leave credit with the HSE and our colleagues in the other trade unions involved in that.

On circular 33/2020 and flexibilities, at this stage we have no clear picture of how effective it was in ensuring that healthcare workers with childcare needs could provide that service to themselves.

Let us remember that the ultimate issue was that in the event no flexibility could be reached, a health worker could basically work from home or take leave. That is a very difficult thing to quantify. If we are changing people's rosters, they still have to fit in to the needs of the health service. If a worker was taking leave for childcare, it is not yet understood how many workers got access to that or were able to avail of it. I do not believe the issue of childcare was ever addressed through circular 33/2020. While I stand to be corrected, I do not believe I will be.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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When Mr. Bell says he does not think it was addressed, does he mean it was not adequately addressed or simply that it was not applied?

Mr. Paul Bell:

I believe management would try to work the circular, as would the workers who share that circular, and I believe efforts would be made. However, I have no hard evidence of workers who are finding it very difficult to provide childcare, or who have exhausted their annual leave or special leave arrangements, accessing that particular-----

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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The special annual leave credit that Mr. Bell describes is an issue if we look back on this and ask who was in what type of situation and what arrangements they had to make. It is a very different thing looking after a two year old, an eight year old or a 13 year old in terms of the presence and commitment that is needed. Without the data on how many were parents, the different stages of the child and whether it is early or middle childhood, and without being able to assess how much they needed to step away from work to provide care to their own children, as opposed to childcare, it is very difficult to assess the practicalities of how that leave credit might be applied appropriately and fairly, and in a way that recognises the different experiences people have had. The role of the data is crucial and it is crucial we get a sense of what people have in their own lives and the different changes they needed to make.

Mr. Paul Bell:

The HSE has to show some enthusiasm to gather that data and disseminate it among the stakeholders. Let us remember also that some healthcare workers were taking leave for childcare to allow their partner to go to work in the health service. Another issue is that lone parents ran into serious difficulties because they had no support whatsoever.

One other point is being lost in this discussion about the services being provided, namely, many health workers also had to pick up the slack where their comrades had to take special leave or annual leave to provide childcare. This has affected many other workers throughout the health service.

The Deputy is correct that data has to be collated with integrity and has to be something we can all work with. This issue is not going away. It has to be resolved now, given the possibility we could be facing a similar emergency again. Health professionals are telling us there is always a possibility of a rebound of this disease, which would impact on the health service.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I understand and agree. What this is has shown is the read-across for other people working in environments where childcare has an impact. If this conversation does nothing else, we can finally put to bed the idea that childcare is a woman's issue or a man's issue. It is a societal issue and if we want to have children and to work, and to have a productive and caring society, we need to think collectively about how we are delivering flexible, supported and secure childcare to all parents. We need to recognise they do not have one job – again, job is not the right word - but that they have two roles in society and both of those need to be supported.

The Department of Children and Youth Affairs comes before the committee later and, like other members of the committee, I will be asking it about its engagement, so I will leave that for the moment.

As a final point, given my time is nearly up, I want to ask Mr. Bell about one of the two anecdotal cases. A member advised SIPTU that her child was four and her parents were elderly and cocooning. She was working a normal roster pattern of 12 hours a day. She was able to source private childcare but the financial costs were so prohibitive that she was not able to take it up. What happened?

Mr. Paul Bell:

That individual had to remain off work. As I understand it, the costs of the childcare being offered were prohibitive.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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She had to take paid or unpaid leave.

Mr. Paul Bell:

Yes.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Does Mr. Bell know what happened?

Mr. Paul Bell:

No. I just know that she had to remain on leave and share the responsibility with another family member. What happened there was that the childcare became available but the cost of it was prohibitive. The other issue was that there was no financial support even where childcare could be provided.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I am out of time. I thank Mr. Bell.

Photo of Michael McNamaraMichael McNamara (Clare, Independent)
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I call Deputy Funchion.

Photo of Kathleen FunchionKathleen Funchion (Carlow-Kilkenny, Sinn Fein)
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I thank the witnesses.

Photo of Michael McNamaraMichael McNamara (Clare, Independent)
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I got the order wrong, but the Deputy has started.

Photo of John McGuinnessJohn McGuinness (Carlow-Kilkenny, Fianna Fail)
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I will let my constituency colleague go first.

Photo of Kathleen FunchionKathleen Funchion (Carlow-Kilkenny, Sinn Fein)
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I thank Deputy McGuinness. The two witnesses clarified that consultation was lacking, if it existed at all, particularly with the Department of Children and Youth Affairs. While I do not know at this stage why I am ever shocked by anything I hear in the Oireachtas anymore, it is unbelievable that the Department was not in consultation with the witnesses. Ms Ní Sheaghdha made the point that this issue has not gone away and has not been resolved. What can be done to rectify the situation for healthcare workers? In particular, can the representative of SIPTU speak about the childcare and early years workers as well? One thing this has shown is not only how invaluable the role of the front-line workers is but also how invaluable the early years and childcare sector is. It has been neglected, unfortunately, as well as underfunded and taken for granted for a long time by the Government. The pandemic has highlighted that. What can we do, particularly in view of the fact that there is talk of a potential phase 2 and that there might have to be another lockdown? We do not know that, but what can be done? I doubt that anybody could sustain some of the examples the witnesses have given, such as spending weeks without their children and having to rely on family members. Nobody should have to do that anyway, but it certainly could not be sustained into the future. What do the witnesses see as the solutions that would benefit their members? They should also bear in mind the people who work in the early years and childcare sector. That is probably more relevant for SIPTU as it has a specific unit, the Big Start campaign, that deals with childcare workers.

Mr. Paul Bell:

I will preface my remarks by saying that I am not an expert when it comes to representing childcare workers. However, when we look back on the pandemic, there will be a number of aspects which we all will assume were weaknesses in trying to respond to the crisis. Childcare has been one of the weaknesses in the sense that there seemed to be no understanding of the need for a structured childcare industry where people who are providing childcare, the childcare workers, are properly paid and supported and to ensure that the service is available at the direction of the State to provide childcare for essential workers. While we are talking today about healthcare workers, there were other workers who were essential to the economy and they may have fallen into the same position of trying to provide various vital services but not having the back-up of childcare.

The Government must have a stronger input into the provision of childcare. At this stage, taxpayers' money is being used to fund childcare and provide services, but when it came to the crunch on this occasion, there seemed to be an understanding that somewhere along the line the Government and Department of Children and Youth Affairs were remote in trying to encourage or having a say in the provision or direction of childcare services. That is a weakness, and it has caused problems in the health service. It is something on which the Government will have to reflect. Regarding the Department of Children and Youth Affairs, it might interest the Deputy, and I believe my colleagues here will confirm this, that we did not speak to that Department until about 12 or 13 weeks into the emergency. That engagement was provided after the failure of the initial childcare proposal, which we knew from the start was going to be very difficult to implement.

Photo of Kathleen FunchionKathleen Funchion (Carlow-Kilkenny, Sinn Fein)
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Can Ms Ní Sheaghdha respond on the same question?

Ms Phil Ní Sheaghdha:

The most important aspect of the question is what we are going to do now. Clearly, the matters that can be corrected must be corrected. We are awaiting a hearing at the Workplace Relations Commission, to which the trade unions in the health service have lodged a claim regarding annual leave and the additional costs that healthcare workers endured in having to come to work and ensure that their children were looked after.

That is a remedy which should not require a hearing before the Workplace Relations Commission. The right thing should be done and done immediately.

Preferential treatment will have to be provided for healthcare workers. They are essential and we do not have a surplus of them. I have already set out how we are reliant on overseas nurses. We are not going to have the same numbers of them. We are going to be very short. Anybody who can come to work must be facilitated to do so, but not at cost to themselves. I know of one nurse working in South Tipperary General Hospital, for example. It cost her €150 a week more to go to work than what she actually earned.

Photo of John McGuinnessJohn McGuinness (Carlow-Kilkenny, Fianna Fail)
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I cannot say I am surprised or shocked by the evidence given by the witnesses today. Throughout the tenure of a number of Governments, the State has shown scant regard for front-line workers except, of course, when the house is on fire, when a pandemic is under way or when something terrible is happening. In those cases, the State is wonderful. The hypocrisy, disrespect and disregard for front-line workers shown by the HSE, the five Government Departments involved and the Government itself demonstrated by the evidence the witnesses have given at this hearing is shocking. This is now continuing in the discussions which Ms Ní Sheaghdha says the INMO is not party to and in the survey which Mr. Bell says SIPTU was excluded from. If anything is to come out of this committee today, it is the clear support for the restoration of leave used and pay lost by employees in dealing with childcare issues. I agree with Mr. Bell that this is not just about our health services; it goes right across all front-line workers, whoever they are. Were Mr. Bell's colleagues in other unions involved in this survey? Why does he think he was excluded?

Mr. Paul Bell:

We are not clear that we were excluded, we are just very clear that we were not requested to participate. We do not believe that any other organisations or their members were involved in collating or participating in a survey.

Photo of John McGuinnessJohn McGuinness (Carlow-Kilkenny, Fianna Fail)
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Does that not mean the survey is fictitious?

Mr. Paul Bell:

It is not for me to answer that question but I have not seen the survey and I do not know how it was conducted. I have no evidence in that regard. We were quite surprised, however, to hear the Health Service Executive declaring that there had been a survey and giving figures as to the number of people involved who may need childcare. To be very clear, that is where it rests. We, as a representative organisation, requested further information, as did other trade unions within the public sector, but that information was not provided.

Photo of John McGuinnessJohn McGuinness (Carlow-Kilkenny, Fianna Fail)
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In Mr. Bell's experience as a trade unionist, has he experienced this type of exclusion - because that is what it is - in areas of the private sector in which there is union representation? Is it experienced only in dealings with Government and Government Departments?

Mr. Paul Bell:

The Health Service Executive will have to answer as to the word "exclusion". All we understand is that if an organisation, whether in the private sector or the public sector, says that it has conducted a survey, the first thing we would expect to see, even before the survey is taken, is the questions that will be posed, the cohorts with whom the organisation wants to touch base, and the genders and arrangements about which information is sought.

There might also be a focus on issues such as lone parents, or there could be a focus on-----

Photo of John McGuinnessJohn McGuinness (Carlow-Kilkenny, Fianna Fail)
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I do not have much time left.

Mr. Paul Bell:

-----situations where both workers work in the health service. I would have seen it as a fairly complex piece of work but we never saw what it was. The HSE has made a-----

Photo of John McGuinnessJohn McGuinness (Carlow-Kilkenny, Fianna Fail)
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I have a question for Ms Ní Sheaghdha. Where is the blockage in regard to the INMO's direct involvement in the consultations or conversations with Departments or the HSE which she is saying the INMO was not involved in? I find it an outrageous treatment of workers' representatives that such exclusion should take place. Can Ms Ní Sheaghdha tell us why nurses have not been paid since the last engagement the INMO had with the HSE?

Ms Phil Ní Sheaghdha:

I thank the Deputy. The point we are making is that there was an announcement that a survey had been conducted by the HSE but nobody was aware of the survey. That is why we sought the information under the freedom of information process. What we found in the correspondence is that it looks more like a table-top exercise involving CSO and Revenue figures as opposed to a survey. Perhaps there was a survey but, if so, it certainly was not in consultation with the trade unions. From the Revenue and CSO figures, it seems they made certain assumptions that there were in the region of 8,000 people who would be in the category of healthcare worker with family responsibilities. That is where the figure of 8,000 came from, from what we can see in the data we received under freedom of information.

Photo of Michael McNamaraMichael McNamara (Clare, Independent)
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We are going to have to move on so that the other speakers can get in.

Photo of John McGuinnessJohn McGuinness (Carlow-Kilkenny, Fianna Fail)
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Will the Chairman allow Ms Ní Sheaghdha to finish her answer to me?

Photo of Michael McNamaraMichael McNamara (Clare, Independent)
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I must move on or we will be taking from the time allowed for Deputy McGuinness's colleagues. I just cannot make the extra time. In fact, I will have to get two minutes back from either Deputy Butler or Deputy Foley for the time Deputy Donnelly went over. There is nothing I can do about that.

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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The terms of reference of this committee are to examine the response to Covid-19. It is obvious after the evidence we have heard today, which I have found shocking and distressing, that the response was not adequate. That is putting it mildly. The infection rate among healthcare workers, as Ms Ní Sheaghdha said, is the highest in the world, with 88% of those workers having acquired the illness due to their occupation. I want to ask her about the 4,823 healthcare workers who are currently out because they are too ill to work as a result of their occupation. How are they coping and what supports are in place for them? Have they received anything extra in terms of supports to help them from a mental health point of view and to look after their children at this most distressing time? When people are well and going to work, they have to make sure their children are looked after. We know that 62% of parents took annual leave, 48% of spouses and partners took leave and 30% took parental leave. Where are those 4,823 workers left now, too sick to be in work and too sick, I presume, to look after their own children? Was anything offered to them?

Ms Phil Ní Sheaghdha:

This is exactly the point. Those figures were produced to us on only two occasions, both following a direct request from us to the Minister to have the information provided. That is the role of the Health and Safety Authority and if anything comes out of this committee, it must be that the HSA, the statutory body with responsibility for examining this issue, is on the pitch. Its not being on the pitch means that healthcare workers are less important than other workers who have occupational illnesses and occupationally acquired personal injuries. It is very likely that there will be long-term effects of Covid infection. We know from the evidence that is coming out of China, for example, that there are long-term lung conditions, etc. The point is that we also have had issues where we have lost healthcare workers - workers who have died - but this is not a matter that is reportable to the health and safety authority in this country. That is an absolute scandal.

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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Were any supports offered to those healthcare workers who cannot work because of Covid-19? They are obviously very ill. Was any support offered to help them to care for their children while they are out sick as a result of being a healthcare worker?

Ms Phil Ní Sheaghdha:

I refer to the evidence we have received from our members who were Covid-positive. There is a scheme which allows for those workers to be paid while on sick leave. However, the premium payments due to them because they are healthcare workers were not paid so they lost money when they were out. They had to isolate in their own homes and they had to ensure that they were not mixing with their partners and children. It was extraordinarily difficult. Many of those workers informed us that it was a time they would never want to revisit in their working lives.

As to whether they felt supported, in fairness, and on balance, those who did have occupational health support, who were predominantly working in the public sector, said they received phone calls and follow-ups, and they were also provided with access to counselling helplines. To be honest, that scheme did not apply in the private sector. There is not a national occupational health department, but there is such a resource for the HSE. Those that work in the areas of mental health and intellectual disability noted in particular that they felt very much left alone.

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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I thank Ms Ní Sheaghdha. I wish to ask one final question. We know from the survey the percentage of healthcare workers who had to take annual leave and parental leave. There is an onus on us, as a committee, to examine that in detail. It seems obvious that we are possibly facing into a winter of discontent in the context of healthcare. We will have Covid and non-Covid healthcare issues and we will have the normal winter surge and the flu. If healthcare workers cannot get their leave restored so that they can take parental leave or annual leave, it seems that we will be sleepwalking off a cliff because we could be facing a resurgence of Covid-19. We do not know, but we have to plan for it. Part of the purpose of this committee is to look at what we got wrong and what we need to get right as we move forward.

Ms Phil Ní Sheaghdha:

That is a very important question. Covid-19 is still here, and we are approaching our public health service delivery on two fronts. We are providing Covid services and non-Covid services. Some private hospital beds will be available but it is imperative that they remain available to the public health service. In addition, right now we have to ensure that we try to make working in the health service as a nurse, midwife or healthcare worker the most attractive option because people who currently have childcare issues are making decisions about whether they can remain at work. That should never be the decision an essential front-line nurse or midwife has to make.

Photo of Michael McNamaraMichael McNamara (Clare, Independent)
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I thank Ms Ní Sheaghdha. I would like to bring in Mr. Bell to respond to some questions.

Mr. Paul Bell:

It may not be widely known that in some cases health workers had two distinctive periods of self-isolation. They may have been off themselves for a 14-day period due to the suspicion that they had Covid-19 and, having gone back to work, if someone they were in contact with or a family member was exposed to Covid-19, they had to have another 14-day period of self-isolation.

Employees in the healthcare sector work unsocial hours. The injustice is that they did not get paid premiums on which they were depending, sometimes including mandatory overtime payments. That is a matter that has been raised between the HSE and the Department of Public Expenditure and Reform and will feature in the Workplace Relations Commission. It is also the case that healthcare workers of various grades in certain settings had no access to any of those payments. That is predominantly the case in the private sector. What is most disappointing is that one major private hospital which received State funding during that period refused to apply the public sector formula to cover health workers when they were on Covid leave. That was most disappointing on the basis that taxpayers had paid for those hospitals to be available to assist during the Covid-19 crisis.

Matt Carthy (Cavan-Monaghan, Sinn Fein)
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I thank the witnesses and, in particular, their members who have done us all such a great service. While they have got plenty of plaudits in this House I am reminded of the phrase to the effect that a slap on the back is not far from a kick in the arse.

That phrase probably was never more appropriate. The litany of disregard and disrespect outlined to the committee this morning is absolutely shameful.

Will Ms Clarke outline where she stands this coming Monday? It would be useful for the committee to get a real-life experience of our front-line workers.

Ms Kimberley Clarke:

I had finished maternity leave and was due back to work when the coronavirus started. I had just returned to work but had no childcare. I had to get my sister, who was on annual leave, to mind my child. Then I had to take eight weeks of leave before I got approved to work from home.

At the moment, I am working from home but due to the childcare reopening that I had prearranged, I am due back to work on Monday, 29 June. However, my child has never met the childminder. As he has to go through an initiation phase with the childminder, I have had to take more annual leave for that first ten days. This means he can be introduced to his childminder who is phasing in the children. I have to take ten days of annual leave and then after that I can return to work full-time.

Matt Carthy (Cavan-Monaghan, Sinn Fein)
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Ms Ní Sheaghdha and Mr. Bell have both made the point consistently on annual leave. In previous committee hearings, we have talked about employers in some cases forcing employees to take annual leave during the periods they are not working. Essentially, what we have heard today is that our public service is doing the exact same thing. Everywhere I go, I see the flags saluting our healthcare workers. We will hear the plaudits from Ministers in here tomorrow. What we found out today, however, is that while our healthcare workers are being applauded, their representatives are also being forced to take a case on annual leave to the Workplace Relations Commission. By any definition, it is not annual leave when somebody must take it to mind their kids during a pandemic. Do Mr. Bell or Ms Ní Sheaghdha believe the Department will renege and accede to the simple request that the annual leave in question be restored for that period?

Ms Phil Ní Sheaghdha:

To be fair, we have a fairly well-established industrial relations procedure in the health service. If the employer had agreed to it, we would not have needed to refer it to the Workplace Relations Commission as an outstanding matter that is disagreed. That is because the employer has not conceded the point.

Interestingly on a previous matter, circular 33/2020 was introduced on 29 April but it did not apply retrospectively. From that point forward, one could have availed of it. It is important that as part of that circular, the HSE stipulated that managers should consider such requests in light of service requirements and the employee's particular circumstances.

Service requirements will always trump employee rights in the health service because there are not enough employees to begin with. When managers are faced with that dilemma, what does one think they will do? They are going to force their workers to take annual leave. In wording it in that way, the circular allows that type of mentality to apply. What we are saying is-----

Photo of Michael McNamaraMichael McNamara (Clare, Independent)
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I must bring in Mr. Bell on that.

Matt Carthy (Cavan-Monaghan, Sinn Fein)
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Perhaps I could ask Mr. Bell a final question. He mentioned that one of the private hospitals in receipt of public money has not been adhering to the public service agreements with regard to its workers. Would he care to name that private hospital?

Photo of Michael McNamaraMichael McNamara (Clare, Independent)
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The Deputy will recall at the beginning of the committee that we asked people not to be identified.

Mr. Paul Bell:

To assist the Deputy, the big major private hospitals that receive funding are well known. We ran into difficulty with one of those major employers. I am sure that through his own investigations, the Deputy will be able to find out what hospital it was.

We objected on the basis that those hospitals effectively became section 38 employments, just like St. Vincent's, Beaumont or Tallaght hospitals. We believe that the same rules should have applied. We were resisted in one of those major private health providers.

Photo of Michael McNamaraMichael McNamara (Clare, Independent)
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Like Mr. Bell, I have every confidence in Deputy Carthy's ability.

Matt Carthy (Cavan-Monaghan, Sinn Fein)
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I thank the witness.

Norma Foley (Kerry, Fianna Fail)
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I welcome the speakers here this morning. I acknowledge the superb work of those who are represented by the witnesses' organisations, as we journey through Covid-19 and before that.

Mr. Bell made a remark that SIPTU was forced to source personal protective equipment, PPE, for its members. I find this quite shocking and perhaps Mr. Bell will elaborate on it. Was the union reimbursed for that? Mr. Bell also said that while members were receiving PPE, there might be an issue with quality. Will Mr. Bell also elaborate on that please?

Mr. Paul Bell:

At the beginning of this whole process, contradictory information was given about the wearing of face masks. We found there was a serious weakness with regard to the members we represent in community care. We decided that we would support those members by trying to provide a limited number of face masks until that policy changed. The policy changed with the HSE on the quality of PPE, but the Government was making it quite clear that PPE was being provided. There were ample amounts of PPE but it seemed it did not pass the test the HSE attributed to such equipment and some of that equipment could not be used. Over recent weeks this issue has been addressed more and more. Again, however, some of the issues we faced were around contradictory messaging or when something happened in one region and not in another. The issue of face masks was one of those.

Norma Foley (Kerry, Fianna Fail)
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Is Mr. Bell saying it is being addressed or it has not been completely addressed? Is Mr. Bell suggesting that some workers are making use of PPE that is not of the standard it should be?

Mr. Paul Bell:

Not at this stage. Absolutely not. It is my understanding that the HSE has managed to address that issue. We just wanted to make it clear that not everything we wanted to see happen did happen as fast as it should. We saw serious gaps in the area where members worked in residential settings such as care homes when there was a difficulty in supplying PPE-----

Norma Foley (Kerry, Fianna Fail)
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Where there were gaps, the union was obliged to fill in. I thank Mr. Bell for that. I now turn to the two submissions that have been made to the committee this morning. It is very clear that neither SIPTU nor the INMO was consulted regarding childcare provision. The SIPTU members were not surveyed on the survey we have spoken of, and the only survey I am aware of that we can verify here is the survey by the INMO. Ms Ní Sheaghdha has been reduced to seeking a whole series of freedom of information requests to try to gather information on what has been happening and, no doubt, what is proposed to happen. I believe this to be an absolutely shocking indictment of where we stand currently. Where stands the morale of the INMO workers at this point? It has been made abundantly clear that nine out of ten nurses and midwives are women, and equally the vast majority of healthcare workers are women. One wonders if nine out of ten of the workers were male with childcare responsibilities, would we find ourselves in the position we find ourselves. Will Ms Ní Sheaghdha please address the question of morale within the INMO membership?

Ms Phil Ní Sheaghdha:

I thank Deputy Foley for the question. On morale during Covid-19, our members have felt extraordinarily proud of their contribution and have stood very tall due to there suddenly being an understanding in general terms about the massive contribution they make. On morale in that respect, our members report that they are extraordinarily proud of their achievement. When one looks at the Covid-19 statistics in the State, it is not a coincidence that the numbers of people who recovered and walked out of intensive care units did so. It was because people got excellent nursing care. It was also because they were nursed prone, which is recommended. It takes a lot of work and a lot of concentrated clinical judgment and clinical expertise to ensure this happens. As a representative of nurses and midwives, I am extraordinarily proud of the numbers when I report them internationally.

The number of citizens and other people who live in this country who have recovered from Covid-19 is remarkable. It is exceptional. Although the nurses and midwives whom I represent are very proud, know how to do their job, do it well and to the best of their ability, they are not proud of the manner in which they were treated with regard to childcare in particular, as well as infection. Why is the State resisting the involvement of the Health and Safety Authority, HSA, in examining why infection rates were so high? That is a question we are asked by those workers on a regular basis. Although there may be nothing underneath it, they believe it must be independently examined. This committee should have a say in that regard and insist upon such an examination.

Photo of Michael McNamaraMichael McNamara (Clare, Independent)
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We are out of time, but Deputy Whitmore wishes to make a brief point. I have one question relating to the evidence given by Ms Ní Sheaghdha. She stated that her members were required to return to work notwithstanding being close contacts of people. At that time, were they wearing face masks? Did any of them test positive for Covid-19 subsequent to being forced to return to work despite having been close contacts?

Ms Phil Ní Sheaghdha:

That is the exact point I was making. Those are questions we have posed to the HSE. We now have the statistics, but far more detail is required. This is why the HSA needs to come in and ask these questions.

Photo of Michael McNamaraMichael McNamara (Clare, Independent)
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Ms Ní Sheaghdha believes it is possible that some of her members were forced to return to work-----

Ms Phil Ní Sheaghdha:

We have written to the HSE to ask whether it has examined the number of infections in healthcare workers who were derogated to return to work despite being close contacts. It stated that it does not have that statistical information, but we believe it should have it. Furthermore, we believe that there should be a simple application of the 14-day self-isolation rule for close contacts. It should not matter whether it arises in the health service or elsewhere.

Photo of Michael McNamaraMichael McNamara (Clare, Independent)
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Presumably, the difficulties in this regard resulted from staffing shortages.

Ms Phil Ní Sheaghdha:

Yes.

Photo of Michael McNamaraMichael McNamara (Clare, Independent)
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I thank Ms Ní Sheaghdha. We have no further time for this session. We will need to hold another session to deal with the issue of infection of healthcare workers in particular. That is something the committee will have to discuss. We have been given a significant amount of information today, much of which shocked many members. I thank the witnesses for appearing. Deputy Whitmore has a point or a question. I thank her for waiting and ask her to be brief.

Photo of Jennifer WhitmoreJennifer Whitmore (Wicklow, Social Democrats)
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I thank the Chair for allowing me in. This session was incredibly interesting. It was my first time to attend the committee. Many important points were made and questions asked. As the Chair stated, the rate of infection among healthcare workers is one of the things that will need to be looked at further. A significant amount of the discussion today dealt with issues unrelated to the issues of childcare. That reflects how we arrived at the current situation. Throughout the Covid crisis, children were relegated to a secondary position. Issues relating to children and childcare were not given the focus they required. Childcare was to be the focus of this session and we should reflect on that.

Photo of Michael McNamaraMichael McNamara (Clare, Independent)
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I acknowledge that some of the discussion diverged from that issue. We will have to take account of that. I am conscious that we must vacate the room. I thank the witnesses for providing the information they brought to light today, for answering all of our questions and for remaining with us past the time to which they agreed.

Sitting suspended at 1.10 p.m. and resumed at 2 p.m.

Deputy Jennifer Carroll MacNeill took the Chair.