Oireachtas Joint and Select Committees
Wednesday, 20 May 2026
Joint Oireachtas Committee on Health
Staff Morale in the HSE: Discussion
2:00 am
Pádraig Rice (Cork South-Central, Social Democrats)
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We have apologies this morning from Deputy Cullinane, who has been substituted by Deputy McGettigan, and from Senator Nicole Ryan, who is on maternity leave.
I remind members of the constitutional requirement that members must be physically present within the confines of the Leinster House complex in order to participate in public meetings. I will not permit a member to participate when they are not adhering to this constitutional requirement. Therefore, any member who attempts to participate from outside the precinct will be asked to leave the meeting. In this regard, I ask any members partaking on MS Teams that prior to making a contribution to the meeting, they confirm that they are on the grounds of the Leinster House campus.
The minutes of 6 May have been circulated. Are they agreed? Agreed.
Today, the committee will consider the issue of staff morale in the HSE. It seems to me that every report and survey we have is pointing in one direction: our health services are under-resourced and understaffed and staff morale is on the floor. While no doubt staff numbers have grown in recent years, they have not kept pace with demand, nor have we undone the cuts from the post-economic crash era, including the moratoriums and embargoes, and all that went with it. Instead of learning from the mistakes of the past, it seems we are returning to the era of austerity with the recent recruitment freeze on non-front-line grades in some regions. This crisis in the health service cannot be ignored any more. It is having a big impact on staff and their well-being and morale. It is unsustainable to continue to expect our healthcare workers to do more with less. This is a far cry from the transformation envisaged under Sláintecare.
I am looking forward to this morning’s discussion to tease through these issues around staff morale and staffing issues more generally. To assist the committee in considering these issues concerning staff morale in the HSE, I welcome from Fórsa, Ms Ashley Connolly, head of the health and welfare division, Ms Linda Kelly, national secretary, and Ms Clodagh Kavanagh, chairperson of the divisional executive; from SIPTU, Ms Liz Cloherty, health sector organiser, and Ms Martha Buckley, healthcare assistant; from the Irish Medical Organisation, IMO, Professor Matthew Sadlier, president and chair of the IMO consultant committee, Dr. Rachel McNamara, vice president and chair of the non-consultant hospital doctor, NCHD, committee, and Ms Susan Clyne, CEO; and from the Irish Nurses and Midwives Organisation, INMO, Mr. Tony Fitzpatrick, director of professional services industrial relation, and Ms Sarah Meagher, vice president.
On privilege, witnesses are reminded of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable or otherwise engage in speech that may be regarded as damaging the good name of a person or entity. Therefore, if their statements are potentially defamatory in relation to an identifiable person or entity, they will be directed to discontinue their remarks. It is imperative that they comply with any such direction. Members are also reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the Houses or an official by name or in such a way as to make him or her identifiable.
To commence today's proceedings, I invite Ms Connolly to make her opening remarks.
Ms Ashley Connolly:
I thank the committee for giving us the opportunity to address members in relation to what is and can only be deemed a crisis in the health service.
Fórsa represents clerical administrators and health and social care professionals and has over 35,000 members.
The report by TASC, funded by the health and welfare division of Fórsa, presents a stark warning about morale across Ireland’s health and social care workforce. The research is based on a substantial evidence base in view of the fact that 3,775 workers responded to a national survey and 24 workers took part in focus groups. For members of this committee, the central message is clear: low morale is not a marginal staffing issue, it is now affecting retention, service capacity, patient care and confidence in the delivery of Sláintecare. It is not enough for the committee to receive and internalise the report; specific actions must now be pursued.
The report's executive summary shows the scale of the problem. Almost half of respondents said they often or always feel burnt out by work. A total of 68% said they had experienced illness caused by work-related stress. More than three quarters reported frequently thinking about leaving their role, and 67% said they are considering leaving. On workplace recognition, 54% were dissatisfied with the recognition they receive for good work, while 62% were dissatisfied with the extent to which their organisation values their work. Confidence in reform is also low, and 78% felt staffing levels are inadequate to deliver the community-centred model of care promised under Sláintecare.
The lived experience behind these figures is captured in the report’s direct testimony from members. One worker said front-line staff feel that they are shouting into a void, reflecting a strong sense that senior management is disconnected from day-to-day realities. Another said, “The people who sit at the top don’t actually understand what’s going on down on the floor”, while another described the effects of current pressures bluntly by saying, “Staff are burnt out to a degree that I have never seen before.” Members also linked understaffing directly to service failures. One participant stated:
If you don’t have an admin person there the clinics are not booked, clinics are not cancelled. If somebody goes on maternity leave, they’re not replaced.
Another warned that goodwill is running out: “My staff can stretch if there’s light at the end of the tunnel, but that light has gone out.” I will hand over to my colleague Linda Kelly to continue.
Ms Linda Kelly:
The recommendations in the report are practical and high level. First, staffing levels should be based on assessed local need, with routine cover for maternity leave and faster recruitment processes. Second, retention strategies should focus on manageable and sustainable workloads in order that experienced staff remain in post. Third, pay equity should continue to be improved, especially for workers in the community and voluntary sector. Fourth, worker voice should be strengthened through a more consultative culture, so decisions are informed by front-line experience and evidence.
The report captured the views of our members at a time when we were in the midst of challenging the brutal, blunt instrument of the pay and numbers strategy. It is only fair to warn the committee that things have not improved since then. In fact, they have worsened significantly. We are back to a situation where three regions have formally introduced a recruitment embargo with no clarity on who is and is not included.
In the area of primary care, the HSE and the Department of Health have agreed a plan to outsource core work usually carried out by our physiotherapist, speech and language therapist and occupational therapist members to address gaps created by the previous embargo. As predicted, agency spend has risen year on year since 2023 and now averages €80 million a month. These services cost around 30% to 40% more, and the stop-start approach is driving up costs while benefiting private for-profit companies. It proves the current budget and staffing strategy simply is not working.
The report tells us what we all already know, namely that understaffing, poor retention, weak consultation and pay inequities are creating a vicious circle. Experienced staff leave, pressure grows on those who remain, morale falls further and services become harder to sustain. We are asking everyone here on the health committee to break that cycle. Sláintecare – and the cross party approach to Sláintecare – was a significant, once-in-a-generation decision made by the members of a previous health committee as political leaders. Staff and citizens now need them to go one step further and agree a different approach to funding our healthcare system. We need to urgently move to a multi-annual funding system that is based on the needs of our population and not an arbitrary number decide by the Department of public expenditure. If members fail to do that, we will all have failed to realise the promise of Sláintecare.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank Ms Kelly and invite SIPTU to make its opening remarks.
Ms Liz Cloherty:
I am sector organiser in SIPTU health division and I am accompanied here today by Martha Buckley, who is a healthcare assistant in a long-term care facility in County Cork. On behalf of SIPTU health division, we thank the committee for the opportunity to meet today.
SIPTU health division represents over 42,000 members who provide and invaluable service working in public and private healthcare settings across Ireland. Our membership includes healthcare assistants, support staff, mental health nursing, allied health professionals and National Ambulance Service staff. We welcome the opportunity to address the Joint Committee on Health and present our submission on staff morale in the HSE. The objective of our submission is to highlight the experience of our members working in the health service and to inform the committee on the key issues which have been identified by our members as leading to an increasing depletion of staff morale within their workplace. Our submission focuses on six key sections.
The first is health service demand and the HSE pay and numbers strategy. Ireland’s health system continues to face significant capacity challenges due to Ireland's ageing population, workforce shortages and infrastructure deficits. This applies considerable pressure within our health service, where demand continues to outpace supply and the burden of providing safe care in a challenging environment is shouldered by staff across the HSE. In addition, the HSE pay and numbers strategy provides a ceiling once budget and whole-time equivalent employment levels are reached. While the budget has now transferred into the six health regions, it has been our experience discretion is being used to prioritise some grades over others and is effectively placing certain categories of staff at risk of outsourcing due to this strategy. This is despite demand levels increasing and areas continuing to be under-resourced, which is leading to staff burn-out and risks to patient safety. Many services and grades contribute to the journey of the patient in healthcare. Prioritising one job over another creates risks to both jobs and services. Public sector healthcare should be provided directly as opposed to being commodified for businesses to increase their profit margins.
On safe staffing, while there is a safe staffing and skill mix framework in place for nurses and healthcare assistants in acute settings and work is underway on the framework in long term residential care, LTRC, settings, a safe staffing framework does not exist for all other grades who work in the HSE. There is no understanding of what the minimum level of staff should be or how low staffing can go, to be deemed unsafe. This leads to uncertainty amongst staff, unsafe working conditions, burn-out and undermines the ability of staff to provide safe care.
On staff engagement on workplace changes, the information and consultation agreement between the HSE and existing employees serves to ensure that employees receive the information to which they are entitled, to guarantee consultation occurs prior to decisions being made which affects them and commits to staff involvement in change processes. Despite this agreement being in place, our members have repeatedly raised issues regarding workplace and work practice changes being made without consultation or their involvement. This results in reduced staff morale, distrust with management and workplace stress for employees.
On our members roles and responsibilities, our submission highlights the experience of our members roles evolving and responsibilities expanding over time without appropriate recognition. This is leading to role dissatisfaction, lack of clarity, increased workplace stress and, ultimately, attrition, with people seeking better paid alternatives. In addition, our submission outlines areas of dissatisfaction highlighted by our membership, particularly in relation to career progression opportunities. This is leading employees to feel stagnant in their roles and to a higher level of turnover in critical areas of the HSE.
In addition, there are issues in relation to pay and conditions of employment. The cost-of-living crisis has dramatically impacted all workers across Ireland.
Approximately 78% to 79% of the HSE workforce are women. Many of them are faced with childcare costs and did not feel the benefit of public sector pay increases. In addition, community mental health nurses, healthcare assistants working in home support and members working across the disability sector have been disproportionately affected by the rising fuel crisis while working in the HSE. This is due to the requirement to use their own vehicle in the course of their duties. The current Civil Service mileage rates are not sufficient to cover the cost of wear and tear on vehicles in addition to the rising fuel costs. This is placing additional stress and financial hardship on employees.
Many factors can lead to low staff morale in the workplace. It is imperative we collaboratively engage to ensure staff feel safe, supported and valued, which will ultimately result in a better health service. Our submission has tried to focus on key areas that broadly represents issues raised by our members on their experience of low morale while working for the HSE. We have provided more information within our submission and we are happy to answer any questions you may have.
Pádraig Rice (Cork South-Central, Social Democrats)
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Thank you very much. I invite the INMO to make its opening statement.
Mr. Tony Fitzpatrick:
A Chathaoirligh and members, thank you for the opportunity to discuss the very important issue of staff morale in the healthcare system. I am joined by Ms Meagher, a second vice president, Ms Meagher, who is a GP liaison nurse in Letterkenny University Hospital.
Nurses and midwives are the largest professional group within the health service and are central to the delivery of safe, effective and compassionate care across acute and community settings. They provide care in some of the most demanding, pressurised and often emotionally charged environments within the health system and are highly skilled at responding to complex clinical situations, including emergencies, trauma, end-of-life care and periods of sustained operational pressure. However, while nurses and midwives are trained to work in high-pressure environments, sustained exposure to unsafe staffing levels, excessive workload, workplace violence, overcrowding and inadequate organisational support is having a significant impact on staff morale, well-being and retention. These pressures not only affect the welfare of nurses and midwives themselves but also have implications for patient safety, service quality and the long-term sustainability of the health service. Healthcare worker assaults have previously been discussed by members of this committee. Over 12 nurses and midwives per day are assaulted physically or verbally in the workplace. The impact of this on an entire team across our acute and community settings cannot be ignored.
I draw the committee's attention to the recently published WHO Europe mental health of nurses and doctors, MeND, report. It should act as a serious warning to policymakers. The report has specific data regarding Ireland but looked across the WHO Europe region. It found one in three nurses and doctors reported symptoms of depression or anxiety while more than one in ten reported thoughts of self-harm or stated they would be "better off dead". These findings are not abstract statistics to Irish nurses and midwives and need to be heeded. The INMO surveys our members annually across a range of workforce and workplace issues. Over recent years, the findings consistently point to a workforce operating under sustained pressure, driven by increasing service demand - which occurs yearly - staffing shortages and the ongoing impact of the pay and numbers strategy. The latter has not gone away and has even come to the fore again in recent weeks. Members continue to report high levels of stress, burnout, workplace dissatisfaction and concerns regarding their psychological and physical well-being.
Nurses and midwives work in complex, fast-paced clinical environments that require a high degree of professional skill, judgment and adaptability. However, evidence shows it is not the clinical nature of the work that is the primary driver of stress and burnout but rather unsafe working conditions, inadequate staffing levels, excessive workload and preventable adverse events. These are something that are occurring too often now in our healthcare system. The evidence linking safe staffing to patient safety, staff well-being and retention is now well established all over the world as well as in Ireland. Appropriate staffing levels, safe skill mix and manageable workloads are essential to delivering safe, high-quality patient care and improving patient outcomes. Conversely, inadequate staffing is consistently associated with lower job satisfaction, increased burnout, stress, absenteeism and higher staff turnover. The recent INMO survey demonstrated the extent of those concerns. In 2026, 67% of respondents stated that current staffing levels and skill mix in their area did not meet clinical or patient demand. Almost half reported patient safety was put at risk "very often" or "always", while a further 39% stated that patient safety was "sometimes" put at risk. Only 3% of respondents stated patient safety was never put at risk in their workplace. Burnout in nursing and midwifery is not a personal failing of any of our members. It needs to be considered as seriously as an occupational injury, although one born out of chronic short-staffing. There are a number of surveys but I am conscious of time.
The gap between the care we know is right versus the care that the system permits is a huge driver of burnout. Addressing burnout means addressing those gaps. Our members continually report moral distress where they cannot meet the demands of the service they are trying to deliver. Recruitment is far too slow within the process and, as legislators, members have a role to play in increasing the morale of our members. They can do so by underpinning safe nurse and midwife staffing levels with legislation. The only way to ensure safe staffing is a given is to pass and enact the patient safety (licensing) Bill in order to give HIQA more powers, including the right to measure staffing on duty against the recommended safe staffing levels set out in the frameworks that are already government policy. We again call on the committee to use its powers in that regard.
We met some Oireachtas Members last week about our members working in the healthcare system who are from overseas, especially the African continent, having excessive delays of up to two years for family reunification. That is an issue that also needs to be addressed to increase morale.
Pádraig Rice (Cork South-Central, Social Democrats)
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Thank you very much. Last of all, I invite the IMO to make its opening statement.
Ms Susan Clyne:
The IMO thank the Chair and the committee for the invitation to discuss issues relating to morale.
Morale matters. It impacts performance, trust, professional relationships and the physical and mental well-being of employees. Ultimately, it also impacts patient care. Highly skilled and deeply committed doctors go to work every day wanting to provide the highest quality care possible. However, too often they are prevented from doing so by systemic deficits in staffing, capacity, infrastructure and resources. These pressures negatively impact patient outcomes and the ability of doctors to practise safely and effectively.
To provide the committee with a clear evidence-based picture of morale among doctors, the IMO undertook a survey of consultants, NCHDs and public and community doctors working across all HSE regions and CHI. We also examined the factors driving low morale. The findings are staggering. Some 94% of doctors report low to moderate morale and of these, 67% say morale has disimproved in the year, with two thirds reporting low morale is negatively impacting on their mental and physical well-being. If results of this scale emerged in any other sector, there would be immediate action to understand the causes and to take measures to address them. That urgency is too often absent within our health services and we consistently fail to understand or address the multifactorial issues besetting our services and instead seek to focus on narrow issues and cost containment. When we examined the factors driving low morale, doctors identified the following key issues: 90% of them report increased demand without matching resources; 58% are working long and unsafe hours - and very often illegal hours; 64% report unsafe staffing levels within their medical teams; 67% cited poor work-life balance; and 70% are concerned about an increasing focus on productivity and discharge targets over patient outcomes and quality of care. Some 65% are working with outdated IT systems that are not fit for purpose.
Patients are facing long waits for care and they are too often being treated in overcrowded and inappropriate treatment environments. Consultants and medical teams face enormous challenges caused by inadequate bed capacity, access to diagnostics and poor clinical space. Hospitals are operating under sustained pressure, with elective care routinely cancelled or delayed. Doctors are trying to manage unsafe patient volumes without sufficient staffing or infrastructure to deliver timely and effective care. Some four out of every five doctors do not believe the physical work environment or available resources are adequate to deliver patient care.
None of these problems are new but they are worsening for doctors and patients. We can all agree that value for money matters, that productivity matters and that expanding our health services matters. However, these goals cannot be achieved without addressing the fundamental problems around safe staffing levels, adequate capacity, modern infrastructure and a medical workforce that is supported to deliver high-quality care. The Government must move to multi-annual budgeting for the health services and begin with a realistic budget.
Recent cost containment measures announced by the HSE have generated significant concern among doctors. Almost all respondents believe these measures will negatively affect patient services. They have also created considerable anxiety among NCHDs regarding career progression and job security. NCHDs are particularly vulnerable. Most are employed on short-term six-month contracts, and non-training stand-alone posts account for approximately 40% of the total NCHD population. We already hear reports of difficulties for NCHDs securing these stand-alone posts in July. This is the same group of doctors most exposed to unsafe staffing levels and excessive working hours. Many are still working shifts of up to 24 hours and are routinely required to work additional shifts at short notice because hospitals have been unwilling to secure locum cover for sick leave, maternity leave or rota gaps. This is not sustainable, it is not acceptable and, in many cases, it is illegal.
We know the problems and we know many of the solutions but what is lacking is the long-term vision, investment and workforce planning required to make our health service fit for purpose. The Department of Health recently produced a workforce paper but without a fully resourced implementation plan it is meaningless and lacks any credibility. Debates about record health budgets, overspending and productivity targets often fail to reflect the lived reality facing doctors and patients every day. Numbers tell one part of the story but the lived experience tells the rest. One doctor told us there are "Ever-increasing meaningless targets with no consideration for the reality of treating patients - no interest in outcomes, only throughput." Another said, "I am constantly stressed. It feels like going into battle every day trying to deliver quality care and keep patients safe." These voices should concern all of us because they reflect a health service where staff are exhausted, patients are not receiving timely care and goodwill is being stretched to its limits. Without meaningful engagement on safe staffing, bed and diagnostic capacity and retention and working conditions, morale will continue to decline and patient care will continue to suffer.
Pádraig Rice (Cork South-Central, Social Democrats)
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We will now move to questions and answers from members. We will move through an agreed rota of the various parties. Each member will have nine minutes for questions and answers. We will aim to take a break in about an hour and if there is time members will have a second round of questions.
Martin Daly (Roscommon-Galway, Fianna Fail)
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I thank the witnesses for attending today. This is an extremely important topic. What keeps coming back in all of the presentations is levels of staffing, capacity, infrastructure and resources. I want to reflect on the number of young Irish doctors who leave these shores and go to other jurisdictions, most especially Australia, for a number of years. Many of them come back but some do not. A recurring theme when we speak to them is the culture in Australia in the hospital and healthcare settings where they work. For example, my son went to Australia. I asked him what is the difference between Ireland and Australia and he said he was working in an emergency room where there was access to senior decision-makers who may be SHOs, registrars or consultants, adequate staffing in departments and a culture where people are encouraged to contact more senior decision-makers when they are in trouble. I ask the IMO to respond to this.
Ms Susan Clyne:
We now see about 60% of interns leaving the Irish system after intern year. This level is growing and increasing. Many stay away for longer periods. They are also leaving at various stages of the training scheme. Cumulatively this is having a huge effect, where doctors are not coming back into the system. Unsafe staffing, long working hours and the amount of stress are the key drivers. I will ask Dr. McNamara to speak about our NCHD colleagues, who feel a moral hazard going into work. They feel unsafe. They are concerned about the negative incidents and adverse events that will happen. As Deputy Daly knows, very often they are in charge of huge numbers of patients in the hospital system without adequate staffing. Dr. McNamara will speak a little further about this.
Martin Daly (Roscommon-Galway, Fianna Fail)
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I have an additional question which might address this. Do we rely on a model where the Irish State spends considerable amounts of money educating young medical graduates for export and we have to import doctors from other jurisdictions to carry out the day-to-day work of our health service?
Martin Daly (Roscommon-Galway, Fianna Fail)
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Our system is reliant on a large number of doctors we have to bring in from other jurisdictions and we are not retaining and recruiting the people the taxpayer spends a lot of money training here.
Martin Daly (Roscommon-Galway, Fianna Fail)
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This applies to nursing and allied health professionals.
Martin Daly (Roscommon-Galway, Fianna Fail)
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Yes, absolutely.
Ms Susan Clyne:
However, most of these graduates are in the NCHD category and we simply do not have enough consultants. The Hanly report from more than a decade ago suggested we should have double the number of consultants and half the number of NCHDs yet we still flood the system with NCHDs without investing in consultants.
Dr. Rachel McNamara:
I thank Deputy Daly and I will pick up on his point on safe staffing in particular. I remember vividly sitting on a ward and crying about 15 or 16 hours into a 24-hour shift because I was so deliriously tired that I was afraid my next decision would end up killing someone. This is the reality for doctors sitting in hospitals up and down the country. Model 2 and 3 hospitals are staffed by a single individual overnight. This is a situation that cannot be allowed to continue. This is the key safety issue. When will look at all of the incidents of high-profile litigation and horrific outcomes for patients and families, I do not think there has been a single one where safe staffing has not been a key driver and a single point of failure, with one clinician operating out-of-hours or in an emergency department under particular pressure. This is the key issue causing the exodus, causing people to leave not only the country but the profession entirely. They get so far in a training scheme, with a lot of investment and a lot of time invested by that individual and the State, but it is not tenable for them to continue in the role.
Martin Daly (Roscommon-Galway, Fianna Fail)
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I am on a tight clock.
Martin Daly (Roscommon-Galway, Fianna Fail)
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I appreciate the answer and I appreciate Dr. McNamara's personal experience, which is something that is a recurrent personal experience when I listen to young doctors. One of the big issues in the system for young doctors, nurses and allied health professionals is the lack of digitalisation in our health service. Under the European Union's Digital Decade and the European Commission's Digital Compass 2030 we are supposed to have fully digitalised patient records. Ireland is not simply in the middle of the table, it is an outlier it is so far behind. Only five of our 47 public hospitals hold a functioning electronic record system. This is in a country where we are a leader in social media and IT. With regard to many other Government services, such as Revenue collecting money and other Departments, we are leaders or lie mid-division in the EU but in healthcare the Department of Health and the HSE have allowed the situation to develop where we are an outlier. We are simply off the charts in terms of digitalisation. I am on a tight timeframe but what difference would a proper functioning electronic record system make to doctors, nurses and allied professionals in our healthcare settings?
Ms Susan Clyne:
There is a huge problem. The systems are antiquated. There are multiple systems to log onto before we can see a patient record. A key issue is that the patient record needs to be from the community through to the hospital. We are decades behind. Doctors and all of our colleagues read about AI and hear the HSE lecturing on AI but we are so far away from AI; we cannot even get functioning computers in the hospitals.
I think both my colleagues would speak on this to their own experience.
Professor Matthew Sadlier:
I will briefly come back to Deputy Daly on the issue of doctors leaving the country. I disagree with the concept that we are training doctors for export. We are a small country. We have one university in the top 100 in the world. Doctors do need to leave the country to get experience. This issue is doctors coming back. It is not the issue of doctors leaving. While we always had a large number of interns going to Australia, we had a large number coming back but the fear now is that number coming back is getting smaller and smaller. That is the main problem there. We need to be more creative. We need to look at Australia. We need to look at reciprocal training arrangements. We need to look at encouraging doctors from other countries to come here while our doctors go there to get mutual experience. However, that lack of creativity in central HR in the HSE is just mind-boggling.
The second thing is on digitalisation. We did a project recently where we looked at the records in St. Brendan's Hospital from 100 years ago. They were completely the same as they are now. You could have walked into an Irish hospital in the late 19th century and your medical information was recorded in exactly the same format as it is today. It is absolutely crazy. There is no political leadership to actually press a button. Whatever system is introduced will not be perfect but at least it will be something, so something needs to happen.
Martin Daly (Roscommon-Galway, Fianna Fail)
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We have a situation where we have highly trained doctors, nurses, allied health professionals and administrative staff running around the hospital with paper records after receiving electronic referrals from GPs in the community. We also-----
Martin Daly (Roscommon-Galway, Fianna Fail)
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We also know that the new children's hospital has a different operating software system than St. James's Hospital on the same site, with no interoperability. That is a fact.
I thank the witnesses for their answers. I appreciate it.
Dr. Rachel McNamara:
I will add a final point on chronic underinvestment. We are still not at a 1% healthcare spend on digital. The strategy sets out that we need to be spending 2% to 4%, at a minimum, and that is to stay steady, not to catch up. We are dealing with hundreds of systems on a daily basis and they do not speak to each other.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank Dr. McNamara very much. Our next speaker is from Sinn Féin. Deputy McGettigan is substituting for Deputy Cullinane.
Donna McGettigan (Clare, Sinn Fein)
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I thank all the witnesses for coming in today. It is a very important issue. I am sure low morale in staff is not an easy issue to speak about.
I will go to Fórsa. In its view, is an embargo an effective way to manage budget overspend?
Ms Linda Kelly:
I would say it is probably as effective as using a sledgehammer to swat a fly. That is really what is happening. The impact of the embargo is creating huge structural problems within the health service staffing pipeline. We know already from the last embargo that was health service-wide that it slowed down recruitment, which was already not very fast, to a point where it can now take between nine to 12 months - it was six to nine months previously - to get somebody from advertisement into post. We also query how useful it can be when we know, even based on the HSE's pay and numbers strategy, that it did not fill all of its funded posts last year. If it did not fill all of its funded posts and it is still funded this year, what is the purpose of the embargo? It is around robbing Peter to pay Paul. It is not actually helping to address the budget.
What we have seen consistently as well over the last number of years since the embargo was introduced is that it slows down recruitment and stops critical posts from being replaced and the agency spend then increases. Initiatives to privatise core services have increased. I am very frustrated when we are in talks with the employer. We ask if the money is being spent in agency and there is an issue with direct employment, can we not address this? We are told that it is a different budget. These are paper-based budgets. I do not think it is a credible response from us as senior decision makers in a country where we are all invested around high-quality public service provision that we cannot move something from one budget line to another if it means providing a better core service in a more sustainable way.
Donna McGettigan (Clare, Sinn Fein)
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Fórsa mentioned in its opening statement a figure related to agency spending. Will someone expand on that and advise where the data came from?
Ms Ashley Connolly:
This was shared with us by the employer. In essence, when people enter into a contract with the agency companies, there is an overhead or overhang. It is between 8% to 18% and then VAT has to be added, so it ranges from being 31% to 41% more expensive to bring staff in via an agency company. That has been shared with us. That is in comparison to direct employees. In addition, that is not capturing the number of management private consultants who are also being brought in to do stuff like focus groups and surveys, which is work that can easily be carried out by direct employees. We share the concern, as in this money should be directed towards better patient services. It is unacceptable that we continue to have conversations about private companies profiting off the back of the health services, yet we see services not being delivered in the community and in the acute setting.
Donna McGettigan (Clare, Sinn Fein)
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I will move to SIPTU. It has called for a safe staffing framework for all health grades, not just nursing and healthcare assistant, HCA, grades. What would that process look like and how should it be implemented?
Ms Liz Cloherty:
I thank the Deputy for her question. What we are looking for is an evidence-based safe staffing framework that would be applicable to all grades across the health service. Currently, there is one in place, as the Deputy knows, for healthcare assistants and nurses in the acute settings. There is one under way in the long-term residential care settings. There is currently nothing in place for all other staff who work across the health service. They are generally based on old reports. If we look at radiation therapists, their present staffing requirements are based on a report from 2004 and are significantly outdated. What we are looking for is proper research to be put in place that would provide an evidence-based safe staffing framework for all grades.
There are many disciplines that contribute to patient care in our health service including, as the Deputy knows, the transfer of patients by our porter staff, the catering staff who feed the patients and the domestic staff who clean our hospitals, all of whom are forgotten. What we have seen with the blunt instrument of the pay and numbers strategy is that certain grades are prioritised over others now that the budget has transferred into the regions, which means there is a move to outsourcing these grades. There is nothing in place to tell us, for example, how many porters or catering staff are needed or how many old reports, as we said, in terms of the diagnostics. This is leading on a continuous basis to work overload, staff being under pressure and, ultimately, attrition for more services.
Donna McGettigan (Clare, Sinn Fein)
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What are the barriers to moving to a 24-7 health service and how should we get there?
Ms Liz Cloherty:
The barrier to moving to a 24-7 health service is problematic because staff continue to be asked to do more with less. For example, when we look at moving to a seven-day service, this is not an issue of, say, our members moving. It is simply that we do not have the resources. Again, that comes back to the pay and numbers strategy. Ultimately, if we are asking staff to move to an 84-hour work week, we need to increase the staff, which is not happening. We might look at the public commentary that is out there that machines are laying idle after 5 p.m. or people are doing cartwheels in our hospitals at weekends, all of which have been comments made in the public domain, when the fact is the staffing is not there to provide the services. We are asking staff to do more with the current resources and then putting a cap in place when we are trying to recruit. When line managers are even being asked to change the rosters to a seven-day service, that can only be done where we are adequately putting in the resources to do so.
Donna McGettigan (Clare, Sinn Fein)
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I will move to the IMO. What changes in reforms and investment would have the greatest immediate impact on doctors' morale and patient flow?
Ms Susan Clyne:
It is around staffing and bed capacity. Picking up on the comment, there is a lot of targeting of healthcare workers and doctors, in particular, that they are an obstacle to providing extended services. Doctors are on call 24-7, as many of our colleagues are. They are on shifts at that time, but there are not enough staff. If somebody is brought in on Saturday for a discharge round and he or she is due to run an outpatient clinic on Monday, that clinic will be cancelled. This will happen until we have the critical mass of staff. We are way below the OECD levels of staff across all doctor grades and we simply do not even have the physical infrastructure or number of beds and clinical space. Picking up on the comment, it would be a joy for many of our members to have corridors where they could do cartwheels because very often, they are actually treating patients in corridors.
Donna McGettigan (Clare, Sinn Fein)
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Gabhaim buíochas le Ms Clyne. The IMO reports that most doctors are concerned about productivity and discharge targets being prioritised over patient outcomes. What specific targets or management practices are driving unsafe decisions and how should they be redesigned?
Professor Matthew Sadlier:
It all comes back to the capacity issue. It all comes back to the fact that the solution to the capacity issue seems to constantly be faster discharges from hospital, this construct that half our hospitals are filled with people who should not be in hospital and a concept that community services are a substitute for hospital care. It all comes from the mythology that ultimately evolved out of Sláintecare. We need more hospital beds. We have almost the same number of hospital beds that we did when we had a much smaller population. Our hospital bed numbers have gone from 11,000 to 12,000 while our population has gone from 3.5 million to 5.5 million. That just does not work out.
We had the Hanly report, which has been mentioned, which is two and bit decades ago. It stated if you want to move to an effective hospital system, some very difficult political choices have to be made. You have to maybe consolidate some of the smaller hospitals to create hospitals that have the size that are able to do it but there was not the political will, either in opposition or in government, to achieve that goal. That goal has to be achieved. You cannot run weekend services in a hospital where you have three doctors. You could not even dream of running seven-day services in a level 2 hospital. In most level 3 hospitals, it would be an impossibility. Some of the level 4 hospitals are able to do it because they have the weight of numbers.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank Professor Sadlier. We are over on time on that. I thank the Deputy. The next is a Fine Gael slot. I call Deputy Roche.
Peter Roche (Galway East, Fine Gael)
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First, the witnesses are most welcome. I thank them for the opening statements by the four contributors.
Across all of the statements, there are a number of constants. One is that the facts that have been presented to us today are quite stark and quite worrying. When we talk about staff morale and staff burnout, retention, staffing shortages and all the stuff that goes with it, I am reminded of patients waiting at home for a medical appointment, patients who got a medical appointment that was cancelled and the patients in hospital. God knows, I am sure, many of them would be sheltered from seeing exactly what has been suggested here today. What worries me is that given all of what the witnesses have said, it seems that either few attempts have been made heretofore in terms of engaging the Department on the issues or else it is completely ignoring the facts. That is what I am annoyed about. If half of what the witnesses have said is true, we have a crisis. This committee is the only vehicle by which we can get that issue aired. Some day it would be wonderful, but I suppose would not be acceptable, were the Department's officials on that side of the room to hear exactly what the witnesses were saying and somewhere in between, there would come a fix. One issue I have been hearing about for the longest time, and it has come out here as well, is that when somebody goes on maternity leave or even extended maternity leave or when someone goes off sick, there is no replacement for him or her and you wait until that person comes back. That system is appalling. It is completely wrong. Given the crisis, there is no hospital that is not busy. There is no staff member who is not running around; I will not say "doing cartwheels on corridors". It behoves us to take responsibility and take what it is that the witnesses are saying to the Department because we cannot keep pretending that it will go away.
Ms Liz Cloherty:
Can I come in on that point? It is really just to highlight that the public commentary is simply not true. To go back to that issue of moving to a seven-day service, our members provide that service, whether it be through overtime or being on call, but the reality is that blunt instrument of the pay and numbers strategy is where you put your caps in place. Ultimately, what happens is once they reach that cap and whole-time equivalent, it then moves to the outsourced model because anything that you are employing through the outsourced is deemed as non-pay whereas direct employment is deemed pay. It is to highlight that point.
To come back on the maternity leave point as well, when that remains unfilled - maternity leave is completely predictable given the workforce being predominantly female - only a small percentage of it is accounted for in the budget. All of that additional workload continues to fall on every grade within the HSE. It is aspirational to try to move to the seven-day services. I would point out that they are being provided but are being provided under increasing workloads by staff or are outsourced. The budget needs to be fit for purpose going forward to have a safe staffing system across all of the grades in the HSE, which would ultimately lead to better health outcomes for all.
Ms Martha Buckley:
Can I refer to Deputy Roche's comment? I have been a healthcare assistant for 20 years. The Deputy spoke of the staff, doctors, nurses and carers and aligned personnel being sheltered from what they are seeing. I can tell the Deputy that healthcare assistants are not sheltering from the crisis in hospitals in Ireland. They can see families' patients in a bed, an elderly person in an accident and emergency unit, a nursing home or anywhere in Ireland. The staff do not shelter from what is going on. We cannot. We do not have the time to shelter. They can see a rushed healthcare assistant who is the heartbeat of any hospital or nursing home, and the passion that we have for the residents that we care for. We do not shelter, hide away or try to protect the crisis. They have to see the crisis that is going on in Ireland at the moment. We do not shelter away from it.
Ms Linda Kelly:
The Deputy's comments are reflective of what most of us as taxpayers feel, that is, this is a system that is beyond redemption in terms of how it is currently set up. However, I want to clarify that the Department is fully aware. The Department has been provided with our report. All of us here, as the staff panel of trade unions, meet the Department of Health, as well as the HSE, at the national joint council. We have put forward these concerns until we are blue in the face. The instruction from the Department of public expenditure is that your budget is your budget and that is your primary concern.
That is why when we sat down to look at our statement, there are two priorities for the committee. The current budget system is set up to fail. It does not set up the HSE to succeed. You could predict that the incoming CEO of the HSE was going to have to come out about the budget because it happens every year. We are all used to it. We are all almost becoming a bit immune to it. We need to move to a different funding system if we have any hope of changing the system.
On my colleague's point, the HSE has the largest workforce in the entire State. It also has the largest female workforce and there is no standard provision for maternity leave. That is an absolute disgrace to this Republic in 2026. It is not a workplace that is kind to women in that regard. In the Department of education, if a teacher decides to start a family and goes on maternity leave, they are automatically replaced. Why is there one rule for one Department and sector and another rule for healthcare? It does not make sense.
I appreciate the Deputy's comments so much because they are reflective of what the general population feels. Those two issues have to be tackled.
Peter Roche (Galway East, Fine Gael)
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What stood out for me was the agency costs of €80 million a month.
Mr. Tony Fitzpatrick:
The issue with that is this pay and numbers measure. It is not a strategy; it is a moratorium. It is not a strategy that is good for patients or good for the staff working within the service. Going back to the safe staffing component, we have a framework from 2018 for medical and surgical wards. We have a framework from 2022, for emergency departments, for nursing and healthcare assistants.
The issue then is with regard to the implementation. This is not unique to nurses or midwives, and it also applies to doctors, allied health professionals and all of the support grades. The research from around the world shows that when there is sufficient staffing in place, many other things are better. Money is saved in the long term, there is no need to spend money on agency, staff morale is better, there is better job satisfaction, the intention to leave certain grades decreases and burnout is reduced. It is better for the patients and better for the staff. It is a no-brainer.
Reference was made to Australia. Several states in Australia have legislated for safe staffing. An Irish nurse who goes to Australia and works in a medical ward knows that she will look after no more than five patients. It is one nurse to five patients. The outcomes for those patients are way better, and the nurse enjoys going to work and being able to deliver safe care. All of the Australian states have done that. We have the legislation. It is time that we legislated for safe staffing and ensured that when patients go to our hospitals or community care areas, they have the staff that are required. They should have the best staff, whether it is a nurse, a midwife or a doctor, to meet their needs and look after those patients.
Pádraig Rice (Cork South-Central, Social Democrats)
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Thank you. I have several questions. The evidence presented to us this morning is alarming in terms of the conditions facing nurses, doctors, healthcare assistants and workers across the healthcare system. It should be setting off alarm bells in the HSE and the Department of Health. I really hope that this morning's session is the start of a change process, and that the Minister, the officials and the new CEO of the HSE are listening. When they come before us again, we will talk to them about these issues, because they are really important. It is clear that staff morale is on the floor, and this also has a huge impact on staff well-being. Staff are being spread paper-thin, and it is not good enough. It is affecting staff, but it is also affecting patients and citizens, and impacting outcomes across the board. It needs to change.
It is interesting to hear again and again the reference to the need for multi-annual budgeting. This was promised by the Government back in 2016. A decade on, it is included in the new programme for Government, and we constantly hear commitments from the Government, but there is no actual delivery. At a household level, people use multi-annual budgeting. When people are buying a car, they ask if they can afford the repayments on a car loan over three or five years. If they are deciding to go to college, they ask if they can afford the student fees over a three- to five-year period. We should be budgeting for the health service on a multi-annual basis and doing that planning. We should also be devolving powers to the regions to make decisions, so local regions have financial control and can provide the staffing and services at a local level.
It is also concerning to hear the repeated reference to increasing privatisation within the health service. It is an issue that is not aired enough or discussed enough, and there is no spotlight on it. I am glad that the witnesses have raised it this morning.
I have a number of questions for each of the witnesses. I will start with Fórsa and, in particular, the recent announcement on the freeze of recruitment for non-front-line workers. What impact does Fórsa think that will have on the workers it represents? Has Fórsa been told what grades and roles are included in that? Has there been any engagement from the Minister or the HSE? It would be good to get an update on that. There is a lack of information on the impact this will have and what particular grades it will impact.
Ms Ashley Connolly:
We were not made aware in advance that this notice was to issue and, in fact, it was our own membership who alerted us. We have addressed that with senior management in the HSE. We have sought clarity regarding this constant rhetoric concerning critical versus non-critical posts, and who determines what is critical and what is not. We have asked the HSE to provide us with clarity, and we still await that clarity.
It was very disappointing that as we were engaged in the Workplace Relations Commission, following on from the Labour Court recommendation, this announcement was made. We have extreme concerns about the stop and start of recruitment, and the impact it is having. If we look at community care, the ESRI published a very interesting report yesterday that has shown what is needed for the delivery of community care as we become an ageing population. Does anybody think that we are preparing to ensure those thousands of additional staff are available?
The stop-start recruitment means people are asking whether they will have a future career in the HSE. They are asking whether they should even enter the HSE. It seems like a basket case. It does not know whether people can stay or cannot stay. People ask if they will get permanency or not. This is driving down retention, of that we have no doubt.
One of the things that was very prominent at our conference last year, when we launched this report, was that our members came up and said they felt heard for the first time, because their employer is not listening. There is a lot of concern in the three regions that have gone into tier 3, while the other three regions remain in tier 1. There is a lack of clarity about what that means. To be honest, it was very disappointing for Fórsa to see management and administration again being targeted or identified as an individual group. No one in the health service can work without the others. It is a multidisciplinary service. It requires all members to work cohesively to deliver patient services.
Pádraig Rice (Cork South-Central, Social Democrats)
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Perhaps we can write to the HSE and the Minister to get clarity as to who is affected and to get an update on that. There is a lack of clarity.
It would be great to hear from Ms Buckley on her experience of the role of healthcare assistants. There was a lot of discussion this time last year, when the "RTÉ Investigates" programme came out, on the issues of staffing, training and morale. It would be great to hear Ms Buckley's experience and that of other workers.
Ms Martha Buckley:
As a healthcare assistant for 20 years, I have seen the good, the bad and the ugly, especially during Covid when we were in dire straits. The Government gave front-line workers applause, but front-line workers and healthcare assistants no longer feel heard. Today, for the first time, I am delighted to have a voice. It was a healthcare assistant who brought about the "RTÉ Investigates" show. Healthcare assistants are the real engine behind any hospital or nursing home.
Many staff feel physically exhausted, emotionally drained and professionally overwhelmed. Healthcare assistants need to be recognised. More training needs to be provided. My colleague, Claire McSweeney, and I set up a training school for care skills - it is like a training academy - but people are leaving to go to other places for better working conditions. Healthcare assistants are constantly being asked to do more with less, with more patients, higher care needs, increased workload, but with fewer staff, less support and little opportunity for recovery.
Burnout is a huge issue. We need to stop treating burnout like it is just a bad case of being tired. Tiredness is cured by a good night's sleep. Burnout is a chronic structural injury experienced by people trying to run on an empty system. Physical exhaustion is a reality when working a 12-hour shift, on your feet, without a proper break, drinking lukewarm tea or coffee while standing up, and then going home with chronic back pain or migraine, only to be texted three hours later asking if you can cover another shift because someone has called in sick. The system takes 100% out of a carer. We show empathy to patients, but we are sometimes a shell of ourselves going home.
Pádraig Rice (Cork South-Central, Social Democrats)
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It absolutely should not be that way. That should not be the reality, and it needs to change.
I have a question for the INMO regarding the nurses. Last week, we had statements in the Dáil for International Nurses Day. I made the point that it would be better if we were legislating for safe staffing levels rather than having statements on the floor of the Dáil. During those statements, the Minister for Health told the Dáil that since 2020, the safe staffing framework for nurses had delivered an additional 2,000 whole-time equivalent registered nurses and healthcare assistants. She said that the framework was now fully implemented in all of our adult emergency departments nationally, and it was nearly at full roll-out in all applicable wards. Does the INMO agree with the Minister's contention that the framework is fully implemented in emergency departments and all applicable wards?
Mr. Tony Fitzpatrick:
People say "Mind the gap". The reality is that that is not the case. We talked about the pay and numbers strategy, previous moratoriums and so on. While it may be identified as such, this is not the safe staffing that we need to put in place. We will take the figure of 2,000 additional nurses and healthcare assistants. Funding may have been provided by the Department to put them in place, but then a moratorium comes around. If somebody goes on maternity leave, they are not replaced, even though they should be. Maternity leave is a major issue. Some hospitals have departments where maternity leave could be at 10% or 20%, and the average is 2% to 4%. They are not replaced. When those staff are on maternity leave, they are not replaced, even though there are collective agreements that state they should be replaced. The framework for safe staffing is eroded, and because there is a pay and numbers strategy and it has now been devolved to regions, the departments will say they do not have enough staff to fill those posts.
Therefore it might fill a physiotherapy or other post and-----
Pádraig Rice (Cork South-Central, Social Democrats)
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How many-----
Pádraig Rice (Cork South-Central, Social Democrats)
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How many nursing and midwifery posts remain unfilled?
Mr. Tony Fitzpatrick:
Looking at the figures, it is thousands. In reality, with maternity leave posts, the HSE refers to temporary vacancies and permanent vacancies and there are too many vacancies across all those groups. They have not been fully implemented. The emergency departments are severely overcrowded without the staffing recommended by the framework.
Pádraig Rice (Cork South-Central, Social Democrats)
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We are nowhere near the staffing levels we require. I thank Mr. Fitzpatrick.
The next slot is for the Independents and it is Senator Clonan.
Tom Clonan (Independent)
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The witnesses are welcome. I apologise as I was at the disability committee which sits at exactly the same time and I will have to go to the Order of Business in the Seanad, so I apologise that I will leave.
I absolutely - 100% - support everything the witnesses represent and what they do in their advocacy and representation of their members. If I make an observation that has already been addressed or ask a question that has already been answered, I apologise. I was not here.
I have to declare a couple of conflicts of interest. I have known Professor Sadlier over the years. I listened with great interest to the contribution about the online grooming of children and so on. It was very good. I have a family member who is a member of the medical profession. He left the HSE recently after about 30 years so I know first hand the pressure on everyone in the health service and the need that is overwhelming the available resources. As a family, we have seen the impact that has on individuals at all levels, in our case at the level of a medical doctor.
I also have an adult son who has been through Temple Street, Crumlin and St. Vincent's hospitals and had major surgery so I have seen how things have changed in the past ten or 15 years, particularly in the aftermath of the financial crash. I remember particularly after one surgery - my son had spinal surgery for more than eight hours - that the anaesthetist stayed and manually ventilated and extubated him because she did not think he would do well in intensive care. In intensive care, I saw the rate and pressure on everyone there. It struck me when he was in the step-down unit - I was sleeping on the floor beside him in Temple Street, watching the nurses - that in programmes like "Shortland Street" the characters have time for affairs, they read magazines and have water cooler moments. I do not mean to be facile. The staff were on their feet all night with so many sick children. As was said, if we had the proper staffing levels of one:five, there would be better outcomes for everyone. There is moral injury and distress for the members of the witnesses' organisations.
I do not really know what to say. We are out of step with the international community on this. I was struck last year by a photo on Bondi Beach of hundreds of our beautiful young physiotherapists, occupational therapists, OTs, speech therapists and doctors asking that we build some houses so they can come home.
In a previous life, I did a lot of research on the experiences of my colleagues in the Defence Forces and found there were very high levels of bullying, sexual harassment, sexual assault and so on. I know from reading the research and literature on the workplace surveys that have been done in the HSE about the level of bullying and harassment and some of it would make the military blush. There seems to be an issue with culture in the organisation.
In all our interactions on site, from the porters to the security guards to the people on reception to the administrators, every person we have interacted with on our journey has gone above and beyond. I suspect, therefore, the toxic culture is coming from pressure from the Department of Health. It is hyper-masculine, muscular chested. I have experienced it here as a public representative in interacting with some of these senior people. They can be quite defensive and aggressive.
There is a peculiar narrative in Ireland about people who work in the healthcare system. Are we the only jurisdiction in the world that characterises doctors as being bad people, that there should be compulsory medical service, that doctors are the problem? I hear this repeatedly. Successive ministers have said we need to get people working properly and that that is the problem, when in fact it is the resourcing. I wonder why that narrative exists. Is it unique to Ireland?
Second, where is the resistance to everything we all share, such as the acknowledgement we need more investment and resources, coming from? It is an act of collective self-harm. It is a no-brainer. Apart from anything else, health should be properly resourced. Where do the witnesses detect the resistance is coming from?
The witnesses are all in the representative area. I was in Wexford last year where I met Phil Ní Sheaghdha at the annual INMO conference. I robbed a glass of prosecco at the reception and there was energy in that room from great people. The witnesses are doing their utmost. Do they think the professional bodies, such as the colleges representing the different medical specialties, are vocal and proactive enough in highlighting the problems the witnesses have? I am referring to the groups representing OTs, physiotherapists and so on, not the unions, but the professional groups. I get the sense they are a little - collaborative is too strong a word - but they seem a little passive in the face of all this. I am sorry for the long introduction. The witnesses now have three minutes to answer all those questions.
Ms Susan Clyne:
I think all our colleagues will agree that the obstacle to receiving more funding and resources lies with the Department of public expenditure. I do not think anyone would disagree with that. The Department of Health and the HSE often agree with our proposals or that we need X, Y and Z, but the Department of public expenditure tells them they are not getting the money. Health budgets are determined now. The HSE does up a service plan. We all try to feed into it about what would be good. We all want new services for patients. The service plan goes to the Government. There is then a row or negotiation between the Department of Health and the Department of public expenditure. The service plan stays the same. The tasks everyone has to do and the services everyone has to deliver stay the same, but the money goes down. It is just an arbitrary number. If people say a service will cost €10 million to fund, the Department of public expenditure will give €7 million and say "Do it" and that is it. The Department of public expenditure is absolutely the obstacle.
Mr. Tony Fitzpatrick:
It goes back to the issue of whether doctors are bad. They are not. They are great people and do incredible work. Nurses and midwives do as well, as well as all the others represented here. They do incredible work, but that narrative exists and it goes back to the financial crisis when people were told to put their heads down because they were public servants. These are incredible people who do incredible work every day for the public and that narrative needs to change. The political system needs to learn from that because there is a vilification of front-line healthcare workers and front-line public servants. These people are working in an ineffective system, but they are incredible people trying to carry a very heavy load and that has a personal impact on them as well. Those lessons need to be learned. People need to stop criticising the staff in the health service all the time because there are incredible people working in the service.
Tom Clonan (Independent)
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I remember where I was the day I heard Trump was elected, but I also remember nearly dropping my toast after the financial crash, which was caused by - I do not want to demonise anyone. When I heard on the radio that it was the fault of public servants - teachers, gardaí, nurses, doctors-----
Pádraig Rice (Cork South-Central, Social Democrats)
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Fórsa wants to come in as well.
Ms Linda Kelly:
To the point on professional bodies, Fórsa represents most health and social care professionals and works closely with the professional bodies and they are incredibly active. However, what we have seen in recent years is an absolute de-prioritisation by the HSE of involving workers, staff representatives and professional body representatives in decision making. One thing that is clear in our report is that there is a culture of top-down decision making, without involving worker voices. We experience it as a staff panel and representatives, but staff experience it too, as do the professional bodies. How loud can we expect people to shout when they are consistently ignored?
Ms Liz Cloherty:
On the Senator's first point that doctors are bad, that narrative is being put out as applicable to multiple grades in the service.
It comes back to asking staff to do more with less and not recognising the fact that many of our staff will be finishing a shift and then coming in to do an on-call shift straight afterwards in order to provide that 24-7 service. It is not about the staff not doing enough.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank Ms Clyne.
Pádraig Rice (Cork South-Central, Social Democrats)
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We are well over time for this slot. I thank Ms Clyne. I suggest taking a break and resuming in five minutes. Is that agreed? No. The Deputy can come in, if we are happy to wait for ten minutes to take the break. That is grand. I call Deputy Sherlock.
Marie Sherlock (Dublin Central, Labour)
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I apologise for stepping out of the meeting earlier. I welcome the representatives of Fórsa, SIPTU, the INMO and the IMO. Four presentations were made and each of the organisations, as representative bodies, has produced a survey. Those surveys provide stark findings of the level of burn-out and frustration across the health sector workforce. We are all clear that there are considerable capacity and staffing issues, and none of these issues are new. We could have had the exact same conversation three, five or 15 years ago. That is the great frustration here. There is a bit of Groundhog Day to all of this. The added frustration is the blame game. When we put questions to the HSE, it is the fault of the Department of Health. The Department of Health blames the Department of public expenditure and reform. When I talk to the Minister, local management on the ground is the issue. We have a situation whereby on 58 of the past 70 days, there have been over 500 delayed transfers of care across our acute hospitals. I asked a question of the Minister on that issue in the Dáil last week and all I heard was blaming local management for arrangements in Limerick. Frankly, that is not good enough.
In the few minutes I have, I would love to understand what the key and critical actions that could be taken by the Department of Health are. As legislators, we can apply pressure to the Minister and the Department to take particular action. What are the changes that could have some real and substantial impact on the issues we are talking about?
There are three questions. The first relates to the heads of Bill for the 2017 patient safety legislation, which went to pre-legislative scrutiny. I would like to hear the witnesses' views as to why they believe that legislation has not been progressed.
It beggars belief that notwithstanding the WRC agreement and all of that, we still do not have proper cover for maternity leave across the health service. I would like to hear the witnesses' views as to how we might deal with that particular issue.
The other key issue relates to liability and responsibility. We are now 12 months on from the nursing home crisis. That affected, in particular, healthcare assistants and nursing staff. The issue was that some of those workers were blamed when there were real structural issues at play, which meant that workers were left high and dry. They were under-resourced and shortcuts were taken with regard to care. I listened to Dr. McNamara talk about being put under enormous pressure and working exceptionally long hours. As I understand it, we still have issues with regard to abiding by the Organisation of Working Time Act. Do we need to put in place a much more powerful system of enforcement and go after, prosecute and initiate prosecutions of employers and hospital mangers, who allow such situations?
I ask these questions so we might have some understanding of the specific measures that could be taken and might have some small but tangible impact on all the issues here. We know that addressing capacity and staffing will ultimately deal with the issues, but those will not be changed today or tomorrow. There are actions that could be taken over the coming weeks to force people to make particular decisions within our health service. Perhaps the witnesses from each of the organisations would respond.
Mr. Tony Fitzpatrick:
I will take 30 seconds. On patient safety, legislation for safe staffing is working in Australia and California. It is important we do that. It would ensure that all of the other issues, including maternity leave, would be covered. We must ensure we have back-filling and deal with that issue on a consistent basis. Professor Sadlier said that capacity and staffing are the two biggest issues. There was a bed capacity report in 2008 and another in 2018. The reports stated that we needed more beds, and not just acute beds but step-down beds too. We have a framework for staffing but it has not been fully implemented. We need to legislate for safe staffing. There is no doubt that needs to move forward, and quickly, to ensure we have better patient experiences, better outcomes for patients, better experiences for the staff working in services, better morale for the staff and better outcomes, ultimately. It will save money because we will not be wasting it on agency staff and then bringing in one of the big four to tell us how to approach the issue differently. Hundreds of thousands, if not millions, are being wasted on that currently when that money could be going to front-line services.
Dr. Rachel McNamara:
It has to be targeted. We are forever being told how many extra non-consultant hospital doctors, NCHDs, and nurses we have in the system. It is not about plugging in numbers willy-nilly. It is about targeting them where they are most needed. Even if we put another 200 doctors into the system, some surgical specialist registrars, SpRs, will still be working 100 hours.
I will raise the maternity leave piece again. It is having an impact on patients and, at an individual level, on doctors. I know doctors who have worked the day after miscarrying because there is so little slack built into teams that they feel that if they do not go in, patients' lives will be put at risk. There is nowhere for them to turn. International studies have shown that maternity outcomes for young doctors are directly attributable to the stress and conditions with which and in which they work. It is a crisis. Somebody mentioned a crisis earlier. NCHDs report that only 4% of them are working with high levels of morale. That is a practically negligible level. For a patient to experience that as an environment in a hospital is unacceptable.
Ms Susan Clyne:
I will come to the sanctions piece. The IMO has taken the HSE to the High Court on three or four occasions around the Organisation of Working Time Act. We are currently in talks with the HSE. In our most recent agreement in 2023, there were sanctions to be placed on hospitals. With budgetary considerations, the management of the HSE overruled those sanctions because it was taking money from one place and putting it in another place. The management decided not to bother about that. The HSE knows where the hospitals are. It knows how many extra NCHDs are needed to be able to do 48 hours in an average week. We are not even aiming for a normal week of 37 hours. We are aiming for 48 hours. That is how high our ambition is.
Professor Matthew Sadlier:
It all comes back to the Hanly report of 2003, which stated we needed a radical reform of our hospital system. In fairness, it was politicians who campaigned around the country to prevent that from happening. We need political leadership to have a radical look at where our hospital structures are. That may require some closures. It may require other hospitals to be built. We need a coherent political message for the system. You cannot make an omelette without breaking eggs. Unfortunately, for the 27 years that I have been involved in this rubbish, we have had this persistent refusal to break an egg.
Marie Sherlock (Dublin Central, Labour)
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It is not about quick fixes.
Marie Sherlock (Dublin Central, Labour)
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It is about direct and targeted intervention.
Ms Ashley Connolly:
The Government needs to be listening to those who work in the service. It needs to be engaging meaningfully in order to fix the problems. We have sat in many rooms and put forward quick solutions that could easily be implemented on issues such as maternity leave. When you have an average of 4.5% of people on maternity leave at any time and they are not being replaced, it means that services are not being delivered.
That is disgraceful and it does not need to happen. We also have to acknowledge the narrative is wrong. Staff feel unheard and devalued. It is all about deflection and the blame game. Nobody wants to look at real solutions because it is easier to remain in the negative and spread the blame around so nobody is dealing with fixing the problems.
Pádraig Rice (Cork South-Central, Social Democrats)
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Thanks very much. I suggest we take a break for five minutes, if people agree. That is agreed. On our return, we have six members who wish to get in. I am keen to give everybody the same amount of time. We need to start at five past and I will give everybody exactly nine minutes to get all the members in.
Pádraig Rice (Cork South-Central, Social Democrats)
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We will continue the committee's consideration of staff morale in the health services. Our next slot is for Fianna Fáil and Deputy O'Sullivan.
Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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I apologise for being late; I was at another committee. I welcome everybody. I have a wife who is a medical scientist in CUH, my sister is a radiographer with BreastCheck and my sister-in-law is a psychiatric nurse. There is not a family occasion or family dinner where we do not end up talking about the health service in some way. I am not saying I understand it better than anybody here - I do not and do not claim to.
I will ask an open question to begin. Based on the research the witnesses have done regarding clinical, administrative and social care settings, where do they find the issues with morale are most acute?
Ms Linda Kelly:
There is no particular black spot. It is everywhere because it comes from systematic underfunding of the system. As we mentioned earlier, the health budget is set up to fail, whether it is the HSE, section 38 organisations or the community and voluntary system. There needs to be another look, as a country, at how we fund the health service and at our priorities. At the moment, our priority is around continuing a bad system of funding. The research we did for the report with TASC was across all the sectors we represent. In the research analysis, there was not a statistical black spot. It was not more acute in the HSE versus another organisation, or anything like that. It is widespread across the sector.
That highlights the need for a high-level strategic response. This committee is well placed to push and discuss that and to identify how we can improve it. It will take a number of years to do it. It will not be something we can do by Christmas but it is something we should be aiming for. In 2030, how do we want health budgets to be prioritised? Where do we want people to be? How do we want services to be supported? That would bring confidence to staff. Staff feel the only plan at the moment is for them to be criticised publicly and portrayed as lazy or as not doing their full hours of work. They feel there is no real plan to have a functioning health service. It would be wonderful if there was the imagination for a more positive vision of the health service.
Ms Liz Cloherty:
I agree with our colleagues that every grade in the health service is impacted by the pay and numbers strategy. What is happening is posts are not filled or caps are reached. That is adding to the workload of staff. It is one and a half to two times more than what would be required of one person. I will give an example. The way the budget works at present in the health regions is it is up to the REO as to where they put positions, which can lead to the suppression of posts.
I will give the example of home support. The waiting list currently contains 5,406 people. The highest level in the country is 1,200 in the west and north west.
On the deficits at present, there are 256 fewer positions in the HSE now than in December 2023.
Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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Ms Cloherty mentioned home care support. My mother used to be a home care worker years ago. If someone tells the HSE as their employer that they intend to retire in 12 months' time, why does the HSE have to wait until that person retires to advertise the job? That can take another nine to 12 months to fill. What is the rationale? Is there a protocol?
Ms Sarah Meagher:
That scenario is unfortunately not exclusive to home care supports. Across the HSE there is no forward planning and no prediction of staffing levels - who is retiring, how many are retiring. It is commonplace every day in every role that people retire and a week later the HSE or employer starts looking to replace that individual. Not only is it leaving that end of it ridiculously late, but on the other end the person retiring is waiting for their pension and lump sum and they cannot get a straight answer on that so they cannot even plan to retire.
Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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Is it a management decision or a directive from the Department of Health?
Mr. Tony Fitzpatrick:
The problem is there are now too many layers. In the past, if the director of nursing knew Mary on a certain ward was retiring in three months' time, she would advertise the post in the local paper or wherever and fill the post. There would be a recruitment campaign, etc. Everything is centralised now within the HSE. The problem is that director of nursing cannot now just replace Mary; she has to fill out loads of forms and make business cases that go up three, four or five layers of management within the HSE for approval. That will take a month to two months and they may approve it but they also may not. If they do approve, it will come back down through the system, which will take another couple of months. If it actually gets to the point of recruitment, it will probably take a year before Mary is replaced. It is the employment control system - back to pay and numbers - that is causing that situation. Give the authority and autonomy to the managers at local level to know Mary needs to be replaced because the ward will be short if she is not, and let them replace them. It is a bureaucratic mess of several layers all through the system to get that approval.
Ms Liz Cloherty:
On the home care piece and recruitment in the HSE in the west and north west, for example, where 1,200 people are on a waiting list, there are 100 vacancies in that area. The HSE advises us that it is recruiting there for only 46 positions. That clearly tells us it is not recruiting what is required, which leads to outsourcing to private providers. The budget for home care for this year provides for 26.7 million hours to be delivered. The HSE's ambition is to deliver only 8 million of those hours and the rest is to be outsourced, and we know that is predominantly for profit, which leads to worse outcomes.
Dr. Rachel McNamara:
I cannot overstate the importance of the IT infrastructure and the impact that has on people's ability to do their work. It came through very strongly in our surveys that all healthcare staff, including NCHDs and consultants, are dealing with ten to 20 systems a day. If one goes down, your ability to do your job, move forward and care for patients is completely disrupted. Those are conscious decisions throughout the years to get a quick fix in to do one tiny piece of the task rather than taking a longitudinal approach and totally reconfiguring it. There is no point in waiting for the electronic health record in 2032 to start looking at how antiquated the systems are because we have to factor in all the people who will have to go through the system between now and then. IT infrastructure burns people out because they cannot do what they would like to do to serve patients.
Ms Susan Clyne:
On whether there were black spots, in our survey we also went across all six regions and CHI and HSE centres. The results are consistent - it is bad everywhere. To Mr. Fitzpatrick's point about recruitment, that is just a disaster. In any other workplace, women would be comfortable about going into work, saying they are pregnant and talking about maternity leave. It is a nightmare. Many NCHDs leave it until the last minute to tell their employer. They know there will be a difficulty for their colleagues. They are worried about their colleagues. Whatever about knowing about retirements, you know when someone is due their baby, yet that person goes on maternity leave and there is no cover. That does not mean there are fewer nights or weekends to be covered. It just means somebody else works additional nights, weekends and shifts.
Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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I do not know if I can squeeze in another question but I was going to ask about workplace violence, the level it is at and the extent to which it is under-reported.
Mr. Tony Fitzpatrick:
It is a major issue, as we highlighted in our opening remarks. It is completely unacceptable that any healthcare worker, no matter their grade, goes to work and faces verbal and physical abuse. It is way too common. Something serious needs to be done about it. It is often the case that at the point of contact where healthcare workers interact with the public, they are frustrated with the system and it is taken out on the staff delivering the system, yet the decisions having that impact are made politically or in the Department of public expenditure or the Department of Health. Much more needs to be done to address that issue.
Pádraig Rice (Cork South-Central, Social Democrats)
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It is a key issue. I call Deputy Clarke.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I thank the Chair, and all our guests for coming in this morning. I have come in with pages of questions but there is one I am asking myself as I sit here. Regardless of whether someone was a newly qualified nurse, doctor or healthcare assistant, would they want to work in the HSE? I am not sure the answer is "Yes". That is absolutely damning. According to the opening statements, doctors feel unheard, staff are pushed beyond safe limits and half of workers often or always feel burned out. Staff are removed from the decision-making process and professional bodies also appear to be excluded from decision-making processes. Nothing the witnesses have said today suggests the HSE is a positive work environment for anybody to work in. If that was replicated in another workplace, the employer would be falling over complaints left, right and centre about the workers' conditions. It is abhorrent that somebody would go into work the day after a miscarriage. I find it disgraceful that any woman would be worried about telling her employer she was pregnant because of the impact it would have on her co-workers. That is absolutely disgraceful. It is not that staff feel unvalued or undervalued - they actually are. That is the problem. It is not a perception of something that is not the reality. It is not that staff are imagining something that is not happening to them. It very clearly is. When that is coupled with the Department of public expenditure being penny wise and pound foolish and budgets set up to fail, it is back to the question as to why any newly qualified medical professional at any level would want to work in the HSE.
The witnesses have made really good contributions. Our job as an Oireachtas committee is to legislate but it is also to hold those responsible within Departments and ministerial positions to account. What do the witnesses want us to focus on today? What primary asks do they want us to go back to the Minister and the Department with? Where do we start with this? Something has to change. Otherwise, more women will be afraid to tell their employer they are pregnant because of the impact on their colleagues, because their colleagues just will not be there. It is the same with home care. Who would want to apply for those 46 positions the HSE is recruiting for?
Ms Sarah Meagher:
On what ask the committee might bring back to the Department, it is to legislate for safe staffing. That is what is going to fix 90% of the problem. I am a nurse and we have the frameworks, but they are not across all sites or specialties and there are no frameworks for the other disciplines. There is no framework at all for paediatrics yet.
Mr. Tony Fitzpatrick:
As a follow-on to the framework, while legislating for safe staffing is the big ask, the Deputy is right. For any nurse or midwife coming out of college, they are great professions and they really want to deliver for the public and have a very satisfying career, and safe staffing will allow them to do that. According to the surveys of nurses in Australia, they are paid more but the second thing that comes up is very much that you can go into work and deliver safe care. That is really important. We do not want the HSE to be perceived as it currently is. There is dysfunction within the system. That can be fixed but it needs the Department of public expenditure, Department of Health and the HSE to get together and start listening to the voices of all the representatives here.
We have represented nurses and midwives for over 100 years. We know what we are talking about with regard to these issues and we can see that it is going to go into a vortex or spiralling situation that is going to get worse unless radical action is taken to solve it.
When the staff need the help, the occupational health, employment supports and the employment schemes are not sufficient to support staff within that system. I am not even going to go into the issue of housing. A total of 77% of the salary of a nurse in a month is going to housing in hospitals not too far away from here. That is going to add to the problem. All of these things need to be addressed and urgently.
Ms Liz Cloherty:
We have launched our claim with the HSE to engage on a safe staffing system for all grades across the HSE. That is what is required to ensure that staff feel safe at work, to increase the staff morale and to ensure that burnout does not happen. There needs to be a ring-fenced funding piece for replacements of maternity leave, recruitment needs to be fast-tracked, and direct employment needs to be prioritised and not outsourced to private providers where profit is the bottom line. We need to ensure all those aspects are put in place.
Ms Linda Kelly:
We will come back to the committee. We are doing our own research at the moment with Ulster University on safe staffing for health and social care professionals. We have to follow the money and the money is what is setting the system up to fail, so we do need multi-annual funding from the Department of Public Expenditure, Infrastructure, Public Service Reform and Digitalisation. We need a staff bank to cover maternity leave. There needs to be specific explicit budget provision and staffing for maternity leave. Regarding the chaos Mr. Fitzpatrick so accurately described, I do not have a word to describe the decision-making regarding recruitment. I feel like I go down the rabbit hole-----
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I could think of a few.
Ms Linda Kelly:
We are not talking about new funding. When we are talking about somebody retiring or leaving, that post is already funded and there is no question that the post is funded. There needs to be devolved decision-making at budget level. It does not need to go through a seven-stage process up to the REO to be considered once a month when we know that the post has been there. If we got the four priorities of devolved decision-making, a staff bank for maternity leave, multi-annual funding and safe staffing legislation, we would be doing a hell of a lot better.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Will the system be less antiquated by 2032?
Ms Martha Buckley:
We have given the Minister the findings and suggestions. It is in his office somewhere in a file. We are repeating ourselves over and over again. If they came and worked with me for 12 hours, they would not be long changing their tune on the work that we do. Healthcare assistants in Ireland have to be recognised and registered. We are seen as low-skilled when actually healthcare assistants are the backbone and engine behind any hospital organisation, so the Government really needs to recognise healthcare assistants. We need to be registered because we are professionals in our own right. We are the backbone of any organisation, so the Government needs to listen to healthcare assistants. We are seen as low-skilled and we are not low-skilled at all. We are the most intimate people when it comes to patient care and end-of-life care, so we really need to be recognised and registered like nurses and doctors.
Dr. Rachel McNamara:
New graduates across all the disciplines come in because they are motivated. They have done a hard course, have worked really hard and want to help people. It is a vocation they have gone into. I have seen my colleagues and parts of myself just worn away by the system, the disillusionment and constantly trying to operate in an unsafe environment and trying to deliver safe care. Regarding the systems that are set up for staffing, resources, infrastructure and space - trying to manage a full care episode in a corridor - it concerns the moral injury involved in trying to do that over and over again and driving people out of professions. Anyone who has managed to make it through the system of training becomes hardened, because as an NCHD you do not have a permanent job until you are in your late 30s. I have seen colleagues and friends of mine have to harden so much to get through and I am sure it is the same for the other colleagues around the table.
Professor Matthew Sadlier:
It was said that staff are undervalued. In my area of psychiatry, and we have not spoken much about community services, they did not talk to one medical representative body or one nursing representative body in writing the current strategy and model for the mental health services, Sharing the Vision. That strategy did not consult the employees because they know the employees feel that the sectorised model of mental health does not work. What happened in Kerry might have been a mistake, but it was predictable and I could have said that was going to happen.
Colm Burke (Cork North-Central, Fine Gael)
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I thank the witnesses for their presentations. I very much appreciate the work they do generally and for the people they represent within the healthcare sector. It is important that we also send a positive message. As a result of the work being delivered in our healthcare facilities, life expectancy in Ireland has increased and that is due to the contribution of everyone in the healthcare sector. It is important we acknowledge that.
Regarding the issue of junior doctor issue and doctor recruitment with regard to the HSE, my understanding is that the number of doctors in the HSE has increased by over 4,000. The number of consultants is up by 40% since 2020. The issue of junior doctors is one I raised in this committee back in 2014. I spoke about the lack of structure for junior doctor training. There is a structure for GP training - it is a four-year training process - but the issue of junior doctors moving from hospital to hospital is now an even bigger challenge than it was ten or 12 years ago because of the accommodation issue. Why has that not been addressed within the HSE so that if someone gets a job, it is not just for six months but is a two-year contract? Within that, they can rotate between hospitals. Why has that not been addressed because that is exactly what is in place in every other country? Why has that joined-up thinking not occurred?
Ms Susan Clyne:
We have asked for that as part of contract talks, that HSE be recognised as your employer. At the moment, an NCHD is employed by a different hospital every six months. That is a new employer, so the person goes on emergency tax and has to find new accommodation and new childcare or education facilities for their children.
Colm Burke (Cork North-Central, Fine Gael)
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What kind of numbers of doctors are we talking about?
Colm Burke (Cork North-Central, Fine Gael)
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This was raised with the HSE in this committee 12 years ago and it was agreed that there would be reform in that whole area. Now it appears that we have not moved one inch in those 12 years.
Ms Susan Clyne:
No, there has been no reform in the area. An NCHD does not even know where he or she will be in two years. It would be something if you at least had an idea of what your rotation is going to look like, but you do not always know what your rotation is going to look like. There are no supports. There is no welcoming committee to help you find accommodation or crèche places. There are no supports for them. Even though there is a negotiated piece whereby they cannot be asked to work the 24 hours before they move, we still have problems with employers trying to put them on night shifts the day before they have to turn up at another hospital 200 miles away.
Dr. Rachel McNamara:
I have colleagues and friends who are living in separate counties to their kids for this period of time. There seems to be no rationale for it in a lot of schemes. You might be Dublin-Cork and Dublin-Cork. We have been told multiple times that they are looking at it, but it needs to be regulated so that you are expected to move only a minimum number of times just to complete the scope of the training.
Colm Burke (Cork North-Central, Fine Gael)
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We now have six different HSE groups. If we want to put in a comprehensive plan to deal with this, is that now going to get even more complicated because of the different regions?
Ms Susan Clyne:
It will, yes, undoubtedly. We had hoped that the regions would bring some kind of structured system but, unfortunately, we have joint union forms in each of the regions and everything is decided now by the REOs, so we are fighting on six multiple fronts and national contracts are not-----
Colm Burke (Cork North-Central, Fine Gael)
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I will move on to recruitment within the HSE and the whole structure. Mr. Fitzpatrick pointed earlier to going from local level to regional level to national level to get approval. I remember someone starting a job in a hospital where the equipment was about ten years out of date and having taken on a job as a consultant being told that if the hospital put in a request for new equipment, it would be lucky to have it in four years. In the Dáil last week, I raised the fact that of the 23 linear accelerators in the country, of which 14 are in Dublin, 12 are more than ten years old and eight are more than 15 years old. Why is there such a difficulty in upgrading equipment? If we want staff to deliver a safe and good service, they have to have the facilities and the equipment.
Mr. Tony Fitzpatrick:
Again, this goes back to the multi-annual funding piece that needs to be done. An estates plan is needed, that is, a plan to have equipment and for the replacement of that equipment across the service. On the staffing issue, it is ludicrous that we have these approved posts that have to go through a convoluted system in which it takes months to get approval and approval may not be given, and then follow through on that.
Colm Burke (Cork North-Central, Fine Gael)
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On the change now in the HSE, what is going to be the new requirement? I had a meeting with HSE South West on Monday morning and it advised it is continuing to recruit.
Mr. Tony Fitzpatrick:
HSE South West is a good example. I will use an example from Cork University Hospital. In theatre in CUH, in order to be able to maintain and provide the services and ensure surgeries continue, there is a requirement to put in a night duty shift for nursing staff, but that requires additional posts. There were meetings yesterday and there is no approval for that. At the same time, in CUH in the theatre there is insufficient staffing to deliver what is currently being delivered. There are plans to open elective hospitals and surgical hubs, etc., which have been talked about. You need to fix the problems that exist in the current tiers. You need to get a fast-tracking process to approve new posts and new capacity because that is required to meet the demand. The difficulty with staffing is you need new funding or new money to come from the Department of public expenditure, through multiple layers of the HSE, the Department of Health, etc. They will say they will supply a specific number of staff so you can open up and have night duty in CUH and then a specific number of staff for the surgical hub, etc., which is grossly insufficient. It is going to impede the development of these services. Multiple unions are involved in discussions on these surgical hubs in Swords, Cork, Limerick and Galway. These issues need to be fixed but how those processes go through is dysfunctional. The Deputy mentioned HSE South West. Now you need approval to go from the hospital to the region through multiple layers within the region to get approval of posts and it just does not make any sense. It is pure nonsense.
Colm Burke (Cork North-Central, Fine Gael)
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If we take the case of Cork looking for, say, a senior nurse, how long is it now taking to get that approval?
Mr. Tony Fitzpatrick:
That approval process is taking months and you may not get the approval. The decisions may be delayed. We will come back to the employment control meeting - or whatever term is being used for it now - next month and then there is the recruitment process. In the recruitment process with the HSE there are hundreds of nursing panels. There are probably thousands of other grades of staff or panels that are in existence but people are not moving off the panels into the posts that are vacant. There are 5,000 vacant nursing posts within the system. That needs to be addressed urgently because people are being left short continually with regard to-----
Colm Burke (Cork North-Central, Fine Gael)
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With the setting up of the regions, is that process going to speed up?
Mr. Tony Fitzpatrick:
I do not believe it will. The central HSE will say it has given a region its budget, that it should stick within it and if it has to suppress a consultant post there to fill two physiotherapy posts over there, or whatever it is, that is what will be done. It is not the right way to go about it because there is a defined need.
Colm Burke (Cork North-Central, Fine Gael)
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However, we have created quite a number of new posts over the last four to five years and-----
Mr. Tony Fitzpatrick:
The difficulty is people keep comparing with, say, 2019. In 2019, we went back to the staffing levels in the HSE in nursing and midwifery that we had when Bertie Ahern was the Taoiseach back in 2007. People forget that-----
Colm Burke (Cork North-Central, Fine Gael)
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In fairness-----
Pádraig Rice (Cork South-Central, Social Democrats)
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Thanks, Mr. Fitzpatrick.
Colm Burke (Cork North-Central, Fine Gael)
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In fairness-----
Pádraig Rice (Cork South-Central, Social Democrats)
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Thanks, Deputy.
Colm Burke (Cork North-Central, Fine Gael)
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In fairness, consultant posts have increased substantially from any time before. There 4,880 posts now.
Pádraig Rice (Cork South-Central, Social Democrats)
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Sorry, we will have order.
Pádraig Rice (Cork South-Central, Social Democrats)
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I am sorry, Ms Clyne. Order, please.
Pádraig Rice (Cork South-Central, Social Democrats)
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Thanks very much. Deputy, as I indicated before the break, we are quite tight on time and I want to get everybody else in as well. If people could respect the clock and the Chair, I would appreciate it.
Next is a Fianna Fáil slot, to be taken by Senator Costello.
Teresa Costello (Fianna Fail)
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Thank you. I thank the witnesses for coming in. I have huge respect for all of what they do. It is terrible listening to the experiences and how they are feeling. We have all benefited from their services at some point in our lives, so there is respect here.
Are there any examples where morale improved in an area? If there was a change, how did that come about? Are there no examples?
Professor Matthew Sadlier:
We are here to point out the difficulties. To say there are no benefits, there has been a psycho-oncology programme issued around the system that has been relatively well funded and well supported and it has been a huge benefit to patients, but that is because there was big pressure to put it on. It got supported by the cancer control programme and by mental health. In the Mater hospital, where I work, the team is functioning very well, so that is a good innovation that has happened. Is it perfect? What is? It is certainly something that is much better than it was a number of years ago.
There are innovations happening all the time but the problem is they are happening against the backdrop of our hospital service being way too small for our population. To come back to Mr. Fitzpatrick's point, which is very relevant, in 2007 we had a population counted at about 4.5 million and we now have a population of about 5.5 million. This is the backdrop to everything we are saying. We had mass emigration from the country in the 1950s. That kind of ended somewhere in the 1980s - at that level - which means we are now getting an older population. We had an artificially young population for reasons we do not need to go into that would probably take seven years to cover, but we are catching up with the rest of the world. This means not only do we have an increasing population but we have an increasingly ageing population. This puts a higher demand on our healthcare services and ultimately that is the root issue. It is a very good thing overall but it is what is putting the pressure on the services.
Teresa Costello (Fianna Fail)
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I am sorry if I repeat anything anybody has already asked. To what extent do morale issues differ between clinical, administrative and social care roles?
Ms Linda Kelly:
Particularly for our union, which represents clerical administrative staff throughout the health service as well as health and social care professionals, clerical admin staff have been very unfairly targeted through all this recruitment embargo as if a medical secretary is surplus to requirements and as if the staff who run the wards, support nurses and clinicians are extra or a luxury.
Teresa Costello (Fianna Fail)
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You cannot leave out one part of a machine.
Ms Linda Kelly:
That is exactly the point my colleague made earlier. There is an absolute lack of recognition for clerical admin staff within the system. We have the luxury of seeing two sides of that coin. Our health and social care professionals really struggle in terms of the capacity to work to the fullness of their licence and to provide the services and the innovation they want because they do not have clerical admin support and because they do not have every part of the machine in their departments. These decisions are being made by decision-makers who have no experience on the front line. They are saving what they see as €40,000 for a clerical admin post but the cost to the service of what is required, either by employing agency staff or due to the fact other staff cannot do their jobs properly, mean it is a false economy.
Dr. Rachel McNamara:
To add to that, when there is not a medical secretary on a ward, it is invariably the healthcare assistant, the nurse, the non-consultant hospital doctor or the consultant picking up those admin tasks, which is not very cost-effective for the system. On that, we had one or two people in our survey who, in the comment section we had on what is working, said they felt supported in their current job.
They said their morale was good because they have a full team and can access their annual leave. That is a bar we are trying to aim at, which is pretty reflective.
Teresa Costello (Fianna Fail)
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It is not a high bar.
Ms Martha Buckley:
It is rare that a healthcare assistant is brought into the Oireachtas so the morale for healthcare assistants in Ireland today is massive. The morale for healthcare assistants in Ireland is ecstatic. For one positive thing, I am on a high. Our voice is being heard today because we are never allowed into the Oireachtas.
Teresa Costello (Fianna Fail)
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My dad was very well taken care of, and the healthcare assistants were amazing with him. He was a handful. God bless him, he was very unwell, but by God there was patience and care.
Teresa Costello (Fianna Fail)
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My sister is a healthcare assistant. She often sits me down. I know the love, care and dedication. It is a vocation. For anybody who is in medicine, it is a vocation. Healthcare assistants are dealing with people at their most vulnerable. They do not want to have to deal with them. They are there because they need them. People need healthcare assistants.
Ms Martha Buckley:
It is a vocation to work in health. We are talking about morale, and we all agree that morale is on the floor. Healthcare assistants have a voice for the first time in the Oireachtas. That is a huge thing to celebrate because we are seen as low skilled. I thank everyone today for letting us have a voice.
Teresa Costello (Fianna Fail)
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There is a seat at the table, and it is well-deserved. I do not know if this question was asked. What systems are in place to track and respond to workplace violence in healthcare settings? How is accountability enforced when risks are not mitigated?
Ms Sarah Meagher:
Risk assessments are supposed to be carried out. Every site is supposed to have its own risk assessment, which is supposed to identify the existing controls and any additional controls required to mitigate the risk of violence and aggression. As it stands, in the first place there is a lack of the risk assessment being done. There is a lack of implementing control measures that have been identified where a risk assessment has been done. There is a lack of training for staff of all grades across all disciplines in what is termed PMAV, which is the prevention and management of aggression and violence. When aggression and violence occur, there is the most cumbersome reporting process. Mr. Fitzpatrick said it is more than 12 in his opening statement. I can guarantee it is a damned sight more than 12. The process requires that it be uploaded onto the national incident management system, NIMS. That takes you away from your role. Whether someone is a doctor, nurse, midwife, cleaner, domestic or security staff, it does not matter. It takes you away from your role to find a computer so you can sit down and log into the most prescriptive, unsuitable and time consuming process whereby it gets logged. The computer system will tell you the risks it associates with it. It will then go into the ether and is never seen or heard of again.
Teresa Costello (Fianna Fail)
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Unless you have been hugely injured, general verbal abuse is just tolerated, and people move on.
Ms Sarah Meagher:
That is it completely. I spent 20 years working in an emergency department and I can guarantee I was easily verbally abused more than 12 times per week. What also has to be factor in is the absolute lack of appropriate physical supports in terms of appropriately trained and qualified security staff, panic alarms, personal alarms and all of those things. Lone workers are particularly at risk.
Teresa Costello (Fianna Fail)
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I want to give the healthcare assistants the last 20 seconds with their experiences of it and a brief overview of what they do, so people know what they do.
Ms Martha Buckley:
Healthcare assistants are the backbone of any organisation or hospital. We are the engine that drives the organisation and without us the system stops. We are the person who holds the resident's or patient's hands when they are taking their last breath. We need to be recognised too today because all of the team are vital, but healthcare assistants are seen as low skilled. I have brought findings from the nursing home survey from "Prime Time". We have brought findings to Government. We have brought suggestions. They are in Government Buildings as we speak. They can come to the table and recognised us as professional people in our own right. We are special people. Carers in Ireland are special people, whether in a hospital or home care team, home helps or nursing homes. We are special people and should not be seen as low skilled. We are professional people in our right. I thank the committee for giving us a voice today.
Pádraig Rice (Cork South-Central, Social Democrats)
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Thank you, Ms Buckley. It is great to have you here today as well.
Maria Byrne (Fine Gael)
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I had to go out to the disability committee meeting in between but I have been here for most of this. I apologise if something was asked while I was out. My first question is on long-term staffing retention. The HSE issued a booklet about staff and well-being. Is the well-being and health of healthcare assistants being looked after? Many private companies have a staff well-being programme. Does that exist within the HSE? I have seen ads for programmes like that for staff, but is it really doing the job it is meant to?
Ms Sarah Meagher:
I received an email to my work email last week about a staff well-being training day, which is great. It is fantastic. It should be supported and there should be more of them. However, staff do not actually have the time to attend those programmes. Those do not count as working hours, which means we are now taking an extra day away from home. That is an extra day of caring responsibilities, be that a child or a parent or whatever. That is an additional expense on the employee. There is the additional cost of getting to that programme, so they have to pay for diesel, which they cannot pay at the minute because of the price of it. All of those things are great in theory and should be supported but the practical supports that would allow staff to benefit from those programmes are not in place.
Ms Liz Cloherty:
I will speak about retention. On healthcare assistants again, one of the biggest issues that is raised in the context of staff morale and attrition from the role is that there are no career progression opportunities for them. There is an advanced healthcare practitioner apprenticeship in the private sector. Nothing like that exists for healthcare assistants in the HSE. A report from 2019 states that healthcare assistant should become a protected title and healthcare assistants should be registered. That has not moved on. These are all leading to further attrition in the area of healthcare assistants. It is important to emphasise that while staffing is one aspect, other aspects contribute to staff morale such as recognition for the role, career progression and all those pieces that come together.
Ms Ashley Connolly:
On initiatives for wellness, I support my colleagues with regard to the time. What happens when you work in the health service is that you deprioritise yourself. You deprioritise your own wellness and health. What you do is always focused on the patient or the service you are trying to deliver. We see those cracks daily where people are pushing themselves to the limit because they are worried that patient will not be seen or that the family will not get a return phone call, or there is something vital that has to be delivered. It is that pressure our members bring home with them every day. Our clerical administration engages with families trying to organise appointments and to find that one slot a family needs to get for a child or adult to be seen. It is heartbreaking. They really struggle to know how they can continue to go on when they do not see that light. Those are the words that were used. The light has gone out. They do not see the hope and that is why real change must happen.
Mr. Tony Fitzpatrick:
We did a survey and 45% of nurses and midwives felt burnt out to a high degree and that should be a wake-up call. We have midwives saying they could not sleep after their shifts with the events of the day repeating in their heads. There are nurses who love their jobs but feel numb. Their nervous system is completely exhausted. These are warning shots. There is wellness and the cuddly stuff, if you want to call it that. However, if you just allowed staff to go to work, rewarded them properly and ensured they had safe staffing while they are in the workplace, that would go a long way to improve morale and well-being as well. Loads of research supports that.
Dr. Rachel McNamara:
We have evidence that NCHDs are being asked to work illegally. NCHDs are never asked if they are taking their annual leave, if they are minding themselves or if they are taking their lunch. In the December 2022 agreement, we introduced compensatory rest. An unpaid day must be allocated to NCHDs if they have worked ten days in a row. We have seen all the evidence that this is not being accommodated.
I have been instructed to take mandatory wellness programmes. It is a sticking plaster at best over the actual things impacting on well-being.
Maria Byrne (Fine Gael)
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I thank Dr. McNamara for her honesty. I compliment everybody who works in the healthcare system, from the cleaner to the administrator to the healthcare worker to the nurse to the consultant. I really admire the work they do. We often hear about people getting aggressive and we have also heard about it here. Is this aggression from other staff members or is it from patients who are frustrated with the system? It is difficult to work under these circumstances and I acknowledge this.
Ms Susan Clyne:
It is well-documented that there is a rise in violence and aggression. As Mr. Fitzpatrick said earlier, the physical environment in which patients are waiting or being cared for, and in which healthcare staff are trying to deliver care, is not conducive to people staying calm or people being able to be talked down from a situation. The HSE does not put enough in place to protect other patients and healthcare staff from this violence and aggression. It needs particularly well-skilled security people who are trained in these situations and it needs panic buttons. Perhaps in a busy emergency department, as our colleague said, there are plenty of people around but there are many healthcare settings where the staff are predominantly female, there are not many people around and it is very difficult. The HSE has to start taking this seriously. It is not enough to go on radio or the media and condemn these acts.
Ms Linda Kelly:
I am a member of the HSA health and social care advisory committee. It is the first time the HSA has had this type of committee. There are two dynamics in healthcare we need to be aware of. There is violence and aggression from those coming in to use the service, such as family members who are frustrated with the service and the system taking it out on staff, but there is also a significant amount of violence as a result of the medical incident or the medical condition where someone is unstable and is reacting. We also need to be conscious of this dynamic. It is one of the reasons assaults are underreported in healthcare settings. There is not a single healthcare worker who wants to press charges or call it an assault when it is a patient who, through no fault of their own, has hurt them. We need to address this dynamic and culture because at the end of the day that worker is still hurt and still needs to access sick leave and schemes. The impact is all the same even though the origin of it is different. We as a committee are looking at how we can deal with this. It is great there is cross-sector input into the committee so we can try to address it.
Ms Liz Cloherty:
We know the HSE has reported there were 12,500 assaults on HSE staff over the past two years, which is likely underreported. This could be combated by having a safe staffing framework for all grades. My colleague sopke about security staff. The security staff members we represent continue to be under increasing pressure, particularly where patients present with suicidal tendencies to an emergency department and there is understaffing and they are asked to monitor. There is not enough staff in place to ensure the safety of patients.
Professor Matthew Sadlier:
This is one of the side effects of the movement of care to the community. We used to have a department in a hospital base where mental health services staff saw patients in a building where there were a lot of staff. Now, with the distribution of services to office blocks, we have patients attending with no security. Individual staff members, often female, are in an office scenario where there is no other staff member in the building. We need to think about this and this concept of moving to the community.
Pádraig Rice (Cork South-Central, Social Democrats)
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We have five minutes until we are due to finish with two speakers remaining. If people are agreeable we might run slightly over. Is that agreed? Agreed.
Michael Cahill (Kerry, Fianna Fail)
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I welcome our guests. I am constantly on about staffing in Kerry, to the extent that it is embarrassing. Many positions are unfilled and it is extremely worrying. We have beds closed in all of our community hospitals in Kenmare, Cahersiveen and Dingle. In the case of the new community hospital about which there has been big fanfare, the opening has been deferred to the extent it is embarrassing. I am consistently told healthcare settings find it extremely difficult to attract staff despite advertising. I am also told it is extremely difficult to attract staff to our peninsulas and rural areas despite the scenery. I am acutely aware the existing staff in all of these community hospitals and University Hospital Kerry are run off their feet. Do contract staff get an accommodation allowance? It was denied in a response to a parliamentary question I submitted. What can we do to attract employees? How can we incentivise them to come? I am acutely aware that in Australia alone there are between 7,000 and 9,000 Irish medical personnel who were educated and trained here. This is sad and it implies there is something seriously wrong here, be it in salaries, conditions or whatever.
I am also aware that in the community home help and carer hours are being cut and days are being cut. This is a huge problem, especially where families and relatives do not live near their loved ones. It is a recipe for disaster. We need to open the beds in all of our community hospitals. A frightening number of positions in University Hospital Kerry remain unfilled and we can take it that it is the same scenario around the country. We need to incentivise those whom we train and educate here to stay for a certain period of time. I know young people want to travel, and I see it at home in my family, but they are leaving for a reason and it is more than just seeing the world. Once upon a time it was when people retired that they started travelling but now it is at the very beginning of their careers.
Mr. Tony Fitzpatrick:
I will come in on the question on Killarney. I was in Killarney recently and my boss is from Kerry. In the hospital in Killarney the paint is falling off the walls and there is a brand-new facility next door. SIPTU and the INMO have been looking for engagement on staffing the new state-of-the-art facility but the HSE is not meeting us. Our members have had to ballot to try to force management to engage with us. It is meant to be opening this month. This comes back to a ludicrous situation where we have a brand-new facility. What is the safe staffing requirement for that facility? We should be able to move patients from the old dilapidated building, with paint peeling off the ceilings and walls, to the brand-new building with sufficient staff to care for them.
It is a prime example of where the HSE is not stepping up to the mark in Killarney and Kerry to deal with those issues.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank Mr. Fitzpatrick.
Pádraig Rice (Cork South-Central, Social Democrats)
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I will just get a quick response from Fórsa as well.
Pádraig Rice (Cork South-Central, Social Democrats)
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I will take one more speaker for a quick response.
Ms Ashley Connolly:
I think there is always a deflection. The employer always says that we cannot get people. That is incorrect because when we look at the for-profit companies, they can. What is the difference? I think it relates to the fact that people do not want to work in the health service. They are burnt out from working in it. That is one of the reasons. The region the Deputy refers to is in tier 3 and there are real questions to be asked about why it is not at its head count, yet it is over budget.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank Ms Connolly very much. We will take our final speaker.
Michael Cahill (Kerry, Fianna Fail)
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We should acknowledge the wonderful work the existing staff are doing. They are covering for positions that are not being filled. They are run off their feet. They are under extreme pressure. It is affecting them mentally and in every way at this stage.
Pádraig Rice (Cork South-Central, Social Democrats)
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Absolutely. It is a key issue. I call Deputy Quaide, who is the final speaker.
Liam Quaide (Cork East, Social Democrats)
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I thank the Chair very much for letting me in. I apologise to the committee as I was at the disability matters committee prior to this. As I have joined the meeting late, I apologise if what I ask has been covered already.
I want to ask about bullying and grievance processes and their relationship to staff morale in the HSE. In May 2023, the former CEO of the HSE, Bernard Gloster, appeared before this committee and the focus of the session was bullying within the HSE. His comments at that stage were quite promising. He said that the HSE had extensive dignity at work policies, training and procedures but that all of that had to be matched by what was called a parallel change in culture. He said one of his top three priorities during his tenure as CEO was to address bullying within the HSE. That commitment came in the context of a series of Newstalk "Lunchtime Live" programmes at the time in which HSE staff shared personal experiences of bullying, intimidation and a culture in which people felt afraid to speak up and were isolated or penalised if they did. It was often the case that they watched the alleged perpetrator of bullying progress in their careers while they remained stranded. From what I have seen myself, certainly up to a few years ago, pursuing a grievance in the HSE was akin to a kind of Kafkaesque ordeal. As we all know, the HSE's own grievance procedures mandate that a hearing should be arranged within seven working days, yet at that stage staff, certainly in the south west, were routinely left waiting for months. I do not think it was confined to the south west. They were just languishing in a very vulnerable position for maybe five, six or seven months. Sometimes they would have to continue working with the person against whom they had made a complaint. The person and their union might follow that complaint up repeatedly, yet nothing would move. Many staff, understandably, just give up on the process because it becomes part of the harm they are experiencing. There is a sense of depletion and disillusionment with that.
In the experience of the witnesses, have they seen any cultural change in that period? Is there any analysis happening around adherence to grievance procedures or culture change within the HSE, aside from the Your Opinion Counts annual survey of staff morale? Can staff have any realistic confidence that this issue is being taken seriously within the broader context of what they have described today?
Ms Linda Kelly:
I might begin if that is okay. One of the frustrations of all of us here on the staff panel of trade unions in recent months has been that there has been a commitment by the HSE to resource the national investigations unit. That is the unit that is responsible for investigating dignity at work complaints, which is the piece around bullying. It is separate to the grievance procedure. Instead of that actually coming to fruition, it has been caught in the pay and numbers strategy. We now have posts that are unfilled. It is a very small staff group within the national investigations unit. Instead, there is a reliance on private investigators to the tune of over €1,000 a day. Somebody mentioned being penny-wise but pound-foolish earlier. That is a key example. If you want staff to have confidence that you are building a better culture, then you would resource the investigations unit, not because you want a witch hunt but because you want people to have confidence that there is a robust system in place to address concerns in a timely manner. If there was one way we could look to improve it, and that certainly has been something we have been looking for, it would be a commitment from the HSE to have that implemented. We are just hitting a brick wall, like so many of the different asks we have.
On the other side, regarding the grievance procedure the Deputy mentioned, as we all widely experience, those timelines are meaningless. With my hand on my heart, I could not come in here today and say to the Deputy that there has been any improvement in regard to that.
Mr. Tony Fitzpatrick:
I agree with that. The grievance procedure is way too slow. If staff raise legitimate grievances, the process is that there is a meeting within seven days and an outcome within seven days but that is not happening at all across the system. With regard to dignity at work, the key piece is there needs to be sufficient training for all staff on the dignity at work policy to ensure we have a better workplace in that regard. Again, it goes back to the dysfunction of the system around capacity and staffing and all the issues that follow from that. Not enough has been done with regard to dignity at work. At the moment, the grievance process is totally dysfunctional.
Pádraig Rice (Cork South-Central, Social Democrats)
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I will take two very brief questions together from Deputies Clarke and McGettigan and then we will conclude.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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One has to be passionate about one's job, but we also have to acknowledge that some jobs come with a certain level of stress and pressure attached. I want to bookend my previous question. Witnesses can give a yes or no answer to this. Do they think that the health service is surviving on the goodwill of workers?
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I thank the witnesses.
Pádraig Rice (Cork South-Central, Social Democrats)
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If Deputy McGettigan can be as quick, it would be good.
Donna McGettigan (Clare, Sinn Fein)
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Yes. That is fine. We have all spoken about multi-annual budgeting. We in Sinn Féin have called for this as well. What would it look like and what are the barriers to it?
Ms Linda Kelly:
At the moment there is a lack of engagement with staff representatives on funding generally. Typically, we find out information, not from the employer but either through the publication of documents on the Department of Health's website or through other documents that are circulated rather than through direct engagement on what is required on funding. We know there is a working group in the Department of Health that is looking at population-based resource allocation funding for the health service. The devil is in the detail in terms of how all of that is going to work. We are aware that they are looking at a shadow budget this year with a view to moving to that cycle, but there is very little engagement with workers and staff representatives. If we are going to have a system whereby we have multi-annual funding, all stakeholders have to be involved. Everybody needs to be in the picture because it is too big a systems issue for it to be something that is kept secret by a small few who want to make decisions without input from people. That is certainly something. There is a working group within the Department but there needs to be engagement with everybody across the system on what they are planning and how we can build improvements onto that.
Ms Susan Clyne:
There are endless reports in every single Department about population growth, the needs of our population into the future, the physical infrastructure and the number of staff that are required for health. They have it all. It is very easy to work out a budget. The problem with the budgets is that they never start off realistically and then we get this blame game when funding is over the budget and it is overspent. It is very much targeted towards the employees. The narrative is that they want to protect patient services. They cannot protect patient services. The employees cannot keep on delivering those services at a safe level. Everybody in government has the information. We have had it for decades.
Only a few days ago an ESRI report came out showing how many health and social care professionals are going to be needed for the older population. We know the number of beds.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank Ms Clyne.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank everybody very much. I do not mean to rush anyone, but another committee is due to meet at 12.30 p.m. and we need to clear out the room before the next meeting starts. I thank Fórsa, SIPTU, the INMO and the IMO for their contributions today, the evidence they presented to us, all of the written submissions and the opening statements about their ongoing work. As I said at the start, the evidence presented today is stark. It should set off alarm bells. It does need a response from the Department, the HSE and the Minister. For our part, I propose that we write to the Minister and ask about the legislation on safe staffing levels, see where it is at and get an update, with the agreement of the committee, on the registration of healthcare assistants, which was raised earlier. I take the point about engagement with the Department of public expenditure, which is a very good one. It was suggested the committee engage with the Department on the multi-annual budget and we could write to the Minister, if people are happy for us to do that.
I thank everyone for the engagement. It was a very good session. Thank you for your time. I really appreciate it. The meeting is now adjourned until 26 May at 3.30 p.m. when we will meet in private session.