Liz McManus (Wicklow, Labour)

I note that in the Minister's speech, she continually repeated the word "fair". This is a verbal device used by script writers. However, it is somewhat paradoxical when one considers that the Minister's political outlook is to promote inequality. The leader of her party has made it clear that he considers inequality to be good for us all. If Members consider the Minister's approach to the health service, they will have observed a deepening of the divide, promotion of privatisation and greater provision being made for those patients who can afford to pay. Meanwhile, public facilities such as the acute hospital sector are struggling to an increasing extent to stay within their budgets. The entire concept of fairness does not come easily or appropriately to the Minister's lips.

A short time ago, I raised an issue relating to elderly people. If one cannot look after the very elderly, who literally have been robbed by the State, I am unsure how one can claim to be fair. However, the Minister has presided over a system and has promoted a privatised option in respect of paying repayments to elderly people, which simply has not been working.

A new feature has arisen in the health service, namely, a serious escalation in the nurses' dispute, which has been simmering for some time. It arises in a context of a health service that has been shamefully mismanaged by the Government. This is the Government that promised to eliminate waiting lists within two years of its re-election. It promised 200,000 medical cards and to end the severe problems that persist in accident and emergency departments. None of the aforementioned promises were kept and a point has been reached at which the Government's commitments no longer have any credibility.

This loss of confidence in the Government on the part of patients and those who care for them creates uncertainty and disaffection at a time when certainty and commitment are most needed. The Government is reaching the end of its term and, remarkably, despite a significant increase in health funding, the list of key stakeholders in the health service with whom the Minister has failed either to begin or to conclude negotiations is lengthening on a daily basis. Hospital consultants, junior hospital doctors, chiropodists, dentists, pharmacists and general practitioners have all found their contract negotiations being attenuated or ended peremptorily by the HSE and the Department of Health of Children. However, the most serious dispute is with nurses, the biggest group of health workers by far. It is disturbing that the Minister for Health and Children has displayed a certain lethargy and, at times, an ignorance about the critical problems affecting these professionals.

At the start of this year I tabled the following motion in the Joint Committee on Health and Children:

That the Joint Committee on Health and Children notes, with concern, the emerging industrial unrest between the Health Service Executive and the nursing and midwifery unions, the Irish Nurses Organisation and Psychiatric Nurses Association.

It is clear to the committee members, from representations received, that the professions hold a deep sense of grievance with regard to their hours of work and relative pay position within the health service.

Nurses and midwives are among the most flexible of public servants who provide essential care to the community on a seven day, 24-hour basis. They are an essential part of our health service.

The joint committee believes they hold substantial grievances, are prepared to engage in significant reform towards improving patient services and are seeking accommodations in line with those provided for other public servants.

On that basis, we call on the Taoiseach, Minister for Finance, Minister for Health and Children and the Health Service Executive, and its employer organisations, to engage with the INO and PNA and to take all reasonable steps towards ensuring equitable conditions apply in the health service and, therefore, avoid a potentially damaging dispute in our already challenged health service system.

The motion was supported by all members of the committee across all parties, including the Minister's. However, the Government has not done what it was asked, and we now face a deepening crisis. Every effort must continue to be made to find a resolution to this dispute. None of us is under any illusion about how difficult is that task.

There is a well thought out industrial relations structure in place which has, generally, served us well, but it is not clear that this dispute can be resolved within the current mechanism. I pay tribute to the members of the national implementation body who have spent the last few weeks trying to move towards a conclusion. It is important to recognise that this dispute is not just about money but is also about a shorter working week. Nurses have shown that they are willing to be flexible and to approach this issue in new and innovative ways.

A feature of nursing that has not been acknowledged by the Government is that nursing is continually changing. I recall a previous occasion when nurses were in dispute with a Minister. The Minister at the time, Deputy Noonan, established the Commission on Nursing, which had the brief of considering the changing role of nursing and making recommendations for the future. That commission was worthwhile and dealt with many issues. In a way, this dispute is a follow-on from concerns that might not have been addressed at that time.

There might be merit in establishing another commission on nursing to consider the changes that are being, and will be, faced by nurses in the 21st century. Deputy Twomey itemised some of them, such as the role of nurse practitioners and the issue of prescribing. A commission could consider these issues in conjunction with the forum on health, which the Minister has agreed, at long last, to establish. I regret that the forum on health, which was proposed by the Irish Congress of Trade Unions a year ago, was not taken up energetically by the Minister. If it had, we might not be in the current mess.

The health service needs nurses. It cannot provide for patients without them. The standard of care they provide is of high quality, even though the conditions in which they work can often be stressful and inadequate. It is not fair on patients or nurses to have to continue dealing with conditions the Government has failed to address. Overcrowding in hospitals, the extent of MRSA infection and the fact there is an insufficient number of step-down beds, which leads to beds not being appropriately occupied, are unfair to patients and to the staff looking after them.

Nursing and midwifery manpower is a fundamental issue for the health service. Over 11,000 Irish trained nurses have left the State since 1998 and we are increasingly dependent on nurses coming to this country from overseas to fill the gap. Approximately 8,000 have done so in the last eight years. The number of qualified nurses taking up employment in sectors other than nursing is considerable. That is not an indication that nurses have it cushy. These realities must be acknowledged when finding solutions to this dispute. I greatly regret the ill-considered and aggressive criticisms of nurses that have appeared in some media.

The Labour Party would support the argument that change can only come about through partnership. We support and promote that principle. We understand that for many nurses the idea of partnership might have a hollow ring to it but partnership for change is ultimately the only way forward. The forum for health is about developing that partnership and, indeed, repairing much of the damage caused by this Government. When a system is in constant crisis, partnership is hard to retain and people tend to work in an isolated way. That has happened more frequently. The old ways of doing things certainly have not been replaced by better and more understanding about the importance of team work as a result of the pressures within the health service being so considerable.

It is interesting to consider what the INO has been saying about issues affecting its members. This dispute is being presented as if the nurses have, out of the blue, made unrealistic and unreasonable demands and the Government is standing firm. It is not that simple and should not be dealt with so simplistically. In December 2005, shortly after the current Minister took office, the INO made a thoughtful pre-budget submission. It described what had to be done to make the health system fair. It talked about the elimination of the practice of keeping patients on trolleys for long periods in accident and emergency departments, continuous overcrowding in many acute hospitals, repeated cancellation of elective admissions, inadequate or absence of service for the mentally ill, inadequate community based services to meet the needs of those on the margins and people who live alone, and excessive workloads on frontline staff. That was the picture of the health service in December 2005.

It is now April 2007. Has the situation improved and have the problems eased? They are probably worse than ever. No amount of massaging the figures by the HSE will convince people that matters have improved significantly. In December 2005, however, the INO was itemising its issues of concern. They included the anomaly between nurses and social care workers, the issue of the 35 hour week and the Dublin weighting issue. The latter has not taken a central role in this dispute but it is clearly important. The nursing shortages are most acute in the Dublin region, where nurses simply cannot afford to buy a house or afford to live. That problem has been endemic in the system for some time. Various means have been used to meet the needs of Dublin hospitals, including bringing nurses to this country from overseas, heavy use of agency nurses and so forth. I hope the Taoiseach might live up to the reputation he built as one who was able to solve difficult industrial disputes. I am not sure if this reputation is justified, but I certainly know that the perception exists that the Taoiseach has ways of sorting out difficult problems and finding consensus. If this is so, he should be challenged to get down and start finding the consensus and the way through here.

Nobody can afford to have a situation deteriorate in the way that is now opening up to us. More than any other group of people, patients need to feel secure and know they are being cared for. There is a presumption that nurses will care for patients and nurses have shown that they are responsible in that regard. They have not gone on an all-out strike, have given a considerable amount of notice and have been making the case about these issues for years. The level of frustration and low morale have now reached a point where nurses feel completely alienated by the lack of attention given to them and feel very strongly that they have not received fair treatment. The Minister spoke about fairness, but it is all about the evidence of fairness rather than just the words used.

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