Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I too wish to begin by joining other speakers in welcoming the representatives from the INMO to the Gallery. They will be the most welcomed people ever to Leinster House. They are very welcome here today and I thank the president, vice-president, the officers and the general secretary for being here. It is important that they are here to hear the people's representatives debate what is a very important issue.

I acknowledge, accept and recognise Deputy O'Reilly's bona fides in respect of this issue. I do not intend to use the time available to me to answer some of the political charges, with which I fundamentally disagree, that have been levelled at me over the past 20 minutes or so. I intend to use the time available to me to outline where we are, what we have done and, more importantly, what we need to do in the future.

The Government will support the motion before Members this evening because it shares the analysis that we are facing a serious challenge in the nursing workforce and because we share the impetus to address it. The motion endeavours to address a number of very important issues facing nurses, midwives and, as a result, the health service in a logical and sequential way. All of us recognise the importance and the contribution of nurses and midwives. We recognise this as politicians and public representatives but also as citizens, as anyone who has had any contact with the Irish health service can see the dedication and professionalism of nurses and midwives are absolutely key to its day-to-day operation. There were a number of references to vocation and to how nursing is not a vocation. In case it was implicit that I might think it is, let me be clear that I do not. The professional, education and quality of Irish nurses is something of which I am very proud and seeing our nurses able to make an even bigger contribution to our health service, as they wish to, is also very important to me. I acknowledge that nurses and midwives often carry out their work in a high-stress working environment and in difficult situations, dealing with people at the most vulnerable moments in their lives.

We know that there are issues, and indeed there are some which are beyond the scope of the motion before us, which are priorities for me and for the Government. These include increasing bed capacity in the acute sector and the community sector. A number of representatives of Sinn Féin referenced trolley waits. Nobody referenced the fact that bed capacity was cut by colleagues in the Fianna Fáil Party long before the troika came to town. They decided there were too many beds in the Irish health service. If one keeps cutting beds, how can one be surprised when more people turning up in our health service cannot access one? We are increasing bed capacity and that will improve, and must improve, the working environment for nurses and midwives. This is part of a massive capital investment programme in a health service that had been starved of capital investment. Even during Celtic tiger Ireland, when motorways, schools and many other important projects were built, hospital bed capacity was not increased. That bizarre policy is now being reversed. We are taking measures like these and others to address the issues but the Government also recognises there is also much more to do.

We live in a world in which there is a global shortage of nurses and midwives and Irish nurses are much sought after internationally due to the quality of the education, training and experience they have received in universities and through their hospital experience. The recruitment moratorium that was put in place across the public service from 2007 by a previous Government has had a real impact on staffing levels. Some specialties, including midwives, have been particularly affected. Our current reliance on agency workers and overtime is not a tenable or sustainable solution.

Despite these challenges, I will put on the record of the House some progress we have made in increasing nursing numbers. Nursing numbers stood at 36,777 at the end of 2017 but I accept more needs to be done and that we are still not back to where we were before the recession. Nurses and midwives now amount to approximately one third of the health workforce. This arose as part of the nursing recruitment and retention agreement that was agreed with the INMO and SIPTU in 2017. Under this agreement, the HSE agreed to appoint and fund 1,224 additional nurses and midwives. The HSE filled 942 of these posts. A key contributor to this increase has been offering permanent posts to graduate nurses. Thankfully, we have moved away from the days when, as a country, we were unable to offer our graduates a permanent job. It was the reality here for a number of years that Irish nursing graduates were being told that they could have a temporary job in the health service or they could go abroad and a have a full-time permanent job. As Minister, I can now offer each nurse who graduates from an Irish university this year a full-time permanent post in the Irish health service. I reiterate that offer on the record of the Dáil today.

The recruitment and retention agreement set out a number of initiatives to increase the workforce in addition to the additional posts. These measures include converting agency staff into direct HSE employees, offering all graduating nurses and midwives full-time contracts and increasing the number of undergraduate places in 2017. We are now training more nurses than ever before in the history of the State. The challenge is to make sure we can keep them in the State when they graduate. International recruitment campaigns continue and we have an added incentive of a relocation package of up to €3,000 to nurses who return to Ireland from overseas. As well as working to attract new staff, the agreement has commitments aimed at retaining those nurses and midwives already employed in the health service. It provides for a new career break scheme. Nurses and midwives can also avail of improved educational opportunities and career pathways through important initiatives like the advanced nurse practitioner programme. In acknowledging that there is more to do, it is important to point to the importance of these initiatives.

The motion refers to the high level of student nurses considering emigrating when they qualify. I know we all wish this was no longer the case. However, I point out that even in an environment of intense global competition, the HSE has appointed 861 of the 1,055 nursing graduates, which is more than 80%. However, I accept that retention of nurses when we get them into the health service is the key issue. It is not good enough just to recruit them; we need to retain them. We are all aware that we need a plan for the future of our workforce. To that end, an additional 130 nursing undergraduate places were made available in the nursing degree programme. The HSE also introduced a pre-retirement initiative for nurses and midwives, with 37 employees taking up that offer. We have also rehired a number of retirees. These measures attempt to retain nurses who would have left the service to retire and ensures the knowledge transfer to new entrants.

I have talked about the Government's recognition that we need to do more and it is legitimate and justifiable that unions would raise the issue of pay in that context. We are all too aware of the impact of the budget cuts made during the financial crisis. The nursing and midwifery workforce suffered pay cuts, increment freezes and the moratorium on recruitment which I referenced earlier. As was the case with all public servants, people were asked to do more, with less, for less. However, the measures agreed in the public service stability agreement provide a statutory roadmap for the unwinding of the financial emergency measures in the public interest, FEMPI, legislation. This includes a series of salary increases that will see public servants, including nurses, receiving on average a 7% increase over the lifetime of the agreement.

The agreement commits to 90% pay restoration by 2020. In addition, a number of allowances have now been restored. Addressing pay, though, is a complex issue, and more work needs to be done on it. This is why I am pleased to see that the second phase of the work of the Public Service Pay Commission is under way. The commission is adopting a modular approach to reporting on its work, and its first module will include an examination of nurses and midwives. I look forward to its report and it being a roadmap for Government in how we deal with this issue. The Government took the decision that there should be a phase two of the pay commission in recognition of the recruitment and retention challenges we face in the health service. I know our unions and stakeholders, including the INMO, have an opportunity to feed into this process and to make their submissions and have them assessed.

Calls for pay parity for all new entrants are being addressed as part of another process under way being led by the Department of Public Expenditure and Reform. A data-gathering exercise has been carried out, and my colleague, the Minister for Public Expenditure and Reform, provided a report to the Oireachtas on these findings. This report makes clear the Government's commitment to working with the parties to address these issues, mindful of the cost involved. Further engagement, as colleagues know, is scheduled for this week.

As a result of the work being undertaken by the Public Service Pay Commission and the other numerous processes I have outlined, I do not agree that this is the appropriate moment to establish a new independent commission on nursing. I would rather see the pay commission conclude its work, and the outcome of that being implemented in terms of recommendations on recruitment and retention. I would also like to see further progress made in rolling out the framework for safe nurse staffing and skill mix in medical and surgical care settings, which I launched with the INMO and SIPTU in recent weeks. This is the first time in the history of our State that we have actually provided an evidence base as to how many nurses and other healthcare professionals are needed on each ward to manage patients safely and to have a good working environment. During the pilot stage of this framework, it demonstrated significant benefits for both patients and staff, and I welcome the support of nurses in the roll-out of this nationwide. We have seen in the pilot sites a sustained decrease of up to 95% in the use of agency staff. Therefore, it is clear we need to spend to save and that investing in evidence-based programmes such as the framework can make real progress in addressing the issues of retention and recruitment.

It is clear that the issues in the motion are complex and important. It is right and proper that they are raised on the floor of the Dáil and that as a country we try to grapple with how to address them now that we find ourselves in a better economic space. We have all accepted that nurses and midwives are a significant and important part of our health workforce, significant both in the number of staff they represent and in the sense of the services they provide, which we greatly value. In not opposing the motion, the Government accepts there is more to do but also acknowledges that a significant amount of work is under way. The work of the pay commission is extremely important, and I know that unions have made submissions to it. Let us await the findings of the pay commission to see the recommendations it makes, which will guide Government as we go forward. However, I assure the House and nurses and midwives that under this Government's policies we will see more nursing jobs, more colleagues working with them on the ward, more beds open, a plan for universal healthcare, as envisaged by Sláintecare, and the issue of pay continue to be addressed not just through the public service stability agreement, but also through the ongoing work of the pay commission.

See this speech in context