Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

That is right.

The motion before the House speaks to the importance of nurses and midwives in Ireland and to the many challenges now faced by those professions. I wish to recognise the work of Deputy O'Reilly in developing and tabling the motion, which Fianna Fáil will support.

It is abundantly clear that all is not well for Ireland's healthcare professionals. This is true for our doctors and equally true for our nurses and midwives. I acknowledge the attendance in the Gallery of representatives of nurses and midwives. The importance and value of nurses and midwives is well recognised and cannot be overstated. They provide the majority of care in Ireland by a long distance. They make up a full third of everyone employed in healthcare in Ireland. For every hospital doctor and consultant, there are about four nurses and midwives, and for every GP in Ireland there are about ten nurses and midwives. Therefore, they carry the biggest load. They work every day to provide the very best in clinical and non-clinical care in our hospitals and throughout our communities. Ireland's nurses and midwives are highly educated, highly trained and highly skilled. They have an outstanding clinical reputation around the world and are duly sought after in an increasingly competitive global healthcare labour market.

However, we need them here in Ireland. This means we must make Ireland an attractive place for nurses and midwives to work, to develop professionally and to have their careers here. We cannot compete, nor should we, with the zero-tax offers of the Middle East and, sadly, we cannot compete with the Australian climate, but there are many things we can do. We can ensure equal pay for equal work. We can ensure a workplace where our healthcare professionals do not work in fear of being assaulted daily. We can ensure that on wards, in emergency departments and in primary care the nursing teams are of a sufficient size and skill mix to be able to do the job they know how to do. We can ensure there is access to high-quality training.

Right now, these things are not ensured in Ireland. As the motion sets out, assaults on staff in hospitals have skyrocketed. In 2011, there were 673 reports of assault. By 2016, just five years later, that figure had grown to 3,462, an absolutely extraordinary rise in the number of reported assaults. Three quarters of respondents to a recent INMO survey said current hospital conditions are resulting in poorer-quality training. Trolley counts are higher than they have ever been. Waiting lists are longer than they have ever been. Hospital bed occupancy is estimated to be at approximately 100%; some estimates put it at over 100%. Either way, it is much higher than accepted, safe international levels. All of this, of course, makes for a very stressful and difficult working environment for all our healthcare professionals, including, obviously, our nurses and midwives. We are seeing the results in demotivation, frustration, resignation and emigration. A recent survey of hospital nurses found that for every ten nurses leaving their jobs, seven are resigning. Therefore, it is not retirement or sickness; it is voluntary resignation from those jobs. I met INMO representatives just yesterday. They cited the following as some of the top reasons for these resignations: pay, including the difference in pay for new entrants; working conditions, including incorrect team sizes and skill mixes; and a deteriorating learning environment.

As to whether there is currently a shortage of nursing staff on average across the HSE, there are mixed views. The capacity review by the HSE benchmarks Ireland against some of the best healthcare systems in the world: Australia, New Zealand, Norway, Denmark, Finland and Sweden. It shows that Ireland has the youngest population. As such, we should need less healthcare than the other countries. We should need fewer hospital beds, doctors and nurses. The capacity review also shows that Ireland has more nurses per population than Australia, New Zealand and Sweden, although fewer per population by quite a bit than Norway, Denmark and Finland. The INMO has written on this and it disputes the benchmarking figure. It believes the figures for Ireland are overestimated relative to the other countries. On top of this - this is one for the Minister - for some bizarre reason, the capacity review does not include an analysis of the number of nurses and doctors we have, the shortage today or the number we need in the future. It includes an analysis for primary care, GPs, practice nurses, acute beds, ICU beds - all sorts of things - but it does not include an analysis for nurses or doctors in hospitals. There is, therefore, no official HSE or Government figure for the projected shortfall in the coming years, so we do not know that, and we need to know it quite soon.

There are things we do know. We know there are approximately 2,200 fewer nurses and midwives working in the system today than there were ten years ago. We know that in those ten years healthcare activity has increased a lot, so we know there are substantially fewer nurses and midwives dealing with a substantially greater workload. We know that in 2017, almost 80% of student nurses said they were considering emigrating after graduation. We know that in some hospitals and community care teams, understaffing exists and is making the job unbearable. We know that in the UK, a recent report estimated that the NHS will be short somewhere between 14,000 and 42,000 nurses and midwives.

The figure of 42,000 is more nurses and midwives than work in Ireland, so that is an estimate of how many the NHS could be short.

We know that Brexit is being blamed, quite rightly, for a record number of nurses and midwives from other EU countries leaving the NHS, which is something that maybe should have been considered beforehand. Applications for nursing degrees in the UK from people from other EU countries is down by a quarter. We also know the NHS is actively targeting experienced and graduate nurses and midwives in Ireland, and that it has an awful lot of resources at its disposal to attract them into the UK. The question is, what can we do about all of this if we accept that we have a serious problem on our hands, that the current position for our nurses and midwives is not sustainable, that their working conditions and unequal pay are not acceptable and that inadequate access to continuous professional development is not acceptable? We can make sure that pay equality is achieved quickly. The report on pay equalisation was a key demand made by Fianna Fáil in the confidence and supply arrangement. The report has been published and there is an onus on the Government as a matter of urgency to set out a roadmap for how equal pay will be delivered and rectified for new entrants. We need the complete unwinding of FEMPI on a fiscally sustainable basis and we need it to start before 2020. My understanding of the current Government proposal is that consideration will begin in 2020. Fianna Fáil's view is that it needs to begin before then. The Government needs to ensure that nurses and midwives receive ongoing training. The Government needs to take immediate steps to ensure the rise in assaults is not just stopped but immediately reversed. It is utterly unacceptable and entirely preventable. We should ask no one in this country to go into work in fear of being assaulted. Longer-term measures will help, including reducing stress on the hospital system thereby reducing the frustration of patients, but there are short-term measures that can and should be taken. We need to ensure that the staff ratio and skill mix are correct. The framework for safe nurse staffing and skill mix is an indicator of where we need to go. The pilot study is interesting. It has seen improvements in the retention of nurses, the reduction of agency staff and positive outcomes for patients. The lessons learned in this pilot must be rolled out on a wider basis.

The Minister has laid out steps that have been taken and it would be unfair to say nothing has happened because things have happened, but when I talk to nurses, midwives and other healthcare professionals, they say that they see an awful lot of reports and hear a lot of warm words but, to date, they have seen very little action, and it is action we would like to see as soon as possible on behalf of the nurses and midwives.

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