Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I move:

That Dáil Éireann: notes that:— members of both the Irish Nurses and Midwives Organisation (INMO) and the Psychiatric Nurses Association of Ireland (PNA) have rejected the Public Sector Pay Commission recommendations and that both unions have served notice of industrial action in the weeks ahead;

— the INMO has given notice of a strike for 24 hours on 30th January, 2019;

— should the dispute go unresolved, there will be further 24-hour strikes on 5th and 7th February, and then on the 12th, 13th and 14th of that month; and

— the PNA is to implement an overtime ban on 31st January, and on 1st, 5th, 6th and 7th February, with possible strike action by its members on 12th, 13th and 14th February next;agrees that:— such industrial action is not in the best interests of patients and that every effort must be made by Government to defer the action by urgently engaging with both organisations and also utilising the Workplace Relations Commission and the Labour Court; and

— it is deplorable that no substantial engagement has taken place prior to this;recognises that:— there has been a significant increase in demand for health services over the past decade, with further increases anticipated owing to changing demographics;

— the number of staff nurses has fallen by 1,754 between 2008 and 2018;

— there are significant challenges in recruiting and retaining nurses and midwives;

— the difficulties in recruitment and retention are having an adverse impact on patient care in both emergency and scheduled care;

— at least €1.4 million is being spent on agency nurses per week;

— there is only one applicant for every four nursing and midwifery vacancies in the Health Service Executive;

— there was a 40 per cent increase in vacancies in psychiatric nursing positions from November 2017 to September 2018;

— nurses and midwives are the lowest paid graduate professionals in our health services;

— nurses and midwives work a 39 hour week while all other allied health professionals work 37 hours;

— nursing/midwifery agencies have increased the rate for nurses/midwives they engage with by 20 per cent; and

— previously a commitment to review nursing and midwifery salaries in the context of advances in their education and training, and the expansion of their roles was given in 2006;further recognises the recent pilot projects on safe staffing levels, and their very strong results in terms of patient care and outcomes; and calls on the Government to:— engage with the INMO and the PNA to resolve the dispute and to ensure that any strike action has minimal impact on services for vulnerable patients; and

— commission (while recognising, in particular, clause 3 of the Public Service Stability Agreement, and the Public Sector Pay Commission Report) an independent judge-led review of the nursing and midwifery professions, taking account of the introduction of the nursing degree programme, the extra specialties and extended duties that have evolved and that can be further enhanced, as well as examining the remuneration, contracts, and allowances for same with a view to addressing the chronic recruitment and retention issues.

In 14 days there is due to be a national strike by the Irish Nurses and Midwives Organisation. If it goes ahead, it will be just the second national strike by the INMO in its 100 year history. The following day, the Psychiatric Nurses Association will commence escalating industrial action. The motion before the House which Fianna Fáil has tabled calls on the Government to do two things. The first is to urgently engage with the INMO and the PNA to avert strike action. That could include the Workplace Relations Commission and the Labour Court if it proved useful to all sides. The second is to establish an independent commission on nursing and midwifery, chaired by a judge, to assess the nursing and midwifery professions, including pay, conditions, staffing and career structures. We believe such a commission would provide a mechanism to address the very real issues being raised by nurses and midwives and would do so within the bounds of the public service stability agreement.

The strike action is not something that nurses and midwives have chosen lightly. It is something they have been forced into by a Government that does not listen and appears not to care. They are not alone. Unprecedented anger and frustration is being felt right across the country by nurses, midwives, GPs, non-consultant hospital doctors, NCHDs and consultants. In spite of spending billions of euro more on healthcare in recent years, and having one of the highest healthcare spends anywhere in the world, this Government has at the same time managed to alienate pretty much the entire healthcare profession.

The INMO and the PNA have been raising concerns about retention and recruitment and knock-on effects on patient care since 2013, and they have been largely ignored by the Government. In fact, just last month the Government cancelled its scheduled meeting with the INMO. At the same time, the Taoiseach went so far in this House as to blame nurses and midwives for causing the upcoming winter crisis because they might take a few days off. That lack of understanding is also seen in the Government's countermotion, which regrettably does not address the core issues at play as this strike is being considered. In fact, I debated with a Government Minister on Sunday who went so far as to say that the Government did not really know if the strike was about pay or whether the nurses and midwives were all that aggrieved. That was an extraordinary statement to make in the face of potentially the second national strike in 100 years.

The INMO is asking a very simple question. Why are nurses and midwives paid thousands of euro less than other degree level graduates in the HSE? That is the question. Why are they the lowest paid degree level graduates in the HSE? They deserve an answer to that question and there must be movement on that question.

At the same time there are other issues and opportunities across the profession that can be addressed. The Public Service Pay Commission reported last August. It recommended increases to allowances of 20%. It recommended promotion to senior posts earlier. It recommended recognition of additional specialties, as indeed were identified last year by the INMO's own members at their annual conference. It identified serious failings in career supports, advancements, professional training and in a range of other areas for nurses and midwives in the HSE.

On the issue of core pay the report showed that Irish nursing graduates are paid significantly less than they are in Australia, the US and Canada - English speaking countries around the world actively looking to hire our nurses. Nursing agencies have increased their fees by at least 20% and in some cases by up to 44%. They would not have done that unless it was becoming harder to hire agency nurses based on pay. The report pointed out that the use of agency nurses is increasing, which surely is a false economy given that last year the spend on agency nurses was somewhere between €1.4 million and €2 million a week.

On recruitment and retention the report identified numerous issues. These included hiring specialty grades such as in emergency medicine, intensive care and theatre. It included hiring for senior nursing roles. The report pointed out the heavy reliance on overseas recruitment and the increasing use of agency staff. Right now there is one applicant for every four nursing and midwifery vacancies within the HSE. We know that there has been a 40% increase in vacancies in psychiatric nursing positions just from November 2017 to the following year. We also know that the difficulties with recruitment and retention are having an adverse effect on patient care in emergency and scheduled care. For example, in Galway University Hospital, one in every three of its operating theatres is closed on a full-time basis because the hospital is not able to hire enough theatre nurses. How many patients lives are being harmed by that? How many scheduled operations are being cancelled because one in three theatres in the only level four hospital in the region is closed?

In response to those facts the Government regularly points out that the total number of nurses is increasing. The report from August last year showed that while that may be true in total when one includes directors and managers, it is highly variable by hospital, it is static for community nursing and it is falling in mental health. Just as concerning, the report pointed out that workforce planning in the HSE is so poor that it does not know how many nurses it is trying to hire. We do not even know how many nurses we want. We do know that the number agreed between the INMO and the Government has been missed, to the tune of 69%, in terms of the number of additional nurses to hire.

Pay and conditions, staffing levels, career supports and advancement, patient care and many other issues need to be addressed. In so doing, the issues at the centre of the strike can be addressed. At the same time, both the commission report and unions have identified numerous opportunities to make the professions more attractive while greatly improving patient care. Fianna Fáil believes that the best way to do that, while staying within the bounds of the public service stability agreement, is an independent commission on nursing and midwifery. It should be led by a judge. It should be strictly time limited and it should have terms of reference agreed between the Government and the unions. Meaningful engagement by the Government with the unions is needed now. It has not happened for years. The industrial relations apparatus of the State is at hand to help. At this point, every effort must be made to avoid industrial action. If the motion is passed by this House and acted on by the Government, and if the Government engages in good faith in a meaningful way with the unions, I believe we can avoid strike action, make the professions more attractive and improve patient care all at the same time.

See this speech in context