Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

I am very happy to have the opportunity to speak in this debate and to discuss the issues and the looming crisis that is coming down the line in respect of the likely nurses' strike. I particularly want to pledge my support to the amendments to the motion which the Social Democrats are very happy to support. Those amendments relate to the issues raised by Sinn Féin in particular.

There is no need to recite the problems in our health service. We are all too familiar with them. There are very serious problems. We spend more in this country than most other countries spend on their health services yet there is a significant amount of unmet need. There is very poor access and in no other country do so many people have to pay upfront to access the most basic health services. We desperately need system change. Whether we are talking about trying to operate the existing system in a better way or reforming it and moving to a new and more modern public health service, there is one obstacle which it is impossible to see how we can overcome without drastic action. That is the obstacle of the serious problem of the crisis in recruitment and retention. It applies right across the board within the health service for most disciplines but it is particularly acute when it comes to all kinds of nurses. That is where the biggest crisis is. This crisis has been flagged for some time by both the INMO and the PNA. The Government has persisted in ignoring the looming crisis. The attitude of the Taoiseach and the flippant and dismissive tone he has been using when speaking about this issue is entirely unhelpful. It is insulting to the nurses at the centre of the dispute. It is time the Taoiseach, the Minister and the Cabinet woke up to the looming crisis coming down the tracks. It is very hard to see how we will avoid the crisis of a nurse's strike over multiple days unless Government takes urgent action to address the matter.

The undoubted general shortages that exist at the moment with nurses, particularly theatre nurses, are causing significant problems. It is not an issue of a shortage of beds, theatres, equipment or consultants. The main reason procedures are cancelled is as a result of a shortage of theatre nurses. Let us be clear about it. That is where the problem lies at present and that is what must be addressed before we talk about building more hospital beds or hospitals. Maternity services must be midwife-led. There are serious shortages there. Previously we had good quality, seamless services right across the community in terms of children's health, including vaccination programmes and developmental checks. All of those key services that are provided by public health nurses and basic services for children are not being provided as a result of a dire shortage of public health nurses particularly in the Dublin area.

That is how the system operates at present.

Theoretically, everybody in the House has signed up to the reform programme that is Sláintecare. The latter locates nurses at the very heart of the delivery of health services and that is how it should be. Irish nurses are highly qualified and, in the main, are capable of delivering public health services. We have talked for years about the need to reform the model of care to get away from the expensive hospital-based care system and to bring services locally into the community. Nurses are at the heart of those community services. We also talk about the need for an emphasis on prevention and early intervention, and again it is nurses who we need to deliver those services. For 20 years we have been talking about the need to address the major issue of chronic illness management within our health service. We know that up to 80% of the burden of the health service relates to chronic illness management, yet we have very few chronic illness programmes; it is nurses and senior nurse managers who are equipped to lead out on those programmes and who should be providing them. If the Minister and the Department of Health have any sense, they will realise that is the key to addressing the logjams within the health service. We need clinical nurse managers and nurses right across the board to deliver those services. We are also facing a massive challenge in respect of our ageing population and the need to provide community services to support people living in their own homes for as long as possible. The necessary supports in respect of home care supports, home help services and all of that should be overseen, managed and supervised by nurses. That is what the reform programme is about. It is about switching to a different model of care. It is about getting much better value for money and improving access to health services. We cannot do that unless we have sufficient nurses.

Nurses are voting with their feet. It is undeniable that at the root of this problem is the fact that pay is unacceptably low. There is no reason highly qualified nurses should be lowest among professionally qualified healthcare staff but that is the situation, both in the starting point of the pay scale and going up the pay scale and incremental improvements. At each stage, nurses earn €7,000 less per year than their counterparts - therapists and so on - in other health disciplines. That is an enormous gap which is insulting to nurses, who are just as highly qualified as other health professionals working at the coalface. They are just as highly qualified as the range of allied health professionals, yet they are lagging so far behind. There is a massive demand for nurses. There is a large market for well qualified English-speaking nurses such as ours. There are lots of different packages on offer in places where it can be much more pleasant and more affordable to live. Those packages are better than what is on offer here. We need to value our nurses. We need to recognise that we are facing a real crisis. We need to say that unless urgent action is taken to ensure that there is pay parity between nurses and other health professionals, we are going to continue to haemorrhage nurses. Our health service is in crisis. If we lose more nurses it will collapse and we are very close to that tipping point. I call on the Minister of State and the Taoiseach to wake up, see what is happening before their eyes and avert this crisis before it is too late.

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