Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I move amendment No. 2:

To delete all words after “Dáil Éireann:” and substitute the following:“notes:

— the industrial action already taken by nurses and midwives in recent weeks;

— the decision of the Labour Court to intervene in the dispute is in the public interest; and

— the acceptance by the Government of the Labour Court recommendation; and believes that:

— while respecting the requirement on nursing unions to ballot their members, the recommendation represents a fair and balanced solution to the dispute which is consistent with the Public Sector Stability Agreement; and

— an important opportunity exists to enhance the status and significance of nursing and midwifery through collaboration and dialogue, and through the implementation of Sláintecare.”

I thank Members for their contributions and I thank the Deputies tabling this motion for the opportunity to discuss the recent dispute between health service employers and the nursing unions, the Irish Nurses and Midwives Organisation, INMO, and the Psychiatric Nurses Association, PNA.

Following the recommendations issued by the Labour Court on Monday, the INMO and the PNA industrial action scheduled for three days of this week has been suspended. That has been very welcome news for patients throughout the country. Taking the point made by other Deputies, it is also welcome news for nurses and midwives, who want to be back in their workplace, not on a picket line. Since this suspension was announced, I can assure the House that the HSE immediately commenced work to address the cumulative impact this dispute had already caused and to get our health service back a degree of normality.

It is clear that the previous three days of industrial action, which involved a withdrawal of labour by nurses and midwives across the public health services, had already had a significant impact. The further planned escalation, if it had proceeded, was likely to severely challenge the ability to provide a safe service to the public. On that basis, the Government very much welcomes the decision by the nursing unions. I understand and accept the decision to take this action was not taken lightly by nurses and midwives, who would rather be at work. I agree on the point that this was an action not taken lightly.

I would also like to take this opportunity to thank the members of the Services, Industrial, Professional and Technical Union, SIPTU, who did not engage in industrial action throughout this period. It is important to point out that SIPTU nurses and midwives did not engage. When we talk about other unions it is important to acknowledge their decision and thank them for their ongoing services. The Government has accepted the recommendation of the Labour Court to resolve the industrial action with the nursing unions. That is important. An independent recommendation was given by the Labour Court, the highest industrial relations mechanism in the land, and the Government accepted that recommendation in full at its meeting on Tuesday. The Labour Court intervened in this dispute due to the exceptional circumstances and the grave and extensive implications of the dispute. I would like to thank the Labour Court for its intensive work between the parties, particularly over the weekend. I also thank my own officials, the HSE and officials in the Department of Public Expenditure and Reform for the hard work they put in to help us to arrive at a point where the Labour Court involvement and engagement proved fruitful for both sides by producing a recommendation. While I am very conscious that the recommendations remain to be accepted by the INMO, I would like to thank the union's leadership for its continued engagement with health service management throughout this dispute. That is very important to note. During this dispute the INMO was working to put contingency plans in place and I thank the leadership for that.

As referred to in the constructive Fianna Fáil amendment to the motion, an amendment which I welcome, the Government agrees that all sides to the dispute should be given time to consider the recommendations without interference. It is important we allow the unions to do what they do, have their deliberative process and consult with their members. I understand that the INMO is to consider the recommendations further at its executive meeting today. The INMO will also consider its ballot process. The Government does not intend to interfere with that process and I suggest that we in this House should not do so either. It is now a matter for nurses and midwives, the members of the unions, to give their views on these matters. I should also note that talks are continuing with the PNA and that the Labour Court has invited the parties to a hearing on Friday of this week.

However, the original motion, as presented by Solidarity-People Before Profit, seems to set out a very simplistic approach to dealing with a complex dispute. The recommendations issued on Monday by the Labour Court are grounded in the reality of what is achievable within the public service pay agreement. I heard from most parties in this House, although not from all groupings, that people wanted a solution to be found within the public service stability agreement. Indeed, many Members put it to the Government that it was possible to find a way forward within the context of that agreement. This was complex but that was the work that was under way. The recommendations also met the three principles this Government repeatedly stated it wanted to achieve in any solution to this dispute, namely, that a deal would be fair to taxpayers, fair to public servants as a whole and fair to nurses.

I welcome the recommendations as putting forward further realistic measures which should help improve staff retention and recruitment within the nursing and midwifery profession. It is also very important that the recommendations require staff to agree to improved productivity measures as part of the introduction of an enhanced nursing practice role. The recommendations include a range of changes and initiatives to deliver enhanced practice in nursing and midwifery. These include: contract changes; agreements to flexibility and assessment of rosters in the context of the framework on safe staffing; a review of staffing and skill mix in all areas, including ambulatory and outpatient areas; full co-operation with the implementation of integrated care organisations in our health service; and full co-operation by all sides with the implementation of the healthcare assistant review.

As part of the roll-out of these productivity measures, provision will be made for an enhanced nurse practice salary scale. Funding will linked to savings from reduction on agency staffing costs, using funds from the new entrant salary scale agreement and savings from increased productivity. The Labour Court also stated that these savings would need an independent verification mechanism under the auspices of the court. It even went so far as to state that if savings are not realised it will reconvene to examine this mechanism.

The recommendation also proposes a new location allowance for nurses working in medical and surgical areas. In the longer term, it is also proposed that an expert review of the nursing profession is to be undertaken, to be completed by 2020. Another positive development is the commitment to the national roll-out of the safe staffing and skill mix framework. As the Minister for Health, I very much welcome this and the acceptance of the recommendation by the Government. This will be implemented by the end of 2021 at an accelerated pace compared to what had previously been agreed. Additional advanced nurse practitioners are also to be recruited. If we are serious about Sláintecare, and I am, we will need more advanced nurse practitioners. The commitment under this recommendation to providing 700 across our health service will be a great help. In summary, this recommendation provides the foundation for significant and meaningful reform of the nursing and midwifery profession as we know it.

The motion also raised the separate issue of union recognition in the context of a separate dispute. The union in question, the National Ambulance Service Representative Association, NASRA, is affiliated with the PNA. This group is to engage in industrial action over three days starting on Friday. This is a further escalation to an earlier one-day withdrawal of labour earlier this year. NASRA is a group which is currently not recognised by the HSE and, therefore, does not have negotiating rights for ambulance personnel. The PNA, which is a non-ICTU affiliated union, has negotiating rights for nurses working in psychiatry and intellectual disability sectors. SIPTU, Fórsa and Unite represent the ambulance grades. It is regrettable that this industrial action is being taken. I have asked my Department to engage with the HSE to explore ways forward and see if we can progress a resolution to this dispute.

The proposers of the motion also describe the health service as being "starved of resources", despite record funding being provided to the HSE in 2019. We have many challenges in our health service and face many challenges in reforming it. There is a lot of ongoing work. However, the idea that it is starved of resources does not stand up to much scrutiny. Clearly, funding alone is not the answer. I note the reference in the motion to providing an equitable health service. I do not believe Solidarity-People Before Profit has signed up to Sláintecare. I think it is the only grouping in the Oireachtas not to have done so, although I am open to correction on that. The vision set out there will greatly assist us in achieving improved access to services based on a person's needs. Sláintecare is the bedrock. It is about delivering an equitable and universal health service. It is a document that all major political parties and most Independent Members of this House have signed up to.

To support the delivery of Sláintecare, the Government has put key structures in place to drive and implement reforms. These include a dedicated Sláintecare programme implementation office, led by an executive director, which is now established with an allocated budget for this year. The Sláintecare programme implementation office will publish action plans every year and progress reports twice a year.

In the meantime, for the first time, the HSE based and developed its national service plan for this year on the framework of the Sláintecare implementation strategy. The focus on Sláintecare in this process is an important element of the strategic transformation of our health service.

It is worth noting that the changes to the nursing profession contained in the Labour Court recommendations are transformative and in line with the agenda of Sláintecare. When trying to resolve an industrial relations dispute, to find it being resolved in a manner that is compliant with our health reform policy, Sláintecare, is very encouraging.

The cost of living is also something the proposers of the motion have also put forward. The Government has taken, and will continue to take, a number of measures to try to address issues relating to the cost of living.

By the end of 2019, the Government will have spent €6.6 billion in the past four years to accelerate the delivery of housing supports. In my Department, over successive budgets we have extended access to free GP care, reduced prescription charges, which will be reduced again at the end of next month, and reduced the threshold of the drugs payment scheme, which will be reduced again at the end of next month.

I would like to return to the Labour Court recommendation made on Monday in respect of nurses' dispute. I firmly believe that these recommendations present an opportunity to enhance the status and the significance of nursing and midwifery through collaboration and dialogue and through the implementation of Sláintecare. There is a lot of work to be done by all the parties involved if the recommendation is accepted. A new nursing contract needs to be agreed; and an agreed model of measurement and verification of savings needs to be developed. The expert review group on nursing, which many in this House called for, while many others called for a commission, will also need to be set up. However, the parties must now be given the time to consider the recommendation without the interference of Government and, I respectfully suggest, the Oireachtas. It is important that we allow nurses and midwives the space to consider what this recommendation means to them, to their colleagues and to the workplace and to give their adjudication on that.

As opposed to the proposers of the motion, the Government takes a longer term, strategic view of the situation and we are working to ensure that the role of our nurses and midwives will be enhanced, strengthened and aligned with the future health needs of the population.

In respect of the other dispute, I hope engagement can happen to try to find a way forward to resolve it because we do not need any more industrial relations disputes in our health service.

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