Ivana Bacik (Dublin Bay South, Labour) | Oireachtas source

I pay tribute to my colleague Deputy Duncan Smith who has led for us on this important motion. As Deputy Smith has said, this is the last Labour Party Private Member's motion in the lifetime of this Dáil. It might even be last Private Member's motion. In any case we thought it was vitally important we would put it down on the issue of healthcare and especially healthcare staffing. We are all conscious what a crisis exists. Notwithstanding the very lengthy Government amendment, which is about four times as long as our original motion, you could boil it down to saying there are simply not enough staff to provide the adequate and decent level of patient care all of us would hope to have for ourselves and for our family members.

The healthcare system is an issue. Problems with healthcare come up in every constituency across the country. I was in Tipperary on Friday with Deputy Alan Kelly and I heard there from so many people in Nenagh about their concerns and about their own experiences and their families' experiences with overcrowding, with lack of access to treatments and lack of access to GPs in the area. I was in Limerick on Monday with Councillor Conor Sheehan and heard the huge concerns and huge issues there with University Hospital Limerick. All of us think of the dreadful and tragic death of Aoife Johnston in UHL, and again we extend our deepest sympathies to her parents and family. Concerns about access to healthcare are deeply held across the country.

I also pay tribute to the heroism of healthcare workers who are providing services in an underfunded, understaffed and overcrowded environment, to our nurses doctors and carers but also all those who keep hospitals, surgeries and clinics going, to cleaners, catering staff and porters, many of whom across the healthcare system, as the Minister will be well aware, come from other countries to provide us with the benefit of their skills and expertise, even as we are exporting so many of our own healthcare workers and healthcare professionals. As we face into the winter season, and, as Deputy Smith said, there is a real concern about that, we know we will see additional problems and additional difficulties exacerbated by a lack of clinical staff . It does come down to funding. Last year the Government announced a health budget with a €2 billion hole in it. Bernard Gloster, the CEO of the HSE, said at the time that the moneys allocated were inadequate. Indeed, that was when the Minister announced a recruitment freeze during a staffing crisis. This year, we appreciate the cuts have been more subtle. Last year's recruitment freeze has been called other names. In the Government's amendment to our motion the Minister says the pay and numbers strategy is not a recruitment moratorium. It is called things like a ceiling, but the reality is we are facing a real shortage of vital front-line healthcare workers, and this is at a time when we are already seeing record overcrowding before the winter surge, when 700,000 people are languishing on waiting lists, and when we see a serious over-reliance on agency staff.

I was interested to note that, right at the end of the Government amendment, the Minister acknowledges that the agency spend in recent years has been higher than the Government would have liked. That is an understatement. At this time, having begged doctors, nurses, midwives and healthcare assistants not to leave us for Australia, the Government has effectively turned around and said, "We still can't hire you here." The INMO is repeatedly warning that embargoes, freezes and ceilings on recruitment will send healthcare into free fall. We are also hearing about serious problems even where sanction is given to fill vacancies. The time it is taking to fill them is too long and it can take up to a year. When someone retires, leaves for another position or takes leave for any reason, positions are not ring-fenced for backfilling. Far too many people are having to act up and are having to do more work than they have capacity for. Clinical managers with no local autonomy are competing with all other requests in regional health areas. We have serious concerns about workforce planning, which is one of the issues addressed in our motion.

Government representatives are at pains to tell us that recruitment is happening, and the Minister has set this out at length in the amendment. Of course, it should be happening and we acknowledge there is some recruitment happening, but the deficit is enormous. It is a projected deficit of 49,000 nurses by 2041 and thousands of positions vacant at a time when we see a growing population and an ageing population, with medical needs becoming more complex. We need to recruit more staff. Any of us can go into any accident and emergency department and talk to anyone who has been waiting for appointments and who cannot even get to see their GP. It is plain to see there are simply not enough healthcare workers in this country, and it is having real impacts on people. I see it in my own community. I have spoken about the mid-west and the huge issues there, but in Dublin Bay South, those who attend the accident and emergency department at St. Vincent's or St. James's hospitals speak of their experience waiting long hours. I speak to those who work in healthcare. I spoke to one agency healthcare worker who would love a permanent job but cannot get one because of the freeze. He said, "Every day is like your first day on the job. It doesn't make sense to move around all the time. We are paid the same and a private company takes the cream off the top." The Minister says there has been additional investment in health services under this Government and he has set out some detail in his amendment, but tell that to the people languishing on hospital trolleys, to the people who have been turned away from scheduled appointments at hospitals likes St. Vincent's, or to the people who are turned away for DEXA scans at the same hospital because there are no staff to run the scanner. That kind of thing does not happen in an adequately resourced health service. Patient safety should be the marker for success.

If we want to talk about money and cost benefits, I return to that point about agency staff, which we focus on in our motion. The cost of hiring healthcare staff from for-profit agencies increased by 139% between 2015 and 2022, the sum being €619 million. Last year the HSE spent €650 million on agency staff, which was 3% of the entire health budget. This is a huge issue when we see workers like the worker I quoted who want a permanent job but cannot get one and continue, therefore, to be paid through the agency. This issue with staffing is not the fault or the responsibility of the healthcare workers who are desperately trying to provide a decent service and clearly it is not the fault of patients who are presenting at hospitals looking for help. The blame lies squarely at the feet of the Government and we need to see adequate resourcing in place and adequate workforce planning to ensure we will have sufficient staff to run decent services through the winter.

These problems go beyond shortages in emergency departments. It is often easy to focus on hospitals and difficulties with emergency departments because this is all very starkly visible, but there are also problems within the primary care system and the Minister is well aware of this. There is a particular issue in Dublin with public health nurse shortages, meaning children are missing key developmental checks. There is lack of access to paediatric speech and language therapists, and there are long delays in initial psychological assessments and follow-up with specialist teams. These are causing real problems for children by delaying the necessary treatments and the necessary services that should be provided. These checkups really matter to catch issues early enough to ensure intervention can be effective. Many parents come to us and speak to all of us about their huge concerns and fears for their children. We need to see better planning on child healthcare provision in those primary services too.

I will speak a little about how visible the dysfunction in the healthcare service can be. I am reminded of this every day when I cycle past the former Baggot Street hospital. I was there yesterday for an event outside the hospital and every single person outside the hospital was looking at this beautiful and iconic building in the heart of the city. It is a HSE-owned property that has been lying empty for far too long at a time when nurses and doctors cannot find accommodation. We are all aware that one of the issues with staffing and recruitment is connected to the housing crisis and the lack of affordable housing for our healthcare staff, yet the former Baggot Street hospital lies empty. Our hospitals are overcrowded and this hospital building lies empty. I have a family member who worked there until the recent past providing care to people who needed it. It is really sad to see it still sitting idle and vacant when we see such shortfalls in housing and accommodation provision for healthcare workers and when we see such shortfalls in staffing in our hospitals and in our primary care services. When positions are left vacant, people are deprived of care, the care that could be provided by those who want to help. In an economic boom, there is no excuse for Government policies that underline and reinforce hardship and lack of access.

We need to lift the cap under the pay and numbers strategy, or whatever it is called, we must give local directors of nursing and midwifery the sanction to fill and recruit for a vacant post, and we must legislate for safe staffing in our health services. Patient safety should be the absolute priority in workforce planning, healthcare planning and budgetary planning.

Níl rud ar bith níos tábhachtaí ná sláinte ár bpobail. Tá mé ag iarraidh ar an Rialtas maoiniú ceart a thabhairt don chóras sláinte. Is fearr an sláinte ná an táinte.

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