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

I thank the Labour Party for tabling this motion on staffing levels in the HSE. The Social Democrats are happy to support it.

There is no doubt that in recent weeks there have been several claims and counterclaims. This has made it difficult to get to the truth of the matter and the facts. The Minister's plan seems to be to muddy the waters instead of engaging in any kind of meaningful way with the unions. We have been repeatedly told that an additional 28,000 healthcare professionals have been employed since the Government came into office. That figure is a welcome one. However, the Minister repeatedly fails to say the base figure. It is all very well to say that a large number of additional staff have been hired, but the key thing is the starting point. I can tell the Minister and the House that there were approximately 120,000 healthcare staff in 2020. For context, it is important to point out that this figure was barely 4% higher than the level in 2008. Of that 2020 figure, the number of doctors was just 3.3 per 1,000 head of population, which is the sixth lowest rate in the EU. The number of nurses was 12.9 per 1,000 people, which is admittedly above the EU average of 8.4 and the OECD average of 8.8, so the Minister often uses those figures. However, the OECD has repeatedly said that the figures for Ireland are overestimated because we are not comparing like with like. Ireland includes midwives, unlike most countries, and has traditionally counted nurses who work in management, education and research, while the majority of other countries only include practising nurses who provide direct patient care. I understand this will change, which is welcome, but until the distinction is made between front-line work and other work, we must acknowledge that our figures are inflated. When the Minister spins the line that Ireland now has the second highest level of nurses in Europe, I will be forgiven for taking it with a pinch of salt.

The substantial loss of institutional knowledge during the austerity period must also be acknowledged. Approximately 10% of staff nurses left during this period and this loss of skills has compounded the current problem. After all, it is not just a question of numbers; it is also a question of experience and institutional knowledge. Another good indicator is the level of staff turnover, which is too often ignored. The staff turnover rate for nursing and midwifery was 6.4% in 2020. By the end of last year, it had jumped to 8.7%. I appreciate that there are several variables to consider with turnover, not least of which is the housing crisis, but job dissatisfaction is clearly a driver. A recent INMO survey found that a whopping 63% of respondents had considered leaving in the previous month.

It is also important to consider the environment in which our healthcare staff are working. Among the 38 OECD member states, Ireland has the highest bed occupancy rate at 90% and, as we know, it is over 100% in many of our hospitals at times. This is well above the recommended maximum occupancy rate of 80% to 85%. While the number of hospital beds has increased, this year the European Commission found that Ireland still had the fifth lowest number of beds in the 27 EU member states. This means our healthcare staff are working in environments that are chronically overcrowded, leading to much higher workloads and considerable pressure. This is unsustainable. We have heard this from the INMO and SIPTU as regards nurses and from other representative bodies, Fórsa in particular, as regards other healthcare professionals.

I accept that a safe staffing framework is now in place for nursing, but it needs to be fully implemented. Furthermore, we must ensure it reflects the reduced working week, which was reduced from 39 hours to 37.5 hours per week. The INMO has said that no provision was made for this loss of nursing hours. That must be addressed, because it was a pertinent issue that arose in the Workplace Relations Commission, WRC, hearing. There was a request that those figures be recalibrated. That must be done urgently. Last week, I asked the Minister to ensure the numbers are recalibrated so the facts can be put on the table. This back and forth dispute of figures should not continue. We need to have the facts of the matter, put them on the table and ensure the commitment to safe staffing levels is adhered to.

In other areas of the health service, staffing numbers are going in the wrong direction, despite the Government's talk about record numbers. At a recent health committee meeting, SIPTU said the number of healthcare assistants in the HSE decreased between January 2023 and July 2024. It has fewer healthcare assistants now than it had at the beginning of last year, at a time when the demand for homecare is growing rapidly. Is it any wonder the State is becoming more and more reliant on private providers? It is beginning to seem as though this is a deliberate policy and that a policy of outsourcing and privatisation is at play. At the same meeting, SIPTU told committee members that we have a 30% shortage of radiation therapists. This crisis is reflected in the level of outsourcing which has cost approximately €10 million in the current year.

Representatives of SIPTU and the Irish Cancer Society will be in the coffee dock this afternoon to speak to Members about these issues. I ask Members to try to make time during the day to drop along to hear about the illogic of what is happening. We could be treating far more people with vital life-saving cancer treatments, but we simply do not have the staff. Clear steps can be taken to address that, but the Government is not listening. Regrettably, many other areas of the health services are chronically understaffed, from the National Ambulance Service to CAMHS, which many people have mentioned. We need to move to a situation where we have safe staffing levels, not only in nursing as previously committed to, but right across the health service.

We need to start regarding that as investment rather than a cost because, ultimately, the savings will be made if people have access to early intervention and are able to recover from their conditions.

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