Liz McManus (Wicklow, Labour)
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Question 85: To ask the Minister for Health and Children, in view of the decision by the INO and PNA to pursue industrial action to have their grievances addressed, the action she will take to address these concerns and ensure that essential services are not disrupted; and if she will make a statement on the matter. [6500/07]

Mary Harney (Dublin Mid West, Progressive Democrats)
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The background to the planned industrial action by the Irish Nurses Organisation and Psychiatric Nurses Association is that they will not take part in the current benchmarking process which is reviewing the pay of public servants and is due to report in the second half of 2007. The INO and PNA have so far declined to sign up to the new national partnership agreement, Towards 2016. Both unions have lodged eight cost-increasing claims related to pay increases and a reduction in working hours. The additional cost of these claims would be almost €1 billion per annum. The unions are also seeking retrospection estimated to cost in excess of €500 million.

In November of last year the Labour Court recommended that the pay claims be processed through benchmarking. On the claim for reduced working hours, the court recommended that the parties should jointly explore the possibility of initiating an appropriate process aimed at achieving major reorganisation of working arrangements and practices within the health service generally. While health service employers have accepted this recommendation, the unions have stated they neither accept nor reject the recommendation.

Following the publication of the Labour Court recommendation on the union's claims, I wrote to both unions and arranged for exploratory discussions to be held between all the parties concerned on 19 January last. While I understand the discussions provided clarity as to the respective positions of the parties, the meeting adjourned without agreement on the way forward. It remains the Government's view that benchmarking is the appropriate mechanism to resolve the pay issues. Management is readily available to enter into discussions on an appropriate process aimed at achieving major reorganisation of working arrangements and practices within the health service generally, within the context of the Labour Court recommendation and the prevailing national agreements. I urge the leadership of the INO and PNA to give further consideration to the recommendation of the Labour Court and to make the case on behalf of their members, as other nursing unions have done, before the benchmarking body.

The INO and PNA served three weeks notice of industrial action on 2 February. This notice states that there will be a nationwide work to rule and series of work stoppages across health employments. Health service employers have been endeavouring to agree contingency arrangements to ensure maintenance of essential services during the planned industrial action. However, the INO and PNA have not stated the format, location and timing of the work stoppages. The failure to provide this information is a very serious matter. The HSE requires this information to ensure that services and patients are not put at risk. I ask the leadership of the INO and PNA to urgently reconsider their position.

Liz McManus (Wicklow, Labour)
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I thank the Minister for her reply, although it does not bring us very far. The Minister will recognise the health service is still in crisis. Only today we received notification from Beaumont Hospital that the much-vaunted accident and emergency strategy simply is not working. At one point this morning there were 52 people waiting on trolleys and chairs in the accident and emergency department at the hospital, which is the highest figure ever.

Does the Minister accept that, where nurses are working in these conditions, she needs to take note that the almost 100% response to the ballot carried out by the Irish Nurses Organisation and the Psychiatric Nurses Association was for industrial action, and that this is such an overwhelming vote her reply is an inadequate response? Is the Minister stating this matter can only be progressed through the benchmarking process? It seems a more imaginative approach is needed if we are not to see many difficulties being created in the health service by people who, as everybody recognises, do tremendous work, often in stressful conditions. Nurses do not lightly take industrial action, yet in this case they have overwhelmingly decided to take industrial action.

What is the precise approach the Minister is taking? Is it only through benchmarking or is the Government considering alternative means that may lead to some resolution to this very serious situation?

Mary Harney (Dublin Mid West, Progressive Democrats)
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As the Deputy is aware, there is labour relations machinery in the State through which the eight claims in this matter were progressed. The Labour Court recommended that nurses pursue certain matters through the benchmarking process, in particular the issue with regard to the approximately 1,000 nurses in the mental health area, where those reporting to them receive about €3,000 per annum more than the nurses. The Government recently negotiated a national pay agreement with hundreds of thousands of trade unionists, who have accepted the agreement, which gives a 10% pay increase over the next 27 months. Some nurses, including those represented by SIPTU, have accepted this agreement. It is not just an issue with regard to nurses but one of public pay policy.

The Deputy may be aware that, as I stated at the Joint Committee on Health and Children last week, major work practice changes are needed in the health system. In particular, we need staff working more closely together as part of a team at primary care level. We need longer working days from certain health care professionals, particularly those involved in diagnostics, so that patients can get the service they require, on a non-emergency basis, for longer and after 5 p.m. In that regard, I have suggested — I am not the author of the suggestion, which comes from the Irish Congress of Trade Unions — it would be worthwhile to establish a process whereby we could bring various stakeholders in the health system together to find whether we could develop innovative solutions with regard to the work practice issues, such as the kind of model we devised in the 1980s with regard to the economy. That is worthy of consideration. I would like to think the INO and the PNA would consider pursuing, for example the issue of a 35-hour week, through that process.

The health care system has substantial numbers of nurses working in it, 12.2 nurses per 1,000 patients, whereas in France the figure is 7.5 and 8.5 throughout the European Union. With regard to the issue of a 35-hour week, as I have said to the nurses' organisation, if we can, with the same number of nurses, cover in 35 hours what is currently covered in 39, there will not be an issue. However, if a reduction to a 35-hour week were to require the employment of 4,000 more nurses, there would be an issue. What is required is an innovative process in which some of these matters can be explored, for example, different ways of working or a better skills mix. We could develop many innovative processes for better working practices in the health system if we could establish a forum in which these issues could be pursued. I hope a forum can be established in this case. The issues relating to nurses can be explored in that context.

Liz McManus (Wicklow, Labour)
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I think the Minister would acknowledge that the nurses have been very open to the idea of changes in practice with regard to health reform. However, the problem relates to the lack of engagement by the Minister, the Department and the HSE. The Minister talks about a forum and an innovative process, but when will that forum be established? What will be its terms of reference and how speedily will the process begin? If the Minister has faith in it, why is she talking about it in such broad terms when a head of steam which will have a major impact on the delivery of health services, particularly at acute hospital level, is building up?

There seems to be almost lethargy about the way the Minister is talking. It seems to be almost an abstract view that it might be a good idea to develop a new approach. Is this the approach? Has the Minister talked to the nurses about a timeframe, terms of reference, how it will be done etc? Does she recognise that child care workers who are being paid more than nurses answer to nurses? This imbalance is unique and I am not aware of anything similar happening in any other sector. While such difficulties require an innovative approach, they also need a coherent and realistic approach. Exactly what approach does the Minister suggest?

Mary Harney (Dublin Mid West, Progressive Democrats)
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We have a process for dealing with relative pay claims, the benchmarking process, and this is the approach suggested by the Labour Court with regard to the issue raised by the Deputy. There are 1,000 nurses working in the mental health service in which those reporting to them are paid approximately €3,000 more than them. The reason for this is that their work is extraordinarily difficult and it is very difficult to get people to work in the area. I accept there is an issue when the person to whom these workers report is paid less than them. The Labour Court recommended after adjudication that this should be considered in the context of benchmarking. I understand the nurses organisations want any increase extended to every nurse, not just those working in that environment.

The innovative approach I suggest will not work if all the stakeholders are not involved. By all the stakeholders I mean those that represent the key professions that work in the health system, including radiographers, physiotherapists, occupational therapists, junior hospital doctors and so on. We cannot resolve in isolation the issues that affect nurses and the new working arrangements we want to see without it being done as part of an overall arrangement with other key professionals.

I repeat: we have processes and want them to be used. Public pay is determined in the context of the social partnership agreement, not in any other process. Changes in work practices that could involve a shorter working week could be pursued through an innovative approach through a process or forum. Others are exploring this option. It is not a matter for me, as I do not represent the workers involved. However, my door is open, as is that of the Government, to any process agreed by the various stakeholders to look at devising innovative work practices within the health system.