James Bannon (Longford-Westmeath, Fine Gael)
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I welcome the Minister for the Environment, Heritage and Local Government, Deputy Phil Hogan. I also thank the Ceann Comhairle for affording me time to discuss this important matter, namely the need for the Minister for Health and Children to outline his position on the issue of agency nurses, given the untenable cutbacks in the wages of such health care professionals and the abuses in the system which are leading to a stranglehold in the employment of such staff through the endorsement by the HSE of the monopoly position of one agency which I believe was paid €47 million in the period 2007 to 2011.

I cannot stress more strongly the need to address the current situation in the employment of nursing personnel which is leading to what I can only describe as a major abuse of the health care system. While I am aware that this is in no way an indictment of the position of the Minister who inherited the problem from the previous Administration, it is one that needs to be urgently addressed. That money needed for patient care is being squandered on private employment agencies is scandalous.

From my perspective and that of any taxpayer, it is an outrage a situation has been allowed to developed which has seen an embargo on the employment of front-line staff and resulted in money being made hand over fist by a private employment agency at the expense of the sick and vulnerable and nursing staff. All right thinking people are outraged that the embargo on the employment of front-line medical staff has led to a situation where a gravy train has been created for private agencies. The €376 million spent by the HSE on agency nurse wages employed by 277 companies between 2007 and June 2010, with €100 million going to agency owners, is indicative of the abuse of the system.

For the HSE to have handed a monopoly in the provision of agency staff to one private agency is incomprehensible and very annoying. It is my understanding €100 million has been paid to agencies to attempt to maintain staffing levels without breaking the previous Government's moratorium on the employment of new staff. To put it mildly, this is criminal. Given that it has been proved that employing a stand-in nurse can cost more than one third more than a full-time staff member, where is the logic in continuing this practice? It is obvious that patients do not benefit from the continual turn-around of staff; nurses do not benefit in any way from engaging in temporary work and, to make matters worse, the taxpayer is being screwed yet again. It should be borne in mind that agency nurses are now at the mercy of one agency and have seen pre-tax salary cutbacks of between 20% and 50%. They enjoy none of the rights of full-time employees. They have no entitlement to sick pay, pensions, maternity leave or paid further education programmes such as postgraduate courses.

I understand an attempt has been made by the HSE to establish a national pool of nurses, which would eliminate the middle man or woman. While this would go some way towards removing the terrible waste, I cannot help but think that if the health boards were still in place, this could be done better at a regional or local level.

Another abuse of the system is the allowing of double-jobbing. Nurses who availed of the buy-out package or early retirement are returning to the system on a temporary basis, which means they are receiving both a pension and a salary. This is totally unfair to those who are struggling to make ends meet on wages which have been paired to the bone.

Slashing the pay of agency nurses would not improve services. In the long run it would be detrimental, as having high numbers of rotating agency nurses on wards would remove continuity of care, leaving patients, staff nurses, doctors and management with new faces on a daily basis. While all agency nurses are professionals, it takes time to adjust to a new ward, thereby causing potential inefficiencies at ward level.

Last week alone in one midlands hospital 58 shift periods were left uncovered. The first consideration is patient care. Another is the stress on ward staff to make good the lack of necessary personnel. Front-line services are being severely affected by the lack of staff. Wards are being closed, services reduced and waiting lists becoming ever longer. Unless one has an emergency one will not be treated in a timely manner and many less urgent illnesses or ailments are left being untreated owing to a lack of services.

Joanna Tuffy (Dublin Mid West, Labour)
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The Deputy's time is up.

James Bannon (Longford-Westmeath, Fine Gael)
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These ailments may not be life-threatening, but they are often the cause of people being unable to work which, in turn, places an economic burden on our already crumbling economy.

Agency nurses are very much aware of the economic crisis, as most are struggling to survive and many of them are the only person in a family working and they pay taxes like everyone else. Does the Minster believe it is right and just that anyone's pre-tax wages should be cut by between 20% and 50%?

Joanna Tuffy (Dublin Mid West, Labour)
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I have to call the Minister.

James Bannon (Longford-Westmeath, Fine Gael)
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These nurses work alongside colleagues and perform the same duties and have the same responsibilities and level of accountability, yet they have no pension, sick pay or maternity leave entitlements. Now they do not even have a decent wage. I ask the Minister to bring to bear some logical thinking on the issue of the employment of nursing staff. I am certain that he cannot see any benefit in putting in place an embargo on employment only to spend three times the amount on the employment of temporary staff.

Joanna Tuffy (Dublin Mid West, Labour)
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The Deputy went well over time.

Phil Hogan (Carlow-Kilkenny, Fine Gael)
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I thank Deputy Bannon for raising this matter and apologise for the absence of the Minister for Health and Children, Deputy James Reilly, who has asked me to reply on his behalf.

The HSE introduced new arrangements for contracting agency staff on 14 March 2011. The appointment of agencies to provide health staff, including agency nurses, is a HSE procurement matter. The new contract for agency staff is part of the approved HSE service plan for 2011 and will deliver cost savings in excess of €40 million across the health sector, thus helping to protect services. The use of agency staff has always been a feature of the health system and will remain an ongoing requirement to fill short-term vacancies and ensure continuity of service provision. All agency staff, including agency nurses, are employed directly by the agencies that are successful in the HSE's tendering competitions.

The new agency contract was raised by health service trade unions at the health sector implementation body established under the public service agreement and was subsequently considered by the national level implementation body. I understand the unions expressed serious concerns about the fact that agency nurses would now be paid at a lower rate than had previously been the case. The HSE pointed out that this was a matter for the agency concerned. The implementation body noted that a process of engagement between both the social partners at national level and the parties within the public service on the implications of the utilisation, terms and conditions of agency staffing, arising from the transposition due by December of this year of the directive on temporary agency work, 2008/104/EC, should commence as soon as possible. The body also recommended that the parties should seek the assistance of the Labour Relations Commission regarding implementation issues.

In summary, therefore, the contract negotiated by the HSE remains in place, but it is my understanding that both parties will attend the Labour Relations Commission to discuss certain issues relating to its implementation. The HSE is required as part of the employment control framework to keep the use of agency staff to a minimum. It has indicated that where possible, in the context of the employment control framework, part-time and work sharing staff will be offered the opportunity to increase the number of hours they work before agency staff are used. However, the HSE is also required to achieve the overall employment targets set out under the Employment Control Framework 2011-2014 as part of the package of measures being undertaken by the Government to address the crisis in the public finances. The framework requires the HSE to achieve a net reduction in employment of approximately 1,500 each year from 2011 to 2014.

The employment control framework provides that agency personnel can be used in exceptional circumstances to provide emergency relief for medical-professional staff providing essential front line health, welfare and protection services. Furthermore, the HSE is allowed under the framework to fill posts on an exceptional basis to maintain essential services at risk and to meet priority service change and reconfiguration requirements once the overall required reduction in employment is being met.

The new contract secured by the HSE for agency staff is only one of a wide range of measures being put in place within the health service to protect services while still achieving the expenditure reductions required under the EU-IMF agreed programme for the stabilisation and recovery of the public finances. The health aspects of the public service agreement recognised that reductions in expenditure and employment numbers would be required and were specifically designed to help protect services in this way.