Róisín Shortall (Dublin North West, Social Democrats)
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I thank the Minister for Public Expenditure and Reform, Deputy Donohoe, for coming in to the House to respond to this topical issue.

In December 2015, the Irish Nurses and Midwives Organisation, the Psychiatric Nurses Association of Ireland and the SIPTU nursing unions concluded an agreement with the HSE and the Department of Health. The agreement was to restore recognition of the incremental credit for the 36-week clinical placement to all graduates since 2011, when it was stopped. However, as the Minister is aware, the Department of Public Expenditure and Reform chose to amend this agreement to sanction recognition only for those currently on placement and future graduates. As a result, nurses who graduated between 2011 and 2015 will now be earning less than their colleagues who graduated before 2011 and the new 2016 graduates.

In reply to parliamentary questions on the matter tabled by me last week, the Minister stated that the question of extending the recognition to these nurses may be reviewed on foot of consideration of whether the sanction granted would result in an increase in recruitment and retention rates of training nurses in 2016 and 2017. How on earth does the Minister intend to measure this? The fact is that for the majority of recent graduates, full-time positions are simply not on offer. Consequently, the Minister's strategy cannot accurately gauge the effectiveness of this measure to retain nurses in Ireland. Why is such a study necessary given that in the business case set out by the HSE and the Department of Health in favour of the 2015 agreement, it was acknowledged that restoration of the increment would aid in retention of graduate nurses, a problem the HSE was trying to grapple with at the time. This finding was further supported by a recent survey conducted by the Union of Students in Ireland. The survey suggested that the withdrawal of the incremental credit was a factor not only for those who had remained in Ireland and are now deciding to leave, but also for those who have left when it comes to deciding whether to stay abroad or come back home.

In recent briefings to Deputies, representatives from the Irish Nurses and Midwives Organisation, the Psychiatric Nurses Association of Ireland and SIPTU nursing unions raised the real prospect of a scenario whereby unless we take action now, we may not be able to ensure that the winter initiative beds will actually be opened and, moreover, that we will face spiralling overtime and agency costs. Given that we are currently spending in excess of €22 million on agency staff, should every effort not been made to retain the staff we currently have, and, thereby, demonstrate the value of their contribution to the health service? On the most basic level, this is where these measures falter. Nurses serve on the front line of our health service. Without their dedication and commitment to patients, our health system would simply cease to function. How can we expect them to believe they are valued when faced with such evident inequality in their treatment? The HSE has no issue with this. The Department of Health has no issue with this. Why is the Minister blocking this agreement?

Paschal Donohoe (Dublin Central, Fine Gael)
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I thank Deputy Shortall for raising this matter, which I know to be of interest to many within the House.

The issue, as the Deputy described, relates to the campaign by the INMO and other nursing unions, including the Psychiatric Nurses Association of Ireland and SIPTU nursing unions, aimed at restoring incremental credit for the 36-week clinical placement undertaken in the fourth and final year of their degree programme in respect of former nursing trainees serving in the period 2011-15. The background to this matter is that incremental credit for the 36-week clinical placement undertaken by fourth year student nurses was abolished by the then Government in December 2010 as part of a range of measures aimed at reducing the public service wage bill.

Following consideration of a submission made on behalf of the nursing representative bodies, including INMO, PNAI and SIPTU nursing, as well as the Department of Health and the HSE, my predecessor sanctioned recognition of the 36-week placement as qualifying for incremental credit for students on a placement in 2016 and in future on 19 February this year. The sanction stated that the question of awarding incremental credit for the placement to nurses who graduated between 2011 and 2015 may be reviewed on foot of consideration of whether the sanction granted in respect of 2016 and future graduates resulted in an increase in the retention rates for these graduate nurses. Nurses who undertook the placement in 2016 have recently completed their placements and are only now in the process of becoming registered. Therefore, the extent to which the restoration of the credit will result in an increase in the retention rate of graduate nurses will not become evident in the immediate term.

Notwithstanding this matter, it is the case that officials from my Department and the Department of Health met recently to discuss whether there was scope to accelerate this review process for the restoration of incremental credit to 2011-15 nurses. Furthermore, the Minister for Health has now written to me in on this matter.

Many initiatives are currently under way to improve nursing staff levels throughout the country. The HSE is offering permanent posts to the 2016 degree programme graduates and is offering full-time permanent contracts to those in temporary posts. The HSE launched an international staff nurse recruitment campaign focused on attracting nurses back from the UK to jobs in Ireland last year. There was a particular emphasis on targeting Irish nurses who had left Ireland in recent years and who are keen to return home. The campaign offered them a relocation package of €1,500, nursing registration costs with NMBI and funded postgraduate education. There has now been an increase of 1,163 nurses employed in the public health service, from over 34,000 to a little over 35,500 in the two years to August 2016, numbers having fallen by 4,000 in the previous seven years.

The question of whether there is scope to accelerate the review process for the restoration of incremental credit to 2011-15 graduates is currently being reviewed by my Department in consultation with the Department of Health with a view to bringing the matter to a conclusion at the earliest time.

Róisín Shortall (Dublin North West, Social Democrats)
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I thank the Minister for that reply but there are several points that the Minister seems to be ignoring. Can the Minister stand over a situation whereby people doing the same job are not being paid the same amount? That is what it amounts to for graduates who came out between 2011 and 2015. People who graduated before that get the incremental credit, but people who graduated this year do not. How can the Minister justify an arbitrary decision to single out particular graduates by virtue of the year they graduated and suggest that they are worth less than their colleagues who graduated in other years?

Does the Minister accept that the campaign run last year by the HSE to try to attract back graduates was not very successful? Graduate nurses who have found work elsewhere, who are being paid decent wages and who are living in countries where the cost of living is not as high as here will continue in their current roles if they continue to be discriminated against, as in the case of recent graduates here.

The Minister has said he will review the situation on the basis of recruitment in 2016 and 2017. Again, that is completely unfair to these people. Why should they have to wait to see the result of the outcome of the review post 2017? The Minister for Health could tell the Minister for Public Expenditure and Reform very clearly that the biggest issue facing the health service at the moment is the difficulty in staff recruitment and retention.

There are many reasons for that. Pay is one, cost of living is another and lack of respect and a sense that people are not being adequately valued is certainly another. People can only feel that sense is reinforced by the Minister's failure to honour the agreement the nursing unions have reached with the Minister for Health, the Department of Health and the HSE. The Minister is welching on an agreement already reached between the nursing unions and his Cabinet colleague, and that is unacceptable. Will he apply himself to this as a matter of urgency, restore parity for these nurses and take some steps to try to assist in the recruitment and retention of vital nurses in the health service? We cannot afford to delay this any longer.

Paschal Donohoe (Dublin Central, Fine Gael)
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I am not welching on any agreement. A process was put in place between the Department of Health and my Department and that process is being carried out. On the different points the Deputy puts to me and the effect of recruitment, my colleague, the Minister for Health, is best placed to comment on the effect of that campaign. I note, to emphasise the figures, that the number of nurses working within the HSE has grown this summer compared with last summer when there were 34,953 nurses working within the health service. That figure now stands at 35,538.

Róisín Shortall (Dublin North West, Social Democrats)
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How many vacancies are there?

Paschal Donohoe (Dublin Central, Fine Gael)
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In respect of recruitment in the United Kingdom I understand 420 applications have been received for posts. That work is under way.

In response to the Deputy’s first question about standing over this, I did not do this. This decision was taken in December 2010 when our country was facing gigantic economic difficulty. Now, because of the change in our circumstances, it has been possible to undo and change some of the decisions made then. On foot of my discussion with the Department of Health and with the Minister for Health, who has raised this with me on several occasions, I am committed to completing the process we have and honouring the agreement we had in respect of the people who have already received this credit and putting in place a process to review where we stand for people who fall between the two periods the Deputy has referred to. I will do that with the Minister for Health.