Louise O'Reilly (Dublin Fingal, Sinn Fein)
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43. To ask the Minister for Health the position regarding current nurse numbers; and the success to date in 2017 on reaching the target set under the most recent agreement between his Department and an organisation (details supplied). [27957/17]

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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I congratulate the Minister on his reappointment. Indeed, I congratulate the Minister of State, Deputy Jim Daly, on his appointment. I am sure if the Minister had been reassigned he would miss my repeated questions upon this exact subject.

My question is straightforward. It relates to staffing. I would like an update. I have received some updates but perhaps the Minister may be able to enlighten us as to where the nurses who are so vitally needed will come from.

Simon Harris (Wicklow, Fine Gael)
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Deputy O'Reilly and I get to hang out another bit longer anyway.

I thank the Deputy for her repeated question on what is an important issue in relation to nurse and midwifery numbers in this country.

As the Deputy will probably be aware, nursing and midwifery numbers at the end of April this year stood at 36,549 whole-time equivalents, having increased by 625 whole-time equivalents in the 12 months from the end of the previous April, and by 1,870 in the three years from April 2014 to April 2017.

Under an agreement, the Deputy knows well, reached with the INMO and SIPTU nursing, encompassing proposals put forward on 8 February and those in a related addendum on 4 March, health service management committed to increasing the nursing and midwifery workforce in 2017 to deliver 1,208 additional permanent posts. Delivery of these posts is possible through a combination of new development posts, for which additional funding is being provided in the current year, and the local conversion of agency employed staff into direct employees. Nursing and midwifery numbers increased by 126 from the end of February to the end of March and by a further 113 from the end of March to the end of April.

A broad range of measures is being implemented to give effect to the agreement. These include the conversion of agency employed staff into HSE direct employees, offering all graduating nurses and midwives full-time contracts, ongoing recruitment campaigns in Ireland and abroad - I welcome the one in Glasgow recently - and the implementation of a range of retention measures.

The recruitment measures include careers days, HSE attendance at national and international recruitment fairs and a communication from the national director for HR to all nursing and midwifery graduates telling them how to apply for a full-time permanent post in the Irish health service. A high level group with an independent chair has been established for the oversight of the implementation of this agreement and the first meeting of that group was held on 24 May 2017.

Key retention measures include enhanced maternity leave cover, a career break scheme and offering nurses and midwives improved educational opportunities and career pathways. In addition, 130 additional undergraduate places are being provided in 2017, which means we will train this year more nurses than we have ever trained, in terms of undergraduate places, in the history of the State.

I also issued a written direction under section 10 of the Health Act 2004 - it has never been done before for nurse recruitment - to the Health Service Executive in order to emphasise the importance of the full implementation of this agreement.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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I welcome all of that. Indeed, it is good news for Australia, America or wherever these bright young men and women will end up. The simple fact is they do not want to work in the health service as it is currently constituted. They are not only saying that to me. They are voting with their feet and they are leaving. For example, 22 nurses were trained as part of a co-operation between CUH and UCC. These were 22 highly specialised nurses trained in paediatrics and general nursing - absolutely top quality, top notch front-line professionals - and all 22 of them have left. That is a damning indictment of the efforts that have been made to date.

Deputy Kelleher mentioned the Sláintecare report. We all are hopeful of positive news from Government in that regard but we will not be able to do it without the staff. I am not convinced that enough is being done.

Simon Harris (Wicklow, Fine Gael)
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I did not think the Deputy would be. Thankfully, when the INMO members had an opportunity to be balloted on this, over 80% of them voted in favour of these proposals, seeing them for what they are, which is a genuine and sincere effort by nurse representatives in this country, by my Department, by myself and by the HSE to try and increase recruitment and retention of nurses.

I will give Deputy Louise O'Reilly another practical example. The Deputy talks of her 22 nurses. The HSE recently went to Glasgow to a nurse recruitment fair where it met 27 Irish nurses who had been working in Scotland now ready and willing, and wanting, to come home and talking to the HSE about how do they take up opportunities in this country. The message needs to go out from all of us in this House that there are now opportunities for those nurses to come home.

The Deputy and I have talked about the issue of pay previously. There are now pay proposals on the table through the Department of Public Expenditure and Reform and I am sure those issues will be debated by nursing unions in the coming weeks and months.

One cannot get away from the fact there are 625 more nurses working in the Irish health service at the end of April last than there were at the end of April 2016 and the numbers are growing. It is not all about pay. It is also about career pathways. That is why there are measures such as taking on 120 new people to study and train up as advance nurse practitioners this September. I genuinely believe those career pathways will encourage more people to stay in this country.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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I would be interested to know how many of those are nurses who we had to go abroad to recruit at significant expense when, in fact, our own graduates have no interest in staying in this country, as the Minister well knows. Brexit, in this regard, may be the Minister's friend. We understand that a lot of nurses who may have chosen to go to England may be forced to remain here.

When the Minister referred to the conversion of agency staff into directly employed staff, that does not add any extra bodies although it represents a saving to the taxpayer. With regard to the projected figures, I understand that 1,200 was the target by the end of the year. Is the Minister confident he will meet that target? I refer to the 1,200 additional nurses, not necessarily 1,200 recruits, because we must consider the retention as well.

Simon Harris (Wicklow, Fine Gael)
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To answer the Deputy's question directly, I am clear that the commitment in the agreement is to have 1,208 additional nurses, not just recruits, working in the Irish public health service.

Deputy Louise O'Reilly is correct in saying we need to do everything we can to keep our nurse graduates here. It is also right though, and indeed moral, that as a country we would go to some of the destinations where many of our best and brightest left to go to during the economic recession, meet them, make it easier for them to come home and let them know about the opportunities. Certainly, we are getting a positive response in relation to that. I am also grateful that the INMO has offered to assist with that.

In terms of nurse numbers, on 30 April 2015 there were 35,080 whole-time equivalent nurses working in the Irish health service. Exactly one year later, there were 35,924. On 31 March this year, there were 36,436 and on 30 April this year, 36,549. I am the first to acknowledge we have a way to go to get back to the levels we were at but we are genuinely making significant progress.