Louise O'Reilly (Dublin Fingal, Sinn Fein)
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2. To ask the Minister for Health the vacancy rates for consultants, doctors, nurses and midwives in the HSE; and his plans to fill those vacancies while also retaining existing staff in the HSE. [41006/17]

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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My question is very straightforward. It provides the Minister with a platform and opportunity to tell the House all of the good news he has on recruitment and, specifically, retention measures for staff. My understanding is that we are losing consultants and other health care professionals as fast as they are coming in due to the poor quality of the working environment.

Simon Harris (Wicklow, Fine Gael)
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There is a degree of chicken and egg in this case. The Deputy referred to the poor quality work environment but to improve that we need more people to work in the public health service. I appeal to people, in particular our young graduates from nursing and medical school, to work with us and to give the Irish health service a chance as we enter a period of reinvestment.

The staffing environment of the HSE is dynamic and subject to significant service demands. When a position is vacated, work may be covered through a variety of measures, such as redeployment, restructuring or reallocation. It may also be necessary for duties to be covered by agency staff or through overtime arrangements. The HSE does not operate a vacancy rate, as the question terms it, but rather records a staff turnover rate. The HSE estimates that the adjusted turnover rate for 2016 was 5.7%. This means that, each year and at any one time, people will be moving in and out of about one in 20 posts across the health service. This can be for a range of reasons. People may simply move to a new location while remaining within the HSE. Other reasons include retirement, resignation or taking up other types of leave such as maternity leave.

As the Deputy is well aware, there are difficulties in filling consultant posts in certain specialties and locations. Approximately 200 such posts may be vacant at any one time. However, most of these are filled on a locum or agency basis to ensure continued service delivery. The figures at the end of July 2017 show that there were more consultants employed at that point than at the same time last year. They also show that the number of consultants in the service has increased by more than 700 in the past decade. The number of non-consultant hospital doctors has also increased year on year. I note also that there were over 36,000 nursing and midwifery staff members in employment at end July 2017. This is an increase of more than 700 in the past 12 months against a backdrop, as the Deputy rightly points out, of intense global competition. Under the agreement reached with the nursing unions earlier this year, the HSE has developed a funded workforce plan for an additional 1,224 nursing and midwifery posts in 2017.

One element of this workforce plan is that of agency conversion. I am supportive of the efforts being made in converting agency staff into permanent posts.

The Public Service Pay Commission did not find that the rate of staff turnover in the health sector gave cause for concern generally. However, it did identify problems in recruitment and retention in specific and specialist groups, including nursing, which are internationally in demand. The commission will now carry out a more comprehensive examination of underlying difficulties and is committed to reporting on several health sector grades in 2018.

I welcome the fact the health sector unions voted in favour of the public sector deal in the knowledge that this body of work will take place at Public Service Pay Commission.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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If pay were the only issue, it would be sorted by now. However, it is not. Poor working environment is also an issue.

The Minister is right that it is a chicken and egg question. We do need people to come and work in our health service. I note the Minister issued an appeal to graduates. I would appeal to him to make their workplace more appealing and, thereby, encourage more of them to work in our health services. We will not be in a position to implement the maternity strategy or any of the other documents that sit gathering dust on shelves in the Department of Health unless we have the staff to so do. Recording vacancy rates is important because it will identify where we have staffing deficits. While talking about staff turnover and where those staff might be going, the evidence is that staff are leaving the health service to work in the private sector or abroad. We also know that we have a problem with consultants who are practising but are not on the specialist register. I have not seen any proposal to address this. This issue will get worse because a situation will arise whereby they will drift into a legal entitlement to a contract of indefinite duration unless something is done to ensure they are converted.

Will the Minister give the figures on the conversion of agency staff to directly employed staff? If he could give that information in hours it might be helpful.

Simon Harris (Wicklow, Fine Gael)
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I do not have a figure to hand for the conversion of agency staff to permanent staff here but I will revert to the Deputy directly on that.

I am sure the Deputy did not intend it in respect of the maternity strategy but I can assure her, challenges aside, that it is not a document gathering dust in my Department. We are moving ahead with the plans to relocate one of our stand-alone maternity hospitals to an adult acute hospital site. We will be publishing an implementation strategy for the national maternity strategy in the coming weeks.

My message to young graduates is simple. They will have more colleagues working alongside them in their hospitals this year than last year. If they work with us, they will have more people working alongside them next year than this year. We are back reinvesting. Health Ministers in years gone by could not offer young graduates a full-time permanent contract if they worked in the health service. This is now happening.

The Deputy is correct that it is not all about pay. The recruitment and retention process which will be undertaken by the Public Service Pay Commission, in consultation with the unions, will not just be about pay either. Some of our nurses are coming back to the country, a fact we need to acknowledge. I saw it when I went to a recruitment fair in the HSE. I saw it recently when we took on 17 new nurses in Cork University Hospital to re-open critical care beds. Six of those nurses were Irish who had been working in the UK but decided to come back. The independent group set up to monitor the nursing pay agreement will publish its next report shortly, which I will lay before this House.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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I do not doubt there are nurses coming from overseas to work here. However, they are staying six months and then they are going on elsewhere. This has been said to me on more than one occasion by nurses' representatives because that is what they see in their workplace.

I welcome the fact that there will be a nursing commission. We need a commission along the lines of the previous one to address this issue.

I do not believe the Minister and the Government are doing enough to retain staff. A clear message needs to be sent to the staff that their work is valued. The feeling on the ground is that their work is not. There are people working in our health service who are under extreme pressure. They will tell the Minister that they are haemorrhaging staff left, right and centre. We do not make it any easier for them. It is taking months for staff to get full-time permanent contracts.

Simon Harris (Wicklow, Fine Gael)
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That is not true

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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It is true. It was taking much longer previously, but it is still taking months to get a permanent contract. They need to be issued as a matter of course. If that involves devolving the authority to do so down to the level of hospital management, then that should be done. The centralised recruitment process is not working.

Simon Harris (Wicklow, Fine Gael)
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We did that in the agreement I reached with nursing unions. I also signed a section 10 direction to the HSE. The last time such a direction was signed by a health Minister was when Mary Harney brought about the policy of co-location. It is the strongest instrument available to a Minister. In this case, it delegates the sanction for the employment of nurses directly to directors of nursing, many of whom will be members of the nursing unions, such is the priority we are attaching to this.

I am not suggesting we have enough nurses, midwives or doctors working in health service. However, the facts matter. There are more nurses working in the health service this year than last year. I hope there will be more next year than this year. There are more doctors working in the health service this year than last year. I accept there are significant recruitment and retention challenges, not just in this country but globally. One can ask how Britain is managing to recruit and retain nurses in the context of Brexit.

There are many challenges with a mobile workforce. We want them to stay in this country. We have a new public sector deal, which has been accepted by unions. We also have new career opportunities such as advanced nurse practitioners, the new community nursing scheme and the task force on skills mix to check how many individual nurses we need in each ward to ensure they are safely tasked. There are several measures under way that will aid the recruitment and retention process in order that we will continue to see more nurses and doctors working in the health service.