Jonathan O'Brien (Cork North Central, Sinn Fein)
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St. Finbarr's Hospital on the south side of Cork city was told in June last year that the agency staff it employed were being let go. As a result, the remaining staff were left to work in extreme conditions. With their union, they have been trying to secure adequate staffing levels to ensure patient safety. Conditions got so bad that on 2 January, they were due to work to rule. At the last minute, however, the HSE decided to reintroduce 14 agency staff for a period of one month. That time is up and the HSE has informed staff that 16 nursing and five home care assistant posts will be lost. What steps are being taken by the Government to ensure that will not happen?

Donnchadh Ó Laoghaire (Cork South Central, Sinn Fein)
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As Deputy Jonathan O'Brien outlined, the hospital plays a crucial role in providing health services for people in the city and surrounding areas. It provides rehabilitation and step-down facilities for patients from Cork University Hospital and the Mercy Hospital, which frees up a substantial number of acute beds. The hospital has a number of vitally important rehabilitation wards. In recent months it has come under severe pressure. As Deputy Jonathan O'Brien outlined, the last minute reintroduction of agency staff in early January is coming to an end and it appears that 16 nursing and five home care assistant posts will be cut. This will result in additional pressure being put on a hospital that is already under significant pressure. The medical staff, particularly the nurses, are not only concerned about their working conditions but also about the effects on services and patient health. This is happening at a time when we should be investing in health services, not cutting back. It is wrong that there is any prospect of cutbacks at St. Finbarr's Hospital

Pat Buckley (Cork East, Sinn Fein)
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It is ironic that we are discussing the issue of staffing while representatives of the Psychiatric Nurses Association and the Irish Medical Organisation are appearing before the Joint Committee on the Future of Mental Health Care to discuss the challenges in staff recruitment. As my colleagues outlined, cutting staff and creating a toxic environment in any hospital, never mind St. Finbarr's Hospital in Cork, is criminal. On top of this, we have heard the magic word "review". A review is a money saving initiative on the part of the HSE. One of the staff said, "We are just hanging in there." If that is what passes for a job, the HSE and the Government have a lot to answer for. I appeal to the Minister of State to treat the staff with respect. They do a wonderful job and should be respected. Given what they do, all nurses should be sent a "Thank You" card and beatified when they finish work. It is not a job but a vocation. I ask the Minister of State to address this issue in a humane way, not with statistics or a review.

Catherine Byrne (Dublin South Central, Fine Gael)
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I am taking this matter on behalf of the Minister of State, Deputy Jim Daly. I thank the three Deputies for raising it and expressing their concerns.

The overarching policy of the Government is to support older people to live in dignity and with independence in their own homes and communities for as long as possible. This is clearly what they and everybody in this House want. We also have patients who are in genuine need of residential care, either on a long-stay or short-stay basis. The HSE is responsible for the delivery of health and personal social services, including those at facilities such as St Finbarr's Hospital. The hospital is part of the older persons social care directorate and one of 24 hospitals in the Cork Kerry Community Hospitals Group.

The HSE has worked with the Irish Nursing and Midwives Organisation in recent months on staffing levels and ratios at the hospital. HSE management has undertaken a review of staffing in consultation with the nursing unions, with a view to ensuring safe and adequate staffing levels and a skills mix to meet the care needs of the residents in long-term care and the rehabilitation wards. It included a review of resource management, the skills mix and service costs. The executive proposes to reconfigure the staffing levels and skills mix at the hospital to provide for optimum use of approved staffing resources and a reduction in the over-reliance on overtime and agency costs. The current proposal, if implemented, will potentially provide for a reduction of 16.5 nursing whole-time equivalents and 5.1 health care assistant whole-time equivalents. This will eliminate the reliance on the use of agency staff and maximise overall direct employment within the hospital.

The HSE has assured the Department that there are no plans to reduce the number of directly employed staff at the hospital and certainly there are no plans for redundancies. The Department understands the executive has demonstrated that staffing levels in terms of WTEs have increased in the past few years and that HSE management is satisfied that the reconfigured staffing levels will be adequate to provide the service being delivered.

The engagement between management, staff, the INMO and SIPTU is underpinned by the terms of the national public service stability agreement. Agreement was not reached locally and notification was issued for the commencement of industrial action. The matter progressed to the Workplace Relations Commission, WRC, conciliation services and the parties met in December 2017. Following subsequent correspondence and discussions, an interim arrangement was put in place without prejudice to either party’s position and this has provided for the deferral of any industrial action, with the agreement to engage on the change programme as soon as possible. This was in place until yesterday, 31 January.

A conciliation conference has been organised by the WRC for 8 February 2018. Management has agreed to an extension of the interim arrangements up to and including the date of the WRC conciliation conference and to not later than Thursday, 15 February which will allow a reasonable period for the parties to consider any proposal emerging from the WRC process. This issue is being addressed by the HSE and key stakeholders through an agreed process, and officials from the Department will continue to monitor this situation carefully. The HSE has been asked to keep the Minister of State, Deputy Daly, updated on developments.

Jonathan O'Brien (Cork North Central, Sinn Fein)
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With all due respect, what the Minister of State has just said does not make any sense. She is saying that a review of staffing has been undertaken in consultation with the nursing unions with a view to ensuring safe and adequate staffing levels within the hospital. Anyone reading that would presume that there may not be safe and adequate staffing levels at present and therefore we should be looking at increasing them. However, the reconfiguration of staffing levels to ensure that there is a safe level of staff within the hospitals entails cutting 21 whole-time equivalent posts. That makes no sense. I am glad that the interim period is being extended until the issue comes before the WRC, but staff are telling us that the conditions are unsafe and the Minister of State's answer is not to employ more staff but to cut 21 posts. It is ridiculous.

Donnchadh Ó Laoghaire (Cork South Central, Sinn Fein)
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The Minister of State referred to consultation. It seems extraordinary that the Department is asserting that there was consultation with the unions on staffing figures and yet the situation has proceeded to a work to rule and now to the Workplace Relations Commission. That does not sound like an ordinary process. It certainly does not seem that any points which may have been made by the unions in consultation were taken into account. The Minister of State referred to agency staff and said that there is no threat to permanent staff, but it is clear that the global figure, inclusive of agency and permanent staff, will be reduced and nothing the Minister of State has said indicates the contrary. On the basis of current proposals there will a reduction of 16 nursing staff and five home care assistants. The Minister of State is saying that no permanent staff will be got rid of but the hospital will still be down staff. That will put pressure on the permanent staff and will lead to a reduction in services. The HSE and the Department need to back away from what is very clearly a cutback which will compromise safety and health care and will continue to put nurses, who are already in a precarious position, under extreme pressure.

Pat Buckley (Cork East, Sinn Fein)
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Towards the end of her reply the Minister of State said, "This issue is being addressed by the HSE". We see the words "issue" and "review". I do not believe a bit of it. This has been festering for months. Were it not for the bravery of the staff within St. Finbarr's Hospital in speaking out on this issue, it would not even have come to the fore. The way staff are being treated is disgusting. It beggars belief that we will not invest in our elderly people. I have nothing against the agency staff, but we need to maintain a proper level of staff within our hospitals and give them a sense of purpose and belonging. I hear that the issue is being addressed by the HSE but it has failed so many times that it is frightening. I spoke to the INMO a while back and I was told that the HSE is spending €2 million a week on agency staff. I do not understand why we cannot retain our own staff, who are experienced and believe in what they do, within the system. I ask the Minister of State to go back and get a proper black and white statement so that we can go back to the staff in St. Finbarr's and tell them that their jobs are secure and that they are doing a great job.

Catherine Byrne (Dublin South Central, Fine Gael)
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I will go back on some of the original script which I was given. It is very clear from the script that a conference has been organised at the WRC for 8 February and that management has agreed to an extension of the interim arrangements up to and including the date of the WRC conciliation conference and to not later than Thursday, 5 February. This will allow a reasonable period for the parties to consider any proposals which emerge from the WRC.

Jonathan O'Brien (Cork North Central, Sinn Fein)
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It should not have to go that far.

Catherine Byrne (Dublin South Central, Fine Gael)
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I am not the relevant Minister. I am just here on behalf of the Minister of State. I might finish by referring to the written statement which has been given to me. The HSE remains committed to ensuring an effective and efficient information and consultation process with the staff and the trade unions on the proposed change programme. Management is satisfied that the proposed staffing levels and skill mix will be provided for the enhancement of nursing duties. Management has confidence in the unions and staff and that the change programme proposed will uphold the equality and safety of the service provided by St. Finbarr's Hospital. All I can give Deputies is the information I have in front of me.

Jonathan O'Brien (Cork North Central, Sinn Fein)
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I appreciate that.

Catherine Byrne (Dublin South Central, Fine Gael)
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I will bring the Deputies' concerns back to the Minister of State, as I do with most Topical Issue matters. Regardless of whether the Deputies wish to pursue it themselves, I will certainly pursue on their behalf the issue they have raised. I have been given a script and I do not want to defer from it because this is not my area. I will relay the Deputies' message to the Minister of State but, in reading the script, it is very clear that the management, staff and trade unions are in a position to look at the proposed change programme and that will happen in February.