Maureen O'Sullivan (Dublin Central, Independent)
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Gabhaim buíochas leis an gCeann Comhairle as an deis seo a thabhairt dom labhairt ar an ábhar seo. Is cinnte go bhfuil díomá orm nach bhfuil an tAire Sláinte i láthair, ach leanfaidh mé ar aghaidh leis an Aire Stáit, an Teachta Catherine Byrne.

We all know the considerable work that goes on in our hospitals, for which the staff must be acknowledged. We know there are many difficulties with getting into the system because there is ample evidence of the waiting lists. There was always the feeling, however, that once one entered the Irish system, the treatment and care were excellent. While that continues to be the case, there are growing exceptions. Patients are in the system, but the understaffing and workload are so significant that it has a detrimental effect on the mental and physical health of both the staff and patients. The working environment, therefore, is not as it should be. Although I am speaking about the Mater Hospital, in particular, it applies to other hospitals also.

On St. Vincent's ward, which is an oncology and haemotology ward at the Mater Hospital, the patients are very unwell and they need extensive nursing and medical input. Consequently, the ratio of patient to nurse was historically 4:1. Nowadays, the standard is 6:1, but there are many days when there is one staff nurse for 12 patients, with a student nurse from 1st, 2nd or 3rd year on the ward also. It is difficult, therefore, to give the patients the care they need. For that ward to have the staff it needs to provide that care, there should be six staff nurses and two managers daily. In recent times, however, there have been four members of staff and one manager.

The patients on the ward are there for chemotherapy or complications relating thereto. They must experience a safe, effective delivery of chemotherapy and support with follow-up monitoring, which needs two nurses who are qualified and trained in safe chemotherapy administration practice on the ward at all times, according to the ward's policy and guidelines. In the past two weeks, it was lucky to have one qualified chemotherapy-trained nurse, leading to inexperienced nurses administering chemotherapy or vital chemotherapy being delayed. There has been some improvement in the numbers following meetings with the Workplace Relations Commission, the director of nursing and the union, but the issues leading to those problems are not being adequately addressed. Rather, there is high staff turnover because of the stress involved in working on a ward with very ill patients who do not receive the recommended care from qualified staff.

Experience counts for so much, which newly qualified and overseas nurses who do not have experience of Irish hospitals may lack. Newly qualified nurses need the guidance of qualified staff in order that they will become experienced staff in time. Nurses who are trained abroad are entering a system with which they are not familiar. I am not undermining or demeaning in any way the newly qualified or immigrant nurses, but they need to be guided by the experienced staff in Ireland in order that there is a mix of skills.

Nurses are under a great deal of stress. On a recent Sunday, three nurses were on sick leave, two of whom were trained in safe chemotherapy administration, which left on the ward two nurses who had been qualified less than two years previously and who were not qualified to administer chemotherapy. That is not acceptable for patients or nurses.

It is disturbing that the information I present today is in a context of excellent facilities and treatment for cancer. So many advances have been made and we know so much more about cancers and their treatment. It was disappointing and alarming, therefore, to hear about the staff issues. I know it is not confined to the Mater Hospital because I have information about other hospitals also.

Catherine Byrne (Dublin South Central, Fine Gael)
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As I will take this matter on behalf of the Minister for Health, Deputy Harris, I asked the Deputy whether she wished to withdraw the matter but she did not.

I understand that the Mater Misercordiae University Hospital has experienced some difficulty in recruiting both permanent and temporary specialist oncology nurses for the oncology day unit in the hospital. Due to a combination of resignation, sick leave and maternity leave, there were several vacancies. The Minister was assured by the HSE that all avenues have been and are being explored to address the lack of oncology nurses. As a result of these efforts, one nurse commenced induction yesterday and another will commence induction in December, after which all staff nurse vacancies will be filled.

The Mater Hospital is working with the clinicians and nursing staff to reduce the impact on service delivery through redeployment of appropriately trained staff and the provision of additional raining. The national cancer control programme has also supported the Mater Hospital in resourcing an additional oncologist who has been appointed and will commence in the new year. The hospital continues to work closely with the Ireland East Hospital Group in conducting a review of its operational capacity as demand for oncology day services continues to rise.

More generally, there are recruitment and retention difficulties in certain other areas of the health service, including nursing specialties. In these instances, the HSE utilises a range of long-term measures such as overseas recruitment with agencies, rolling recruitment campaigns, recruitment fairs, social media recruitment campaigns and short-term measures such as staff reassignment to support service delivery.

The HSE also continues to offer contracts to graduate nurses and midwives once they have obtained their registration from the Nursing and Midwifery Board of Ireland, NMBI. The Minister believes the recent pay proposals put forward by the Public Service Pay Commission were a positive step towards making the public health service a more attractive place to work for nurses and midwives. The Government proposals made to address the issue of new entrants' pay will also benefit approximately 10,000 nurses to the value of approximately €3,000 each. The recruitment and retention of nurses and midwives has been a consistent priority for the Minister. Challenges exist with recruitment and retention of these professions against a backdrop of shortages at a global level.

Despite the challenges, the data show that the HSE has managed to increase the number of nurses and midwives employed. When the number of nurses and midwives employed by the HSE is compared between September this year and last year, it shows that there was an increase of 1,050 whole-time equivalents.

Maureen O'Sullivan (Dublin Central, Independent)
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I went ahead with this matter today because of its urgency. I see there has been some progress. I had heard that some nurses came into work while unwell rather than let down their patients and fellow staff but that is not good safe practice, especially considering the immune systems of people who have cancer.

We know that nurses are a very skilled workforce, they have degrees in science, some have Masters degrees and other qualifications, and they have done a great deal of work and study to become registered. They want to deliver the service for which they have been trained and give the best care to their patients. For cancer patients, it is about giving them every chance to recover and live their lives.

I know St. James's Hospital and the pressures on their services well. I know from someone who is currently receiving treatment there that it begins at 8 a.m. and the nurses see dozens of patients daily. The first tranche is at 8 a.m. and the next is at 9.30 a.m. or 10 a.m. Not all of these people are receiving chemotherapy, some are getting injections or hormone infusions and blood. There are 12 beds in the ward, and as soon as the treatment of one patient is finished, the next is called. The nurses and doctors are run off their feet from 7.30 a.m. until late at night. It can be after 8 p.m. before they finish. I am sure that like me, the Minister of State has had family and friends with cancer who have gone through our system, facing the illness. The treatment and the effects that go with it are very difficult but we have good success and recovery rates. Cancer is not the death sentence it once was. However, we need the qualified and the experienced nursing staff to work alongside the newly qualified because the experienced staff can bring their new colleagues along.

We know that the problem is the overall pay and conditions, with the cost of living including housing that has resulted in our very well-trained nurses travelling to other countries. It is those countries which benefit from the education and training provided here and it is the patients who suffer in the meantime.

I have the reply and there are issues which I will have to follow up with the Minister.

Catherine Byrne (Dublin South Central, Fine Gael)
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We all understand there are problems in the health service, particularly with the recruitment of staff for hospitals across all departments. I want to impress on Deputy O'Sullivan and others in the Chamber that both the Minister, Deputy Harris, and I believe that those working in the services in hospitals across Dublin do a fantastic job. Sometimes they find themselves pushed and can work under a great deal of pressure with several cases at once, particularly in units as important as oncology day wards. Living very close to St. James's Hospital, I understand the situation there.

The Minister wants to assure Deputy O'Sullivan that he will continue to monitor what is happening in the Mater Hospital and will work to address recruitment issues in the short and long term and carry out measures which will improve the situation as we go into next year. I assure the Deputy that the HSE recognises the need to focus on recruitment and retention of front-line staff and is committed to making a public health service a more attractive place to work. I understand Deputy O'Sullivan's frustration, it is something that I am contacted about daily in my own office, and I will continue to raise it with the Minister on the Deputy's behalf.