Thursday, 31 January 2019
Ceisteanna ó Cheannairí - Leaders' Questions
As we gather in the Chamber this morning, communities are gathering in Dunlewey, Gortahork and Falcarragh for the funerals of the four men who were killed last Sunday evening. Guím gach tacaíocht ón dTeach seo go dtí an ceantar sin inniu, go háirithe go dtí clanna agus cairde an cheathrair.
Yesterday, 30,000 members of the Irish Nurses and Midwives Organisation, INMO, began a 24-hour work stoppage and completed that at 8 a.m. This is only the second time in 100 years that they were forced to do that, which gives an indication of their frustration and anger at the issues facing them in their jobs daily. Today, an additional 6,000 psychiatric nurses have initiated an overtime ban which will impact on services throughout the country. Further strikes are planned by the INMO and the Psychiatric Nurses Association, PNA, for tomorrow relating to overtime bans, and again for next week. There is a huge recruitment and retention crisis in the mental health sector, which we will discuss later, but particularly in nursing. There has been a 40% increase in vacancies in psychiatric nursing since November 2017.
What we had yesterday was the Taoiseach acting as a commentator once again. It was like he was Ingrid Miley outside the talks and giving his commentary on those talks. There is no sense of leadership from him, no sense of engagement, and no sense of concern to try to avoid the second strike, which will happen next Tuesday for the INMO, or to stop the overtime ban which is happening today.
What progress has the Taoiseach or the Cabinet made since last Monday, when the Labour Court met for eight hours and tried to work a path between both parties? Did the Government get a report from that court work on Monday? What actions have been taken by the Government during this week to try to address the concerns of the nurses in both organisations and to try to establish a process within which their concerns can be dealt addressed with respect and integrity? Is the Government just putting its head in the sand again, when once again next Tuesday they will take to the pickets and all the Government will offer is tea and sympathy?
I would like to share in the offering of condolences to the families in Donegal who are going through an unspeakable level of grief and pain today. The thoughts of this House are with Donegal in general, but in particular with the four families concerned and the wide circle of friends who have been impacted in such an extraordinary way. I thank the Deputy for raising that.
There are a couple of comments I would like to say in regard to the nurses strike yesterday. First, the Government understands the frustration and the resolve of nurses. We want to thank them for their pragmatism in regard to putting contingency plans in place yesterday and, although there was extraordinary disruption, there was also significant co-operation with management to ensure essential services were provided. I want to thank them for that.
The Government does not want to be at odds with nurses in Ireland. They are great people, doing very difficult work, often in very pressurised circumstances. We want to work with nurses, the INMO and the psychiatric nurses to build a better health service that can attract many young people into this profession. While some progress has been made in regard to recruitment over the past five years and well over 3,000 extra nurses have come into the system, we recognise the challenges around health recruitment generally at the moment. That is why the Government set up the Public Sector Pay Commission to look into healthcare and nursing specifically and to make recommendations. While I know the INMO has not been happy with that, it certainly was a significant effort by Government to recognise the challenges they face at the moment.
However, we have to have this conversation with nursing unions on the basis of the broader picture, which is a public sector pay agreement they have signed up to, we have signed up to and many other public servants and the unions they are part of have signed up to as well. What we are saying is that we want to talk. We want the Labour Court to do its job and work with management and Government and with nursing unions to make recommendations as a basis for a way forward that can avoid the impact of strike action for two days next week. We are serious about that and we want to engage, but we have to, as the Taoiseach has outlined repeatedly, ensure that we do that within the confines and parameters of a pay agreement which nurses themselves signed up to be part of.
I thank the Tánaiste. He speaks of the Government's understanding and respect for nurses, yet the front of today's Irish Examinerreports there are plans under way by the Government to dock nurses' pay increases and pension increases for striking. Can the Tánaiste confirm this is being discussed by the Government? What kind of message does the publishing of that story send out in terms of the Government wanting to engage with respect and to engage with their issues? What kind of message does it send when the Government allows that story to be printed during an industrial dispute? It does not send a message of respect or regard, or of openness, or of trying to deal with the issues.
What we do not need is tea and sympathy: what we need is respect. The Tánaiste speaks of his respect and we all have that, yet the Government allows this to be published and it will allow another picket to proceed on Tuesday and overtime bans to proceed in the psychiatric services today. The Government needs to outline a plan between now and next Tuesday to engage, not to give tea and sympathy.
The Deputy knows as well as I that the Government does not give permission to any newspaper to set its headline and front pages. Those are decisions that are taken by newspapers and their editors.
What the Government has said is that we are taking legal advice regarding the options that are available to us, consistent with the pay agreement that everybody signed up to with their eyes open. There is a responsibility on the Government to deliver on that, and that involves hundreds of millions of euro of extra pay across the public sector. There is also a responsibility on unions and their leadership to fulfil the obligations of those agreements. That is what protects Ireland in terms of industrial peace and ensures that civil and public servants get the pay increases they deserve and that we allocate the appropriate level of resources to deliver on those commitments, which is what we are doing. What we cannot do is interrupt that process and undermine it fundamentally for any one sector. I do not believe that if the Deputy was the Minister for Public Expenditure and Reform today, or, in fact, if members of the other parties were the Minister today, they would propose a breach in the public sector pay agreement to resolve this issue either. We want the industrial relations machinery of the State, the Labour Court in particular, which is good at this, to work with both sides to find a basis to at least avoid industrial action next week. The Government is sincere about that but we have to do it within the parameters the Taoiseach has outlined.
The exorbitant cost of the national children's hospital is going to have a serious impact on the delivery and progression of other projects over the next number of years, and that much has been confirmed by the Minister for Health and the Department. Despite the massive implications, nobody involved in the process appears to want to take any responsibility. It seems the Government has set its face against any statutory review by either the Comptroller and Auditor General, as was hinted at by one of the Tánaiste's ministerial colleagues recently, or any other State organ. The Secretary General of the Department of Public Expenditure and Reform, whose job it is to supervise procurement and public expenditure, is still refusing to appear before the Joint Committee on Health to account for his Department's role in the process. The Minister for Health, for his part, and the Department are hiding behind the review of the process being conducted by PricewaterhouseCoopers at a cost of €450,000 in taxpayer's money, to add insult to injury.
At at meeting of the Joint Committee on Health on 16 January, Mr. Tom Costello, chair of the board of the national children's hospital, said: "If we were to start again on a project of this scale and complexity we would adopt [exactly] the same procurement approach." That seems to be a head-in-the-sand approach.
No lessons have been learnt. Nothing is going to change and the taxpayer simply has to get on with it. What we need to know is what projects will be affected. At the Committee of Public Accounts this morning I put it to the Secretary General of the Department of Health, Mr. Jim Breslin, whether a number of projects, including the second cath lab for Waterford, are under consideration. That funding was promised to Waterford Oireachtas Members and regional Oireachtas Members. There is a raft of capital projects which we now understand is under consideration. We were told that money was guaranteed and yet today at the Committee of Public Accounts the Secretary General of the Department of Health said it had not been signed off on and it is under review. It is one of a number of capital projects that is under review by the Department. Other projects affected are the new MRI scanner at Midland Regional Hospital, Mullingar; the upgrade to wards in Cavan hospital; the national radiation oncology programme in the Tánaiste's county of Cork; and the second cath lab in Waterford. We need straight answers. Only a few minutes ago the Minister of State, Deputy John Halligan, said in my ear that the Minister had said the project was safe. Which is it? We had the Secretary General at the Committee of Public Accounts telling us it was under consideration and a local Minister of State saying the funding is secure. There will be victims and casualties as a result of the massive overrun. Services will be cut, capital projects may not go ahead and the Tánaiste must spell out very clearly to people across the State, either in Mullingar, Cork, Waterford or wherever else, which capital projects are under consideration and not signed off on and which are not.
The Minister for Health has made it very clear that he is committed to the second cath lab in Waterford. It is part of the service plan for 2019. The Taoiseach has said very clearly that the funding challenges in relation to the national children's hospital will not result in the cancellation of any commitments that have been made. In the nature of capital expenditure, as others in this House who have been involved in significant capital expenditure management linked to Government are aware, there may well be delays and space to ensure that the extra €100 million or so - half of which is in the Department of Health - that is linked to the increased cost of the national children's hospital this year, can be found by delays that may happen in relation to other big capital expenditure projects. We are spending billions of euro this year on capital expenditure. Capital expenditure is up by 25% on last year. I reassure people that we are not going to cancel other projects that have capital commitment, but the scheduling of payments for some of those projects that may be affected by means of enforced delays through planning or permitting systems or other delays will be looked at in order to create the space and the funding to facilitate the increased cost of the national children's hospital.
In relation to the PwC review, the Government is committed to doing an independent and thorough investigation into the process and how the estimated expenditure of delivering the hospital increased as it did, so that we can learn lessons from that to make sure that when we spend a committed €116 billion of capital expenditure over the next ten years we ensure that projects are kept within budget and that we do it in a way that is transparent and open. When PwC finalises its report it will be published so that we learn lessons from it. Many public projects are coming in on time and within budget. The national children's hospital is a project that we need to learn lessons from and that is the whole point of getting an independent piece of professional work done, which I accept costs money, but in the context of the overall cost of this project and the potential savings from lessons learnt, we hope that it will be money well spent.
I cannot accept the responses to the questions I put. The sum of €50 million alone will come from the capital expenditure in health this year as a consequence of the overrun. The Tánaiste is missing the point that we were informed - Deputy Howlin and other Oireachtas Members in the south east - that the money was already committed to and was there. Now we are being told that the project could be delayed and it is mixed up with a range of other health projects which may not be delivered on time.
The Tánaiste will get a chance to come back. He is saying one thing and the head of the Department of Health is saying something else. History teaches me that I do not know who to believe on this issue. We have been fighting for the second cath lab for so long.
In relation to the overspend, here is what we also learnt at the Committee of Public Accounts today.
On top of the €1.4 billion there will now be an additional €75 million in ICT costs, an additional €52 million for electronic records, an additional €86 million for children's health integration, and an additional €40 million for the Mater campus. The entire project is based on the potential of getting €150 million from the private sector from philanthropy, which is not secure. We do not know yet what the overall cost will be.
What we know is that some capital projects are under review and the Tánaiste and the Minister for Health are not being entirely clear with people as to which projects they are and what projects will be delayed or scrapped. The Tánaiste needs to be very clear with people, not just in the south east but across the State.
Nobody is trying to hide anything. I am looking at my speaking note on the national children's hospital, which has not changed in a week, and it talks about the costs of investment in ICT, the roll-out of electronic health recording through new ICT capital programmes, the kind of thing Deputy Cullinane is now supposedly revealing as some new piece of data that we do not have. This is information that has been in the public domain.
The issue is around the scheduling of capital expenditure to take account of the increased costs of the national children's hospital, to ensure that projects that have been committed to are followed through on. The Minister for Health's commitment to the second cath lab as part of the 2019 service plan is there. I was not at the meeting this morning but what I suspect is that Deputy Cullinane was not told that the second cath lab in Waterford is going to be delayed. He was told that the funding is in a process of review.
I was not at the meeting. All I can say is that the Government is committed to the second cath lab. Many people in this House and elsewhere have worked hard on that, from the Minister of State, Deputy Halligan, to Senator Coffey, Deputy Cullinane and others.
In the past 48 hours the Taoiseach has stated that 25,000 medical appointments have been cancelled due to the nurses' strike yesterday. In some cases, those individuals would have waited months or years for those appointments. Next week, if the strike goes ahead, we will see another 25,000 cancellations. The knock-on effect will be delays across the entire health system, just as are experiencing the worst weather we have had this year. It will take months to recover those lost times, which will result in prolonged suffering and increased anxiety for thousands of people. It is not as if we do not already have serious delays in the health system.
As the Tánaiste knows, in previous Governments I negotiated two public sector pay agreements. I know all too well the constraints in terms of public spending and ensuring that agreements are adhered to by unions and workers, but by the same token, every single public sector agreement, certainly the ones that I was involved in, always had to deal with anomalies and inequalities that were presented at the time through side deals and special arrangements. That has always been a feature of the agreements. Specific issues have been raised by the Irish Nurses and Midwives Organisation, such as in relation to the acknowledged fact of the difficulty in retention and recruitment. Nurses have expressed legitimate concerns. As others have said, this is only the second strike by nurses in 100 years.
It is quite clear that this is not something they resort to lightly. No nurse, as was evident on every picket line at every hospital yesterday, wants to be on strike. Nursing is a vocation and our nurses are among the best in the world. They want to be back at work but they need to know that their profession will be respected and secure in the future.
The Taoiseach said in this House that all disputes end in a settlement. He is right, but that only happens when both parties are fully engaged in an effort to find a solution that will address the real and genuine grievances set out while sustaining the public finances. It is now incumbent on him and the Government to instruct public officials to engage with the INMO to work through these issues and find a mutually acceptable settlement. The Government cannot stand on the sideline and expect a settlement to be arrived at without its direct intervention. The Labour Court did not intervene yesterday because it judged the parties to be too far apart. It is up to the Tánaiste and the Government to reach out to nurses and find a solution. Will he, therefore, assure patients who are worried about next week's appointments that the Government will make an intervention to resolve this dispute before the strike takes place? That will clearly require flexibility and imagination; all settlements do. Both of those are in short supply in the Government's approach to this issue to date.
I agree with virtually everything the Deputy said apart from the final line. The Government respects nurses. The Government accepts and understands that no nurse wants to be out on strike when he or she could be at work. There is an understanding that the INMO has not done this likely. The union does not do it often. This is a reflection of the frustration and anxiety in the nursing profession. We want to work with nurses to address those concerns, but as the Deputy has said, we have to do it within the parameters of the pay agreement. We must not unravel that agreement when there is still significant time for it to run and when as a Government we have committed hundreds of millions of euro to the delivery of our side of that agreement.
The Government wants to look at how we can be flexible. That is why we asked the Public Sector Pay Commission to look at this and to look at issues like qualification allowance, location allowance, dual qualification allowance increases and a series of other ways in which we can maintain consistency with the agreement while making a special arrangement within its confines, as the Deputy said. If we move beyond that, other unions will immediately demand the same, as he knows. My clear understanding is that the Government wants to be fair, open and imaginative regarding how we solve this problem, but we have to make sure we can afford any solution we sign up to. We have to make sure it does not fundamentally undermine a pay agreement which is hugely important for the broader economy and for public sector workers across the country. We also have to make sure that it does not involve shifting significant financial resources to salaries from other elements of healthcare. Moreover, it must not require the Government to borrow to meet the pay commitments it signs up to, which would be madness. Most people recognise that. We want to reach out and talk and we want the Labour Court to be allowed to do its job. We want to find a way of closing the gaps that will allow the court to make recommendations that we hope can be a basis for agreement. However, we have to do that within the confines of an agreement that the Government and INMO has signed up to.
Industrial relations are complex and challenging by their nature. The Tánaiste seems to be acting as if the Government is a passive observer and there is an immutable agreement in place that does not have within it the flexibility that is always created to allow for imagination and the resolving of disputes. That is the nature of every single agreement because the public sector is a complex, multifaceted organisation. That flexibility, imagination and creativity has not existed in the Government's approach to this issue to date. The Irish Congress of Trade Unions, ICTU, which wants to protect the overarching public sector wage agreement - it is the ally of the Government in that regard - knows that there is the flexibility in the agreement to address the nurses' genuine grievance. Will the Government talk to ICTU? Will it listen to how flexibility can be found within the parameters of the agreement? Will it cease being a passive observer, because thousands of our people who have been waiting for months, or sometimes years, for urgent medical appointments are anxious?
The Deputy knows that we are not passive observers here because he has been in the Department concerned. The State and management interacted with the Labour Court in a significant way, as did the nursing unions. At the time, the demands and the confines of both arguments did not allow for a basis for an agreed compromise. We hope this can change.
We are doing something. Plenty of conversations are happening, as I suspect the Deputy will be aware. The Government speaks to ICTU all the time and we listen to it. We also have to operate within the obvious confines of ensuring that we follow through on the commitments that we have made. We must make commitments that are affordable to the State as a whole, that are fair to public servants across the country and that are fair to nurses. We will do all we can within those parameters to try to find a solution nurses can accept and work with, which respects their profession and ensures they are part of bringing about a more attractive professions for nurses in the future.
"Nursing is becoming a passport", "Who will look after us when we get old?", and "How come they can pay bondholders, but not nurses?", are three comments that nurses made to me yesterday. There were recurring themes on the dozens of picket lines visited by myself and my Socialist Party colleagues. We heard of nurses that have no time to talk to patients, which is a fundamental of being a nurse; their feelings of guilt when their 13-hour shifts end; three midwives looking after 23 mothers and their babies on a ward; and trolley beds on wards, which is the overflow from emergency departments. Hospital wards have frankly become dangerous due to ongoing deterioration in the nurse-to-patient ratio. Are we to wait years before this Government recognises there is a crisis in nursing, just like we had to wait with the housing crisis?
Let us be clear. This crisis applies only to the public health system. There were no pickets at private hospitals yesterday because they do not have to adhere to pay agreements. They pay inducements to recruit and retain their nurses. This is about patients and the public health system but it is also about pay. They may have been portrayed as angels over the years, but nurses do not have gossamer wings when the landlord comes looking for the rent. We hear of nurses getting up at 4.30 a.m. because they cannot afford to live in Dublin; nurses for whom mortgages are a thing of the past; and nurses who have been eating beans for the last week up to payday. As one nurse in Connolly hospital said, this is about long-standing abuse of women workers. We hear about the gender pay gap. This is the gender pay gap in action, perpetrated by our own Government.
Does the Tánaiste agree that a society that cannot afford to pay nurses is a sad society we should not tolerate? I note the editorial in The Times Ireland edition urging the Government not to pay nurses. That is how billionaires like Mr. Rupert Murdoch and the establishment feel. They think we do not need a society, just like Margaret Thatcher said. What we saw yesterday was the most powerful display of worker solidarity. Fire-fighters, prison officers and patients visited picket lines.
There was a conveyor belt of pizzas, cakes, donuts and coffee of all kinds because there is an innate solidarity among workers. The Tánaiste's attempt, and the attempt of others, to divide and conquer workers by pitting them against each other will fail. I note the mealy-mouthed words of the Labour Party and Fianna Fáil. I have not heard Labour say “pay the nurses” like a labour party is meant to do because it is reticent about that. One would think that the most dangerous thing-----
I thank the Ceann Comhairle. One would think that the most dangerous thing to happen in Ireland was the public sector pay deal unravelling but there is massive wealth in society. ICTU tells us today that chief executive officer, CEO, pay is climbing by 6%. Three people in this economy own €29 billion in wealth. There is not just a little pie for the health service. There is a huge pie of untapped and untaxed resources in this society, as we know by the Apple tax alone.
How do we get out of this situation? First, I would not be playing tough man talking about penalties on nurses because that would stir up massive support from the public, but the Government is in a dilemma because that penalty and threat fails against workers if it is not applied to nurses. That is the reality. I call on the trade union leadership not to allow this strike to linger on but to harness the overwhelming support we saw yesterday between workers and launch a united trade union campaign to give nurses, midwives and psychiatric nurses a reason to stay or to return. Also, equal pay across the public sector should be restored. We cannot recruit teachers either. All workers, public and private, need a pay rise. What is the Tánaiste's alternative to paying the nurses? Do not just pat them on the back and tell them how great they are; they need pay.
We are not going there again. Instead, we are guaranteeing public sector workers that their pay will continue to increase every year, that we will be able to afford to do it, and that we will work with them on pay, allowances, conditions and so on through the public sector pay agreement, which they signed up to, to provide that kind of certainty and ensure we get incremental improvements each year as opposed to trying to be popular, as the Deputy tries to be every week when she demands that the Government delivers more money for everything, despite the fact that she has no answer when asked where that money will come from, apart from take more money from the super wealthy which is supposedly available.
We have an obligation to be honest with people. We want to work with nurses. We want to find a solution to this dispute. We want to treat them with respect. We want to use our imagination to try to find a way of doing that within the confines of an agreement to which they and we have signed up. We want to make sure that we can afford to do that so that we do not risk the financial stability of the country again. Surely we have learned those lessons. We should try to be honest with people. We take the point. We are hearing what nurses are saying. We are hearing what the public are saying in terms of their sympathy with nurses but we have to make decisions in a way that is consistent and responsible and linked to agreements already signed up to and to find ways within those parameters of using our imagination in a way that can help and improve work and conditions for nurses. That is what we will do but we will be honest with them, unlike the Deputy.
The Tánaiste said our kind of politics will bankrupt the country. His Government is doing a pretty good job with a housing crisis, a health crisis and all the other crises it has created. He cannot go around boasting about Ireland being the best performing economy and saying there is no money. He simply cannot do both. There is a huge amount of wealth available. He is just not willing to pay nurses and workers. He is happy to pay to lift the cap on bank CEOs but he is not happy to pay nurses. What really annoyed nurses, however, was to hear the Tánaiste going on about Brexit. The nurses were being blamed or linked in with Brexit. That is incredible.
It seems that no worker is entitled to break out of the public service pay agreement without being punished. What kind of a democracy is that when someone finds they cannot live as rents rise relentlessly around them?
If the Deputy respects nurses she should be honest with them in terms of what is possible. She talks about divide and conquer or people playing tough man. We are doing neither of those things. The Deputy is the person who is trying to divide here and encourage more people to go out on strike. What we are trying to do is solve problems, treat people with respect, listen to them and try to ensure that the industrial machinery of the State works in this instance, which we accept is difficult and challenging. We are trying to build a health service that can look after patients in the way everyone in this House wants.
We are dramatically increasing the financial supports for that health sector and we are incrementally increasing salaries and income of nurses and all the other people who work across the health sector. However, we have to do that in a managed way that is controlled and predictable to ensure we do not have the highs and lows of trying to be populist about pay demands in terms of how we respond.
That is not what this Government will do. We will be honest with the people about what is possible and then sit down and try to work that through with them in a way that recognises that nurses have a tough job to do in very difficult circumstances. We want to work with them through those challenges in a way that is fair but consistent and affordable.