Thursday, 7 February 2019
Nurses and Midwives Industrial Action: Statements
I very much welcome the opportunity to discuss this matter. The industrial action taken by the Irish Nurses and Midwives Organisation, INMO, and the Psychiatric Nurses Association, PNA, is clearly creating significant challenges and disruption for the health service and more importantly, has created a worrying time for patients and their families. I acknowledge this is not an action nurses and midwives take lightly and that the situation must be resolved. The Government remains steadfast in wishing to resolve the matter.
There is no monopoly on political support for nurses. I am privileged, as Minister for Health, to meet incredible nurses and midwives on a daily basis. I also meet patients on a daily basis who remind me of the excellent work nurses do across this country. This is not a debate about who cares more for nurses. This is a debate about how one resolves an industrial relations dispute in the context of a public service stability agreement, which I believe most if not all parties in this House profess to support. It must be remembered by everyone in the House that the Government, and the unions, including those involved in the dispute, signed up to a three-year public service pay agreement. Honouring agreements does matter.
The public service pay agreement expressly prohibits cost claim pay increases during the lifetime of the agreement. That is what was signed up to, so it is within that space that a solution must be found. Deputies have already heard in this House how the public service pay agreement takes significant steps towards pay restoration. That agreement commits to seeing significant increases in pay by 2020, and nurses and midwives can expect to see their share of the increases beginning this year. Reductions for pay levels up to €50,000, which include a large proportion of the nursing and midwifery profession, will be fully unwound by the end of this year. That represents a wage increase of between 2% and 2.5%, on average, across the sector, with new entrants and lower-paid professionals benefitting the most from the changes. The Government is united in its support to unwind pay reduction measures introduced under financial emergency measures in the public interest, FEMPI, legislation. The agreement was sought in full co-operation and collaboration with public sector unions, including nursing unions.
We are eager to come to a fair and satisfactory solution for all parties involved that preserves the integrity of all elements of the agreement. That puts us in a difficult position in terms of how we reach a solution which respects the public service stability agreement and the other unions who represent other hard-working public servants who are not engaged in industrial action. There is an onus on those in this House who say that we should just support the claim being made by the nursing unions to answer the question to their constituents who work in other areas of the public service as to whether they believe they too should be treated equally in that regard.
However, just because something is difficult – this is clearly a difficult situation - does not mean that we give up. Far from it. There have been repeated attempts to resolve this dispute, none of which have borne fruit yet, but I stress the word "yet". I believe there are solutions to be found but it will require innovation and imagination on both sides. On Monday, my colleague, the Minister for Finance and for Public Expenditure and Reform, and I issued a statement on the current nursing dispute. The statement made it clear that the Government continues to be willing to engage in talks on the range of workplace-related issues to try to resolve the dispute. The statement called for immediate engagement in the context of the current dispute with relevant unions. Unfortunately, I regret that engagement has not taken place. The Workplace Relations Commission remains available to facilitate all the parties in that regard.
Issues of recruitment and retention in the health service, which unions have claimed are at the heart of the dispute, must be taken seriously. We fully accept that the numbers of highly-qualified nursing, midwifery and medical professionals leaving the country is an issue that requires to be addressed. That is why the Government engaged the Public Service Pay Commission to look at roles in the public sector where recruitment and retention had been identified as issues. If we did not take those issues seriously, we would not have set up a specific module of the Public Service Pay Commission to examine those issues in the health service. The commission itself features members with a wealth of experience working in trade union organisations including SIPTU, IMPACT and the Irish Congress of Trade Unions, ICTU. Nursing and midwifery were among the first of the professions investigated by the independent commission. The commission's findings were clear and they were published and accepted in full by the Government. The conclusion after in-depth assessment was the recruitment and retention issues were a cause of concern but that pay could not be found to be the one determining factor. It is a complex issue with many aspects and one that requires a range of solutions. That does not discount the equally clear actions recommended in the report that I, as Minister for Health, the HSE, and the Government are considering to improve staff retention and recruitment within the nursing and midwifery profession.
In addition to the benefits nurses and midwives can expect to receive from the unwinding of pay restrictions under the pay agreement, and the correction of salary scale issues for post-2011 new entrants, the Government has agreed to the commission's recommendations of a 20% increase in local and qualification allowances for nurses, as well as accelerated promotion for staff nurses to the senior staff nurse level. Despite the unions' recent rejection of the findings, the Government is hopeful that through further dialogue and clarification, these recommendations can be accepted and can be put into action this year for the benefit of nurses and midwives.
The industrial action taken by the unions is having a significant impact on hospitals and healthcare facilities. The decision to escalate the industrial action to include disability services was unwarranted. The industrial action taken by the unions is impacting in a real way. By the end of today's work stoppage more than 37,000 outpatient appointments will have been cancelled since the strike action commenced and it is expected that more than 6,000 inpatient and day-case appointments will have been cancelled. Those are not just numbers. Behind each case lies worry and concern for patients and their families.
Looking ahead to next week, a further three days of industrial action is planned, with more cancellations needed. In addition, the cumulative effect of the three days of industrial action will add to the stress on an already strained system. Members should be under no illusion that this is a dangerous situation and that patients would be put at risk.
While the disruption is creating a worrying time for many people, contingency plans have been activated by the HSE to ensure urgent life-saving care is maintained throughout this industrial action. I recognise that the unions are co-operating in terms of contingency planning in these regards. These plans are being modified and refined daily to ensure this essential coverage is delivered during this dispute.
I understand the strength of the unions' concerns and fully recognise that to have a first-class health service requires staff who have first-class support. It is regrettable the unions feel that pay reforms are not coming into action quickly enough but the proposed industrial action and ongoing industrial action are not the answer.
We are fully committed to coming to a satisfactory solution for all parties involved in accordance with the terms of the public service pay and stability agreement. I hear many people say that the solution can be found within the agreement. There is a duty on people to outline how exactly they would bring that solution about. Any solution to this dispute must be affordable and fair; affordable to the taxpayer but fair to all other hard-working public servants, including nurses in other unions who are working today and who have faithfully observed the parameters of the public service pay and stability agreement.
The stakes in this dispute are high. I mentioned recently that this situation is like a tightrope, and it is. The Government must maintain a responsible and prudent handling of our public finances, including public service pay, because without it, all future pay agreements may not only be at risk but may become unaffordable. To agree to the demands of the unions as they currently stand would tilt that handling of the public finances into an unsustainable spiral. This would damage our economy, our health service and ultimately public servants, including nurses, who we wish to support.
It is essential that industrial action comes to a halt as soon as possible. Our Government is sincere in its offer to want to talk and engage with nursing unions to reach a resolution to this dispute. I am confident this can be accomplished through further dialogue and engagement. I really hope after today's stoppage comes to an end that there is a real intensity of engagement as we work together to try to avoid further disruption.
I am sure many of us have had the opportunity to see nurses on the picket line. People have beeped their horns in support. What struck me as I passed were the chants I heard, proclaiming the need for safe staffing. While the key staff essential for running the services in the building behind them are outside on the picket line, there has to be a better way to do our business. I believe that the better way lies in the industrial relations machinery of the State, the Workplace Relations Commission, the Labour Court and not on the picket line. The solution will not be found here on the floor of the Dáil. The solution will be found using our industrial relations mechanism. We want to use that mechanism. We want to come to a solution. We want to find an innovative solution but we also want to honour an agreement that most parties in this House claim they fully support, which is the public service pay and stability agreement, and the commitment we gave to all our public servants, including nurses and midwives, under that agreement.
Patients in Ireland now wait longer to see doctors and to get treatment than patients in any other European country. Waiting times for CervicalCheck have jumped from two weeks to six months. Mental health services are in crisis and chronically underfunded. We have about half the number of consultants we need. The costs of the national children’s hospital have exploded threatening other healthcare projects for years to come.
In this context, our healthcare professionals are at their wits’ end. Hundreds of GPs took to the streets outside Leinster House yesterday to protest the asset stripping of general practice. Consultant posts lie vacant around the country. Ambulance drivers are taking strike action. Psychiatric nurses are taking strike action. The focus of this morning’s session, namely, the nurses and midwives, have just commenced their third day of national strike action, only the second such action in 100 years of INMO history. They have been calling for meaningful engagement for five years. They want to discuss conditions, staffing levels, patient safety, cost saving opportunities, career progression and – one of the core issues of this strike – the inequitable situation where a newly-minted, honours degree educated nurse walks in the front door of a hospital on their first day of work with an allied health professional and the nurse earns €6,000 to €7,000 less.
The Government's response to date is that it will meet the INMO so long as the issue at the centre of this strike is not discussed but, worse, the Government did not even have the courtesy to tell the INMO of its offer directly, rather it issued that offer via press release. If anything, that action, that lack of respect, has further galvanised the tens of thousands of men and women on picket lines this morning. The Government maintains there is no blank cheque. They are not looking for a blank cheque; they are looking for real, respectful, open engagement. The Government maintains it cannot engage on the issue of pay because of the public sector pay agreement but that agreement allows for these issues to be dealt where recruitment and retention has been identified as a problem. The number of mental health nurses is falling. The number of community nurses is falling. Many hospitals across Ireland are struggling to hire staff nurses and have particular issues in specialties such as intensive care and emergency medicine. That provides the space for an urgent review for nurses and midwives within the parameters of the public sector pay agreement. The general secretary of ICTU has stated she believes the INMO issues can be addressed within the parameters of the public sector pay agreement.
We all know that these issues will be resolved sooner or later. The question is: how much pain is the Government willing to inflict on patients, on their families and on healthcare professionals? Not a single nurse or midwife wants to be strike today. They are on the picket lines because they have not been listened to because they are not being respected.
The Government has a few critical days to get on top of this situation and avert strike action next week. Our hope is that it will start taking its responsibility seriously.
Today nurses and midwives are again on strike. The Psychiatric Nurses Association is escalating its campaign, involving 6,000 psychiatric nurses and more than 37,500 whole-time equivalent nurses and midwives. They do not want to be on strike. Nurses want to be caring for their patients, for the sick. What is this nurses' dispute about? It is about a very reasonable unhappiness about their work conditions. They have been warning the Government since 2013 about their work conditions and its impact on the risks to patients' safety. They have many valid concerns, including overcrowding in our hospitals, which are running at 95% to 120% capacity. They have concerns around understaffing. They are seriously overstretched. They are suffering from a phenomenal level of assaults; 70% of all assaults are on nurses. Psychiatric nurses suffer a great number of assaults and that number has been increasing year on year. There are serious issues around recruitment and retention. There are issues around the cost of living and, of course, around pay. They are asking a very fair question about pay, namely, why nurses are starting off on €6,000 to €7,000 less than equivalently qualified, allied health professionals.
Nursing became an honours degree 17 years ago. It is timely that the way they are paid, assessed, rewarded and supported is now reassessed. This matter will be resolved, but when will the Government engage on a meaningful basis with the nurses in this country, the INMO nurses and psychiatric nurses?
Unfortunately, for the first time since 1999, the country’s nurses and midwives have gone on strike across the health service and in the absence of any meaningful engagement with the Government, industrial action is to be further escalated. Today is the third full day of an INMO strike. No nurse or midwife, whether they go into psychiatric nursing or other areas of nursing, ever trained to stand outside a hospital while there were patients inside it. The Government should engage in good faith with the INMO and try to end the dispute once and for all.
The health service is under fierce pressure. It is absolutely creaking, even on a normal day with a full contingent of staff. How many more patients' appointments have to be cancelled before both parties get back into the Workplace Relations Commission and the Labour Court?
Support for the nurses, midwives and psychiatric nurses is widespread but at this stage they are not looking for support; they want a resolution. The only solution is to enter into meaningful talks. We have suggested Kieran Mulvey as a mediator but somebody of that stature is needed because without meaningful negotiations, we are going nowhere.
The pay issue is one element. Stress, workplace conditions, staffing numbers, part-time versus full-time contracts, particularly for psychiatric nurses, continuing education, an accommodation allowance and so forth are all issues that have to be dealt with in this dispute. The Government is claiming that the cost is €300 million. The INMO and the PNA say it is nowhere near that figure and that resolution can be found under existing structures.
I call on Ministers to stop pitching nurses against the rest of the public service. I call on them to solve this issue for the nurses and to start as soon as this debate concludes today.
The Minister said that he is eager to come to a fair and satisfactory solution for all parties that preserves the integrity of all elements of the Public Service Stability Agreement, PSSA. The general secretary of the Irish Congress of Trade Unions, ICTU, has said that there is potential within the existing agreement that protects its integrity but also allows for a resolution to this issue. The effort made by the Government the other evening leaves a lot to be desired, but it can correct that mistake by offering to enter into talks with no preconditions and it can allow independent arbitration on the issues referred to in clauses three and four. At the time the agreement was put in place, it was believed by nurses that those issues would be resolved, notwithstanding the Public Service Pay Commission's recommendations. The Minister was quick to say that the Government implemented in full the aforementioned recommendations, but he was very slow to admit that the chairperson of the commission alluded, in the report's foreword, to the fact that the commission did not have the correct analytics and statistics available to it which would allow it to make a recommendation it could stand over in terms of being the most informed one possible. That must be acknowledged but the Minister was not too quick about saying that.
The Minister spoke earlier in the week about the significant overruns on the children's hospital project, but we did not get a definition of "significant" from him. What some nurses believe is significant is the rent they are paying or the cost of a washing machine that has to be replaced. What is significant to some nurses and others in this country is the price of fuel in the event of a prolonged winter. What is significant to them is €300 or €400. I do not know what significant means to Fine Gael or to this Government, but it is time to get into a room and speak about it to arrive at a resolution. Patients and the public are suffering, with 25,000 patients affected per day of strike. Those whom I have met on the picket lines have said that when they signed up to the PSSA, there were clauses within it which they believed would address their concerns. The Government took credit for them at the time but it cannot run away from them now.
As the Minister knows, I am a former trade union official and am also the daughter of a trade union official. I have been a trade unionist all of my life and was very proud to stand on the picket line with nurses and midwives this morning at Beaumont Hospital. They gave me a number of messages, one of which is a badge for the Minister which reads "Save Staff". I do not imagine that the Minister is opposed to that and that is why they are on the picket lines today. The Minister will have seen pictures of nurses and midwives in Abu Dhabi, Australia and all over the world who are asking the Minister to give them a reason to come home. They are appealing directly to the Minister and asking him to give them a reason to come home by paying them decently. They are asking him to stop educating nurses and midwives to work in health services elsewhere and to stop spending a fortune to supplement existing staff by paying for agency staff every single day of the week. The agency bill is continuing to rise. Indeed, that was one of the first issues I raised with the Minister for Health when I came into the Dáil, and I have continually raised it since then because it is a waste of money to keep escalating the agency pay bill.
The Minister asked what can be done and he put it to those of us on this side of the House to outline what we would do. I have Ms Phil Ní Sheaghdha's phone number in my phone and I will give it to the Minister when this debate is over. The Minister can pick up the phone, ring her and have a conversation with her on what can be done. He can also stop issuing press releases that are doing nothing other than getting the backs up of the men and women on the picket line. The word used by the Minister's boss was "discourteous". He said it was discourteous to issue a press release of that nature and not to talk to the people involved directly. The Minister is dead right when he says that this will not be solved in here. Any dispute in which I was involved when I was working in the union was never going to be resolved in this Chamber and we all know that. There is very sophisticated industrial relations machinery available, but there is no point in everyone sitting around a table, looking at each other when the will is not there to resolve the dispute.
The Minister can send a signal now. He can send a signal to the third-party machinery and to the nurses, some of whom are here today and many of whom are listening or watching on the picket lines. They want to hear what the Minister has to say, but what has he said to them? He has said that he is terribly concerned about short staffing and patient safety, but every day of the week, nurses and midwives are cancelling procedures. They are experts in that now. They pick up the phone and tell people that there are not enough beds or enough staff and that their procedures are being cancelled. Every one of us knows these people because they come to our clinics or are in our families. We know that procedures are being cancelled every single day of the week. The Minister's concern for patient safety in the context of a strike rings very hollow to the men and women on the picket line at the moment. They are on strike for safe staffing levels. The Minister must give them a reason to stay or to come home from abroad. That is all they want.
This dispute can be resolved within the confines of the PSSA. The Minister should not take my word for it but should talk to the nurses directly. They will tell him how it can be done. They are out on strike for the sake of patients. They are on strike because the health service needs more staff. Many of those contributing to this debate today will say that nurses and midwives are only marvellous and are lovely and will ask what we would do without them. They are workers who are on strike for decent wages. They believe their dispute can be resolved within the context of the PSSA. The Minister must listen to them. He should not take my word for it but should talk to them directly. He must stop issuing offensive press releases and pretending that he is offering talks while saying that the Government will talk about everything except pay. That is an absolute insult. Pay has to be central to this. The Government did not oppose the Sinn Féin motion that was passed in this House last April, the very last line of which argued that pay must be central to the resolution of issues around recruitment and retention. We have a recruitment and retention crisis which can be added to the list of the other crises and scandals. The Government has an opportunity now to do the right thing. This dispute will not be resolved in here. Fine words from all of us will not resolve this industrial dispute. What will resolve it is direct, face-to-face negotiations, but the political will on the part of the Government to resolve this dispute must be there. These are workers and this is an industrial dispute. Nurses and midwives do not want a pat on the back. They want to be paid decent wages and they want the Minister to talk to them as professionals.
Ar dtús, ba mhaith liom tacaíocht a thabhairt do na haltraí ar fud na tíre agus i mo cheantar féin. Seasaim leo.
Nursing is a vocation. It takes a special person to work in the medical profession. Unless a person has walked in their shoes, he or she can never truly understand or appreciate the dedication, hard work and humanity of those who work in the nursing profession. Like me, I am sure most Deputies in this Chamber have reason to be grateful for the quality, strength, professionalism and compassion of our nurses. However, nurses and midwives in our hospitals do not feel valued or respected. They feel that they are being taken advantage of because they are caring for people. They feel that as long as they keep doing what they are doing without complaining, the more that will be asked of them. They should never be made to feel this way. They deserve consideration, respect and recognition for the job they do. It is a job that many of us could never do and they deserve proper remuneration for their incredible hard work and tireless dedication to their patients and to their profession.
It is so sad and shameful that each year we lose great talent to other countries. Across the world, hospitals in Australia, the USA, Europe and elsewhere are gaining at Ireland's expense. How could anyone blame graduate nurses for leaving our shores for foreign lands where they will receive proper wages for the work they do? Why should they struggle financially? Why should they work just to survive? Our nurses and midwives deserve better.
They deserve a living wage, not a struggling one. It is the least we can do for those we will turn to in our hour of need. This is their time of need. Let us not turn our backs on them. We and the Minister owe it to them.
Tá mé sona sásta seans a bheith agam caint faoin ábhar tábhachtach seo. Ba mhaith liom mo chuid tacaíochta a thabhairt do na haltraí.
Last week, I joined the nurses on the picket line at Our Lady of Lourdes Hospital along with an Teachta Munster and other local representatives. Later today, I will be outside Louth County Hospital with them in Dundalk. The nurses and midwives on the picket line do not want to be on strike. It is clear, however, from the overwhelming public support they are receiving that the people, including patients who are being affected by the strike, do not blame the nurses. They understand that the nurses have been badly treated by successive Governments. They know, as everybody knows, that our health services are in crisis and they accept that this industrial action is about providing a health service fit for purpose and capable of treating patients effectively and efficiently. They also accept that, without significant changes in pay, the core problems of recruitment and retention of staff, capacity and patient safety will not be addressed. In these circumstances, the nursing shortage and the crisis in the health service will only get worse.
The Minister must know that up to 80% of those who are leaving the profession of nursing and midwifery are resigning. They are not retiring; there are resigning. There are leaving the health service. Fine Gael has almost had eight years to address the recruitment and retention crisis and it has failed. The Minister for Health and the Minister for Public Expenditure and Reform are presiding over the scandal of over-expenditure at the new children's hospital. The Taoiseach argues this is value for money. At the same time, he rejects the demands from the nurses. The Government has no problem with landlords, bankers and vulture funds making huge profits but it is denying nurses the modest and legitimate increase they demand.
Last year, Sinn Féin introduced a Private Members' motion on the pay and recruitment of nurses and midwives. It was passed unanimously but the recommendations were ignored. The unions have proposed sensible, responsible solutions that, if adopted by the Government and HSE, would end the industrial action and improve conditions for staff and patients and therefore improve the health services. They have been ignored. It is up to the Minister for Public Expenditure and Reform, the Minister for Health and the Taoiseach to engage with the INMO and PNA and find resolutions based on workable solutions.
As for Fianna Fáil, come on lads, get real. An Teachta Martin's confidence and supply policy makes the party's protestations over Fine Gael's incompetence and arrogance, even if genuine, ring hollow. Fianna Fáil must know that Fine Gael is in government only because Fianna Fáil supports it in its policies. If Fianna Fáil really supports the nurses, it should stop supporting this bad Government.
It has been a difficult week for the Minister for Health, Deputy Simon Harris. I do not say that in jest. I hope he is going to take very seriously the concerns raised yesterday by the paramedics and doctors because, along with the nurses, they comprise the bedrock of our health service. I am glad the Minister for Public Expenditure and Reform, Deputy Paschal Donohoe, is sitting beside the Minister for Health because they need to sit down and have a chat about the children's hospital also, considering that it took them and their officials so long to sit down and have a chat on day one, which is amazing.
I am glad we got to debate this issue. It is very strange there are those who did not want to debate it. When we talk about this issue, it is important that we deal with some facts, one being that, in 2018, due to under-staffing and under-capacity, nearly 110,000 were forced to wait on trolleys and 7,000 procedures were cancelled. Only one in every four nursing vacancies was filled. There are almost 1,700 fewer nurses than there were a decade ago.
An issue that really bugs me is the amount of money spent on agency nurses. There will always be a role for agency nurses because gaps arise but they have now become the norm. I am sure the Minister for Public Expenditure and Reform will accept this is not an efficient way of spending money. More money is spent because of the policy that has now become the norm. It is continuous. The scale shows why this issue has to be dealt with. The costs of hiring agency staff and recruiting staff are so high that they are even adding to the problem. When I hear it is going to cost X million euro to sort this out, I believe from the prudence perspective that the Department of Health and the Department of Public Expenditure and Reform should consider this issue before circulating figures. They should examine the recruitment costs, the issues related to agency staff, the issues related to comparable pay, the efficiencies that would be brought about if there were enough nurses in the first place and how stays in hospitals would be shortened because of a more efficient service. The savings would be used to meet the requirements for which the nurses are rightly arguing.
My party and I will be fully supporting the nurses and have done so. We will be fully supporting them on Saturday on their day of protest. They do not take this action lightly. Members of my family are nurses. There are very few Members in the Dáil who do not have somebody in their extended family involved in the profession. Nursing is a vocation. We saw last night that nurses were staying on late to finish off their work. They always work longer hours and always stay longer to hand over because it is a vocation.
The nurses will continue to have public support because of the manner in which they conduct themselves, the way in which they act in their profession and the exemplary work they do. Nursing is probably the profession that the public will stand behind most. If the Minister believes he is going to wear down the nursing unions and public, he is completely and utterly wrong. It is about time the Minister sat down with the nurses and engaged with them in a truthful manner. Other Members have made reference to the manner in which he has communicated with the unions to date. It is insulting. Even the Taoiseach has had to apologise to this House for the manner in which the nurses have been communicated with, by press release. It is not the way to do business and it must not continue.
Instead of an elongated strike, which we all know has consequences across the health service, and instead of sitting down with the nurses in the near future, there should be an effort to compromise. Ultimately, strikes come to an end and there will be compromise. Since there has to be compromise of some form, why not sit down in a real fashion, get rid of all the preconditions and do everyone, including all of us, those in the Visitors Gallery, the watching public and all the nurses listening a favour and engage in proper negotiations? Why not? What is to be lost? From a Government perspective, it is going to have to happen anyway. It might as well happen now. We are facing three days of strikes next week. There is no reason the negotiations cannot happen now. I just do not understand it.
Let us consider some of the reasons the nurses feel the need to go on strike. A figure that really hits me is that when nurses are leaving the profession, 60% do not do so because they are retiring; they are actually resigning. They are leaving the profession to work in a private capacity or to do something else. Does this not explain absolutely why there is such a genuine issue?
If one talks to nurses - this is something I see all the time in my daily work - pay is the real issue and a central component of the dispute. In order to resolve it and deal with the issues of recruitment and retention, patient safety must ultimately be recognised as a real issue.
I represent County Tipperary. We have two of the most overcrowded hospitals in the country either side of where I live: South Tipperary General Hospital, as the Minister very well knows-----
That shows the real issues. The staff are working in environments in which they simply do not have enough space or nurses. There are real issues in recruitment. A range of vacancies in Limerick have not been filled. Two weeks ago with other Oireachtas Members from County Tipperary I met management of the HSE and South Tipperary General Hospital where one of the modular units is to be built. They told us straight up that it would not be opened within the timelines it should be opened. There will be a nice new building, but the fact is that it cannot be opened because of the time it will take to recruit nurses. It will take so long because it is not an attractive enough proposition and they will have to work extra hard to be able to do it. It is in our interests to ensure the issue is dealt with quickly because the Government's capital programme is obviously now quite upset owing to the massive overspend on the children's hospital. There are, however, quite a lot of good programmes, strategies and projects into the future, whether it be the national maternity strategy, of which I am hugely supportive, future mental health programmes or future developments across a range of other services in the acute and non-acute sectors. The issue, though, is that, frankly, they are all a waste of time and will all go to pot, unless there are the staff in the first place to be able to implement them.
There is workforce planning I hope in the public sector and the private sector to a great extent. What workforce planning is taking place in the context of the future of the health service? What workforce planning will be accurate and capable of implementing all of thee strategies and ensuring we will have the volume of human resources to carry out the strategies? What workforce planning can be a vision to deal with the issue if the Government will not sit down and talk to the nurses and discuss their issues? What does this say to them about their future? What does it say to those who are taking four-year nursing degree programmes? What does it say to all of the Irish nurses in Australia and all of the other countries around the world who want to come? It says there is no plan and no vision. The nurses will see that the Government has all of these fancy plans but no plan to ensure they will have decent careers.
It is time to wake up and deal with this issue. There is no requirement for the Government to set down preconditions. It should treat the nurses and the public with respect. I am not sure if Fine Gael and the Government know how to do industrial relations, but I ask them to learn quickly because I can absolutely guarantee them that the public will stay on the side of the nurses in this dispute for as long as it takes. I urge the Government to sit down and talk to them now. It is in its interest to do so.
I will address the two Ministers who are present. I want to put in context the reason we are here and welcome all of the wonderful men and women who work in nursing services - in psychiatric, general nursing and midwifery - to the Visitors Gallery. We need to put this issue in the context of the economy. We are living in the fastest growing economy in Europe. Personal wealth in this country has increased by €300 billion in the past five years - no other country in Europe can make such a boast - yet our nurses and midwives are paid less, treated worse and understaffed compared with those in any other European economy. This puts the issue in the context of priorities. One of the key reasons the Government is holding out stubbornly against the will of the people, the general population, and the obvious moral case the workers have is that it does not want other workers to learn the lesson that they, too, can share in this wealth. The wealth created on the backs of and because of the sacrifices made by workers is moving in one direction. It is going to the wealthy; it is not being shared among wider society. That is the agenda of the Government and it wants to maintain it.
I will put another spin on the dispute which is contrary to that constantly put on it by the Government, including the Minister's latest that he had an opportunity to pass a picket this morning. I have never crossed a picket in my life, nor have many other Deputies and Senators. We stop and show a little solidarity. The Minister said he heard the chant about safe staffing and thought to himself how one could have safe staffing if nurses were turning their backs on the building in which they should be working.
The buildings in which they work are not safely staffed. The ratio of nurses to patients is appalling. The safe ratio is 1:4. The real ratio in Ireland is something like 1:8 or 1:11. That is why the nurses are taking the action they are taking. They cannot guarantee patient safety and are sick and tired of apologising to patients and their families. The safe ratio must be attained and the nurses' unions have given the Government a way to do so, which is to prove that where there is a safe ratio of nurses to staff, there is 50% less mortality, less risk of cross-contamination in wards, a reduction in the length of stay in hospital and people get home sooner, as a result of which the longer term care they need afterwards is also reduced. The nurses' unions can scientifically reckon for the Minister that €600 million a year would be saved by increasing the ratio to safe levels. There is the Government's get-out clause and the reason it should pay nurses properly.
Saturday will be a really important day for the general population which is behind the nurses. RTÉ cannot find a single voice to say they do not support them. At 12.30 p.m., at Parnell Square, the entire population who can do so needs to be there to support the nurses.
The Ministers should stop the propaganda and the dishonest spin and tell the truth about the nurses. That is the message I received from the nurses outside today and those on the picket lines every day. They are sick of hearing the Ministers say they are on salaries of €57,000 and that there is no retention or recruitment problem. It is nonsense. There are unsafe levels of staffing in hospitals. A psychiatric nurse who is married to a midwife was at our public meeting last night. He is at the top of the scale and earning €47,000. He had worked through the night and then gone home, having been up for 36 hours, because his wife had to go to work, while he minded the children and took them to school. He must take his annual holidays to mind the kids, such are his hours, including overtime, and those of his wife and they have nothing. The Government should, therefore, stop the spin and admit the truth. We have a problem. The country is haemorrhaging young nurses because they do not want to work in unsafe hospitals or take responsibility for doing so and they are being paid an absolute pittance. That is the reality. Therefore, the Government should admit the truth and talk to them. Phil Ní Sheaghdha and Peter Hughes are in the Visitors Gallery. Why do the Ministers not toddle up after this debate and talk to them and actually listen to the reasons they are on strike? If they will not listen, I hope on Saturday the public will come out in their tens of thousands to fight, not just for the nurses but also for the future of the public health service in order to make the Ministers listen. Eventually they will have to do so.
Two placards held by young nurses on the picket line in Tallaght on Tuesday morning summed up a very important aspect of this dispute. One read, "I am not striking for the good of my health; I am striking for the good of yours." Another was a message to the Ministers: "Pay your nurses as if your life depends on it." These messages highlight that it is patient safety that has suffered first and foremost as a result of the chronic underfunding of the health service under successive Governments. A key part of resolving the dispute is paying staff properly and fairly in order to recruit and retain nurses.
I thought the Minister's move on Monday night, in offering negotiations to the media, not the INMO, was breathtaking in its cynicism, not only because of whom the message was directed at but also because of it what was.
Crucially, the message was not about discussing the central issue of pay but instead was transparently about trying to shame the nurses for seeking pay rises and pay parity. It is the Government which should be utterly ashamed of its behaviour in this dispute and nurses should be unashamed in seeking pay parity. Broadly, working-class people - ordinary people - support the demand for pay parity from nurses because other workers are also experiencing the massive cost of living rises, in particular the cost of accommodation, and also want to have a raise. They rightly see that a victory for nurses is a victory for all workers. The power of that support and solidarity was brought home to me on the picket line on James's Street when firefighters came along with soup to support the nurses and were met with hugs and applause from them. That solidarity and support makes them very strong and means they can achieve a victory in this strike.
The final point is in response to the question on where the money will come from. How about the €250 million spent in nine months last year on agency nurses driving a process of privatisation? How about the €270 million paid to Anglo junior bondholders, supposedly burnt, before Christmas? How about the €80 billion held by the richest 300 people? There is plenty of money available. The question is whether it is used to enrich the super-rich even further, to entrench inequality, to build a two-tier privatised health service, or to pay a decent wage and build a national health service that we need.
Fine Gael Ministers are losing the battle against the nurses in the court of public opinion. It is a battle I believe they cannot win. Senators Colm Burke and Buttimer expressed concern at their parliamentary party meeting last night that Fine Gael could be hit hard in May over this issue. Their nervousness is entirely justified.
Our message to the public is to stick firm with the nurses and remember who is really responsible for disruption in the health service. Our message to the Dáil is that next Wednesday afternoon, Solidarity-People Before Profit will bring a motion before the House demanding that the Government pays the nurses. We have head the fine words today. Let us see the actions and have parties that have spoken for the nurses vote for that motion next Wednesday.
Our message to the nurses is to keep their nerve, keep up the pressure and remember that striking workers never won anything in negotiation that was not first won on the picket lines. They should step up the pressure on the picket lines, and they can win.
Our message to the trade union movement is that the nurses must not be left to stand and fight alone. The entire trade union movement should use the next 48 hours to mobilise the maximum number of people possible to rally with the nurses in Dublin this Saturday. Moreover, other public sector unions should now open up a second front against Government pay policy. This means balloting for industrial action to reverse completely the cuts in pay imposed in the austerity years, including the question of two-tier pay for new entrants. The workers united will never be defeated. Victory to the nurses. Victory to the midwives.
I welcome all the nurses in the Gallery. I want to counteract the nonsense the Government is putting out that staffing levels are okay and that there is no issue with recruitment and retention. The INMO has shown that there are 103 fewer staff nurses employed today than were employed in December 2007 and that there are 1,650 fewer nurses and midwives today than there were in 2007. The INMO has informed us that hospitals are unable to recruit midwifery staff to match the recommended level of staff midwives to birth ratio.
The PNA has said that, according to figures it has got, there is a 40% vacancy rate in psychiatric nursing. At the same time, the INMO has figures to the effect that the HSE is paying out €1.4 million a week in agency nursing costs. In terms of psychiatric nursing, in 2013, €14.3 million was spent on agency nursing. That had increased to €53 million in 2017. That is the scandal we are facing as a public in respect of the way our health service is being run.
The irony is unbelievable regarding the use of agency staff. The HSE is paying agency nurses 20% more than the nurses they work beside in our hospitals. So much for equal pay for work of equal value in that regard.
Those figures came from a response to a parliamentary question tabled last year. The HSE, in response, stated that this expenditure should be considered in the overall context, including increasing demand for services - absolutely - the impact of earlier constraints on recruitment in the public service - absolutely - and ongoing challenges in regard to recruitment and retention of clinical staff.
The HSE is admitting there is a problem with recruitment and retention but why is the Minister not admitting it is a major problem and has to be dealt with? Nurses are leaving their jobs and the country to go to Australia or Canada, private hospitals and agencies. That is the reality.
The Government says the nurses have to be responsible and that it cannot afford to pay €300 million out of a €17 billion health budget or on the back of all the other issues on which money can be wasted. It should think about this. It can afford to pay the €450 million or €700 million, with contractors breaking tenders, in respect of the children's hospital. As reported in the news the other day, it can afford to allow the Department of Justice and Equality pay €1,000 per week on taxis. The Department of Foreign Affairs and Trade can afford to pay €1,000 per day on taxis. Is that a responsible Government?
What is really offensive is that Deputies on the Government side of the House who are telling nurses and midwives to be responsible pocketed €7,800 in the past two years as a result of the reversal of the financial emergency measures in the public interest pay cuts from January 2017. I did not take it because of what is happening here today and to support teachers and others in respect of equality of pay. I gifted back the money. These are the same people who are telling nurses to get off the picket line and not turn their backs on their patients in the hospitals.
I heard reports on the radio this morning that patients are at risk. Patients are at risk every single day of the year. These nurses are out on the picket line because they will not stand over continuing that risk to patient safety.
There is a way for the Minister to resolve this dispute. There is a section in the public sector pay agreement which provides for a review of recruitment and retention. Why will the Minister not look at public sector pay, offer a substantial down payment to start the talks and then go into negotiations on reviewing it?
Irish nurses across the world are in solidarity with this action. They are asking the Government to give them a reason to come home. I ask the Minister to give them a reason to come home and come out on Saturday at 12.30 p.m. to support nurses, midwives, psychiatric nurses and GPs who are saying that the system is in crisis, that it is crippling, and that it has to be dealt with. Will the Minister respond to that request and, following these statements, talk to Phil Ní Sheaghdha, Peter Hughes and those who can make the difference? If he does not do that, patient safety will be on his head.
The Ministers have a big problem and I am sure it is not easy to fix. They are caught between a rock and a hard place. In terms of the reason for that, there has been a rise in inequality in most of the developed world in recent years and the problem has grown. They will not solve the nurses' recruitment and retention issue. Unless they pay them better, it will remain a problem. It will not go away. They will most likely continue to strike until they get what they see is a fair wage.
The Government says it cannot break the public sector pay agreement, and that is understandable, but it will have to break it. Does that mean that more claims and strikes will follow by other people who believe they should be paid more? It is a huge problem but, truth be told, other sectors too are probably struggling to make ends meet.
I do not expect the Ministers to solve the problem overnight, but it is a fact that in the 1980s a person could buy a house in this town for three times his or her wages. People would need nine times their wage to buy one now.
That is a big problem, as is the cost of rent. Nurses and other people are struggling to make ends meet. Contrast is a significant issue. We all look at what others have and what is happening in other areas. That can be very annoying. The Minister, Deputy Donohoe, knows that I have been raising the issue of the loss of money in NAMA for many years. I genuinely believe that had things been done differently, up to €20 billion could have been saved. I have probably looked under the covers in regard to NAMA more than most. It is a significant problem and the nurses see that.
The situation regarding the children's hospital is nuts. I do not know why BAM was considered for the project. BAM delayed the development of Grangegorman by over two years at great cost to the State because it did not get the job. It was contracted to carry out a job in Cork port and after it was given the tender it sought an extra €11 million, claiming it had made a mistake in the tender. It went to court to dispute the matter. Why was it put on a tender list? The price for the hospital is too high. I have looked at it from a construction point of view and approximately 30% of the overall cost is fluff. It is a joke. BAM is conning the State. It is a scam. How does one deal with it? Who analysed the increased costs? Did someone go through it line by line to assess from where all the extra costs came? I would love to see and analyse a full breakdown of all the extra costs. PwC, which has done plenty of work for BAM through the years, is not the right entity to analyse it. Is anybody from the construction sector looking at it? That is where the extra costs arise. We seem to almost turn a blind eye to these crazy prices that come in. Tenderers seem to think that if a project is for the State, the costs will not be analysed and they will get away with things. I will tell the House a very quick story.
A couple of years ago in Dublin, four builders were asked to price a job. The tenders had to be submitted by 5 p.m. on a Friday. A week beforehand, one of the builders rang the other three and proposed a meeting. They were aware of the identities of the other tenderers. At the meeting, a deal was proposed whereby they would meet five hours before the tenders were due to be submitted and open the tenders, with the second-lowest tender getting the job and the lowest tenderer revising its price. It drove the price of the job up by approximately €2.5 million. It was a relatively big job for a private entity. The company carried out an investigation to find out why the cost was so high. It found out what had occurred and threw the four builders out. I would throw BAM out. Yesterday, Professor Jimmy Sheehan spoke at the briefing organised by Deputy Mattie McGrath in the audiovisual room. He made a lot of sense. Connolly hospital should be reconsidered as a location for the hospital. As a builder, I know that if the Government persists with the development of the children's hospital on the site of St. James's Hospital-----
Members will deprive others of the opportunity to ask questions if they do not stick to the allocated time.
The Rural Independent Group has six speakers. The first two speakers, Deputies Fitzpatrick and Nolan, have a minute each and the four Rural Independent Group Members have two minutes each. They must stick to that rigidly because if there is slippage, the last person will not get in.
The HSE has confirmed that 50,000 patients have been affected by the two-day strike action so far this week. All outpatient, inpatient and day surgery appointments for today have been cancelled. Other planned admissions including respite care and rehabilitation to community nursing units, including for people with intellectual disabilities, have been cancelled. Vulnerable people are losing out. The Government must engage with the nurses. All I hear from the Government is that it is disappointed that further strike action by the INMO is going ahead but the strike will be sorted out. The INMO stated that it is disappointed that the Government will not discuss nurses' pay. The Ministers, Deputies Donohoe and Harris, need to realise these are serious problems. They say the Government has no money but the INMO says that nurses need more pay. I ask them to please engage. They should meet the INMO today because the vulnerable people in Ireland who have been waiting a long time for services are not receiving them.
I thank Deputy Mattie McGrath for sharing time. The Minister, Deputy Harris, must engage with the INMO in a constructive and meaningful manner. The ongoing issues of pay inequality, staffing levels and poor working conditions have been in existence for some time. We can no longer afford to lose our newly qualified nurses to other countries where they get respect. I met nurses on the picket line outside the Midland Regional Hospital, Tullamore last week. They are frustrated and fed up with their working conditions. They are pulled from one section of the hospital to another because of understaffing. That is unfair on front-line workers and their health, as well as on patients. The Minister, Deputy Harris, needs to take action. It is appalling that the Taoiseach worked in the health service and saw how bad things were, yet he presides over this crisis. These nurses are working in a health service which, like the Government, is not fit for purpose.
I address my comments to the Minister, Deputy Harris, and the Minister, Deputy Donohoe. I have tried to constructively engage with them on health reform. This issue crystallises into health reform. It arises from issues of recruitment, retention and pay. It is also about health reform and recruiting and retaining nurses to deliver a proper level of care to our patients. The health service is about delivering care to patients. Unless nurses are properly paid and their frustrations and dissatisfaction with their working conditions recognised, we will not have nurses to work in our health system. The strike indicates a failure to anticipate that and deal with nurses' frustrations. It should not have come to a strike situation. There has not been meaningful engagement. The Minister attends the annual general meetings of nurses, GPs and consultants and makes promises but he never follows up on them. He has committed to developing many reforms in our health service but none of them have been implemented or followed through. An Oireachtas committee spent a year developing Sláintecare and discussing health reform, how important it is to deliver primary and hospital care service and how to spend our money more efficiently. It is about value for money. Unless we reform our health service, the Government will spend a fortune on the health service in years to come. One must anticipate, plan and reform. This has crystallised into a strike which should never have happened.
We value our nurses. They are the angels of mercy. They work very hard in conditions so unbearable that they are fleeing the system and country. Many have become ill. However, the Government does not respect them, this House or the electorate. If it did, the Minister for Health, Deputy Harris, would have left his position long ago.
I refer to the appalling vista of the children's hospital which is being built in the wrong place, with no co-located maternity hospital and without a helipad. It is a black hole. The Minister, Deputy Harris should see what is at the bottom of the hole. I am told that the concrete base of the hospital is floating. There are issues with drains and open sewers which must be relocated. It is a mess and the Government is digging itself a bigger hole. The Minister has arrogantly attacked the nurses by threatening to dock their pay if they go on strike. However, no pay was docked from anyone involved with the children's hospital. Consultants were paid €80 million to design a mess. The project went out to tender with BAM without a bill of quantities. It is an unmitigated mess. The Minister is incapable of running the HSE. He would not be able to run a sweet shop such as the one that existed in front of Leinster House in the days before the Minister came to the House. If they had any manners or respect, he, the Minister, Deputy Donohoe and the Minister of State, Deputy D'Arcy, would get a guided tour of the hole that is the site for the children's hospital. With a bit of luck, someone would ensure they stayed in the hole. We would have an election and get rid of them. People such as nurses and other healthcare professionals could then get a modicum of respect. I am an employer. One must respect one's staff. The Minister, Deputy Harris, does not respect his staff.
He does not respect this House and the Members here. He does not respect the electorate. He has no respect for anyone only himself, looking in the mirror. How does he sleep in bed at night with the way he treats people in this country and the shameless way he allows this gigantic overrun? He can smile away if he likes. He will go down in history as the worst, most incompetent and useless Minister for Health that ever sat in this Chamber. It is despicable. If he had any modicum of respect, he would be gone long ago, and to hell with his cabal of a Cabinet as well. He has a Dublin trio with him - the Taoiseach and the Ministers Murphy and Donohoe. They care nothing about Ireland.
What this is about, as well as pay, is staffing levels. All our young nurses are going abroad and, at the same time, we cannot attract nurses to open the other beds in Kenmare Community Hospital. I saw the determination in the nurses' faces last Tuesday in Killarney and Tralee, where I was with them in the pouring rain. The Government promised them that when the country was turned around, it would restore their pay.
Just a week ago, the Minister, Deputy Donohoe, sat there and said he was going to put billions into a rainy day fund. If he has the money to put into a rainy day fund to save the banks or bail out the banks at a future date, he must pay the nurses first and he must pay the people as he promised he would do - he must pay them first. He must get talking around the table with these nurses' organisations with no preconditions, please.
As I said, we need to protect nurses' safety and patient safety, which is at risk due to not having enough nurses and enough protection in our hospitals for them. It was sad to see the state of one girl who will never again be able to work after what happened her in one of our hospitals. I appeal to the Government to get around the table without any preconditions.
We have highly trained young nurses going abroad. Why is that happening? It is clear they are not getting the right opportunities and that they are being treated better abroad. The Government must address this issue or it may bring it down.
I very warmly welcome the nurses and midwives who are in the Visitors Gallery and thank them for taking the time to be here, representing every other nurse and midwife in our country.
It is so important that this issue gets sorted now. The Government is mismanaging it. If we look at what it is paying agency nurses and agency staff, it does not make sense. There is total disregard when it comes to politics. How inexperienced and silly a thing could the Government have done last week to send out a press release from both senior Ministers, the Minister for Health and the Minister for Finance, telling nurses they will sit down with them all right, but one of the conditions is that what they are talking about - pay - will not be on the table at all, that they will discuss other work conditions and everything else, but they will not discuss what the nurses want to discuss? That is what they are protesting about - getting a thing called fair play.
I can only talk with sure knowledge of County Kerry. I walked with the nurses from accident and emergency the last time they protested, when they explained in great detail to me the worry they have about their safety because of lack of numbers. They are really under pressure. I have been inside accident and emergency units in Limerick, Kerry and Cork during the middle of the night. I have seen at weekends how busy and how pressurised it can be. These are the people we rely on in emergency situations, whether dealing with older people, children or middle aged people. They are the people who, when their eyes are closing are damn glad to see a nurse looking down at them when their eyes open again. All I am saying is, for God's sake, wake up to this problem. It is not going to go away. Every Member here has a uniformity of purpose, and that is to demand this from the Ministers for Health and Finance.
It is true what my brother said about a bloody rainy day fund. It is pouring down on top of the Government now. Take the money out, if they have it for a rainy day fund, and give it to the nurses.
The arguments in regard to this dispute have been well rehearsed here and in other places. There are undoubted serious shortages within nursing and, of course, there is then a vicious cycle because, when there are shortages, it means those who are left to carry the can within our health service are carrying a heavier burden, and stress levels increase as a result. We also know that, in many cases, we are at a point where services are unsafe as a result of staff shortages.
That scenario is having a very serious impact on the operation of our health services as they stand. We have been talking for a long time about the need for reform of our health services and to switch to putting the focus on primary care to ensure that nurses' roles are expanded and that they play a key role in regard to, for example, chronic illness management, child health programmes, the maternity programme and all of those different reform plans, such as Sláintecare. All of those plans are predicated on a situation where we have an ample supply of nurses who are well resourced and well motivated. However, we are not going to have that unless the Government responds to the current crisis.
Nurses are going abroad. They are voting with their feet. They are going to places where they are valued and respected, and where they can live a life that is affordable. They are living in countries and cities around the world where there is an affordable cost of living, unlike this country. They are also going to places where there is a very clear policy context and they are not working in a system where, every time there is a new Minister, there is a new policy and everything is thrown up in the air. That is what people working in the health service have experienced over recent years in this country.
The evidence in regard to the shortage of nurses is stark. For every four vacancies, there is only one application. The HSE is spending €2 million a week on agency nurses and we also know the HSE is travelling the world, paying very high recruitment charges, to try to attract Irish nurses back to Ireland but also nurses from developing countries. We know that is the case and the figures from the HSE prove it. We also know the HSE made that very clear when it stated: "The overall picture of the nursing and midwifery workforce is one of a constant challenge to effectively recruit and retain to meet ever increasing service demands." I hope the Minister for Finance has heard that statement, which the HSE made to the Public Service Pay Commission. Unfortunately, it did not get to the Public Service Pay Commission because the Minister's Department, the Department of Public Expenditure and Reform, insisted on that statement being excised from the HSE's submission. I would like him to explain that.
There are also, of course, genuine issues of fairness when it comes to pay parity. Nurses are required to have the same academic qualifications as allied health professionals yet, at every point in the scale, they lag behind by about €7,000, which is inexcusable.
There is strong public support for nurses. The public simply cannot understand why the Government will not engage in a positive and constructive manner in this dispute. The question to both Ministers is what are they going to do about this. We cannot afford a situation where the industrial action escalates even further. This is taking its toll on patients, undoubtedly. What we need now is leadership from Government in terms of taking an initiative in order to free up the logjam that exists; what we need is constructive engagement. What the Ministers are doing is adding fuel to the fire. They have been entirely unhelpful in their response to this. Their actions have been provocative and they have fuelled the fire. What we want from them is action. We know that, under clause 4 of the pay agreement, there is provision for engagement in regard to areas where there are serious problems with recruitment and retention. They should stop the megaphone diplomacy. From Patricia King down, everybody has said it is possible to resolve this dispute within the context of the existing agreement. What we want now is leadership from Government. It should take action over this weekend to ensure we avoid what is likely to happen next week in terms of a crisis in our health service for everybody concerned.
I have been a trade union activist all of my working life. I was a member of the Irish Transport and General Workers Union, the Federation of Rural Workers, the Amalgamated Transport and General Workers Union and the Irish Local Government Officials Union, now called Fórsa. I have represented that union at national level and been president of the Clonmel Trades and Labour Council. I have been on the picket line with nurses at South Tipperary General Hospital and Nenagh General Hospital in the past two weeks. I fully support their claims and believe the industrial action they are taking is fully justified. It is about fair pay and conditions of employment, but it is also about safe staffing levels, the safety of patients and the provision of a quality health service.
The Government spin against the nurses is shameful. Everybody in this House, including the Minister, knows that the health service is in a shambles. They know that patient safety is at risk every day. Cancellations occur every day of the year. A colleague of mine had his cardiac bypass surgery cancelled on two occasions. Having worked 21 years at South Tipperary General Hospital, I know the pressure nurses and staff are under. The hospital works at 125% capacity, when normal capacity should be in the region of 85%. It has one of the highest trolley counts in the country. Mental health services are understaffed and under-resourced. The acute inpatient service is non-existent, having been closed by Fine Gael and the Labour Party in the last Government. The pay agreement cited by the Government does not represent a pay increase. It is a pay restoration agreement which does not even fully restore pay to the previous levels. I believe public representatives should support the nurses. One thing we can do is call on all of our supporters to be at the Garden of Remembrance next Saturday at 12.30 p.m. to support the demonstration called by the nurses.
I believe nurses are fighting a battle to establish and restore a civilised society in Ireland. They are fighting to ensure all Irish people will have adequate and effective healthcare. More than that, they are fighting for priority to be given to caring human values over the greed of the super-rich. It is the greed of the super-rich and the feeding of that greed which are the driving principles of the Government, not just its Fine Gael component. The Taoiseach told us that the Government would have to borrow money to meet the claims of the nurses. That statement is shamefully and demonstrably untrue. Anybody who doubts it might read the 2019 report of Social Justice Ireland which was published recently. The Government states meeting the nurses' claims would cost €300 million per year. The unions dispute this and point out that many of the resources required could be found by reducing the dependence on agency nursing. Even if the Government's claim was correct, the amount of money is minuscule compared to the untaxed, massive and growing wealth of the Irish super rich. The Minister and the Government need to make the super rich pay their fair share of taxation. There is massive wealth in the country and a disproportionate share is owned by the super rich. According to the Central Statistics Office, there are 25,700 individuals who earn between €200,000 and €2 million per year. In the last budget not only were no additional taxes placed on them but the Minister for Finance gave them tax relief, as he had done in the previous two budgets. The money is available to resolve the dispute. The Government simply has to address the very wealthy people who have billions of euro above the peak boom levels in 2007 and 2008. The Minister should resolve the dispute by acceding to the requests of the nurses. The Government should resign and allow the people to make a decision on what will happen in the future.
In conformity with the order of the House made on Tuesday, each party or group has five minutes in total to pose questions. Within those five minutes, either Minister will answer. I will stick rigidly to the time limit of five minutes.
I will ask a few questions. Deputies Rabbitte, McGuinness and Breathnach will then ask questions. We will ask all of the questions at the same time and then perhaps receive responses.
Does the Minister accept that there is genuine pay inequality between new entrant nurses and new entrant allied health professionals? Does he accept that the issues surrounding the strike and this pay inequality can be accommodated within the public service stability agreement? Does he accept that there is a recruitment and retention issue? Does he stand by previous statements he made in this House, in which he described recruitment and retention in nursing as a crisis? Does he accept that there are numerous cost savings which could be identified and secured in the context of better and safer staffing ratios, as identified in the pilot projects last year?
It is clear to me that there has been major erosion of key workers, including nurses and speech therapists, across the health sector. Is there not a need to incentivise them by way of the payment of additional attractive increments to key staff who will sign up to stay for five to 20 years outside any pay agreement?
Will the Ministers, Deputies Harris and Donohoe, the HSE and the Department accept that they have failed to keep on top of the issues that have been plaguing nurses for the past few years? We have this strike because of that failure. Will they intervene directly with the unions to set out a course to bring the strike to an end? Will they stop the provocative rhetoric in their description of the nurses and what they are doing?
Section 3.1.2 of the Public Service Stability Agreement 2018-2020 states:
The Commission will advise the relevant Parties on the outcome of its assessment, which will then be the subject of discussion between the relevant parties. It is accepted by the Parties that the output from this exercise will not give rise to any cross-sectoral relativity claims.
That sums up the opening that we believe is available. I expect the Minister to take it, run with it and allow discussions to commence.
They have been acknowledged within the Public Service Pay Commission. That is why we made specific proposals that we are willing to honour.
Deputy Rabbitte asked if we were willing to enter into discussions and negotiations. We are, but we have to be conscious that we have an agreement in place for 291,000 other public servants whom I will address in my concluding comments.
In respect of Deputy McGuinness's comments, through our participation in the Public Service Pay Commission process and through putting a collective wage agreement in place, we have looked to respond to issues that are being raised by nurses and their representative associations as we have looked to respond to issues and points raised by other groups. In respect of Deputy Cowen's comments, there is a clause there but that is the context for the Public Service Pay Commission report that we said we will honour. Did I miss a question from Deputy Breathnach?
Deputy Breathnach asked me whether we are willing to put different measurements in place. We have looked to respond to that with the new entrant agreement we have put in place that we still hope to be in a position to honour and implement.
I urge the Government to give up this attitude because it is not going to get anyone anywhere and it is not going to resolve the dispute. Does it accept that without pay on the negotiating table, this dispute cannot be resolved? Will the Ministers commit to making a telephone call because it is very easy to come in here and talk about patient safety? By the way, the Government's record on patient safety speaks for itself given waiting lists and every other issue, and the people in the Public Gallery know that. Will the Ministers give a commitment to pick up the phone to have a meaningful dialogue with Peter Hughes and Phil Ní Sheaghdha to ensure that this matter can be resolved because nothing is more certain than the fact that this will be resolved? No dispute goes on forever. Will the Ministers commit to picking up the telephone and talking to them? There is no sense in us coming in here and talking about this clause and that clause. I can go through that Public Service Stability Agreement with the Ministers and tell them where it can be resolved but the Ministers should talk to the people in the dispute instead of talking at them. Will the Ministers apologise for issuing that disrespectful press release that was patronising in tone and very disrespectful to the men and women who are on the picket line, not because they want to be but because the Ministers forced them to?
I believe it is possible to find a resolution to this dispute if all parties to it work innovatively within the confines of the Public Service Stability Agreement. We have consistently spoken about it, as have the general secretaries of ICTU and the INMO. Everyone has said it. There is a duty on us to show how it can happen. We want to engage within those confines. Will I pick up the phone and ring the general secretary of the INMO? The general secretary of the INMO talks to me regularly but the way to resolve industrial relations disputes is through the State's machinery, which the Deputy has outlined.
If the Deputy is looking for a signal from Government, perhaps she should allow me to speak. The signal from Government is clear. We want to find a resolution and believe it is possible to do so within the Public Service Stability Agreement. Other parties to the dispute have said that. We will only do it through intense engagement, which I hope can start imminently and that everybody can put their shoulder to the wheel. I hope we use the industrial relations mechanism that is available to us.
Regarding the statement issued the other day, it was never intended that people would find out through the media. The Workplace Relations Commission, WRC, is usually the body that issues invitations to talks. The purpose of the statement was to outline that the Government did want to put forward proposals to address a number of issues that were being validly highlighted by nurses and midwives on the picket line.
The purpose of that statement is not lost on people. It was more pathetic spin from the Government. It had the opposite effect to the one intended by the Government. The Government should be under no illusions. These men and women have the support of the public and most people here. Will the Ministers apologise for issuing that press statement? Do they accept that it was more than discourteous, that it was disrespectful? Will they commit to sending a signal to the Labour Court that if the parties get around the table, there will be money to resolve this dispute?
It was never the intention of either the Minister for Health or me to be disrespectful to any public service worker. What we were doing was done in light of the fact that questions were being asked about whether we would engage with the WRC. We were indicating our willingness to do so. As the Minister for Health said, nobody in this House has a monopoly when it comes to respecting the fact that nursing is not only a vocation but a highly skilled profession, but it is only appropriate that all who comment on and participate in this issue know that at that point, we were, and still are, willing to engage in the WRC.
I take issue with the Minister for Public Expenditure and Reform's statement on the Public Service Pay Commission. What he said goes to the heart of this dispute. He said that the commission found that pay was not found to be one of the determining factors. Does he believe this anymore because pay, retention and respect for nursing staff are at the heart of this dispute? We could have a three-day dispute in our hospitals next week that will cause untold damage to the Government and the people who use the health service. This is about pay. The Government needs to recognise that if it does not pay the nurses, that decision will come back to haunt it, so it cannot afford not to pay the nurses. Does the Minister still believe what the Public Service Pay Commission said? Is this not about pay?
It is very simple. Does the Minister for Health accept that we have unsafe staffing levels in our hospitals? We should have a ratio of 1:4 but it is more like 1:8 or 1:11. Does the Minister accept that we are short hundreds of nurses when it comes to safe staffing levels in psychiatric and mental health services?
In my introduction, I outlined the possibility provided by the nurses' union that up to €600 million per year could be saved if the Minister for Public Expenditure and Reform implemented the safe ratio that has been outlined by the INMO. Will the Minister comment on that and give us an indication as to whether that is possible? The Minister says he will not talk about pay but he has shifted because in the weeks leading up to the dispute, he would only send the HSE to the WRC to talk to the unions. He is now saying that he will talk to them. When we shout outside on the picket lines, we say "open your purses and pay the nurses." The Minister has the purse, which is full. He can find money for military spending, to bail out bankers, pay off bond holders and do many other things, including the Government's bid to win a seat at the UN Security Council on which €500,000 has been spent. I ask him to open the purse and think creatively about how he can pay the nurses and make the savings when he employs the staff who are required.
I will deal with the questions from Deputies Gino Kenny and Bríd Smith while the Minister for Health will deal with the question from Deputy Boyd Barrett. With regard to the question from Deputy Gino Kenny, I still accept and stand by the analysis and recommendations offered by the Public Service Pay Commission. It is independent in composition. Recommendations came from the commission that acknowledged that targeted changes could be made, particularly with regard to allowances that at that point were unlikely to trigger any competing claims from elsewhere in our public service, so I still accept, stand by and believe in that piece of work. I accept the analysis that was offered.
In respect of Deputy Bríd Smith's point about our willingness to engage, especially from the middle to the latter phase, my Department has been present in the engagements along with representatives of the Minister for Health. If we do find a way, which the Minister for Health and I are committed to doing, of moving beyond where we are at the moment, that will continue to be the case.
Regarding the question from Deputies Boyd Barrett and Bríd Smith about safe staffing levels, I am pleased that we ended the embargo on recruitment and are recruiting more nurses and midwives but I accept and do not dispute that we have a way to go. The Deputies are right. We have agreed a task force on safe staffing and skill mix, which the unions have accepted, which is the framework and Government policy and which has a scientific and evidence base behind how many nurses and other skills are needed on each ward. We have rolled that out to a number of wards and hospitals. There is room to do more in this regard. The Minister for Public Expenditure and Reform and I have been very clear in our utterances in recent days. These are the sorts of discussions we want to be having with nursing unions through intensive engagement using the industrial relations mechanisms.
I have a question to ask, as does Deputy Wallace. The Minister, Deputy Harris, said in his speech that he fully accepted the number of highly-qualified nursing, midwifery and medical professionals leaving the country is an issue that should be thoroughly investigated. Why is it that it only should be thoroughly investigated now? This has been going on for years. The Government and previous Governments have known about it yet it still has not been investigated. I want to know why, because I think that is wrong.
I note what was said in terms of the contributions and responses around the negotiations. Why has it not happened? Why has the Minister not opened up the negotiations at this stage?
The Minister, Deputy Harris, referred to the Public Service Pay Commission position. Is it not true that the Minister for Finance, Deputy Donohoe, met the commission on 26 October and instructed it to the effect that this was not and could not be a pay review? Will the Ministers accept at this stage that this problem will not be sorted without paying the nurses more money?
The Minister, Deputy Donohoe, will respond to the question on the pay commission and his engagement and on the issue of the negotiations.
On Deputy Pringle's question regarding the comment in my opening statement about the need to do more to keep our student nurses, on becoming graduate nurses, in this country, we have taken a number of steps, which have been acknowledged by the nursing unions. We established the Public Service Pay Commission specifically to examine what could be done on recruitment and retention. We specifically asked an independent body with union representation from ICTU, IMPACT and SIPTU former personnel to examine that issue. We have also tried a number of other initiatives, including offering all graduating student nurses full-time contracts. Clearly, there is more to do. Let there be no misunderstanding, we want to have that conversation to resolve the dispute.
I will deal with the questions put to me by Deputies Pringle and Wallace. On Deputy Pringle's point regarding engagement to date, there has been engagement to date. The Workplace Relations Commission and the Labour Court have been involved. It is obvious that engagement did not yield outcomes that were satisfactory to those who represent nurses as otherwise we would not be in this situation. Engagement has taken place. Preceding that, there was the process of the Public Service Pay Commission which went on for the best part of a year in terms of analysis of the issue and recommendations. The commission went through a formidable analysis, which was far from easy, to make the recommendations it made.
On Deputy Wallace's questions, the Deputy is correct that I did meet the Public Service Pay Commission. My understanding is that all other participants and stakeholders in this process also met and made submissions to the commission.
I have experience of institutions that are independent of me issuing recommendations that then cause significant consequences that I have to deal with as well. On Deputy Wallace's point on pay, one of the challenges we face is that the Public Service Pay Commission did issue recommendations in regard to pay for which, in my appraisal at the time, the rest of the union movement would have understood the need. We could have implemented them in such a way that would have allowed us to avoid the vista of knock-on claims elsewhere. In fairness to Deputy Wallace, he is the only speaker in this debate who acknowledged what that risk is, what would be the challenges for the Government in respect of how we manage pay in this country and what that could mean for everything else.
Tá ceist eile agam más é do thoil é. The Ministers, na hAirí, have spent €1 million on a PR firm to cover up the debacle - the black hole - that is the children's hospital. They spent €80 million on consultants to design that mess. Where is the accountability? Will they hold anyone in the HSE or the Department to account? The chairman of the board has resigned but is anyone going to be held-----
It is totally relevant. They do not have money for the nurses or ordinary services, the elderly and so on but they have money to throw it at consultants, design people and design teams. I am asking the Minister if he will get into proper, meaningful negotiations with-----
As I was saying in response to Deputy Mattie McGrath, there is €17 billion of taxpayers' money deservedly going into the provision of services that are available in the health service and into trying to improve them, of which at least one quarter goes into the wages of those who provide care in our country.
The Deputy also asked if we respect the nurses and the contribution they make. Of course, we do. It is insulting to suggest otherwise on the part of any member of the Government. The challenge we face, which Deputy Mattie McGrath has no interest in acknowledging, is there are many other public servants whose work we also respect - over 290,000 of them. If we make any one movement in this wage agreement for one group, it has immediate consequences for every other group, which Deputy Mattie McGrath has no interest in acknowledging, although I know he understands it.
Deputy Danny Healy-Rae asked me to explain why we are putting money into a rainy day fund.
I understand why many would ask that question given the pressures that always exist for today. The simple answer is that we will get into another difficulty in the future because we are an open economy and a huge amount is happening in the world at the moment, as the Deputy knows. Our debt levels, on our emergence from the most recent crisis, are far higher than when we into the times of difficulty we are trying to put behind us. Our difficulties will be even greater if we do not have some reserves available to deal with whatever shock the rest of the world might throw at Ireland in the future.
I understand that is a tough argument to say we need to be better prepared for the future when we face challenges now but it is still the right solution for our country in the long run.
Like many people, including other Members, I am proud to have family and close friends who are nurses. I am the daughter of a midwife and the sister of a neonatal nurse and am acutely aware of the incredible work nurses do. I was delighted to join them on the picket line in Tallaght today because the work they do is among the toughest and most vitally important work undertaken by any group of people in this country. They undertake that work day in and day out.
Does the Minister accept that not being able to find adequate numbers to work in the nursing profession presents an overarching health and safety concern, a crisis and an emergency? Why would one continue to work in a system in which pay is too low, conditions are in need of vast improvement and, crucially, there is no sign of change? That is the situation nurses face.
Our nurses are second to none but the system is failing them and their patients. It is primarily a matter of pay, justice, fairness and equity. Pay is at the heart of this dispute and for Government to make an abysmal offer through the media to settle the pay dispute by excluding pay from negotiations is inflammatory, idiotic and insulting. It shows grossly poor judgment and a worrying absence of any understanding of the plight of nurses and midwives. Will the Minister admit that statement was insulting and wrong and apologise for it? Will he commit to engaging, in a meaningful way, with the general secretary of the nurses' union?
This dispute will be resolved sooner or later. For the sake of patients, staff and the Government, the sooner that happens the better. The Ministers said earlier that they are prepared to engage. Both the Minister for Health and the Minister for Public Expenditure and Reform need to send a clear signal that employers will engage in an honest endeavour on this and there will be no preconditions on negotiations. Everything must be on the table. It will be sorted out around the table, sooner or later, but the Government must give a clear signal and make a clear statement this morning that everything will be on the table and there will be no preconditions.
We cannot put the stability of our collective wage agreement on the table. There will be immediate consequences for every other public servant in the State if there is a change to the agreement.
I appreciate there are many nurses in the Public Gallery this morning who would rather be in their places of work. The challenge that my ministerial colleague, Deputy Harris, and I will immediately face is that, if this wage agreement is destabilised, the same Gallery will be full with other public servants who will want to benefit from the same change. That is the challenge we face.
There are some in the House for whom that is their agenda. Deputies Boyd Barrett, Bríd Smith and Gino Kenny have acknowledged that they also seek the changes being sought for nurses for the rest of the public service.
I will deal first with the question that Deputy Catherine Martin put to me about what the figures say about recruitment and retention. Figures developed by the HSE and the Department of Health that have been shared with us make the point that, over the past number of years, 3,876 more nurses and midwives have been recruited. That change has happened. A report of the Public Service Pay Commission makes the point that turnover rates within that workforce at the moment, excluding retirees, stand at 5%. That figure is 6.8% including retirees. That is the other side of the figures that were put to me.
This also applies in answer to the question of Deputy Shortall. We are willing to engage in the machinery of the State, whether the Labour Court or the Workplace Relations Commission, but we need to adhere to the key condition of preserving the overall agreement that is in place.
I acknowledge the contributions and questions that have been put by all Deputies here this morning.
I want to respond to one particular allegation that has been made this morning about the nature of the current wage agreement. A number of speakers have asserted that we do not have wage restoration or wage growth in place. The agreement, as negotiated at the moment, provides that anybody earning below €35,000 will see wage increases, as they should and deserve. The agreement ensures, contrary to the claims of some, that anybody earning less than €50,000 will have their wages fully restored by 2019. The current wage agreement ensures that anybody earning less than €70,000 will have their overall wages restored to €70,000 by the end of 2020.
Claims that we are not budgeting for, or implementing, wage restoration or wage growth for some people are not true. It is happening. It is under way and part of the current wage agreement.
On the questions that have been put to us about new entrant pay and our response to challenges, the current wage agreement contains provisions to ensure that anybody participating in that agreement could benefit from up to €3,000 from the concluded negotiations with the Public Service Pay Commission of ICTU. I have heard repeated claims this morning that we do not have agreements in place to tackle wage restoration, but we do, for low and middle-income workers. The agreement we have in place makes provision for dealing with the issue of new entrants' pay.
A charge and claim has been made and repeated by Deputies that there are four vacancies for every one applicant for nursing jobs. That is a figure we have often heard. That figure is based on an article from April 2017 that, in turn, had its origin in the Global Jobs website. The figures from the Public Service Pay Commission showed that, on average, there are 1.86 applicants for every place on a recruitment panel. Those are people who want to work in our public services and gain work there.
The Minister for Health, Deputy Harris, and I have acknowledged in our contributions that, in addition to emphasising the understanding and respect we have for all who work in our public services, particularly our health services, we have also looked to sketch the competing claims we have and challenges we face. The following is a core point for Government in its response to these issues. It is not clear to me how, were this collective wage agreement to come to a disorderly end, we would be able to negotiate another to take its place. That has consequences for our public servants, how we pay for them and how we ensure they get the wages they deserve and are entitled to in the future.
I make the point to my Fianna Fáil colleagues that it was their efforts and leadership at another point of great change in our economy that showed how collective wage agreements could play an essential part in how we manage wage pressure and ensure public servants are paid fairly.
A positive legacy of Fianna Fáil Governments is that they showed in collective wage agreements we could pay people by reference to what they earned as opposed to the leverage they had. They showed how that approach could be made to work.
We also went through a period in which we saw how they did not work and we had to deal with the consequences. Again, Fianna Fáil used collective wage agreements to respond to them. There will be a bitter legacy if it emerges that in the future Governments will be unable to negotiate a collective wage agreement for over 300,000 public servants.
That is why this is such a difficult matter. I understand fully and appreciate the great support nurses and nursing unions have received, but it is because of the value of the agreements that this is proving to be such a formidable issue. The Minister for Health, Deputy Harris, and I will continue to work at the Workplace Relations Commission and in the Labour Court to see if we can find a way through.