Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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In the next Topical Issue debate, Deputies Joan Collins and Mick Barry will discuss the situation facing a group of nurses, mainly from India, who are working as healthcare assistants under a work permit scheme.

Joan Collins (Dublin South Central, Independents 4 Change)
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I thank the Ceann Comhairle for selecting this Topical Issue matter. I am raising this issue on behalf of Migrant Nurses Ireland, which explained its members' plight at a presentation in the audiovisual room two weeks ago. The meeting was organised by Deputy Barry.

The issue of recruitment and retention remains a huge problem for the HSE. The Joint Committee on Autism discussed it as recently as today. As part of an international recruitment campaign, through the Department of Enterprise, Trade and Employment, the HSE introduced the general work employment permit scheme for care assistants from non-EU countries. At the time, it was agreed with the Department of Health that the minimum salary would be €27,000 per annum. There are approximately 3,000 people on the permit now. As part of the scheme, these workers are obliged to undertake a Quality and Qualifications Ireland, QQI, level 5 course for the role of healthcare assistant. This is despite the fact that many of the Indians on the scheme are qualified nurses whose qualification allows them to register as nurses with the Nursing and Midwifery Board of Ireland, NMBI, after a language test and adaptation course to the Irish health system. It is a bit mad that they are working as healthcare assistants even though they have that qualification.

The QQI courses cost up to €1,700 and the workers covers that expense. Will the State negotiate changing the conditions to allow these workers to be recognised and become healthcare assistant carers on the basis of their nursing qualifications and completion of an English language test and adaptation course for the Irish health system? It seems crazy that these nurses are overqualified. They have been kept in a low-pay and family reunification exclusion trap because they are mainly in the private sector earning €27,000 as a starting rate. The income threshold to qualify to bring over a spouse is €30,000 per annum, which puts them in a real quandary.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I call Deputy Barry. I nearly called him Minister Barry. The Deputy will be upset by that.

Mick Barry (Cork North Central, Solidarity)
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It is only a matter of time and it will be in a socialist government but that is another matter. The Minister of State, Deputy Butler, has responsibility for mental health and yet-----

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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It is the Minister of State, Deputy James Browne, who is dealing with this matter.

Mick Barry (Cork North Central, Solidarity)
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The Minister of State with responsibility for mental health is here and the Government’s policy is putting these Indian nurses through a mental health ringer. Deputy Joan Collins mentioned that there were 3,000, mainly Indian, nurses working here as healthcare assistants. Some 1,000 came over at the start of the year on two-year work permits. They are working in private nursing homes as healthcare assistants doing vital work for our health service. This is difficult and mentally draining work. The policy of the Government means they are forced to do this work while being separated from their partners and children. It is a forceful separation because the arrangement stipulates that their pay has to be €27,000. The Minister of State may say the private nursing homes can top up the money but he knows that will not happen. They are getting €27,000 per year, yet for a family reunification visa, the minimum that will even be considered is a salary of €30,000 per year. The Government is forcing these workers to do this extremely difficult work while being separated from their partners and children. It is difficult to even make a phone call and reconnect when India is four and a half hours ahead of Ireland. If someone finishes work at 7 p.m. or 8 p.m., how will they make a phone call home to the kids?

There are two ways in which the Government can deal with this issue. There should not be a threshold but the threshold could also be reduced to €27,000 to allow for family reunification or the pay could be increased to over €30,000. In the public sector and the HSE the pay is nearly €32,000. That is the road that should be taken. What say the Minister of State on that?

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Notwithstanding the points the Deputies make, we can all agree that Indian professional healthcare workers are making a huge contribution to the Irish healthcare service and that without them, we would be in serious difficulty.

James Browne (Wexford, Fianna Fail)
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I thank the Deputies for raising this important matter. Ireland’s employment permits system is designed to accommodate the arrival of non-EEA nationals to fill skills and labour gaps for the benefit of our economy in the short to medium term. This objective must be balanced by the need to ensure there are no suitably qualified Irish or EEA nationals available to undertake the work and that the shortage is a genuine one. The system is managed through the operation of the critical skills and ineligible occupations lists, which determine employments that are either in high demand or are ineligible for an employment permit where it is evidenced that there is more than sufficient availability of those skills in the domestic and EEA labour market. In order to ensure the employment permits system is aligned with current labour market intelligence, these lists undergo regular evidence-based review guided by relevant research, a public and stakeholder consultation, the views of the economic migration interdepartmental group and relevant policy Departments, in this case the Department of Health.

Access to the general employment permit, GEP, for the role of healthcare assistant was announced in June 2021 to address skills and labour shortages in the healthcare and nursing home sector. Increases in the ageing population and consequent increases in demand for services mean a significant number of healthcare assistants is required to provide sufficient long-term residential care for older people into the future. The GEP is used by the State to attract third country nationals in occupations with remuneration thresholds of generally €30,000 and is subject to a labour market needs test, demonstrating that the employer was unable to fill the position from the Irish and EEA labour market.

This policy also fulfils our obligations under the community preference principles of membership of the EU. Holders of general employment permits are eligible to apply to the Minister for Justice for family reunification permissions after a period of one year. The conditions governing family reunification, including the remuneration levels required to apply, are a matter for the Department of Justice.

Joan Collins (Dublin South Central, Independents 4 Change)
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I was not expecting that answer. I thought there would be some sort of clarity about how the HSE will resolve the issues these workers are facing. The point that Deputy Barry made is quite correct. When these nurses finish at 8 o'clock in the evening, they cannot ring their children up because it is 1.30 a.m. in India, and when they finish an early morning shift at 8 o'clock, their children are in school. In many ways, they can only contact their children at the weekends. Yet, they must be earning €30,000 per annum to bring a spouse home, and if they want to bring a child home it is an extra €3,000 per child. That means that for those who have one child or two children, it could be €36,000. By virtue of the policy of the Government, the €27,000 minimum income requirement per annum excludes those workers from having any opportunity to bring their spouse or children over. They have been separated from them for nearly two years. The fact that they have to pay €1,700 for the QQI level 5 healthcare assistant qualification, when they are qualified nurses already, seems a bit mad. We want to keep these workers here. The are in a poverty trap and a family reunification trap.

Mick Barry (Cork North Central, Solidarity)
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The Indian nurses work here as healthcare assistants in private nursing homes for two years. At the end of the two years, they have to do the QQI level 5 qualification. That takes another eight months. These are nurses. They are qualified way above QQI level 5. They have already done that, and way more, so why force them to jump through that particular hoop? Then, to add insult to injury, the Government is asking them to pay for it out of their own pocket. They are already to the pin of their collar with the rents in this country, and then they are being asked them to pay, out of their own pocket, for a qualification that they already have the equivalent of and more. It can cost €1,700 for the QQI level 5 qualification.

The Government has two options here, in my opinion. The first is that it waives the demand, and I think that is the preferred option of the nurses. It should be waived. However, if the Government is not prepared to do that, the State should at least have the decency to fund those courses rather than force the nurses, who are giving blood, sweat and tears in providing a vital service, to dig into their own pockets.

James Browne (Wexford, Fianna Fail)
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The framework around access to employment permits for this role, as agreed with the Department of Health, includes the requirement for the employment to offer a remuneration level of €27,000 or more, and for the permit holder to achieve a relevant level 5 QQI qualification after two years' employment in the State. The level 5 qualification after two years' employment is the minimum required for this role. The requirement was put in place to ensure all workers in the healthcare assistant role will develop their skills in a range of qualifications, and ensure a similar standard of learning will be met and delivered in the care of vulnerable patients across care settings.

Mick Barry (Cork North Central, Solidarity)
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The Minister of State is reading a speech. He should reply to the points that have been put to him.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Please, Deputy Barry.

Joan Collins (Dublin South Central, Independents 4 Change)
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I think so as well.

James Browne (Wexford, Fianna Fail)
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This question is for the Department of Enterprise, Trade and Employment. I am answering on behalf of that Department.

Mick Barry (Cork North Central, Solidarity)
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You are not answering the questions that the Indian nurses are asking.

James Browne (Wexford, Fianna Fail)
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I am answering on behalf of the Department of Enterprise, Trade and Employment.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Deputy, if you do not let the Minister of State finish, it will be the end of the matter.

James Browne (Wexford, Fianna Fail)
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The framework for the HCA provision intended that education and training needs be provided by employers, with employees to be given access to funded educational programmes to gain the required level of qualifications as part of paid employment. Given the mix of public, private and voluntary providers in the nursing home sector, it is important to ensure that there is a common validated framework of minimum standards, clinical career pathways and qualifications for staff. The Covid-19 nursing homes expert panel review recommended at all healthcare assistants should have a relevant QQI level 5 qualification or be working towards achieving it. It should be noted that under the Government's Skills to Advance initiative, the level 5 qualifications in healthcare, including the level 5 healthcare support and level 5 health service skills qualifications, are available to employers and employees within the private nursing home sector to achieve the required standard under the new framework at no cost or a low cost.

Joan Collins (Dublin South Central, Independents 4 Change)
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I ask the Minister to arrange to meet these workers, find out what the issues are and try to resolve them.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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The Deputy can talk to the Minister offline. This is not the Minister of State's baby, as it were, at the end of the day. I ask the Deputy to approach the relevant Minister. If she needs assistance, my office will help.

Joan Collins (Dublin South Central, Independents 4 Change)
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Okay. Thank you, a Cheann Comhairle.