Annie Hoey (Labour) | Oireachtas source

I welcome the Minister to the House and thank him for coming in. Our motion is on the safety and welfare of workers in the public health service. It is coming out of a presentation that we had at the health committee.

There was a time when our health workers were thought of as smiling, happy people who were there to help us in our time of need. Now, we associate the public health service, unfortunately, with chronic understaffing, an overworked staff and a feeling, certainly based on what we heard at the health committee, of an unsafe environment for workers. With this shift in perception, there has also been an ongoing increase in assaults, be they verbal or physical, on workers in the public health service, which is why equal supports for all health workers must be made a reality.

The reality is that workers are regularly assaulted in the public health service and we must do better to ensure they are protected. There were 5,593 reported assaults against nursing and midwifery staff in the period between January 2021 and October 2022. I think we all know this is an under-reporting of assaults on staff in our public health service because these statistics only relate to what the HSE collates. They do not cover the section 38 organisations, which are the large voluntary hospitals, psychiatry or a lot of community services where we know incidents of assault also happen.

Ms Sylvia Chambers, who is a nurse in an emergency department in a large Dublin hospital, said:

I am qualified 18 years and I have never experienced aggression like we have in the past few years. On a daily basis there are numerous incidents where we are verbally attacked. I have been spat at, verbally abused and threatened that when I leave work that evening I will be stabbed as I get into my car. I have had grown men of 6 ft 4 in. towering over me or throwing objects at me. This happens on a daily basis. I do not feel safe going to work. My colleagues do not feel safe ... At night time, from 2 a.m. onwards, we only have two doctors. Sometimes we could have up to 60 or 70 patients waiting at that time with two doctors. It is not feasible for two doctors to see all those patients. Parents become very aggressive and tired. The nurse, who is normally the first person they see, receives the backlash ... Staff are leaving due to this because they are stressed. In the last 18 months we have had 30 nurses resign from our emergency department alone. We are on our knees when it comes to staffing levels.

I have a quote from a receptionist. We put out a survey to get some feedback from the workers in our public health service for ourselves. This is from a receptionist working at a hospital front desk. The receptionist has experienced verbal abuse, shouting, banging on the glass panes, screaming and slapping on the counter to intimidate her. She said:

Even though we are behind panes of glass and there is security there, I dread going into work. I get shouted at regularly and it is much more than just understandable frustration. It is abuse and it is awful.

I also have a statement from a health care assistant, who said:

I was left alone with no support staff in a residential unit. A patient cornered me, grabbed my arm [and] I had to block the door with my foot for my safety. There was no one else in the unit at the time so I had to wait as I was afraid he would grab me again. There was no one there to tend to the other patients while I was trapped in the room waiting for the patient to calm down ... My partner wants me to find another job as they are worried for my safety in there. They are also worried that I would be held accountable if something goes wrong but I am often left overnight on my own so any number of things could go wrong that are out of my control. It is a huge stress for us.

At the core of this is the understaffing and overcrowding of our hospitals and health services. Delays in admission from the emergency department are associated with increased mortality for patients. It is estimated that up to 400 people could die each year as a result of emergency department overcrowding. Studies have shown that emergency department overcrowding is associated with delays in receiving pain relief, medication errors and greater lengths of hospital stay. Sometimes patients even leave the emergency departments without having been seen because they simply cannot deal with the situation that they are in.

This morning, HIQA published a report on three hospitals in Cork, Kerry and Tallaght. It highlighted colossal overcrowding, significant staffing issues and huge risks to patient safety. My Labour Party colleague, Deputy Duncan Smith, stated:

The danger that the mismanagement of the health service poses to patients and workers alike is deeply shocking yet not at all surprising. We have seen the numbers of patients on [trolleys] increase tenfold over the past number of months and the recent harrowing testimony of workers speaks to the crisis in the health service.

Furthermore, the Irish Nurses and Midwives Organisation, INMO, stated:

Of the ten HIQA reports carried out in hospitals in the last eleven months, not one hospital has been found fully compliant when it comes to staffing.

We know that our hospitals are overcrowded and have long waiting times to be seen at emergency departments and the sensational narrative is about the difficulty for patients. The narrative that is less explored is the effect that this has on staff working in hospitals and healthcare services. Staff are overworked, exhausted and experience abuse on a regular basis and are then expected to carry on as normal. An emergency department nurse exasperatedly stated:

If I am verbally abused, you have to compose yourself and go on to the next person. I have to go on to the next child; I have to compose myself. Sometimes I am fighting back tears because the comments are so personal.

Some 94% of doctors reported having experienced some form of depression, anxiety, exhaustion or emotional stress, while 81% of doctors are at risk of burnout. Some 62.3% of doctors have had their working week extended beyond their normal contractual hours by 11 hours or more. A non-consultant hospital doctor noted:

Along with nursing staff we are sometimes the first people who come into contact with patients who are distressed and become verbally or physically violent. It is difficult to describe what it is like to experience something like that at 2 a.m. and then have to turn around and go ... see the next patient and other patients who are on a doctor's books that night ... It is not just physical and verbal abuse; it is very specific abuse. As I was saying, it can be gender-based or racial abuse. I have had colleagues experience racial abuse and then, exactly the same as me, turn around and treat the next patient or go back and treat the same patient.

It is also a terribly sad reality that healthcare workers and staff working in the health service often do not report incidents of assault or abuse, either because they are too busy or they do not see reporting the incident as doing anything or going anywhere. An emergency department nurse stated:

I could be verbally abused four or five times in a night, but I will not put in an incident report form because I am too busy. (I have 24 admitted patients that I have to provide care to, and I cannot to sit down at the desk and write incident reports, much as I would like to. I want all of that documented but I do not have the time because I have to prioritise patient care.)

Nurses have recently been refusing to fill in the incident reports as they feel it is a waste of their time. They complete a report and it goes into an abyss. A doctor working in a public hospital noted:

When I talk to some of my colleagues in the coffee room, people do not feel comfortable talking about it. When they say, “Something bad happened to me”, I will ask have they logged it ... and they will say, “No, I cannot do that.”

There are few data available on prosecutions against those who assault workers in the health service. We do not have figures from the Garda on prosecutions for assaults on workers in the public health service, but anecdotally we know the number of prosecutions is very low. There is the double-edged blade of having to care for someone, and then having to prosecute them following an assault, but this is the reality for many workers in social care. The National Ambulance Service stated today at the Joint Committee on Health that it has approximately 22 incidents of assault per month. Paramedics who provide first response healthcare at emergencies are regularly assaulted. I would like to read from the testimony that was sent to us from a worker in the National Ambulance Service:

I have been physically assaulted on numerous occasions. Once l hounded the Gardaí over 12 months to prosecute a patient who assaulted me, eventually it went to court and the defendant/patient got 3 months. He tried to physically assault his heavily pregnant girlfriend in the rear of an ambulance and l got in the way to help her. I regularly used to get abuse from drunk or intoxicated patients and-or their friends often in front of CCTV and-security and gardaí. I would make Garda statements and submit NIMS forms but nothing would come of it.

It is a shocking indictment of the care we show for workers in our healthcare system that some workers will receive better supports than others, based on their grade or profession. Following an assault, healthcare workers can avail of the serious physical assault scheme. Support staff are granted up to three months of special paid leave, whereas medical staff, health professional staff, and clerical and administrative staff can be granted up six months. Nurses can be granted up to six months and can avail of two further three-month extensions. This is an archaic system, which favours some staff over others, depending on their classification as officer or non-officer. It is an entirely unfair system, especially as some staff may be given different amounts of leave if they were both assaulted in the same incident. I know SIPTU and Fórsa have been vocal on this. They both presented on this before the Joint Committee on Health, and have also spoken before the committee previously. SIPTU has today called for support for this motion and said in its statement:

At the Joint Oireachtas Health Committee, we highlighted the fact that healthcare workers employed as support staff within the public health service only receive 25% of the benefits that their colleagues in other grades [get] in the event of an assault at work. At the hearing, SIPTU [representatives] highlighted that, after their nursing colleagues, support grade staff endure the second-highest level of assaults in the workplace, according to HSE data. We also raised the fact that, according to the HSE data, 41% of support staff assaulted at work are still unfit to return after three months by which time they have exhausted their entitlements under the HSE serious physical assault scheme.

What is this motion calling for? This motion is calling for a number of measures from the Government that will help to alleviate the pressure on workers in the public health service. We want the Government to ensure that the framework on safe nurse staffing and skill mix is appropriately funded, operationalised and expanded across health and social services. Inadequate nurse staffing has been regularly highlighted. Even today, HIQA’s reports into University Hospital Kerry and Tallaght University Hospital paint a bleak picture of the realities of unsafe nurse staffing. In the case of both hospitals, unsafe nurse staffing levels mean that the medical assessment units have had to close or operate at a reduced capacity. Funding and operationalising the safe nurse staffing and skills mix framework is a necessary first step we can take.

We also want the Government to publish and resource an urgent workforce retention plan for the Department of Health for all grades. As part of that plan, it should seek ring-fenced funding for continuous professional development for all grades and ensure the fund is equitably distributed. We have a major issue with staff retention in our public health service. The publication of a workforce retention plan will allow us to begin resolving staffing issues in our hospitals.

We want the Government to conduct a review of all relevant protocols to ensure procedures, staffing levels and training are appropriate to minimise the risk of injury from an assault to a healthcare worker, service user, patient or visitor to a healthcare facility. Reviewing procedures, staffing and training means that we can stop the conditions that allow these assaults to happen in the first place.

We want the Government to develop an education and public awareness campaign that highlights some of the examples of assaults on healthcare workers, and highlights the impact of these assaults on healthcare workers and their families. Unless they were watching the Joint Committee on Health recently, the public might not even be aware of abuse and assaults of workers in the health service and the real-life effects this has on the people working there.

Finally, but importantly, we want the Government to commit immediately to policies designed to support healthcare workers if they suffer an assault in the workplace. This support should be based on equality of access and identified need, and not on grade. It should not be defined by an outdated system of officer and non-officer. It is a shocking and archaic reality that some workers will get more time off than others following an assault, even if both workers were harmed in the same assault, because of their grade or type of profession.