John Crown (Independent)
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I thank the Minister of State who has certainly been serving above and beyond the call of duty in Seanad Éireann today.

The working conditions of nurses are a source of particular concern to me. I know that in a health services such as ours we are absolutely blessed by the presence of an extraordinary cohort of nurses. That they are so much in demand internationally is not a coincidence. We have extremely high standards in terms of education, professionalism and culture.

From the perspective of nurses, it looks as if they are under a sustained assault by the Government. I am sorry to have to say this, but these points have been made to me. Nurses have seen their salaries decrease by 15% or more; they have experienced the same increases in tax that others have, with the impact of the universal service charge, water and property charges. They have found that they have to work harder. One of the unappreciated side effects of the downturn in the economy has been that a number of specific policies which have been put in place have affected the working conditions of nurses who are still in a job. As there has been an embargo on nursing numbers, units that may have had a number of staff above what was officially sanctioned suddenly experienced the non replacement of staff who had left their jobs. In addition, there has been a rowing back in the use of agency nurses to fill the gaps, jobs that in truth were filled to try to circumvent issues related to the embargo. As a result, nurses are doing more of other nurses' work. The cutbacks in other professional categories in hospitals have meant that nurses are not getting the support of other allied professions and are doing other work that they should not have to do.

I have previously voiced grave concerns about the graduate nursing scheme. It is very difficult from where I sit to see this as anything other than an opportunity to get increasing numbers of nurses working at a lower pay grade. It must be acknowledged also that it is not Civil Service or HSE officials who have to face people when they are confronted with deficiencies in health services as delivered to them. It is usually nurses who have to bear the brunt. In the face of all of this why are they being asked to accept another increase in their registration fee to the Nursing and Midwifery Board of Ireland? This most recent increase means that in a two year period the fee has increased by 80% at a time when the general rate of inflation is approximately 1%. What extra service or what extra duties are being included in the job description of the Nursing and Midwifery Board of Ireland?

The representations I have received from nurses and their representatives suggest the two functions of the Nursing and Midwifery Board of Ireland are, first, to take their money and, second, to discipline them. Nurses are not seeing anything such as career advancement, the protection of the profession or the setting of appropriate standards. They are very troubled by this. They believe the board has not been a powerful advocate for their working conditions. For all of these reasons, they are wondering why they are being asked, uniquely among the health professions, to accept such an extraordinary increase in their registration fee compared to other allied professionals or those involved in medicine. I remind the Minister of State, as a long-standing supporter of trade unionism, that nurses are still a very highly represented group.

I am glad of this. If it had not been for the strength of the representative organisations conditions of employment would have been worse. It is important to realise that nursing organisations are very concerned about the latest increase and consider it a bridge too far. There has been a march towards increased austerity, deteriorating working conditions, less worker satisfaction and increased contribution demands. Nurses are now being asked not to pay the full newly-increased retention fees that are being demanded. They are suggesting the standing orders be amended to pay the old fee. If this happens a huge number of nurses would not be able to turn up for work the next day because they would not be legally registered and would not be indemnified for professional activities.

I ask the Minister of State to use her good offices to look at this matter critically and find out why this body needs such a large increase in such a short period at a time of low general inflation. What is being done with the money? I ask that the actions of others be followed and that there be a freeze on allied health registration fees for at least three years and until there is a change in the working conditions of some of the most hard-working, under-appreciated and unrewarded members of our health service.

Kathleen Lynch (Cork North Central, Labour)
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I concur with Senator Crown but doubt nurses are under-appreciated. As both the Senator and I know, they spend most time at people's bedsides in hospital, no matter what kind of traumatic event has occurred. Not only do nurses deal with the person in the bed but they usually deal with concerned relatives too so I do not think they are unappreciated. In different circumstances no Government would contemplate doing what we had to do - everyone had to take a share of the burden. Nurses are not unappreciated; they are hard-working and have had to do extra work due to the fact that the Government had to lower the number employed. The moratorium is being eased and we hope that in the near future we can convert some agency staff to the status of full-time staff, though many agency staff do not want full-time contracts, as the Senator knows. Some people prefer to remain as agency staff as that status can allow flexibility to deal with family obligations and the like. We hope to convert some graduate nurse contracts into full-time contracts as this is only right and proper. The measures we took were necessary due to the circumstances facing the country. I do not wish it to be thought that the Government does not appreciate nurses because it very much does.

I am responding to this matter on behalf of the Minister for Health, Deputy Leo Varadkar, and on conclusion of my formal reply I will convey to him the Senator's concerns on this issue. The Nursing and Midwifery Board of Ireland, NMBI, is a self-funding regulatory body with powers to charge such fees as determined by the board in accordance with the Nurses and Midwives Act 2011. As such it must generate its own income to meet its statutory requirements. The board is an independent body answerable to the Oireachtas. It has the responsibility to ensure that it has the financial capacity to undertake all its legal obligations. These costs include an enhanced regulatory process with supporting systems for continued professional development and certain education and training requirements for the professions.

The Department of Health is responsible for oversight of the governance of the Nursing and Midwifery Board of Ireland. The Department has no role in setting or approving registration fees. It was also made clear at the time of the legislation that the board would continue to be self-funding and needed to plan and cost how it would fulfil its legal obligations. Following detailed negotiations with the Executive and board members in 2013, it was agreed in October 2013 that an initial once-off sum of €1.6 million would be granted by the Department to the board to cover 2013-14 costs and that the board would have to increase its income in 2015 to undertake its commitments in the legislation.

On 17 September 2014 the Nursing and Midwifery Board of Ireland voted to increase to €150 the annual retention fee of each registrant nurse and midwife for 2015 from the retention fee level of €100 for each registrant in 2014. The annual retention fee in 2013 was €88 and this, as the Senator already pointed out, amounts to an 80% increase in two years. In a recent letter to all nurses and midwives the president of the board explained that the "decision to increase the fee was taken after a democratic vote and much debate" by the board. He stated that the increase was necessary "to ensure NMBI can continue to perform its regulatory functions effectively."

The Minister, Deputy Varadkar, is aware that a campaign not to pay the new fee is actively underway among the staff associations. His Department has written to the president of NMBI indicating concerns regarding the possible implications for the health service and patient safety should this action continue. It is therefore imperative that the board proactively engages with the staff associations at the earliest opportunity with a view to reaching a negotiated resolution to the current impasse. The necessity to avoid a scenario where non-payment of the fee will potentially become a serious matter for both publicly and privately-funded health services must be an urgent priority for the board.

The Minister has requested that the board give this matter very careful consideration at its meeting on 18 November, with a view to agreeing and implementing a course of action most likely to achieve a satisfactory outcome. It is understand that the staff associations have sought discussions with the board in this regard. We would ask the board and the staff associations to take appropriate steps to reach a satisfactory resolution to this situation in the interests of patient safety and continuity of care. Irish nurses are some of the best-educated and most sought after in the world and we also ask for such steps to ensure this reputation remains intact.

John Crown (Independent)
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I am grateful for the attention the Minister of State and the Minister will give this matter. I am reassured by the personal attention of the Minister of State and therefore wish to raise some specific questions. Nurses are troubled by the board's lack of transparency. I do not refer to vagueness or waffle in terms of transparency; there are specific concerns. How much is being spent on external consultants? What is the hourly rate? How much is being spent on public relations and legal fees? The professional competence assurance scheme is a statutory duty of the board that was set up by legislation three years ago but it still has not been implemented. This is becoming embarrassing.

Nurses believe the board does two things: it takes nurses' money and it disciplines them. Nurses need to see something in return for this money.