Paul Gavan (Sinn Fein)
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Last night at 5.20 p.m. I received a telephone call confirming that the Minister for Health, Deputy Donnelly, would not be taking this Commencement matter. I am not surprised by that, but I want to express my appreciation that the Minister of State has come into the House to deal with the matter this morning.

Last week, I listened to the Irish Nurses and Midwives Organisation, INMO, general secretary, Ms Phil Ní Sheaghdha, on "Morning Ireland". She was speaking after attending the Joint Committee on Health the previous day when she outlined significant nursing staff shortages across our health service. Among the stark facts she revealed at that committee meeting were that 120 cancer patients per day are not getting the treatment they need because four cancer treatment machines are not being used due to staff shortages. She also referred to one maternity hospital that was staffed for 5,000 births but was actually dealing with 8,000 births per year. She was at pains to point out that this does not constitute safe staffing.

On 31 December 2023, there were 2,000 outstanding nursing vacancies on the HSE system. In July of this year, those vacancies were wiped from the system, effectively cancelled. The HSE decided that all outstanding posts that had not being physically filled were cancelled. Ms Ní Sheaghdha also maintained that the staff moratorium has not been lifted in practice. Instead of a moratorium, the HSE has imposed ceilings and caps on recruitment that do not take account of the need for safe staffing or patient demand. Crucially, she also highlighted that directors of nursing have been stripped of their authority to actually make recruitment decisions. The INMO, at the health committee last week, called for a commitment to develop a multi-annual workforce plan and immediately grow the nursing and midwife workforce by a minimum of 2,000 whole-time equivalents annually for the next three years. In the short term, it called for the HSE to end the recruitment moratorium for safety critical nurses and midwives and fill all funded posts, including those not filled but vacant in December 2023.

I anticipate that the Minister of State is going to tell me about the number of additional nurses who have been hired, and that is fine. However, saying that we are increasing the workforce without outlining the actual staffing numbers that are needed does not solve the shortage. This is a shortage that is creating dangerous working conditions for both staff and patients on the ground.

I noticed a comment yesterday from the INMO representative in Cork. The assistant director of industrial relations for the southern region stated: "Despite their best efforts to ensure safe care, our members are facing overwhelming patient numbers in the Emergency Department, further compounded by a staffing shortage worsened by the HSE’s ongoing recruitment freeze." Mr. Kevin Figgis of SIPTU, which also represents large numbers of nursing staff, last week asked the following with regard to those 2,000 posts: "were the posts that went unfilled in 2023 fully funded? And, if they were, where was that money spent?" The Minister of State might be able to answer that question for me. Mr Figgis went on to say:

We believe the failure to fill these posts will continue to place severe pressure on healthcare workers to provide a safe service. The provision of timely and safe care is now an afterthought.

I come from Limerick. As the Minister of State knows, we have had an ongoing health crisis there for a number of years. One of the key aspects is again the shortage of staffing, which was confirmed to me by the INMO. We know the consequences of those shortages of staffing all too well in Limerick.Just last week a lady was told she was 165th in the queue to get bloods taken and that she would be waiting some considerable time. There is evidence of staff shortages, right there. The INMO has taken industrial action not for more money but because of the staff shortage crisis. Will the Minister of State give commitments on how the staff shortage crisis will be tackled by the Government? When will this moratorium be lifted in practice?

Anne Rabbitte (Galway East, Fianna Fail)
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I thank the Senator for raising this important matter. It is important for me to say I have been given my script by the Department of Health on behalf of the Minister, Deputy Donnelly, who apologises for not being able to be here.

The Government is hugely committed to supporting the nursing and midwifery workforce and has provided for an unprecedented level of investment throughout its term, which has enabled the delivery of a record expansion of the HSE workforce. Growth in the number of staff in our health service has never been so high, with recruitment in 2023 being the highest since the foundation of the HSE. As of August 2024, there were 27,901 more staff working in the HSE than there were at the beginning of 2020, an increase of 23%. This expansion includes 9,375 additional nurses and midwives. There is now a total of 47,584 nurses working in our public health service. The Nursing and Midwifery Board of Ireland, NMBI, reports that there are more nurses and midwives on the register than ever before, an increase of 4% on the previous year. In fact, OECD data show that Ireland has more practising nurses per 1,000 population than nearly all other countries in Europe, second only to Finland.

In terms of supply, we have increased the number of undergraduate nursing and midwifery places by 32% since 2019, with plans to increase places further to support workforce sustainability in line with our projections. While it is the case that there was a recruitment pause for a number of months, it was a necessary step in ensuring appropriate control measures were in place, due to recruitment that had exceeded what was budgeted for. Throughout the pause, derogations were in place that allowed for continued recruitment in the nursing workforce in key areas. The pause ended this summer after the Minister for Health reached an historic agreement with the Minister for public expenditure, which delivered an unprecedented €1.5 billion additional funding for the HSE in 2024, part of which allowed for the funding and regularisation of the previously unfunded roles recruited in excess of budget 2023, and those recruited during Covid, equating to 4,000 jobs. In addition, the Minister for Health secured funding for the recruitment of an additional 4,210 staff for the HSE in 2024, which includes another significant expansion of the nursing workforce.

The INMO claims there are nursing shortages. However, the Government has provided €56 million to implement the framework for safe nurse staffing and skill mix in our acute hospitals based on patient requirements. The framework details optimal nurse numbers that apply in medical and surgical wards, as well as emergency departments. More than 1,500 additional nurses have been hired to support the framework and an additional 500 hires are in train for 2024. Once these 500 staff members are in place, the estimated baseline numbers will be reached. While the Department fully accepts there are areas where more staff may be required, the mechanisms exist whereby this need can be met. The Government has consistently evidenced its commitment to supporting nurses and midwives. It has presided over the largest increase in workforce in the history of our health service and has invested record sums in its development.

Paul Gavan (Sinn Fein)
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I thank the Minister of State. I appreciate why she said it was a script she had been handed. I will repeat what she said a few moments ago. She said the INMO claims there are nursing shortages. Any Minister should accept there are nursing shortages and, further on in the statement, the Minister of State effectively did so. The INMO has been trying to make progress through the HSE. It has asked for a Workplace Relations Commission meeting. The HSE has been offered four dates and has refused all of them. The INMO is now taking industrial action because of the extent of the crisis. Quoting figures on the number of additional nurses is not addressing the issue. The issue is that safe staffing arrangements are not in place in our hospital network. The issue is that 2,000 nursing vacancies were wiped off the system by the Minister. It was not a recruitment pause, it was a moratorium. Patients' lives are at risk. The INMO is taking industrial action not for self-gain but to defend our hospital system. Frankly, the response handed to the Minister for State is entirely inadequate and unacceptable.

Anne Rabbitte (Galway East, Fianna Fail)
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Again, I thank the Senator. It is important to reiterate the Government's commitment to nursing and midwifery. Through the Government's record investment, our health service workforce has expanded exponentially since the beginning of 2020. There are 27,901 more staff in total, with the largest portion of this figure made up of nurses and midwives, amounting to 9,375. Despite this incredible increase, we continue to expand our nursing and midwifery workforce this year and next year, with an increase of 500 posts for this year to allow us to achieve the estimated baseline figures outlined by the safe staffing framework. The INMO has claimed the workforce ceiling is a recruitment pause by another name. This simply is not the case. As I have outlined, there is funding for a further 4,210 staff to be recruited this year. It is normal and correct that publicly funded organisations operate with appropriate control.