Dáil Éireann debate -
Tuesday, 12 Oct 1999

Vol. 509 No. 1

Private Members' Business. - Nurses Dispute: Motion.

Mr. Shatter

I move:

That Dáil Éireann:

–acknowledging the vital role played by nurses in our hospital and community health services;

–aware of the fundamental changes that have occurred in the nursing profession and the varied specialist skills developed by nurses;

–supporting the commitment given to implement the recommendations contained in the Report of the Commission on Nursing;

–knowing the continuing constant and rapid developments in nursing resulting from medical, technological and social changes which are increasing the demands and pressures to which nurses are subject;

–recognising that an overwhelming majority of nurses believe that their skills are undervalued and not properly acknowledged and rewarded;

–greatly concerned by the continued failure of the Minister for Health and Children to comprehensively and effectively address the waiting list crisis and substantially reduce the number of patients awaiting essential in-patient hospital treatment;

–committed to putting patients first and ensuring proper patient care and no further escalation in hospital waiting lists;

–deploring the confrontational and condescending stance taken by the Minister for Health and Children, condemns his vilification of nurses;

–recognises that there is a window of opportunity to engage in discussions to find a solution prior to a nurses strike occurring;

calls on the Government to immediately engage in full consultation and constructive dialogue with the nursing unions to resolve the present dispute and calls on both the Government and the nursing unions to agree a cooling off period following the conclusion of the strike ballot to attempt to find a solution to the current impasse before strike action is taken.

I wish to share my time with Deputies McCormack, Naughten, Connaughton, Enright, Kenny, Finucane, Farrelly and Crawford.

An Leas-Cheann Comhairle

Is that agreed? Agreed.

Mr. Shatter

For decades nurses have worked at the coalface of our health service. They have had to care for the young and elderly, the sick and those terminally ill. They have also had to comfort distressed and bereaved relations, provide essential care to those suffering psychiatric illnesses and provide supports and help for those suffering disability. Nurses must also cope with under-resourced facilities, personal stress, over-crowded wards and casualty departments, drug abusers, violent alcoholics and, on occasion, angry patients and relatives critical of delays that have occurred due to our hospitals being short-staffed or under-resourced.

Since the foundation of the State, nurses have been the least militant group in the public service in the fraught areas of industrial relations and pay negotiations. Their almost unanimous vote for strike action is a consequence of a gross failure of management skills at Government level. The strike now fixed to commence next Tuesday, if it takes place, will rock the foundations of our public health service and will have disastrous consequences for many patients originally scheduled for surgery in the coming weeks.

The inability of the Minister's representatives, the Health Service Employers Agency, to agree with the Nursing Alliance treatment protocols for the care of patients during the pending strike, should it take place, compounds the tragic difficulties with which those who require hospital care are confronted. The withdrawal of public health nurses from their community duties presents a serious threat to the health and well-being of many of our elderly within local communities whose health is dependent on their regular visits.

The effects of this damaging dispute are already being felt. Patients are being sent home from hospitals, hospital beds are being left vacant, scheduled operations are being cancelled, people with life threatening illnesses, such as cardiovascular disease and cancer, are being told that essential in-patient hospital procedures are either being postponed or cannot be scheduled. It should never have come to this, but it has because of the gross incompetence of the Minister for Health and Children and his failure to play a proactive role in the running of our health service.

The nursing dispute should be put in context, it cannot be understood in isolation. As at 30 June last, 34,000 patients were waiting for in-patient hospital treatment during the term of office of the Minister and at a time of unprecedented economic prosperity. The public in-patient hospital waiting lists grew from 29,000 to 36,500. In June 34,000 patients were affected, 5,000 more than at the date of the last general election.

The reduction in the waiting lists effected between December 1998 and June 1999 resulted in both health boards and hospitals across the country exceeding their Department-allocated service plan expenditure. As a consequence, theatres, wards and beds were closed during the period June to September 1999 resulting in a loss of 35,463 bed days. Operating theatres and beds, which could have been used to confront the waiting list crisis, were taken out of commission in a cost-cutting exercise at a time when the State's Exchequer surplus was double that originally predicted by the Minister for Finance in his Budget Statement last December. In the first eight months of this year a total of 53,982 bed days have been lost in our hospitals. The number lost in the June to September period amounts to 65 per cent of the overall total bed days lost to date in 1999.

In addition to existing theatres, in use for many years, temporarily closing, there is the scandal of newly constructed theatres and hospital units not being utilised. Limerick Regional Hospital has two main operating theatres out of a total of seven and one day theatre out of two in operation. In addition, two renal dialysis stations, which have been available for occupation since 1998, have still not been brought into use. In the same hospital two radiology rooms, which have been available since December 1998, also remain unused. As at the end of June, 1,570 patients were on the hospital's waiting lists.

University College Hospital Galway has two operating theatres out of a total of nine available for occupation since October 1998, one 26 bed ward available for occupation for use since March 1999, ten observation beds in accident and emergency available for use since June 1999 and two X-ray rooms out of a total of seven available since May 1999. None of these facilities has been brought into use. At the end of June 1999 the hospital had 2,867 patients on its waiting lists.

Tallaght Hospital has four theatres out of 12 uncommissioned since its opening in June 1998. Other units also remain either unused or under-utilised. At the end of June 1999 the hospital had an in-patient hospital waiting list of 1,658. If a private business invested substantial moneys in the construction of additional facilities and left them unused for such a long period of time, either the business would collapse in financial difficulties or the management would be sacked and replaced.

At a time of economic plenty not only are the hospital waiting lists escalating again, but the times people must wait for essential operations in a number of the national target specialities is also increasing. Some 75 per cent of adults who require cardiac surgery must wait between 12 months and two years for essential life saving operations; 79 per cent of children awaiting cardiac surgery must wait for in excess of six months, some for between one to two years; 65 per cent of those awaiting vascular surgery must wait between 12 months and two years; and 52 per cent of adults awaiting orthopaedic surgery must wait between 12 months and three years. Last June 470 adults who fall into this category were waiting total hip replacement operations and 340 were waiting for total knee replacement operations. More than 2,000 other adults were awaiting other orthopaedic procedures. Some 78 per cent of children awaiting orthopaedic procedures must also wait between six months and two years; 55 per cent of adults awaiting ENT – ear, nose and throat procedures – must wait between 12 months and two years and 68 per cent of children awaiting ENT procedures must wait between six months and three years. Last June this included 1,120 children awaiting tonsillectomies.

This is just a selection of the waiting times being experienced by adults and children waiting life-saving or pain-ending operations. Those people are leading diminished lifestyles as a consequence of the State's inability to provide them with the medical service to which they are entitled. These waiting times are the responsibility of the Minister for Health and Children who, in his third year of office, has abysmally failed to achieve waiting time objectives that should have by now been readily achieved. Public hospital objectives are that no child should wait more than six months for essential surgery and that no adult should wait more than 12 months. While endorsing these objectives, the Minister has proved so incapable of properly managing his Department there is no possibility they will be achieved during the lifetime of the Government.

This is the contribution of a Minister for Health and Children who has in recent weeks been talking confrontation rather than consultation with nurses. He and his colleagues have the audacity to accuse nurses of putting patients' lives at risk. By his gross incompetence, lack of commitment and lack of management skills, the Minister put the lives of hundreds of patients at risk as he has complacently presided over the continuing waiting list crisis. This from a Minister for Health and Children who should have, if he was properly managing his Department and on top of his brief, anticipated the concerns of nurses and the difficulties under the public spotlight in recent days, and should have many months ago engaged in dialogue and put in place structures which would have addressed the outstanding concerns of the nursing profession and ensured that what could potentially be a disastrous strike did not occur within a week.

Public discussion in recent days has focused on the nurses' rejection of the recent Labour Court recommendations. However, the difficulties within nursing and the problems being experienced within our hospitals did not start with the Labour Court recommendations last September. It does not require great insight to recognise that nurses generally believe the fundamental manner in which their profession has changed is still not fully recognised and that their skills are under-valued. The dramatic changes that have occurred in nursing are well documented in the report of the Commission on Nursing, as are the further substantial changes envisaged that will occur in the implementation of the 200 recommendations contained in the report.

Well before the recent vote on the Labour Court recommendations and the nurses strike ballot, the growing nursing shortages in major hospitals responsible for national specialities clearly illustrated this fact. The shortages are particularly acute within the Eastern Health Board region. The extent of the difficulties was well posted in surveys undertaken by the Health Service Employers Agency in the first part of this year. At the end of April last, the Mater Hospital had a shortfall of 67 nurses; Beaumont Hospital a shortfall of 60 nurses; St. James's Hospital a shortfall of 35 nurses and St. Vincent's Hospital a shortfall of 44 nurses. The April nursing shortages do not reveal the full story. Within the particular hospitals concerned, the shortages were not simply of nursing numbers but of nurses with specialist qualifications, trained to participate in complex and lifesaving surgery. The consequences of the nursing shortages are that hospitals with major national specialties have been unable to operate at their maximum potential and have fallen short of completing the numbers of crucial operations which they originally anticipated could be undertaken by them. For example, the Mater Hospital, due to nursing shortages last year, fell short of its target number of open heart surgery operations, performing 873 against a target of 1,000.

It is important to remember, as we focus on the statistics and the numbers, that for each statistic given, for each number given, there are patients who fear for their lives, there are patients in pain, patients in general hospitals for many weeks awaiting transfers to hospitals who specialise in targeted specialities. For every seriously ill person awaiting inpatient hospital treatment, there are family members – wives, children, mothers, fathers, grandchildren, aunts and uncles – who await anxiously the provision of essential medical care. For every patient on the hospital waiting lists there is also the knowledge that if they could afford private medical insurance, or if they were financially better off, instead of waiting months and years, surgical and medical treatment which they require could be undertaken within a matter of days. For them there is the knowledge that at a time of extraordinary economic prosperity, we have a Minister for Health and Children who is prepared to sit on the sidelines and institutionalise a two tier health service – one for the rich, one for the lesser well off.

Nursing shortages in our hospitals nationally, which totalled 566 last April, have grown worse since then. It is estimated that they currently exceed 800. During the April to October period there have been further beds and theatres closed as a consequence of nursing shortages. The Mater Hospital, Beaumont Hospital and St. Vincent's Hospital in Dublin are among the hospitals that have had to close beds and function with reduced theatre capacity. Nurses have been walking away from our public health care service, going to better paid and lesser pressurised employments. Pharmaceutical companies are offering well qualified nurses salaries they will never achieve within our public health care system. Hospital and medical services outside the State are also offering Irish nurses opportunities of which they could never avail in the State and the possibility of working in a less pressurised environment with greater ancillary support services.

Confronted by the nursing shortages last April, the Minister behaved in his usual manner – he did nothing. He simply watched the nursing crisis develop. Astonishingly, he did not even take steps to ensure that there would be available to him and to his Department current information on the extent of the nursing shortages, indicating whether the position was deteriorating or improving. When asked, by way of parliamentary question, by me on 29 September last upon the Dáil reconvening after the summer recess, to detail the nursing vacancies in each hospital and within each health board area and the specialities to which the vacancies related, the Minister's response was that the most recent survey of nursing vacancies related to the position at the end of April 1999. As a consequence of the parliamentary question, he replied that he would ask the Health Service Employers Agency to carry out a further study of the position as at the end of September. This Minister, confronted by growing nursing shortages for more than a year and knowing the shortages to be damaging the capacity of major hospitals to undertake crucial specialised surgical procedures, did not even have the wit to ensure the situation was being monitored.

Last week, the Minister for Health and Children, the Minister for Finance and the Taoiseach, by crass and insensitive comment, exacerbated, rather than ameliorated, the current difficulties. The time that elapsed between the date of the nurses rejecting the recent Labour Court recommendations and the results of the strike ballot, afforded a window of opportunity to the Government to enter into dialogue with the nursing unions to find a formula to resolve the present dispute. The Government chose instead to launch a public campaign to vilify nurses. In doing so, it not only further alienated nurses, but soured the atmosphere to a degree that it has to date tragically proved impossible to put in place a treatment protocol detailing the arrangements to apply in our hospitals should a strike take place. The behaviour of the Government to date guaranteed that nurses would overwhelmingly vote in favour of strike action. By acting like bully boys and lager louts, Government Ministers stung nurses into casting more votes in favour of strike action than were originally cast in rejection of the Labour Court recommendations.

It is essential a formula is now found to resolve the nursing dispute. If the strike proceeds, in so far as is possible, national treatment protocols should be agreed to ensure essential care to patients whose lives are at risk. However, even at this late stage, the nurses strike should not be regarded as inevitable. Time remains to pull back from the brink. Seven days remain during which constructive dialogue can be undertaken to agree a resolution of this dispute. It is the solemn duty and responsibility of the Minister for Health and Children to use these seven days wisely and constructively. Sadly, to date, the Minister has failed to behave either wisely or constructively and has essentially abdicated his public duty. A strike is only inevitable if the Minister continues to do nothing and he and his colleagues in Government continue to target and vilify nurses. It is extraordinary that the Minister for Finance has to date shown more compassion and consideration for alleged Ansbacher tax evaders and non-residential deposit account tax fraudsters than he has for our nurses. The more conciliatory tone of the Taoiseach which was partially evident this afternoon was in marked contrast to that of the Ministers for Health and Children and Finance. The communication breakdown between the Government and nurses must be remedied.

Fine Gael calls on the Government to immediately enter into constructive dialogue with the nursing unions. If such dialogue commences, Fine Gael asks that a cooling-off period be agreed to facilitate a resolution of this most damaging dispute before strike action is implemented. Fine Gael asks all Members of this House, including all opposition parties and all Independent Deputies, to support its motion in the vote tomorrow night to force the Government to finally enter into a constructive dialogue which may at the eleventh hour allow us to avoid this very damaging strike occurring.

Mr. McCormack

The Minister for Health and Children, the Taoiseach and the Government stand indicted for not doing anything to avert the nurses strike. On the contrary, the negative statements from the Minister, the Taoiseach and the Government have aggravated the situation. It appears that the Minister for Health and Children deliberately went out of his way to ensure that the nurses would ballot for strike action. Is the Minister aware that he has a statutory obligation to ensure proper cover in hospitals? At the moment there is not adequate cover in hospitals, even before the strike takes place. There are 37,000 people currently on waiting lists even though wards are closed. The Minister has allowed no leeway for discussion but has simply closed the door on any talks with the nurses. This dispute must be settled by dialogue, therefore the Minister should enter into dialogue straight away.

At University Hospital Galway, the casualty department has been overcrowded, night casualty has been overcrowded on a regular basis over the past two weeks, yet two new wards which have been completed since May have not been opened. One-third of the nurses at this hospital are temporary and the hospital management are not replacing nurses on sick leave and are letting temporary nurses go in order to break their service. This dispute has now reached a serious point and I challenge the Minister of State who is present and who represents the constituency, what he intends to do about this issue.

Nurses will not be paid during the strike. They will provide emergency cover without pay. In the Western Health Board area there are about 1,000 nurses in acute hospitals, 250 in district and in community work and about 700 psychiatric nurses. If the duration of the strike is for one month, up to £2 million will be saved in nurses' wages alone in the Western Health Board area. This seems to suit the Minister who this time last year refused to give the Western Health Board £1 million to continue its services for the last two months of the year. The same situation would have prevailed again this year, and the Minister may now be using the nurses' strike to balance the health board budget at the end of the year at the expense of patients.

How can the Minister and the Minister of State, elected for the constituency of Galway West, preside over a health service which is allowing two wards to remain closed at our major hospital, temporary nurses to be laid off, waiting lists to build up, casualty to be overcrowded on a regular basis, and which is putting the health of patients and those on waiting lists at risk? In the Western Health Board area non-emergency surgery beds and day patient beds are not being refilled. The waiting lists in the Western Health Board area show that for ear, nose and throat surgery there are 585 adults and 167 children on the waiting lists, with 55 per cent of the adults waiting more than 12 months and 67 per cent of the children waiting more than six months. For ophthalmology services, there are 917 people on the waiting list, 78 per cent of whom have been waiting for more than 12 months. There are 292 on the waiting list for orthopaedic surgery with more than half of them waiting for more than 12 months.

The nurses' strike is not about wages. There are 201 recommendations in the report of the commission, most of which have not been addressed by the Minister. The key points sought by the nurses in the dispute are, further recognition of staff nurses with broader application and recognition of promotional grades. If the strike proceeds – and I hope the Minister will see his way to opening meaningful talks – the Minister cannot blame the strike for lack of cover in hospitals as there is no cover in them even now in advance of the strike. Services have been allowed to run down.

An Leas-Cheann Comhairle

The Deputy has spoken for three minutes.

Mr. McCormack

Okay, I will conclude. On a recent visit to Galway the Taoiseach closed the door on nurses, giving the same "No surrender" message. I call on the Minister for Health and Children and the Minister of State to open immediate talks and finally settle the dispute.

Mr. Naughten

This day week a crisis will hit our health services unless the Minister uses these last few remaining days to re-open talks with the nursing unions. A strike by nurses will lengthen our ever increasing public waiting list by 18 months, thereby intensifying the anguish being experienced by individuals awaiting elective surgery. Tonight, and every day, we hear of the increasing numbers on our public waiting lists. However, I want to humanise some of these statistics. Seán is suffering from prostrate cancer. He is awaiting an out-patient appointment so that he can be called for an operation. Sarah has been waiting for the last four years for orthodontic treatment. When she was eventually told she would be taken for treatment she was informed that she would have to wait until this dispute was settled. Michael has a heart condition. He has been told that if he does not have this operation there is a 95 per cent chance that he will be dead within five years. These are the victims of the dispute.

The nurses have voted overwhelmingly for strike action because they feel they have no other option. The dispute has arisen due to the neglect by numerous Governments of the basic entitlements which many other groups in the public service have as a right. We must recognise that nurses believe they are undervalued, their skills and experience not acknowledged or rewarded. The nursing profession plays a vital role in the community and in our hospitals. We have now reached the ludicrous situation where the health authorities have to advertise nursing posts as far away as Iceland and Finland. Matrons are unable to find nursing staff, with the situation now reaching crisis in many of our hospitals. Unless the profession is made more attractive, Irish nurses working abroad will not return home. Our health services urgently require these people.

What will happen the elderly man with leg ulcers, with nobody to clean or bandage his wound? He will have to queue for hours to see his GP, or more likely will have to go on a further waiting list, and wait for a number of days to see his GP. Without this treatment the man could be another statistic on our hospital waiting lists. What will happen to the woman taking care of her incontinent mother? Where will she get the nappies and other materials required to keep her mother in a comfortable state for her remaining days? The Minister has talked himself into this current situation. There still remains a window of opportunity and I urge the Minister to use it.

Mr. Connaughton

First of all I take the opportunity in the few minutes at my disposal to beg the Minister to intervene in the dispute, because I genuinely believe the forthcoming nurses' strike is a monument to bad planning by him and his Department. Everybody fully realises that the job of a nurse in 1999 is entirely different from what it was in 1979. The demands of the job are also entirely different. It requires much more training, seeks much more responsibility and demands even greater commitment. There was always great commitment in the nursing profession, but that commitment constitutes an even greater calling at present. The new developments in medicine, patient care, drugs and in the interpersonal skills nurses must have in dealing with people who are ill have meant there is an increasing strain on nurses and when they look around at others in comparable employments who seem to be getting on better, is it any wonder they said they had to blow the whistle?

When the Commission on Nursing examined the entire situation it should have been clear to the Minister and the Government that structural adjustments should have been made and procedures put in place at that time. Had the Minister acted on these issues at that time we would not be here tonight under the pressurised system we have. I know it is particularly difficult to provoke the nursing profession into picketing. As Members are aware, this is their first official strike. The many nurses I know would much prefer to do what they are good at and like best, namely, caring for the aged, the sick and the distressed in our community. Although we are only seven days from action, there is still time for the Minister and the Government to act. It is possible to reach a solution if a bit of compassion and goodwill is shown.

This impasse between the nurses and the Minister has as much to do with the structural adjustments I spoke about in the nursing profession as it has with pay. If the Minister had shown the sort of compassion and understanding I speak off, and as would be expected from a Minister for Health and Children, we would certainly not find ourselves in this position.

It must appear unusual to the Minister that during his term of office, with the passing of every month and year, there are fewer nurses available for the various nursing duties around the country. It is very difficult to understand but, it is true. There must be some reason for it and the Minister is the only person in the House who can provide the answer.

Mr. Enright

Hospital patients for the first time ever are faced with a nurses' strike. I call on the Minister, the Government and the Health Services Employment Agency to re-open talks with the nursing unions. There is still some time left. I am unhappy with the hard-line attitude of the Taoiseach, the Minister for Health and Children and the Government since this problem initially arose. The comments of some members of the Government, including the Minister for Finance's claim that the nurses are "claim jumpers", have caused considerable anger in the nursing professions. Comments of that nature only add to the sense of grievance felt by nurses, increase the likelihood of a strike and it certainly led to the increased numbers who finally voted for strike action.

Currently there are 33,400 people on hospital waiting lists. With all elective operations now being postponed, a very difficult situation will be made much worse. It is essential that the Minister for Health and Children, the Health Services Employers Agency and the nursing unions enter discussions before the strike commences, because certainly on the commencement of the strike discussions will have to take place. It is essential discussions take place now, not later when considerable damage and upset to patients has been caused. There has never been a national nurses strike. The nursing profession does not want one. It is essential therefore that every effort is made to avoid this strike. I call on the Government, from whom good will is required, and the Health Service Employers Agency to enter into discussions immediately. Five hundred and sixty-six nursing vacancies remained unfilled. Nurses are leaving the profession. It is obvious therefore that there is a problem and the Minister and the Department should address it rather than adopt a hard line attitude.

Mr. Kenny

To use the words of another, this truly presents an appalling vista. The Government should make one last ditch effort to deal with the matter. The Government, of which I was proud to be a member, when confronted by the possibility of a nurses strike paid out £85 million on the recommendation of the Labour Court and following the involvement of others, but more importantly established the Commission on Nursing to analyse and consider the structural deficiencies in the nursing profession and to make recommendations on how these could be rectified. The Government has said that it will pay the full amount recommended by the Labour Court, but the key to settlement of this dispute lies in dealing with the structural deficiencies in the nursing profession, including the recognition of expertise and incremental payments in respect of courses followed at one's own cost.

This House is expected to tear itself asunder on this issue with Members on this side sinking their claws in Members opposite, but this party, through Deputy Shatter's motion, has been very responsible in understanding the sensitivity and seriousness of the matter. If the strike lasts six or ten weeks the House will look back when it is finally settled and ask the question, what was it all about. There is great anger among the nursing and medical profession at the attitude of the Minister for Health and Children, the Minister for Finance and the Taoiseach, and there is anger in the community at the fact that there is agreement that a strike should take place. There is also fear among patients.

Yesterday I was contacted by a woman who had a mastectomy a fortnight ago and is due to start a chemotherapy course this week. I was also contacted by two people with brain tumours who wish to be admitted to Beaumont Hospital but whose admittance has been deferred until after Christmas. People will die if the strike goes ahead and the first case that can be attributed to it will have the most serious consequences for everybody.

This weekend the Minister, who has been around a long time, should call all the parties together and deal with the structural deficiencies in the nursing profession on which the nursing commission has made recommendations. Therein lies the solution to the problem.

Mr. Finucane

Is the Government adopting a macho image on this issue? If anything, the intemperate statements made last Friday acted as a further flashpoint for nurses. The statement made by the Minister for Finance, Deputy McCreevy, in Luxembourg in which he described nurses as claims jumpers could only be described as provocative in dealing with such a sensitive issue on which delicate negotiations are required. The Taoiseach later said in Limerick that he agreed 100 per cent with him. Perhaps the Government is adopting a macho image to show its authority in this matter rather than enter serious negotiations.

There are 13,000 admissions each week to our hospitals, including 6,000 emergency cases to our acute hospitals. Already there have been 3,000 cancellations. There is anger and concern in the community and my colleagues have stated what is likely to happen if the strike goes ahead. We are not talking about a militant group of people. The 27,000 nurses are only looking for what they believe they rightfully deserve. It is important that the 200 recommendations of the nursing commission are implemented.

I would have been delighted if the Taoiseach had announced in Limerick last Friday that the good work done by Deputy Noonan with regard to the development of the regional hospital was being continued by opening the 30 bed paediatric ward, the two operating theatres and the radiology and renal dialysis rooms with their specialist equipment, all of which have remained unused for the past year, in a serious effort to reduce the backlog of 1,600 on the waiting list in Limerick for operations. The Minister has been negligent in his duties. I am certain that he would not allow similar units and hospital wards in his constituency to remain unused for over one year.

Mr. Belton

The position is worse in Mullingar.

Mr. Finucane

The Government should not adopt such a macho or confrontational approach, rather the Minister should talk to the nurses.

Mr. Crawford

I thank Deputy Shatter for placing this important issue on the clár. He has highlighted the record of the Minister on waiting lists and the serious problems that have been encountered as a result. The Minister sat on the problem, in the process putting lives at risk and causing much pain, before there was any suggestion of a nurses strike. Over 90 per cent of nurses have voted to go on strike. They did not take this decision lightly. Wards in hospitals such as the Mater remain closed and services unavailable because nurses are not voting with their feet and returning home in spite of the advertisements and the pressure exerted on them to do so. Their skills and length of service are neither acknowledged nor recognised.

In the North-Eastern Health Board there are 1,076 more on the waiting list than in June 1997. That is how serious the situation is. One patient was guaranteed in September 1998 that he would have a hip replacement operation in Our Lady's Hospital, Navan, before the end of that year. If the Minister allows the strike to go ahead the individual concerned will not be seen before the end of this year. He was to have the operation on 24 October but has now been informed to ring back after the nurses dispute has been settled. If the Minister was to visit that man's home he would recognise that the opportunity is his to sort the matter out and save him pain.

In the two years from June 1997 to June 1999 the number on the waiting list in Monaghan General Hospital has increased by 60.8 per cent; Cavan, 78 per cent; Our Lourdes Hospital, Drogheda, 94.7 per cent; and Our Lady's Hospital, Navan, 41.6 per cent. I am quite sure that, because of the problems that have arisen in the past few months, it will be shown even more clearly that the figures will have increased even further before they are resolved.

District nurses, like all other nurses, are very angry at the Minister's lack of understanding of their needs. They feel there is a serious lack of support for a job that is saving the country an enormous amount of money by making sure that as many people as possible are looked after in their own homes. I have had some personal experience of that recently.

Some nurses do not even have sufficient bandages with them when they go out to work, and must travel at their own expense to rectify such shortages. As regards the number of nurses available, one must question the entry procedure for the nursing profession. While some trainee nurses have been called for duty in recent times, many young people who passed the nursing examinations and interviews for entry to the profession were subsequently told there were no places for them. The Minister should examine the possibility of recruiting extra nurses.

The Minister's visit to Monaghan was much appreciated by myself and others, including the Leas-Cheann Comhairle. A minimum of £5 million was required, yet the Minister gave only £500,000. I appreciate that he has provided a further £500,000 since then, but the balance is still needed and the Minister has sufficient funds to provide it. The dispute will be settled, and the Minister should settle it now.

Minister for Health and Children (Mr. Cowen)

I move amendment No. 1:

To delete all words after "That" and substitute the following:

Dáil Éireann:

–acknowledging that the Government has accepted Labour Court recommendation No. 16261 of 31 August 1999 on nurses' pay and allowance claims;

–noting that the Labour Court itself has stated that recommendation No. 16261 is ‘the culmination of many years of discussions and negotiations on nurses' pay and conditions';

–recognising that the Government is committed to implementing the recommendations of the report of the Commission on Nursing, which are designed to address the underlying problems within the profession and develop nursing as a key profession within the health services;

calls on the four nursing unions to call off the threatened all-out nurses strike and to pursue their case in the context of forthcoming discussions between the Government and the social partners on a new national programme to succeed Partnership 2000.

I welcome this opportunity to set out in clear and unambiguous terms the position of the Government on nurses' pay and, in particular, to reiterate our determination to protect social partnership.

Social partnership has delivered major benefits. For this country, it has been a winning formula, and there is no reason to believe that it cannot continue to do so. It has provided the framework within which economic and social goals can be agreed and achieved. The benefits we now enjoy through high levels of employment, low inflation and reduced taxation did not happen by accident. By co-joining the partners in setting overall goals for ourselves, we have empowered people to have a greater say in shaping their own destiny and a greater interest in maintaining the conditions which will make it possible to achieve these goals. Because it is a winner in so many ways, the Government is acting in accordance with the wishes of the vast majority of the people in seeking to protect social partnership and to deal with challenges which may be posed to its continuation and development.

The success which social partnership has enabled us to achieve is not confined to the economic sector. In the social area, including health and social services, significantly increased resources have been targeted at areas of need, most of them the subject of prior agreement among the social partners. While there are still and always will be some unmet needs, very considerable progress has been made by successive Governments in addressing the needs of the eld erly and disabled, the handicapped, children and other groups in need of special care and support.

The overall numbers employed in our health services are now at an all time high, including the number of nurses employed. Social partnership and its fruits have given us the confidence to embark on long-term strategies to tackle the main causes of sickness and death: cancer and cardiovascular disease. There is scarcely an area of the services that is not enjoying a period of development.

Social partnership has also helped develop the attitudes and structures through which we can plan and implement real change. We have seen that it is possible to bring about planned changes in our society. The nursing profession has, particularly over the past five years, embarked on an agenda for change. The conditions and structures which have evolved out of social partnership have helped the profession to make considerable progress in advancing that agenda and laying the foundations for the further development of nursing. The range and scope of the recommendations of the Commission on Nursing could scarcely be contemplated in the days prior to social partnership and it is a certainty that no Government could, at that time, have so readily agreed to fully fund their implementation.

Outside social partnership, it is difficult to envisage how we could find a formula through which we can, in a controlled way, break out of an iron circle of pay relativities in the public sector and agree a basis on which reward is more closely linked to contribution and performance. Within the social partnership framework, we have found better ways of planning for the future, sharing the fruits of success and settling disputes. Our structures have been designed to settle disputes without causing hardship or inconvenience to the wider community. Most people, including Members of this House, would agree that invoking the strike weapon within a social partnership context represents an attack on an edifice which has been painstakingly constructed by people from all sectors of society. It is within that edifice, rather than outside it, that each group can best advance its agenda, provided that others accept the justification for their advancement. It is against this background, therefore, that the Government must stand firm in this dispute, which is not of its making.

The history of nurses' pay talks is a long one, punctuated by a series of offers followed by rejection. In order to provide a context for the situation now confronting us, it is necessary to go back to 1994. Discussions with the Nursing Alliance under the PCW restructuring clause commenced in late 1994, when management offered nurses a down payment of 1 per cent, effective from 1 April of that year, the same as had been offered to other public sector groups. This was accepted by the nursing unions who then broke off talks to consider progress. Talks resumed in February 1996, during which management tabled a conditional offer of £20 million. This offer was rejected following a ballot by nurses. In March 1996, following intervention by the Irish Congress of Trade Unions, talks took place at the Labour Relations Commission, which resulted in agreement on a set of proposals costing £33.5 million. This enhanced offer was rejected by the Nursing Alliance following a ballot.

Direct discussions between management and the nursing unions were resumed in June 1996. The nurses' pay issue was subsequently referred to an independent arbitration board established by the Government and the Congress of Trade Unions to hear outstanding pay disputes. This adjudication board recommended a package worth some £50 million to nurses. This package was accepted by SIPTU and the PNA, but rejected by the INO and IMPACT. Strike notice was then served to expire on 10 February 1997. The Labour Court then intervened and on 7 February 1997 issued a recommendation containing a package costing £85 million. This was accepted by nurses on the basis that a commission on nursing would be established to examine and report on the role of nurses in the health services.

The Labour Court finding of February 1997 provided for special pay increases of up to 17 per cent for the grades of staff nurse and ward sister, with similar level increases for other grades. These increases were substantially in excess of the 5.5 per cent cap on restructuring deals under the PCW agreed by the then rainbow coalition Government and the Irish Congress of Trade Unions. The Labour Court justified the award of such large pay increases to nurses on the basis that their pay scales, to quote directly from the court's recommendation: "have fallen significantly behind other groups". This statement clearly demonstrates that the Labour Court regarded nurses as a special case deserving a special pay award.

I would like to highlight one particular aspect of the court's finding relating to long-service increments at that time. The adjudication board had recommended a salary scale for staff nurses with two long-service increments. The Labour Court subsumed those two increments into a new ten-point salary scale for staff nurses and added a new long-service increment to the new scale. I am left wondering to what extent staff nurses were made aware that long-service increments had been conceded to them at that stage.

The Commission on Nursing was established in March 1997. Its membership included representatives of the four nursing unions. Seven of the 14 ordinary members of the commission were drawn from the nursing profession. The commission's final report, entitled A Blueprint for the Future, was formally presented to me in September 1998. At the launch of the report, I announced, on behalf of the Government, that it had accepted the broad thrust of the report and that it was committed to implementing its recommendations. That remains our position.

The Commission on Nursing made some 200 recommendations for tackling the underlying problems within the profession and developing nursing as a key profession within the health services. While only three of its recommendations related to pay, these have overshadowed everything else since the report was published.

There has been a good deal of misrepresentation about what the commission recommended on the three pay-related issues. In order to set the record straight as to what it recommended, I want to quote verbatim from the relevant sections of the report. Paragraph 6.64 of the report states: "The Commission recommends that the question of additional recognition of long service for staff nurses be examined through the established structures." Paragraph 6.66 states: "The Commission recommends that outstanding claims for allowances should be referred to the Labour Court for argument and determination as a matter of urgency." Paragraph 7.50 states:

The Commission recommends that differentials and incremental annual leave in promotional grades be examined as a matter of urgency, before the end of December 1998, through the established structures. To this examination should be added the effect of the enhanced role for ward sisters and higher grades which has been recommended by the Commission earlier in this chapter.

The fundamental fact that needs to be emphasised here is that the Commission on Nursing did not recommend that staff nurses should be given additional long service increments.

Following the publication of the Commission on Nursing report, there were three residual pay-related issues to be addressed. These were referred to the Labour Court for determination. On 9 February 1999, the Labour Court issued two recommendations covering all three pay issues. The court awarded significant improvements in existing allowances for nurses working in specialised areas and who hold special qualifications – allowances were to be increased from £333 to £1,000 where nurses work in a specialist area, and to £1,500 where they have a specialist qualification. Thousands of staff nurses and a significant number of ward sisters stand to benefit from this increase. This finding was accepted by the Government on 10 February 1999.

Part of the claim lodged with the Labour Court by the Nursing Alliance was for three additional long service increments – each of 6 per cent – for staff nurses. This claim was rejected by the Labour Court on the grounds that, to quote directly from the court's recommendation, "The pay scales for staff nurses were addressed in Labour Court Recommendation No. 15450." That was the February 1997 award, which gave staff nurses a special increase of up to 17 per cent.

In relation to the third pay-related issue, that of differentials, the Labour Court, while accepting that there were grounds for salary increases in promotion grades, believed that these must be based on negotiation and implementation of the Commission on Nursing report, which had not yet been discussed by the parties. Accordingly, the court established a negotiating process to address the implementation of the commission's report. While some progress was made in direct discussions between the management and union sides, there was no agreement on pay and the matter was referred back to the court.

The Labour Court issued its final determination on the nurses' pay issue on 31 August last. The court's package included an average increase of about 10 per cent for ward sisters and higher grades; a lump sum payment of £1,250 for every nurse employed in the public health services, conditional on acceptance of the Labour Court recommendation; additional annual leave for all nurses linked to service, up to three days for staff nurses and up to four days for ward sisters and higher grades; a personal allowance payable on a red circle basis to serving nurses in certain grades to compensate for the apparent loss of existing differentials under the proposed pay structures; and an interim award of 4 per cent to nurse tutors pending the report of the Nursing Education Forum.

In its summary, the Labour Court states that its recommendation "is the culmination of many years of discussions and negotiations on nurses' pay and conditions." The court goes on to say that it "believes that the package now proposed, in addition to the concessions already received on pay, conditions and allowances, represents significant improvements in the financial package for nurses." It also points out that the "issue of nurses' pay and conditions has taken up more of the court's time in recent years than any other issue." It is vital to highlight these salient comments made by the Labour Court in order to counteract the suggestions made in some quarters that the court did not understand fully the issues involved and that its finding was less than favourable to nurses.

The fact is that the value of the final package produced by the court is more than three times what the HSEA tabled in direct discussions with the Nursing Alliance. Moreover, the Labour Court did not exclude staff nurses from its final determination, notwithstanding its earlier ruling that their pay scales had been addressed in February 1997. The lump sum payment and the additional annual leave, taken in conjunction with the significant increase in allowances awarded by the court earlier this year, ensures that staff nurses stand to gain as well as other nursing grades.

Within 24 hours of the Labour Court issuing its finding, I brought the finding before the Government which accepted it on the basis that it brought to an end a protracted negotiating process on nurses' pay going back to 1994. Within days, three of the four nursing unions had decided to recommend rejection of the finding to their members. Having insisted on the three residual pay-related issues going before the Labour Court and having had those issues fully considered by the court, it seems the union leadership then had a change of heart. Not only were they recommending rejection of the Labour Court finding, but the Irish Nurses Organsiation then started looking for parity with paramedic grades in the health services, while the Psychiatric Nurses Association have been talking about parity with teachers. Neither of these aspirations, however, formed the basis of their claim before the Labour Court. At the February 1997 Labour Court hearings, the Nursing Alliance sought to link the pay of staff nurses with that of the Grade Vs in the health services, which is a supervisory-administrative function. Moving the goal posts like this is a totally unacceptable way of conducting industrial relations business. They want to negotiate, in effect, another new claim, having rejected the arbitration finding in respect of the claim they argued for four years on a totally different basis.

I have been portrayed as having being opposed to negotiations. The issue of nurses' pay has been four years in the negotiating process. I have spent more time on industrial relations issues relating to nursing since I became Minister than on any other industrial relations matter.

The Government's approach to the nurses' pay issue and the threat of an all-out strike is correct and responsible. It is consistent with the position taken by the rainbow coalition Government in 1996. It is a pity, however, that some of the Opposition Deputies seem to be suffering from selective amnesia. Deputy Noonan, in replying to an Adjournment Debate on nurses' pay in this House on 26 November 1996 when he was Minister for Health, made the following statement:

I would obviously be deeply concerned at the impact of strike action on the health service and on patients in its care. It is also clear that an industrial action of the type now apparently being contemplated by the NIO could have serious ramifications for the prospects of any new pay agreement based on social partnership. For these reasons, I would again appeal to the leadership of the Irish Nurses Organisation, and the other nursing unions, with the assistance of ICTU, to reconsider their strategy and to adopt an approach in keeping with the partnership model of industrial relations.

Mr. McCormack

He solved the problem anyway.

Mr. Cowen

My position now is entirely consistent with that articulated by Deputy Noonan then. There was no rejection of a Labour Court recommendation in 1997, but there is now.

Mr. Connaughton

It was solved.

Mr. Cowen

Deputy Shatter, however, is now calling on me to do something which his own party colleague would not and could not contemplate when he was in office. Deputy Quinn has gone even further; he has completely reversed his position from the time he was Minister for Finance and subsequently. In November 1996, he warned the country's nurses that they were making a gross error of judgment if they thought the Government could offer them more than the £50 million pay package that they had just rejected.

Deputy Quinn's own views on the management of public service pay were published in a report of an interview with him which appeared in the 5 February 1998 edition of Industrial Relations News. He is quoted as saying that as Minister for Finance “he looked at the economy both as the ringmaster and the paymaster” and that it took him “about 15 months to realise that there was no one managing the public sector side of the equation.” I want to inform Deputy Quinn that we did not take 15 months to figures that one out. My position as Minister for Health and Children—

Mr. Connaughton

It is hard to know what we were at.

Mr. H. Byrne

The Deputies opposite have not got a leg to stand on.

Mr. Belton

The Deputy knows where he will be standing shortly.

Mr. Cowen

—is to manage my side of the public service and, as a member of the Government, to be fully involved in managing the entire public service.

Deputy Quinn also talked of the management negotiating teams not being sure of the political mandate they had. He also spoke of weak management enfeebled because when they did take a stand, they did not get the back up. I assure Deputy Quinn that the teams that negotiate on my behalf know exactly what political mandate they have. In dealing with this dispute, health service managers are very much aware of their responsibilities and have not been afraid to hold a position in the interests of the public at large in areas like the provision of emergency nursing cover to ensure that patients' lives are not put at risk.

Mr. McCormack

Why is the number on the hospital waiting lists increasing?

Mr. Cowen

The record shows that when Deputy Quinn was Minister for Finance, he was not anxious to move beyond the £50 million package that was on offer to nurses in late 1996 and early 1997.

In a radio interview on 12 November 1996, Deputy Quinn said:

As far as the Government as management are concerned, we have exhausted all of the room for manoeuvre that existed for us as one of the signatories to the PCW and I would not like any impression to be given that one extra push or shove might result in additional monies being put on the table. That would be an error of judgment if people were to think that such an additional movement or push would bring about extra money.

When the £85 million package was finally agreed in February 1997, Deputy Quinn levied public services to pay for the nurses' pay increase.

I ask the House to compare his stance then with his recent statements which called on the Government to give nurses what they are looking for and worry about relativities later. This opportunistic and simplistic approach to an issue which has far wider implications than Deputy Quinn now appears to admit is in marked contrast to the more measured response of his party colleague, Deputy Rabbitte. He was prepared to admit in an article in the Irish Independent last week that this dispute cannot be solved in isolation from the pay determination system that governs it, with all the attendant relativities that implies. What some members of the opposition need to realise is that when it comes to defending the wider common good, the same fundamental considerations continue to apply regardless of where they sit in this House.

Mr. McCormack

What is the Minister doing about it?

Mr. Connaughton

He spent a long time in the Library.

Mr. Cowen

I listened in silence to the Deputy.

Acting Chairman (Ms Coughlan)

The Minister, without interruption.

Mr. Cowen

The Labour Court finding of 31 August 1999, together with an earlier finding on specialist allowances and significant improvements which have already been conceded on overtime payments and incremental credit, will cost approximately £110 million in 1999 and £70 million a year thereafter.

Mr. McCormack

The Minister is only filibustering.

Mr. Cowen

This is on top of the £85 million award of February 1997. The combined value of all these improvements on an ongoing basis is more than £150 million and equates to an average increase of approximately 23 per cent.

This is in stark contrast with the restructuring increases to other groups of workers which were limited to 5.5 per cent under PCW. The restraint shown by the rest of the trades union movement in accepting this difference in recognition of the exceptional position of nurses is not likely to extend to any increase above and beyond the recent Labour Court finding. Everybody needs to understand that under the present arrangements it is not possible to disregard existing relativities. Nurses' pay cannot be dealt with in isolation from other public service groups. As the Taoiseach recently pointed out, it is implausible in the present context to suppose that developments in any part of the public service can be viewed in isolation and will not have a domino effect on other groups, sectors or on society as a whole.

Given the enormous amount of time and effort devoted by the Labour Court to finding a solution to the issue of nurses' pay, it is a matter of deep regret, as a former Minister for Labour, that three of the four nursing unions saw fit to recommend rejection of the court's package so soon after it was issued. This demonstrates a lack of respect for or a lack of understanding of the key role of the Labour Court in relation to the resolution of industrial relations issues under social partnership.

Mr. McCormack

What is the Minister's role?

Mr. Cowen

The HSEA entered the process last autumn on what it believed at the time would be the same basis as the Nursing Alliance. That was that both sides would argue their respective positions and that the Labour Court would decide on the merits or otherwise of the claims before it, having considered those arguments. It was perfectly reasonable for the HSEA to assume this, based on comments made by Mr. Liam Doran, chairman of the Nursing Alliance, when interviewed on the "Five Seven Live" radio programme on 21 September 1998. He said and I quote from the transcript of that programme:

We are following exactly what was laid down by the Commission of Nursing, exactly what's contained in the Commission of Nursing Recommendations . all the recommendations stated was that these matters should be referred to the system as it were, that's how we do our business week in, week out, we don't see why there should be any difference in relation to the three recommendations . ... that's all we are seeking, due process.

Mr. Doran has been critical of me recently for continually quoting the Labour Court recommendation. However, he appears to have forgotten that at the time of the launch of the report of the Commission on Nursing he insisted that the three pay-related recommendations be referred to the Labour Court for independent arbitration. Mr. Doran wanted the three residual issues, the three key recommendations on pay, "referred to the system". That was what he sought. On 31 August last this process gave three times the increase management had offered. Having got such a good result, the union leadership almost immediately rejected it.

The Government has accepted the Labour Court's findings and has honoured everything it has been asked to do by way of independent arbitration. We have no option but to stand firm on the outcome of the Labour Court proceedings. As the Taoiseach said, "to do otherwise, would be to act against the interests of the community, interests that will be irrevocably damaged by the inevitable knock-on effects of paying more than recommended by the Labour Court". I reiterate that the Government is committed to paying the full terms of the Labour Court finding and, as far as the Government is concerned, that offer remains on the table. However, there is no possibility of improving upon the terms of the Labour Court finding.

An all-out nurses' strike would be a clear breach of the industrial peace clause in Partnership 2000 and previous programmes. The absolutist and uncompromising stance being adopted by the leadership of the Nursing Alliance threatens the foundations of the real and substantial progress we have made, as a society and an economy, over the past 12 years through the development of our social partnership. Social partnership and its practical application of wage moderation in return for tax improvements has been a key feature of this amazing transformation in our economy and the wider social benefits. The Taoiseach and the Government are extremely concerned that this vital partnership is now under threat from the actions of groups in the public service and most immediately from the nursing unions. Nobody should doubt, however, the resolve of this Government to protect social partnership.

In the Government's view, there is a better approach to public sector pay. The almost mathematical method of applying relativities and analogues is not appropriate in today's changing world. The Taoiseach has outlined a credible alternative to confrontation in this case and a way forward that will provide a better outcome for us all. That alternative is renewal of our commitment at national level to social partnership and a series of practical steps to a new partnership agreement. That national position must be combined with an approach to public sector pay which is imaginative in ensuring that the income of public servants should more closely reflect their performance and not be based on so-called traditional relativities. This is the context within which the aims and aspirations of public servants, including nurses, can best be met.

Discussions are under way at present with representatives of the public services committee of the Irish Congress of Trade Unions about developing a new approach to public service pay determination. The intention is that the outcome of these discussions could be reflected in any new national programme which might be negotiated as a successor to Partnership 2000. A considerable amount of preparatory work in connection with discussions on a new programme has already been undertaken by the social partners and a special ICTU conference seeking a mandate to enter talks on a successor to Partnership 2000 is scheduled for 4 November. The nursing unions are represented at the discussions with the public service unions and it would make more sense for them to work with their colleagues and the Government on developing an agreed framework on public service pay within which the reasonable aims and aspirations of all public servants, including nurses, could be met in a way which respects the needs of our ultimate paymasters, the taxpayers.

I, therefore, appeal to the Nursing Alliance to call off the threatened all-out strike and to pursue its case in the context of the forthcoming discussions between the Government and the social partners on a new national programme to succeed Partnership 2000. A strike is a blunt weapon which has no place in a modern industrial relations process. The Government does not believe it will advance the aspirations of nurses. On the contrary, it will inflict hardship on patients and other clients of the health services who are in need of nursing care.

Nurses represent the largest single group of health care professionals. They are, therefore, a powerful group, but this power must be used constructively. Resorting to all-out strike, even if conducted in the most benign way possible, will disrupt the continuity of care to many vulnerable members of society, including some of the elderly or those suffering from a mental handicap or a mental illness, and is not a constructive use of power. Such a course of action, which is totally unnecessary, would lead nurses down a cul-de-sac. I am alarmed by some of the statements emanating from the leadership of the Nursing Alliance. Phrases such as "war on the streets" and "upping the ante" have a consequence of imposing hardships on patients. This is not what nurses want to do. The Government believes that the interests of nurses would be better served by their union leaders using their influence positively to shape the new partnership agreement in a way that ensures a new approach to public service pay determination, as proposed by the Taoiseach.

The Labour Court said in February 1997 that a nurses' strike could damage, perhaps irreparably, relations between claimants and their employers and inflict unnecessary hardship on the community. The strike weapon has no place in social partnership. The alternative route which the Government has proposed will not involve the public. There is no need to disadvantage the public. The public is entitled to ask why are they being involved by the nursing unions in a strike campaign where there is an alternative route available to the unions that does not involve the public.

Mr. McCormack

The public is entitled to ask what the Minister is doing about it.

Mr. Cowen

It is unfortunate that progress in implementing further recommendations of the report of the Commission on Nursing is being held up by the failure to reach agreement on the deal brokered by the Labour Court. While I fervently hope that the threatened strike does not go ahead, I would be failing in my statutory responsibilities if I did not initiate contingency planning arrangements for the provision of emergency and essential cover in the event of an all-out nurses strike. I am concerned at the continuing failure to agree a national framework for the development of emergency cover for the duration of the strike. There is a meeting tomorrow and I urge the leadership of the Nursing Alliance to agree its approach despite the important issue so we can all agree at national level, given that everybody claims that the objective is not to put patients at risk during the course of any strike.

Deputy McManus today referred to GPs and family doctors not yet being informed about emergency cover arrangements. In the absence of nursing union agreement to a national framework, health agencies are not in a position to be definitive as to the likely cover that will be available. The Department wrote to the IMO last week to appraise it of the situation and will be meeting the IMO on Thursday, the day after it meets the Nursing Alliance, for further discussions on a national emergency plan.

In conclusion, the health service is hugely important to the community and to each individual. We have all benefited from the service at some stage in our lives. It is an unfortunate fact of life that good things are seldom said about what is, by any standards, a good service. The national development plan will be further testament to the importance the Government attaches to building up our health services and improving equity of access to these public services. Nurses do not have to go on strike to have their rightful place in the management of the health service. I want to see nurses and other health care professionals have a real involvement in the running of their own institutions. I want to get rid of hierarchies. I want to give nurses more power in decision making in their own wards and units. All this is possible without recourse to the strike weapon.

Yesterday, when the four nursing unions gave notice of strike action commencing next Tuesday, I appealed to them to call off their action and to see that there is a better way. What is about to befall our health service in less than a week's time is extremely serious. Much has been said about the threat to patient care and even lives. Very little has been said, however, about the effect the strike will have on the profession of nursing.

Acting Chairman

The Minister's time has concluded.

Mr. McCormack

His time is up all right.

Mr. Cowen

I accept that nurses have pursued a number of legitimate grievances over the past five years. It is not enough to simply say that we valued the contribution of nurses.

Acting Chairman

Will the Minister please conclude?

Mr. Cowen

The concrete and significant advances now on the table are evidence that we mean it.

Acting Chairman

The Minister's time has concluded and I wish to call on other Members.

Mr. Cowen

Substantial gains have been made over the past five years. I appeal to nurses this evening not to take this route of strike action and to reject the blind alley that strike action represents.

Ms McManus

I wish to share my time with Deputies Breeda Moynihan-Cronin, Sean Ryan, Penrose and Quinn.

Acting Chairman

Is that agreed? Agreed.

Ms McManus

The Minister's speech was disappointing. It was comprehensive as regards history and, as usual, criticism of the Opposition but sadly lacking in any new thinking or possibilities of a resolution. It underlined the urgency of dialogue between the Minister and the unions to establish if it is possible to prevent a strike. It is clear from the Minister's speech that we are facing a strike and an unprecedented situation in our health services which is a direct result of the attitude being taken by the Minister for Health and Children. Nothing that has been said tonight negates that in any way.

I welcome this debate and I wish to put it into context. Irish health care has a distinguished history of which we can be proud. Our health professionals, including nurses, have a track record second to none. Many of them worked in other countries and built up a reputation of excellence. They are valued abroad and rightly so. Because they have not been valued enough at home a nightmare scenario is unfolding which, unless averted by political leadership – there is no other way – will cause irreparable harm. It is clear that the role played by nurses in the delivery of medical services, coupled with the expanded range of skills they have acquired in recent years, points to the need for a fundamental reappraisal of their position in the health services pay hierarchy. However, this dispute is not just about money. Anybody who has taken the time to listen to what nurses have to say is aware there are a number of elements in this dispute.

The need has not been met and for the first time we are facing an all-out strike by nurses. If, as is likely, it goes ahead, this strike will have an unprecedented impact on our health services. If it is a long strike – all the indicators are that this is what the Government intends – it will do incalculable long-term damage to the fabric of health care. The tragedy is that if we had a good and creative Government we would not be contemplating such a prospect. Even if we had a competent one, it would mean we would not be here seeking an eleventh hour reprieve from a Government that seems incapable of understanding what is required of it. Perhaps I should spell it out.

What we do not need is intimidation, neither do we need abuse, aggression or arrogance. We do not need escalating bad relations between nurses' representatives and Government representatives. Yet, so far that is the main message which has come from this Government. Instead of dealing with the problem over the past week and longer, the Minister for Finance, Deputy McCreevy and the Minister for Health and Children, Deputy Cowen, have retired to the bunker. Their response to the deepening crisis is to keep out of sight while lobbing verbal grenades at nursing professionals. Today's veiled rebuke by the Taoiseach of both Ministers, made in temperate language, was too late to undo that damage, although it is noteworthy in itself.

Mr. Cowen

We got no such rebuke, the record will show that.

Ms McManus

This morning the Minister for Health tried a different tactic, he pleaded with the nurses, rather like the battering husband who deludes himself into thinking that all will be forgiven if he cajoles his wife. The Minister is not unintelligent, he must know neither ploy has the slightest chance of success and is no substitute for equal and open dialogue. Has he not realised the enormity of what is ahead? Is he incapable of coping with it or is it that deep down, he does not care enough? We are all aware the Minister is in the wrong Department, but surely this is more serious than one's predilection for a particular Department. We are all aware of the complexities. Nobody underestimates the difficulties and we know it is not a new problem.

Traditionally, nursing has been a largely female profession. Like thousands of other women who contributed their labour to building up the State and who helped to make it the success story it is, nurses were poorly recompensed and poorly recognised. For generations, they were unable to find the voice and the means to carve out their rightful place in society. What is different is that they have done so now, all 27,500 of them, some of them men, most of them women. Talking down to women may have worked for Fianna Fáil politicians in the past but no longer. It is time the Government got this clear, unequivocal message – women will not be patronised again.

In 1997, when Roy Porter's History of World Medicine was published there was only one significant contribution accredited to Ireland, the creation of the nursing profession. The founders of the great orders, Catherine McAuley and Mother Mary Aikenhead appear in this book as the giants of Irish medical history. That tradition of professionalism has held true despite the lack of official recognition of its worth. However, what was once sustained by a sense of vocation needs sustenance of a different sort now. Political recognition must be given to the fact that the world has changed, nursing has changed and that has meant, at times, unbearable stress for those who helped to save lives and alleviate suffering.

A recent study carried out by the Department of Nursing Studies in UCC showed nursing is still attracting highly motivated students, the majority of whom would be eligible for arts degree courses at university level. There is also a high level of job satisfaction. That is the good news. The bad news is that the vast majority complain of poor working conditions, bad pay and a lack of promotional opportunities. We are fortunate that nursing can still attract people of such calibre. However, it is clear that without new thinking and incentives, the central role of nursing is in jeopardy. The Minister holds the key to a resolution of these issues. He bears the responsibility. That is what Governments are for – they must solve problems and find political solutions that will enable society to function fairly and efficiently. This Government won the last general election on the basis that it would meet serious health challenges. It promised to tackle waiting lists but it has failed to do so. Waiting lists, despite the money thrown at them, are still higher by 4,000 or 5,000 than when the Government took office.

Now we face a health care crisis that is almost inconceivable in its extent and, so far, the Government is proving itself grossly deficient in the task of preventing it. The Secretary General of the Department of Health and Children has been quoted in the newspapers as saying that the strike may well extend to three weeks. If it does, it will result in more than 3,000 new patients being added to the waiting lists per week. One hundred thousand appointments every week will be cancelled. It is happening already. Necessary surgical procedures for cancer patients have been cancelled. In County Wicklow, I am aware of cancer patients who have already been informed that they cannot now have the operations they need. This is the cause of great anguish to them and their families. As a result of the action of Labour Party members, an emergency meeting of the Eastern Health Board is being held to try to cope with the cancellations of services.

This prospect has the hallmarks of a catastrophe, both for individual patients and for the health services in general. If industrial action takes place and lasts three weeks, it has been calculated that it will take more than a year to get back to the point at which we are now, which is already a breaking point that is characterised by waiting lists of approximately 35,000 patients and hospital wards closing due to staff shortages. In 1998, the Mater Hospital carried out only 873 of its target 1,000 open heart operations due to a lack of nurses. On one day recently, 38 patients were treated on trolleys in Beaumont Hospital because of overcrowding. The staff at Loughlinstown Hospital is down by 25 nurses and in other hospitals it is down by considerably more. The Irish Hospital Consultants Association has estimated the actual need of nursing spaces at about 3,000. That is the current state of the health services. On top of that, we are approaching the time of year when accident and emergency units will be under particular pressure due to seasonal demand.

I am concerned about the lack of preparation for this strike and I do not accept what the Minister said in that regard. The national emergency plan has not yet been drawn up which is, in itself, symptomatic of a lack of drive. Most importantly, family doctors and general practitioners have not been included or informed about anything to do with the strike even though they will feel the load and will have to carry the burdens that will arise as a result. Basic information, even at this late stage, would be extremely useful for such doctors.

Saving lives and alleviating suffering is the work of our health services. However, that work is being severely undermined by a lack of strategic planning and strong investment. It is extraordinary that this is the legacy of a Government which presides over the richest Exchequer returns in the history of the State. The kitty is overflowing with money yet the sick and disabled and those who care for them are denied proper support and resources, even though they know that politics holds the key to their requirements and that political decisions can make all the difference to their lives.

Mr. Cowen

What about social partnership?

Ms McManus

Everybody, whether sick or healthy, is conscious of what is possible. A desire to save lives and to alleviate suffering in Northern Ireland led to extraordinary political effort and, at times, superhuman political courage by Governments. That continues to this day. Politicians went the extra mile and the result was a milestone, the Good Friday Agreement. The evidence is there to remind us that Governments can resolve even the most intractable difficulties and that initiative, imagination and, most importantly, political will can lead to a breakthrough of historic importance.

Why is it that the same spirit of political achievement cannot be applied now to save lives and to alleviate suffering? I do not know of any nurse who would prefer to be on a picket line than doing his or her job. However, neither do I know of any nurse who is intimidated by the threatening talk and the unscrupulous use of language by the Minister for Finance. In their line of duty, nurses can experience violent attacks, bullying behaviour and the sheer unpleasantness of tending to basic human functions. They are trained to have stamina as well as sympathy and they will not be cowed into submission.

Sooner or later a deal will have to be struck with the nurses. The only question is whether it will be now, before the strike takes place, or after a long drawn out, damaging and painful strike. That choice is being made by the Government. To say there is no alternative is simply wrong. In politics there is always an alternative. The Labour Court has a fine record but when a recommendation is rejected by a nine to one margin, it is evident that an initiative must be taken.

There is much to be won by a Government initiative. Resolving this dispute would bring hope to a health service that has serious problems which need to be addressed. A resolution that prevents a strike by nurses would do great good and would be the strongest signal possible to those who avail of our health services and those who work in them that the Government, at a time of plenty, is seriously committed and dedicated to real health reform. It is not too late. It is possible to draw back from the brink. The Government has the money, resources and expertise to do the business for which it was elected. I call on the Minister for Health and Children, the Taoiseach and the Minister for Finance to get down to doing that business.

Mrs. B. Moynihan-Cronin

We are on the brink of one of the most serious industrial relations disputes in the history of the State. The health care services will be plunged into crisis in a week from today and some of the most dedicated and committed professionals in the country will be forced on to the picket line in their ongoing campaign to achieve a fair wage and fair play from the Government.

The seriousness of this crisis cannot be understated. A Sunday newspaper reported that a senior official in the Department of Health and Children spoke recently of his belief that the strike would last for up to three weeks. In the three weeks, the senior official estimated that up to 50 lives would be lost. Fifty lives are at risk. In any other situation where this serious risk to human life existed, a responsible Government would do all in its power to avert it. However, this Government will not even enter into dialogue with the nurses. Instead, senior members of the Government, including the Taoiseach, the Minister for Finance and the Minister for Health and Children, have lectured the nursing profession and used the past ten days to begin their public relations assault on that profession. It is a grossly irresponsible and highly insulting way to address the crisis and it only strengthens the resolve of the nurses to resist the arm twisting tactics being used against them.

The motion calls on the Government to reverse its damaging and insensitive policy. It calls on the Government to do all in its power to avert the crisis in these last important days and to enter into dialogue with the nurses. The call has been echoed by senior church figures and leading trade unionists but it has fallen on deaf ears. The effect of the Government's approach to this dispute is already causing widespread hardship. In recent days elective procedures, for which people have waited for months and years, have already been cancelled.

Many speakers in this debate have referred to the changing nature of the nursing profession. I support the professional and determined manner in which the nursing unions have pursued their claim. For too long they have been treated like socially concerned volunteers who are paid a stipend to make ends meet. I am delighted the nurses are determined to rid officialdom of this image and attitude. Nurses are skilled professionals who deserve to be treated as such by their employers and are entitled to use their collective strength to pursue fair play and a fair wage. I urge the Government to recognise this and to engage immediately in dialogue with the nursing unions.

The impending withdrawal of services by the nurses constitutes our greatest crisis ever in health care and hospital services. Irish nurses have a proud record in the health care system. Due to the lack of proper recognition for their skills over the years, many thousands of qualified Irish nurses have found employment in Britain, the USA and throughout Europe.

An Leas-Cheann Comhairle

There are two minutes remaining. I understand the Deputy is sharing her time.

Mrs. B. Moynihan-Cronin

It must be remembered that from the day each public sector worker entered employment, income tax and other taxes were deduced from their wages at source with no opportunity for tax evasion that was rife among elements of the Irish business elite. The onus is on the Government to find a solution to the nurses' claim and avoid the frightening consequences of patients being left without nursing care. The impact of a nurses' strike on the health services is unimaginable. The Government knows that it will have to strike a bargain at some stage. It should do so now before plunging the nursing profession and those who depend on public health care into a strike which will be a nightmare for all involved.

The Minister for Health and Children is ultimately responsible for the care of every patient in this country and there is an onus on him to find a resolution to this dispute. If he fails to do so it will represent a most serious dereliction of duty by a Minister.

An Leas-Cheann Comhairle

Deputy Ryan. I suggest the Deputy waits until tomorrow evening. There are ten minutes remaining. There is less than one minute available now.

Debate adjourned.