Nurses and Midwives: Motion [Private Members]

I wish to share my time.

Is that agreed? Agreed.

I move:

That Dáil Éireann: notes that:

— members of both the Irish Nurses and Midwives Organisation (INMO) and the Psychiatric Nurses Association of Ireland (PNA) have rejected the Public Sector Pay Commission recommendations and that both unions have served notice of industrial action in the weeks ahead;

— the INMO has given notice of a strike for 24 hours on 30th January, 2019;

— should the dispute go unresolved, there will be further 24-hour strikes on 5th and 7th February, and then on the 12th, 13th and 14th of that month; and

— the PNA is to implement an overtime ban on 31st January, and on 1st, 5th, 6th and 7th February, with possible strike action by its members on 12th, 13th and 14th February next;

agrees that:

— such industrial action is not in the best interests of patients and that every effort must be made by Government to defer the action by urgently engaging with both organisations and also utilising the Workplace Relations Commission and the Labour Court; and

— it is deplorable that no substantial engagement has taken place prior to this;

recognises that:

— there has been a significant increase in demand for health services over the past decade, with further increases anticipated owing to changing demographics;

— the number of staff nurses has fallen by 1,754 between 2008 and 2018;

— there are significant challenges in recruiting and retaining nurses and midwives;

— the difficulties in recruitment and retention are having an adverse impact on patient care in both emergency and scheduled care;

— at least €1.4 million is being spent on agency nurses per week;

— there is only one applicant for every four nursing and midwifery vacancies in the Health Service Executive;

— there was a 40 per cent increase in vacancies in psychiatric nursing positions from November 2017 to September 2018;

— nurses and midwives are the lowest paid graduate professionals in our health services;

— nurses and midwives work a 39 hour week while all other allied health professionals work 37 hours;

— nursing/midwifery agencies have increased the rate for nurses/midwives they engage with by 20 per cent; and

— previously a commitment to review nursing and midwifery salaries in the context of advances in their education and training, and the expansion of their roles was given in 2006;

further recognises the recent pilot projects on safe staffing levels, and their very strong results in terms of patient care and outcomes; and calls on the Government to:

— engage with the INMO and the PNA to resolve the dispute and to ensure that any strike action has minimal impact on services for vulnerable patients; and

— commission (while recognising, in particular, clause 3 of the Public Service Stability Agreement, and the Public Sector Pay Commission Report) an independent judge-led review of the nursing and midwifery professions, taking account of the introduction of the nursing degree programme, the extra specialties and extended duties that have evolved and that can be further enhanced, as well as examining the remuneration, contracts, and allowances for same with a view to addressing the chronic recruitment and retention issues.

In 14 days there is due to be a national strike by the Irish Nurses and Midwives Organisation. If it goes ahead, it will be just the second national strike by the INMO in its 100 year history. The following day, the Psychiatric Nurses Association will commence escalating industrial action. The motion before the House which Fianna Fáil has tabled calls on the Government to do two things. The first is to urgently engage with the INMO and the PNA to avert strike action. That could include the Workplace Relations Commission and the Labour Court if it proved useful to all sides. The second is to establish an independent commission on nursing and midwifery, chaired by a judge, to assess the nursing and midwifery professions, including pay, conditions, staffing and career structures. We believe such a commission would provide a mechanism to address the very real issues being raised by nurses and midwives and would do so within the bounds of the public service stability agreement.

The strike action is not something that nurses and midwives have chosen lightly. It is something they have been forced into by a Government that does not listen and appears not to care. They are not alone. Unprecedented anger and frustration is being felt right across the country by nurses, midwives, GPs, non-consultant hospital doctors, NCHDs and consultants. In spite of spending billions of euro more on healthcare in recent years, and having one of the highest healthcare spends anywhere in the world, this Government has at the same time managed to alienate pretty much the entire healthcare profession.

The INMO and the PNA have been raising concerns about retention and recruitment and knock-on effects on patient care since 2013, and they have been largely ignored by the Government. In fact, just last month the Government cancelled its scheduled meeting with the INMO. At the same time, the Taoiseach went so far in this House as to blame nurses and midwives for causing the upcoming winter crisis because they might take a few days off. That lack of understanding is also seen in the Government's countermotion, which regrettably does not address the core issues at play as this strike is being considered. In fact, I debated with a Government Minister on Sunday who went so far as to say that the Government did not really know if the strike was about pay or whether the nurses and midwives were all that aggrieved. That was an extraordinary statement to make in the face of potentially the second national strike in 100 years.

The INMO is asking a very simple question. Why are nurses and midwives paid thousands of euro less than other degree level graduates in the HSE? That is the question. Why are they the lowest paid degree level graduates in the HSE? They deserve an answer to that question and there must be movement on that question.

At the same time there are other issues and opportunities across the profession that can be addressed. The Public Service Pay Commission reported last August. It recommended increases to allowances of 20%. It recommended promotion to senior posts earlier. It recommended recognition of additional specialties, as indeed were identified last year by the INMO's own members at their annual conference. It identified serious failings in career supports, advancements, professional training and in a range of other areas for nurses and midwives in the HSE.

On the issue of core pay the report showed that Irish nursing graduates are paid significantly less than they are in Australia, the US and Canada - English speaking countries around the world actively looking to hire our nurses. Nursing agencies have increased their fees by at least 20% and in some cases by up to 44%. They would not have done that unless it was becoming harder to hire agency nurses based on pay. The report pointed out that the use of agency nurses is increasing, which surely is a false economy given that last year the spend on agency nurses was somewhere between €1.4 million and €2 million a week.

On recruitment and retention the report identified numerous issues. These included hiring specialty grades such as in emergency medicine, intensive care and theatre. It included hiring for senior nursing roles. The report pointed out the heavy reliance on overseas recruitment and the increasing use of agency staff. Right now there is one applicant for every four nursing and midwifery vacancies within the HSE. We know that there has been a 40% increase in vacancies in psychiatric nursing positions just from November 2017 to the following year. We also know that the difficulties with recruitment and retention are having an adverse effect on patient care in emergency and scheduled care. For example, in Galway University Hospital, one in every three of its operating theatres is closed on a full-time basis because the hospital is not able to hire enough theatre nurses. How many patients lives are being harmed by that? How many scheduled operations are being cancelled because one in three theatres in the only level four hospital in the region is closed?

In response to those facts the Government regularly points out that the total number of nurses is increasing. The report from August last year showed that while that may be true in total when one includes directors and managers, it is highly variable by hospital, it is static for community nursing and it is falling in mental health. Just as concerning, the report pointed out that workforce planning in the HSE is so poor that it does not know how many nurses it is trying to hire. We do not even know how many nurses we want. We do know that the number agreed between the INMO and the Government has been missed, to the tune of 69%, in terms of the number of additional nurses to hire.

Pay and conditions, staffing levels, career supports and advancement, patient care and many other issues need to be addressed. In so doing, the issues at the centre of the strike can be addressed. At the same time, both the commission report and unions have identified numerous opportunities to make the professions more attractive while greatly improving patient care. Fianna Fáil believes that the best way to do that, while staying within the bounds of the public service stability agreement, is an independent commission on nursing and midwifery. It should be led by a judge. It should be strictly time limited and it should have terms of reference agreed between the Government and the unions. Meaningful engagement by the Government with the unions is needed now. It has not happened for years. The industrial relations apparatus of the State is at hand to help. At this point, every effort must be made to avoid industrial action. If the motion is passed by this House and acted on by the Government, and if the Government engages in good faith in a meaningful way with the unions, I believe we can avoid strike action, make the professions more attractive and improve patient care all at the same time.

The Psychiatric Nurses Association has given notice that it will escalate its industrial dispute by implementing an overtime ban on 31 January and 1, 5 and 6 February, with possible strike action on 12, 13 and 14 February. That did not happen overnight and it was not taken lightly by the Psychiatric Nurses Association or its 6,000 members. They do not want to be on strike. They want to provide the high quality of care to patients that they are trained to give, but it is impossible for them to deliver that high quality of care due to overcrowding in hospitals, the crisis in their pay and conditions and the cost of living.

Nurses are the lowest paid core salary graduates of any health profession. The staff shortages in mental health nursing are very real. There is a recruitment and retention crisis in mental health. There is overcrowding in mental health facilities. It is clear the staff shortages are the main obstacle to the implementation of the Government policy on mental health as set out in A Vision for Change. Again and again throughout the country we hear that young people or adults who need mental health services cannot obtain them, it is because the staff - nurses, psychologists, psychiatrists or allied health professionals - are not available.

Mental health nurses are voting with their feet - they are resigning or changing their speciality. There was a 40% increase in vacancies in psychiatric nursing positions between November 2017 and September 2018, which is a phenomenal increase in such a short period. They are under intolerable stress, there is burnout and isolation and their own mental health has been put under serious strain. We have also seen a significant increase in the level of assaults on psychiatric nurses, with 11 in 2015 and 149 reported in the first ten months of 2017, which is a 15-fold increase in just a couple of years.

This year, due to the confidence and supply agreement, an additional €55 million was provided for mental health services but the same amount was effectively spent on agency staff last year. There is also the Brexit context. I was glad to hear the common travel agreement has been reaffirmed by the Government but it is clear the UK Government intends to restrict seriously the number of workers who can come from the Continent to work in the UK. The UK is suffering its own crisis in mental health staffing, in particular in nursing because continental nurses who were going to the UK are no longer going there. The UK has started a recruitment campaign to target nurses and, no doubt, with the common travel agreement being reaffirmed, which is to be welcomed, Irish nurses will be the target.

It is not that nurses are unreasonable. They are well known for expanding their practice and abilities. They were some of the first in the world to adopt nurse prescribing and took on prescribing for X-rays, for example. Nurses are reasonable and they are asking reasonable questions. It is time the Minister met them and gave them a reasonable response.

I welcome the opportunity to debate this issue in the House prior to strike action taking place, if only to allow those involved to bring forward solutions which can be explored and could bring about a successful conclusion. I hear the Government, the Taoiseach among them, talking about the public service stability agreement being sacrosanct and saying it is the only show in town and that there will be no side deals with the potential of a knock-on effect on other sectors, should there be a successful conclusion in regard to a pay claim on these issues. However, if one investigates and analyses that agreement, and seeks to preserve its integrity and work within it in order to bring about a resolution, one will see it goes beyond the 7.4% for a three-year deal, beyond restorative pay in regard to FEMPI and beyond restorative pay and parity for new entrants.

There were two avenues within that agreement that were open to the unions representing nurses. There was clause 3, and the Minister was put on ample notice some time ago of the unions' interpretation of that clause. Other unions might not agree with that interpretation, and be that as it may, but the Government has also rejected their contention in regard to their interpretation of that. That is part of the reason we believe it is necessary to have a new nursing commission to look specifically at these details and to adjudicate on that issue alone.

The Government cannot have it two ways. It cannot take credit for putting an agreement in place and putting a pathway in place to deal with reservations that might be contained within it and then, when those reservations are enacted or sought to be addressed, it plays dumb. There was also the pay commission itself, which was a mechanism by which the Government could put this issue at arm's length and allow independent assessment of career advancement or issues within the health service restraining the recruitment or retention of staff. It made various recommendations and drew conclusions, which Deputy Donnelly outlined. Ministers have been quick to say over the last week that they agreed with all the recommendations contained within it, restrictive as they were, but they failed to acknowledge or inform the public in any of those briefings that it is not the pay commission's duty to take the place of direct negotiations in regard to issues that need to be resolved because of its findings.

The Ministers also failed to inform the public that the foreword to that report issued by the commission chairman outlined in some detail the lack of available analytics within the HSE to allow it to make a substantive recommendation. That leaves the entirety of the report somewhat flawed and lacking in credibility. It is because of this that a specific commission should be charged with that responsibility. However, the fact the Government and its members say they had set that in train, and that they agreed with its recommendations and provided for the costs associated with it, is an acknowledgement that they would have worked with its recommendations. Nonetheless, if its recommendations are flawed, then they have to stand up and account for that and allow a process to evolve.

The Deputy is over time.

I accept that but I have very little time to make the point. This is well-intended on our part. I believe we have credibility in what we are saying in regard to protecting the integrity of the agreement while still offering the opportunity for a solution which the Government must play its part in ensuring is reached.

I welcome the opportunity to speak on the motion. The first thing we must do is put pay and conditions in place to retain our front-line staff, that is, the midwives and nurses who provide such a critical service every day. If the right pay and terms and conditions are in place, we can attract people back to work in Ireland, which we desperately need in this specialised field. It is important to identify that nurses and midwives are highly qualified and provide a very specialised skillset. In that regard, we need to ensure they are retained to work in this country in order to provide much-needed day-to-day services on the front line in our hospitals, which we all need to engage with at different times throughout our lives. It is very important that we focus in on the parameters and the terms and conditions, and that we work to put measures in place to alleviate their concerns and deal with their issues. Most importantly, we need to retain nurses with their wonderful skillset and to attract more people back.

Our spokesperson Deputy Donnelly wrote to the Minister on the area of DEXA scans. Currently there are hospitals in Dublin and Naas that cannot provide those services when there are people who need them on a day-to-day basis to monitor their condition and no alternative measure have been put in place for them in either public or private hospitals. The GPs are very concerned about the consequences of the lack of resources in a general context, as well as in this specialised area. It was only brought to my attention on Monday at my clinic in Naas that Naas Hospital has a very sophisticated MRI scanner but it only operates in the morning and cannot operate in the afternoon or evening because there are no staff to operate it. Meanwhile, the hospital is sending patients accompanied by nurses in an ambulance to a private hospital to get those MRI scans done. That is the consequence we are dealing with. It is important we put packages in place to keep front-line people.

I welcome the INMO, nurses and midwives to the Visitors Gallery and thank them for being here with us. We cannot run our health service without our nurses - it is a simple fact. Heretofore, the health service has been managing as best it can on the back of a lot of goodwill on the part of our nurses. They work over and beyond the hours they are contracted to work. They come in early, they stay late, they skip their breaks and they do not often take their holidays, despite the Taoiseach saying they are somehow responsible for the trolley crisis because they take a few days off at Christmas time. In fact, they often skip their holidays.

The Minister has allowed the situation to escalate to where it is today. We are facing into potential strike action, although I do not believe the nurses took this decision lightly. It is the second time ever in the history of the State that our nurses will strike, which says it all. They obviously feel as though they have nothing else they can do but take that action. It has taken that to bring the Minister to the table and to have those conversations to try to resolve this issue.

Nursing is a four-year degree course and it should be properly paid for and recognised. The profession has been changing dramatically in the past 15 or 16 years. The very basic comparison with other jurisdictions, such as the UK, does not take into account the working conditions, which are a big factor. Other countries have additional staff who are not nurses but who help nurses to do their job.

Nurses here do far more work on a daily basis than their counterparts in some other jurisdictions. As such, a basic wage comparison is not sufficient. Working conditions for nurses in Ireland are extremely stressful. Any nurse who has worked in the UK, Australia or the USA will tell one that working conditions and pay are better in these countries. We must look not only at the conditions in which nurses work, but at retention. Why are nurses leaving in droves? Why are they choosing to leave their home country to work elsewhere? The use of agency staff is another major issue. The spend on agency staff is breeding great resentment across the health sector and it must be tackled. While I hope sincerely that this matter can be resolved quickly and that strike action can be avoided, I understand and appreciate absolutely why we have got to this point. It is up to the Minister to resolve the issue.

I move amendment No. 1:

To delete all words after “12th, 13th and 14th February next” and substitute the following:

"agrees that such industrial action is not in the best interests of patients and that every effort must be made to avoid the potential adverse impact on our health services and those patients who are reliant on those services;

recognises that:

— pay for public servants is currently the subject of a three year collective agreement, the Public Service Stability Agreement (PSSA) (2018-2020); this is being implemented through the Public Service Pay and Pensions Act 2017 which provides for the gradual progressive unwinding of the pay reduction measures under Financial Emergency Measures in the Public Interest (FEMPI) legislation;

— by end 2019 public servants on pay levels up to €50,000 will have pay reductions fully unwound;

— the PSSA is delivering wage increases in general averaging around 2-2.5 per cent per annum, with higher benefits for new entrant single scheme pension members and the lower paid, and the PSSA will cost €1.1 billion out to 2021;

— on top of the basic pay increases provided under the PSSA, the Government reached agreement with the Irish Congress of Trade Unions (ICTU) on a measure to deal with the post-2011 new entrant salary scale issue; these proposals will deliver an additional €3,000, on average, over the coming years starting in March 2019 to over 60,000 post-2011 new entrants, including 10,000 nurses; the measure will cost an estimated additional €75 million (€28 million in 2019 and €47 million in 2020) in the lifetime of the PSSA;

— in addition, the Public Service Pay Commission completed its examination of recruitment and retention in the health sector in August 2018 and recommended a 20 per cent increase in the Location and Qualification Allowances for nurses and accelerated promotion for nurses to the senior staff nurse level in order to incentivise nurses and midwives to work in certain areas; the Government has agreed that, if accepted, those measures would be implemented from March 2019, at a full year cost of a further €20 million; and

— the maintenance of industrial peace is an essential requirement of the PSSA; under the PSSA, the parties, including nursing unions, have committed:

— to cost increasing claims;

— to claims related to improvements in pay or pensions or any related matters;


— that all forms of industrial action are precluded; and

agrees accordingly that all parties should engage actively and positively within the terms of the PSSA, utilising to the degree necessary the provisions of the PSSA and the industrial relations mechanisms and machinery of the State in order to ensure that health services can continue to be delivered for patients without adverse impacts from industrial action.”

Of course it is up to me to endeavour to work with willing partners to resolve this, which is exactly what I am going to do. However, the level of revisionism taking place in the House this evening is simply breathtaking. To suggest that it has taken strike action to engage with me does not bear scrutiny. I am sure the INMO will confirm that there has been no time its representatives have sought to meet me when I have not been available to engage. Nor does it bear scrutiny to move a motion calling for engagement to take place and to use strong language around that when engagement took place yesterday and is scheduled to take place at the oversight group on Friday and on Monday when the Department of Health, the HSE and nursing unions meet again. As Deputy Lisa Chambers quite rightly stated, all of the industrial relations mechanisms are in place. The INMO, which is represented in the Gallery, is well aware of the comments made by Fianna Fáil spokespersons at the health committee on 11 July last. The INMO was extraordinarily disappointed by the comments of Deputy Donnelly who, on the basis of his own field research, stated that Irish nurses were the third highest paid in the world in 2013 and among the top five in 2016. That transcript is there for all to read in full, as indeed it has been read and considered, I am aware, by the INMO.

There is no monopoly when it comes to supporting our nurses. There is no one who cares in particular for nurses above and beyond other political parties. We all appreciate the vital role nurses and midwives play in the delivery of our health services. We also all appreciate that the Government and unions have signed up to a three-year public service pay agreement. It is one that Fianna Fáil respects under confidence and supply and it is one from which Fianna Fáil did not seek to deviate in budget talks when the party did not seek one additional cent to address the issues on which it now says it wants movement. When Fianna Fáil agreed the budgetary framework, it did not seek to deviate from its confidence and supply commitments on respecting public sector pay agreements. I respect very much the point made by Deputy Cowen on the fact that working within the context of those agreements is a prudent approach to take. Indeed, the oversight body to monitor the implementation of the agreement will meet on Friday. It will be a very important opportunity for all parties to see how we can endeavour within the context of the agreement to move forward.

The agreement in place commits to seeing increases in pay by 2020. Nurses and midwives can expect to see their deserved share of these increases beginning this year. Reductions for pay levels up to €50,000, which include a large proportion of the nursing and midwifery profession, will be fully unwound by the end of 2019. This represents a wage increase of between 2% to 2.5% on average across the sector, with new entrants and lower-paid professionals rightly benefitting most from these changes. The Government and I support these changes fully. Nurses and midwives are at the heart of our health service, bringing professionalism and compassion to everything they do. We are committed to ensuring that these skills and attributes are recognised and valued within our health service and that pay increases through the agreement reflect this. We are united in our support for this agreement that will see pay restoration for all public servants, including nurses and midwives. The Government is united in its support for unwinding pay reduction measures introduced under the FEMPI legislation. The agreement was sought in full co-operation and collaboration with public sector unions, including our nursing unions, and we are eager to come to a fair and satisfactory solution for all parties involved. However, it must be a solution that preserves the integrity of all elements of the agreement. I presume and hope that is the position of all parties in the House. Otherwise, it will have to be explained why the agreement can be breached for one group but not others. If we are respecting the integrity of the agreement, we must find solutions within that space. I am committed to finding fair and satisfactory solutions which preserve that integrity.

The issue of pay disparity for post-2011 new entrants to the nursing and midwifery profession has been highlighted in the past and this Government has listened. On top of benefits arising from the current public service stability agreement, we have agreed with ICTU, of which the INMO is a member body, to deal with the new entrant salary scale issue. This agreement affects approximately 10,000 nurses and midwives in Ireland who entered the health service since 2011. Starting in March of this year, nurses and midwives employed in the health service since 2011 can expect an additional €3,000 to their pay cheques every year. This represents an essential step towards not only restoring pay for nurses and midwives in our health service, but towards ensuring the recruitment and retention issues that have been referenced in this debate are alleviated. Issues of recruitment and retention in our health service must be taken seriously. We accept fully that the number of highly qualified nursing midwifery and medical professionals leaving the country is an issue that requires investigation. This is why the Government engaged the Public Service Pay Commission to look specifically at recruitment and retention in the health service and at roles in the public sector where these issues had been identified. The commission involves members with a wealth of experience working in the trade union movement, including at SIPTU, IMPACT and ICTU. Nursing and midwifery were among the first of the professions investigated by the independent commission such was the importance attached by Government to the area. The commission's findings were clear and we have accepted its recommendations in full. This does not discount the equally clear actions recommended in the report which I, as Minister for Health, the HSE and the Government are considering to improve staff retention and recruitment within the nursing and midwifery professions. In addition to the benefits nurses and midwives can expect to receive from the unwinding of pay restrictions under the PSSA and the correction of salary scale issues for post-2011 new entrants, the Government has agreed in full to the commission's recommendations of a 20% increase in local and qualification allowances for nurses as well as accelerated promotion for staff nurses and to senior staff nurse level. This change represents a further investment of €20 million above the investment provided for in the public sector pay agreement.

Despite the nursing unions' recent rejection of the commission's findings, the Government is hopeful that through further dialogue and clarification, the recommendations can be accepted. We are confident these measures can support nurses and midwives in their essential day-to-day work and pave the way for growth and progression. The Government is committed to ensuring that those working tirelessly day to day are remunerated for the service they give to Irish society, as reflected by the public service stability agreement. I understand the strength of the unions' concerns and fully recognise that to have a first-class health service requires first-class support for our first-class staff. However, the industrial action proposed by the unions is not the answer and would violate the terms clearly set out in the public service pay and stability agreement. The proposed action risks jeopardising the numerous benefits people expect to gain from the agreement. I do not want to see that happen and I know that no organisation involved wishes to see it either. More importantly, it is essential that this strike action is averted to ensure that our health service can continue to care for those in need without disruption.

While my Department and the HSE will prepare carefully should a strike proceed and while contingency plans are being drawn up, I am confident that industrial action can be averted. We continue to meet with the INMO and PNA in order to resolve this issue. I am pleased to note yesterday's constructive engagement where all parties to the engagement agreed an industrial dispute should be avoided if at all possible. The parties agreed to meet again on Monday, 21 January, to continue engagement and the oversight group will meet on Friday. The Government maintains that a solution can be found through the State's industrial relations machinery and mechanisms, namely the Workplace Relations Commission and the Labour Court. I heard Deputy Donnelly seek that earlier and wish it to be clear that we will use the industrial relations mechanisms available to us. However, we must go through our engagements on Friday and Monday. We are fully committed to coming to a satisfactory solution for all parties involved which is in accordance with the terms of the public service pay and stability agreement which Fianna Fáil supports.

The proposed industrial action is a no-win scenario if it proceeds. It puts in danger the great progress we have made as a Government in recent years to improve pay conditions across the public sector and jeopardises the promise of increased supports I want to meet this year and in the years to come. Crucially, it compromises the very service we are all striving to deliver to those in Irish society who need our care to live healthy, fulfilling lives. I realise this is a decision our nursing unions did not take lightly and that they do not want to see industrial action either. I remain committed with my Government colleagues, the Department and the HSE to using the industrial relations mechanisms of the State to try to find a solution. However, it must be one which honours the integrity of the public service pay agreement to which unions signed up and which parties in the House and society more broadly value as a means by which to ensure the economic stability and proper management of our public finances at this difficult time.

We now move on to the Sinn Féin slot. A total of 15 minutes is available to Deputy O'Reilly and her colleagues.

I will take six minutes and my colleagues will share the rest of the time. I am pleased to be able to contribute this afternoon in support of nurses and midwives. I welcome the nurses and midwives who are in the Gallery. The Minister has said that strike action is not an answer. I have never heard any Minister say that strike action is the answer to any problem. According to the nurses and the midwives themselves, strike action is the answer in this case. That is what they have balloted for. No nurse or midwife, or no representative of nurses or midwives, will thank us if we try to negotiate a settlement to this dispute on the floor of the House. That is not what we are trying to do. As we make clear in our amendment, the parties to the dispute must be given the space to ensure negotiations can take place and the matter can be resolved. We are all at one on that. Nobody wants to see nurses and midwives on the picket line, but the Government must understand that is where they will go unless there is a change in approach. The Government's approach has got us this far. There are two weeks to go until pickets will be placed and industrial action will be taken.

Sinn Féin fully supports the nurses and midwives. While we support the aims of the Fianna Fáil motion, we have tabled a joint amendment with Independents 4 Change, the Social Democrats and the Labour Party to seek to strengthen the motion by including a reference to the fact that pay must "form part of any resolution to this dispute". The pay of nurses and midwives is an important issue that has been ongoing for many years, as is the recruitment and retention crisis. As we all know, the situation has been deteriorating at a significant rate recently. The Minister cannot be unaware of this. He did not listen when the nurses told him about this fact. They are voting with their feet and emigrating. Approximately 80% of those who are leaving the profession of nursing and midwifery are resigning rather than retiring. They are leaving the health service. They are telling the Minister how they feel with their feet. Now they have a ballot for industrial action, but it still seems like the Minister is not getting the message. He cannot pretend that this issue has taken the Government by surprise. I have been raising this issue week in, week out since I walked in the door of this place.

Fine Gael has had almost eight years to address the recruitment and retention crisis crippling this country's health service, but it has completely failed to do so. As a result, the situation has deteriorated. Last year, Sinn Féin introduced a Private Members' motion on the pay and recruitment of nurses and midwives. It was unanimously passed by this House, but its recommendations were not implemented; in fact, they were ignored. The situation has escalated and we now have an industrial relations crisis. The last thing that nurses, midwives and other healthcare professionals want to do is go on strike. In this case, they have been left with no option. Members of the INMO and the PNA are not taking the decision to strike lightly. It is their last resort. The Minister referred to industrial relations mechanisms. The people in the Public Gallery know - they do not need me to tell them - that strikes happen when all the industrial relations machinery has been exhausted and discussions have taken place locally and at the WRC. When discussions come to an end, a call is made for a ballot. Reference has been made to the industrial relations machinery of the State, but face-to-face negotiations are needed because they represent the only way of resolving this dispute.

The unions have continuously sought engagement with the Ministers for Health and Finance to address the core problem. That is what is at the heart of this matter. Engagement with both Ministers is the key to resolving this dispute. The unions have proposed sensible and responsible solutions with a view to addressing the crisis and averting industrial action, but they have all been ignored. Members of the Government have tried to shift the blame for the crisis it has created to nurses and midwives who are working on the front line. For the avoidance of any doubt, I am referring to the Taoiseach's comments about nurses and midwives taking holidays to which they have a legal and lawful entitlement. I hope nurses and midwives continue to take their holidays because if anyone deserves a holiday, it is them. This crisis has not been caused by people taking holidays - it has been caused by the fact that there is just not enough staff. Holidays can and should be taken, and there should be cover. The Taoiseach's comments revealed an awful lot about the Government's attitude.

Given that pay is central to this dispute, it is mystifying that the Fianna Fáil motion does not mention pay. We all know what Fianna Fáil's view on the pay of nurses and midwives is. It has been mentioned. I do not believe nurses are well paid. I would not say they are in the top five or the top three or whatever it is. If this motion is Fianna Fáil's effort to apologise for the things its members have said, it should man up and apologise to the nurses for trying to malign them by saying they are overpaid. If that is what Fianna Fáil is trying to do, it should dispense with all the fancy words and apologise. The nurses and midwives have said that while pay might not be the entire problem, it must be part of the solution. I have to ask Fianna Fáil why the serious issue of recruitment and retention and the issues raised by the nurses did not form part of its negotiations with Fine Gael on three successive budgets. It has renewed the confidence and supply arrangement without securing any commitments for anything. Nurses and midwives deserve our support. We should support them in their demands. They are fighting for the staff needed to be able to deliver a decent health service and to deliver Sláintecare.

There are four more Sinn Féin Deputies on my list. There are eight minutes remaining in this slot, so they will have two minutes each.

Nurses rarely, if ever, go on strike. Given the importance of their work, they rightly view strike action as a last resort. The current situation is so dire that 95% of the nurses in the INMO who were balloted chose strike action. This is the INMO's second strike in 100 years. That should be a wake-up call for the Government. Nurses and midwives are being forced to go on strike in an attempt to ensure patients in our health service are safe. The recruitment and retention crisis is continuing, partly because of terrible working conditions and partly because of the Government's refusal to deal with the pay issue. Nurses are emigrating to countries with functioning health services to escape the HSE. It is difficult to bring them back because conditions in our health service are not improving. The working conditions of nurses are horrendous and are getting worse. When I speak to nurses who have emigrated, they tell me they have rekindled their grá for the nursing profession now that they are in a better working environment with better conditions, pay and resources to deal with patient care.

Even though the population of this country has increased by 500,000 in the past ten years, the number of staff nurses here has decreased by 6%. Services are understaffed and underfunded. Nurses work longer hours than their counterparts in most other countries. Their work can be dangerous and is often difficult. They are underpaid. The INMO is asking for the pay of nurses and midwives to increase in line with therapeutic grades in the HSE, but the Government has rejected this on the basis that it cannot afford it. We all know this is a nonsense. We would have plenty of money in this State if the Government would only spend it wisely. Rather than spending millions of euro each year on subsidising private landlords, the Government should build social housing. The same point applies in this instance. Rather than spending €1.2 million a week on agency staff to make up for the shortage of staff nurses, the Government should pay nurses properly. If the Minister, Deputy Donohoe, can afford to give tax breaks to landlords and banks as he did in last year's budget, and if he can afford to increase Deputies' pay, he can afford to pay nurses fairly.

It is clear that this Government does not value the vital work done by nurses. It has shown nothing but disrespect and disdain for nurses since this dispute began. It is shameful that it has allowed the situation to escalate like this. The nurses and midwives have the support of Sinn Féin and, equally importantly, the support of the people. The Government needs to get a grip on this matter. Everyone we meet on the street is backing the nurses. It is high time the Minister for Health and the Government gave the nurses and midwives the respect they deserve.

Tá mé sona sásta seans a bheith agam caint faoin ábhar tábhachtach seo. Ba mhaith liom mo chuid tacaíochta a thabhairt do na haltraí.

Sinn Féin supports the thrust of the Fianna Fáil motion but there are obvious gaps. The amendment we have brought forward, along with Independents 4 Change, the Social Democrats and the Labour Party, is about closing these gaps. In particular, our amendment tackles the issues of pay, recruitment and retention.

The series of planned strikes by the INMO and the PNA are actions of last resort. An email sent to me and many other Deputies today gets to the heart of this matter. The writer does not want to be named, which is her entitlement, but I want to read part of her email into the record of the Dáil. It states:

While part of this dispute is about pay, the working conditions of nurses and midwives need to be addressed immediately.

I have on a number of occasions needed nursing and midwifery care. On one of these occasions, nearly 9 years ago, I was an hour away from giving birth to my stillborn son. At this time, the nurses and midwives were again looking for better working and pay conditions from the government and I commented to the midwife that I was sorry about how badly they were being treated by the government. The midwives that delivered my stillborn son were amazing. The care they gave to myself, my son and my family was full of love, empathy and compassion. It saddens and angers me greatly, that 9 years later, the working conditions have gotten worse for the nursing and midwifery staff.

I would also like to make you aware that I have a hospital appointment for the 30th January. This is for a simple test which will be the final test of 4 tests needed for a diagnosis. Not getting this test will delay my treatment. Even if my treatment is delayed, I will give my full support to the nurses and midwives on the day. I will also be joining ... [them] on the picket line.

Please give your support to the nurses and midwives and improve their lives and working conditions.

Sin an méid a bhfuil ón bhean chróga seo. I ask the Dáil to support the amendment to the motion tabled by Sinn Féin, the Independents 4 Change, the Social Democrats and the Labour Party.

I am glad we are discussing the struggles faced in work by our nurses this week as strike action by these essential workers looms but it is disappointing that a party like Fianna Fáil which wants to pretend to be the real Opposition has not taken the time to talk to the workers and their representatives who are at the core of this issue.

As party spokesperson on mental health, I am all too aware of the real cost and damage done by the way we have treated nurses in our health system. Such damage has not only been done to our nurses but to our entire service and those who depend on it. When someone is at breaking point, when their life has spiralled out of control and illness has taken over, it is the members of the Psychiatric Nurses Association who are there, not the Minister, the Government or the chief executive officer of the HSE. It is the well trained, professional and caring face of such nurses. It is for this reason the people are firmly on the side of the nurses and they will win this fight. It is for that reason also the Government should hang its head in shame for making threats when it should have been offering olive branches.

We in Sinn Féin demand the Government engage, recognising the need to address pay issues and commit to a pathway to rectifying unequal pay in the health service and for an independent review as laid out in the proposed amendment. I ask the House to support the amendment to the motion tabled by Sinn Féin and other parties.

Ní thógfadh aon altra an cinneadh seo go héadrom. Tuigeann siad go bhfuil siad tar éis deireadh an bhóthair a shroichint leis an bpróiseas faoi mar atá agus go bhfuil gá le stailc le ráiteas suntasach a dhéanamh agus chun an Rialtas a thógáil go dtí an bord cainte.

Nurses and midwives feel they have been taken for granted. The issues they face of pay and of extremely stressful conditions have been going on for years. This has not come from nowhere. I have met the INMO locally in Cork on a number of occasions. The frustrations its members expressed were the same in 2016, 2017 and 2018 as they are now. No nurse would take the decision to strike lightly. They are very committed to their profession and vocation but they feel they have been left with no choice. The thumping, emphatic decision of the ballot, the highest ever in the history of the INMO, with something of the order of a 95% vote in support of it, shows that there must be scarcely a nurse in this country who has not reached the end of their tether and feels there is a need for industrial action. Nurses are committed. They are some of the best qualified and the most capable in the world and are highly sought after. However, it is no coincidence that the number of staff nurses has fallen by 1,700 from 2008 to 2018. They are the lowest paid graduates in the health service, yet the system cannot function without them.

This is a strategic as well as a moral and an industrial issue. The entire health service cannot function without nurses. Unless this matter is addressed, our health system will continue to be in crisis because we will not be able to recruit or retain nurses.

The Government cannot ignore this issue. It cannot treat nurses with contempt. Part of the solution must be to give the nurses the pay they deserve and ensure they do not have to face industrial action. They do not want to do that but they have been put in this position.

The Labour Party will be 100% supporting the nurses in their action. I welcome the INMO representatives in the Gallery and I acknowledge the PNA which is also represented. It is a sorry day that it has come to this point. I have no doubt the senior Minister needs to be away from the Chamber for personal time and I 100% appreciate that. I am glad the Minister of State is here because he is a person who listens.

I want to refer to some of the statistics relating to the current position. Close on 110,000 people were on trolleys in 2018 due to understaffing. The Government also knows there is under-capacity as well as understaffing in the health service. Some 7,000 procedures were cancelled in 2018 due to understaffing. These are INMO figures. There are more than 1,700 fewer staff nurses in Ireland than there were a decade ago. A fee of €10,000 has been paid to overseas recruitment firms for each nurse recruited. Some 60% of nurses who registered in 2017 were migrant nurses. Some 71% of Ireland's nursing and midwifery students are considering leaving Ireland according to a survey carried out last year. In the past decade the number of nurses has declined by 4%. The accumulation of all those figures shows that we have a dramatic and a serious issue when it comes to nursing and midwifery in this country.

I am glad Fianna Fáil put forward this motion as it gives us an opportunity to speak on this issue. It is laudable but I find it ironic given Deputy Donnelly's contribution to the health committee on 11 July when he expressed his views, especially on entry level nursing, which surprised me. I acknowledge he is trying to turn that around on behalf of his party. We and other groups have put forward an amendment to this motion in order to strengthen it. I will return to that point.

Nurses do not go on strike lightly. Hardly any of us do not have a family member who has been or is a nurse, and I am no different. This is not easy for them. Nursing is a very deep vocation. Nurses going on strike is the last resort. Withdrawing their labour shows the level of frustration among nurses.

I represent County Tipperary and on one side of the county we have University Hospital Limerick and on the other we have South Tipperary General Hospital, both of which have among the highest rates of hospital overcrowding in Ireland. I meet nurses all the time. Their level of frustration extends beyond pay but pay is part of the issue. Their working conditions are intolerable and, in many cases, it is affecting their health. However, the issue is also about pay given that nurses are earning €7,000 less than similar healthcare professionals such as physiotherapists, occupational therapists, speech and language therapists and so on. Given the fact they have to spend four years to qualify, that is not acceptable.

The issue, in the main, is also about recruitment and retention, and the figures I outlined show that. The fact there is one application for every four nursing vacancies, which has been shown, demonstrates the issue we are trying to deal with tonight.

Nurses and midwives are the lowest paid graduates in the health service. This has to be dealt with quickly. I hear spin from the Government about nurses earning €57,000. I do not know if the Minister of State uses social media but many nurses put their pay slips up and they are not earning anything near €57,000. The way that figure is manufactured is not the right way of doing things. There is spin that it will cost €300 million and anyone doing basic mathematics will know that if one deducts agency pay of between €120 million and €140 million, the income tax contributed as a result, excessive, inflated recruitment costs, and the efficiencies and benefits of having more nurses and midwives, the figure is a fraction of what has been provided.

If one compares the pay and working conditions of nurses and midwives to our neighbour across the sea and to English-speaking countries, we have a serious problem and they are not being treated fairly. The topic of the year is Brexit but if it goes through in the shambles it is in now, there will be a pull from Britain as it looks for nurses, since it will not look to Europe, and our issues will be accentuated. Nurses working in English hospitals are promoted more quickly, they work 1.5 hours less on average a week and they are better paid.

Another issue that does not get enough attention is the health and safety of nurses and patients as a consequence of the fact that there is not enough nurses. I have seen the condition, health and well-being of nurses as a result of being overworked. I have close personal experience of it. It happens all over the country. I have met nurses. Members of my family are nurses. I have seen this, including the excessive hours and responsibility. We cannot continue to allow the impact on their mental health to happen. The safety of patients is at risk because of the time and effort they have to put in. Mistakes happen if they are working that hard, yet the nurses will bear responsibility and be brought to disciplinary proceedings. That is not fair because of the situation they have been left in, the vocation they have and their willingness to take care of people.

I spent 11 months working on Sláintecare with other colleagues here. We have the national maternity plan, the mental health strategy and a range of requirements. I spent four hours debating the children's hospital at a committee meeting this morning. Nurses are needed to implement all those strategies, otherwise they will be a waste of time. If we do not value our single most important resource - nurses and midwives - to keep the blood flowing in the health system, these strategies will not be worth the paper they are written on.

There has been a lot of commentary about how this will have a knock-on pay impact. I understand the nervousness but it is clear from the pay deal negotiated that there is conditionality to deal with this. The issues raised by the nurses have not been dealt with to date, though there is conditionality in the pay agreement to deal with it. We are heading towards a strike because it has not been honoured. The statistics show that it has not been honoured. It must be honoured. The amendment that others and I have tabled is intended to create space for negotiations to happen within a fixed timeline to deal with the obvious retention, recruitment and pay issues.

Please take this on board because otherwise I categorically guarantee that we will be out on strike in 14 days. We will be dealing with this. The consequences for surgeries and the impact for the public will be dramatic and ongoing. The public will support the nurses because it knows their working conditions.

Céad míle fáilte roimh gach duine atá anseo. I welcome the nurses, students and their union representatives. I am delighted to see them in the Gallery. I regret that the Minister, Deputy Harris, has left, but it is even more regrettable that the Minister for Public Expenditure and Reform, Deputy Paschal Donohoe, is not here. There is no explanation for that. He should be here. He has to answer for why he is not paying these people. The Minister, Deputy Harris, asked the Opposition a question before he left. He said that in our amendments, we suggest that we pay nurses. He asked us to explain, if an exception is made for one group, how it is explained to all other groups in the public sector. I will offer an explanation which is that this group rejected that deal by a margin of 94%. That says something about how it feels about jobs, pay and conditions. This group is a major part of the solution to our health crisis and if we do not deal with that, we will let sick people, future generations and all workers in the health service down. They are a key part of the solution.

The Government seems to reject, with the Public Service Pay Commission, that their pay is related at all. The Minister, Deputy Regina Doherty, repeatedly said on "The Week in Politics" that they are not looking for more money. She should get into the real world and listen to what these workers are saying. The commission findings, according to the Minister, Deputy Harris, stated that recruitment and retention issues were a cause of concern but it could not find them to be a determining factor, and that it involves many aspects. It has many aspects and I hope the Minister of State has read the submissions from the PNA and INMO. They are wonderful, clear submissions. They are not rocket science and if the Minister of State has not read them, he should. Some of the figures which have been read out and quoted by other Deputies include a €7,000 annual pay gap between nurses and other graduate professions in the health service. The starting salary of three nurses equals my salary. Every Deputy is paid a salary which is three times what a nurse is paid. The Taoiseach is paid a salary which is six times what a nurse is paid. We should think of those facts when we determine the future and daily lives of other people in this legislation.

I will focus on an aspect of the submission from the union which shows something interesting about the role the Department of Public Expenditure and Reform has played. Allied with certain parts of the media, it has tried to muddy the issues and encourages us to think that this is a dispute about the numbers of nurses we have compared to other countries, that there is no issue and no confusion, that we are not short of nurses and that the higher turnover of nurses in our public services relates to something else. Some even go as far as to call them irresponsible because of Brexit. It is out of their control and is nothing to do with them. How dare anyone accuse the nurses of being irresponsible and say that now is not the right time because of Brexit? Now might be the right time to pay them properly.

The Taoiseach, the Minister who has just left and others have presided over a system in our health service that is creaking and not working. That means they have presided over a two-tier health service, encouraging private health at the expense of public health. In the submission I refer to, the unions point out that the joint employers' submission which tries to state there is no difficulty with retention takes out chunks of the HSE submission. The HSE submits that the economic downturn has had a profound impact on the nursing and midwifery resource with substantial reductions of between 4,500 and 5,000 nurses and midwives, which is a historical fact that has to be addressed. These chunks of the HSE submission were ignored by the Department of Public Expenditure and Reform. It says that the overall picture of nursing and midwifery is one of constant challenge to effectively retain and recruit. Its conclusion is that the pay of nurses must be examined. The Department of Public Expenditure and Reform ignored that and instead did a public service pay deal that did not look at the details of what its own organisation, the HSE, not just the unions, was saying.

We have been asked to provide solutions and to state why we should pay the nurses and not those in other sectors. We have also been asked repeatedly by the media and Ministers from where we will get the money. The nursing unions have offered some very good solutions in terms of what would be saved by not having to retain agency nurses on a weekly basis and what the Exchequer would save by getting PRSI and tax money back from increased salaries. There are other choices the Government could make. The choices it has made have been detrimental to this country. One such choice was not to take the Apple tax money and to keep it in an escrow account. There are billions there that could be used to pay nurses. One does not have to look far for solutions or to see that the Department of Public Expenditure and Reform is mismanaging the facts in order to undermine this group of workers. I am 100% for the nurses.

I express the full support of Solidarity and the Socialist Party for the nurses' strike. Our amendment makes it extremely clear that the House should support the pay claims of these staff as the best immediate step we can take to deal with the general crisis in our public hospitals. This is about pay equality and parity for an extremely underpaid group of workers. In our opinion, it is about all those workers who have experienced stagnating wages while housing costs in particular are completely out of control. Wage rises need to match what is happening in other areas. This is also part of a struggle for a decent, properly funded public health service, a single-tier national health service as opposed to the chronically underfunded, two-tier health service that is a drive towards privatisation. Nurses, together with patients, are on the front line in suffering the brunt of the latter, with chronic stress, burnout, sickness and so on.

There is a deep irony in that Fine Gael obviously loves the free market but refuses to recognise reality when labour market conditions here dictate that nurses need a massive pay rise. It is a global labour market and there is a shortage of a million nurses worldwide. This is the reason that nurses' pay is significantly higher in other countries. It is the reason that agency pay is 20% higher here. We have a pay crisis and an understaffing crisis because of the absence of a Government willing to fund the service. This is reflected, for example, in the shocking ratio of births to midwives, which is significantly under the internationally recognised standard.

I echo the point that there is huge public support for the nurses, as I am sure they are aware. We had a stall in Tallaght on Saturday and there was a queue of people to sign a petition in support of the nurses. If a public demonstration were held, for example, I think there would be a huge turnout to support the nurses and the idea of a properly funded public health service, and this would add extra pressure on the Government.

There was widespread dismay and disgust at the comments of Paul Bell of SIPTU, which effectively encouraged SIPTU nurses to pass the pickets. Of course, they should do no such thing. They should refuse to undermine their colleagues' struggle and instead ballot and join the struggle alongside the INMO and the PNA.

Many examples have been given as to where the money is to be found. It is to be found in many places, and we could be here all day explaining how the nurses absolutely could be paid. I will add just one more example. It did not get a lot of coverage before Christmas, but the junior Anglo Irish Bank bondholders, those who were meant to be burned, who were not meant to be paid, but who refused to take any sort of haircut, got paid €270 million. The Government could find the money to pay bondholders who were supposed to be burned but says it cannot find the money to pay the nurses. This tells us everything we need to know about the type of Government we have and whom it represents.

I welcome the opportunity to speak on the motion. As everyone knows, nursing is not a job, it is a vocation. Nurses' dedication, the hours they put in and the way they look after people day in and day out is a credit to them. Nurses on the front line have endured horrific working conditions in recent years and they have kept going, kept working and kept airing their views as to the conditions in which they were operating. Obviously, however, no one has been listening. We must give student nurses something to ensure we keep them in the system. What is happening at present? Many young people are finishing school, they pursue their nursing degrees and then they get the hell out of the country. That should not be the case in any society. We should have something to tempt those in the nursing profession in order to keep them here.

I have always stated that if one decides that one is going to spend five, six or ten years in this country, the first thing that should happen is that one's college fees should be paid. The second thing is that people need to be given a wage. The position with apprentices is similar. One cannot just leave them with only money coming from home while they try to work jobs in order to remain in college. The third point is that because of the housing crisis in the various cities - it should be borne in mind that many of the big hospitals are in the larger cities - the wages nurses receive, be they student nurses or people who have been in the profession for a good while, are insufficient to allow them to afford the cost of rent. The Government could have something to say if it had tried, for example, to sort out matters on the housing side. What has been done about affordable housing for young gardaí and nurses or other front-line staff? The answer is nothing. In Dublin - or Galway, Limerick or Cork - can they afford a house with the wages they are on? The reality is that they cannot. There are inept people in the likes of the Department of Housing, Planning and Local Government who have not moved on. It is a pretty simple job to build houses by the square foot if the State provides the land.

The Government must sit down with these nurses. We must sort this out. We cannot keep going down a road of unhappy workers because if we have unhappy workers, we have an unhappy environment that will not survive. The Government therefore needs to address this once and for all.

I welcome the INMO members in the Gallery and I wish to put on record my full support for them and the members of the PNA, who I am absolutely sure do not have a light-minded attitude to the effects their actions will have on patient care and the ongoing crisis in our health service. This is reflected, as has been said already, in the fact that this is only the second time in 100 years that nurses have voted to take industrial action.

I categorically reject the Taoiseach's recent statements that strike action by nurses will cut across spurious and so-called improvements in the numbers on trolleys in emergency departments and on waiting lists. This is yet another attempt to blame overworked, hard-pressed staff for a crisis that stems from - and I address this comment to Fianna Fáil Deputies - decades of underfunding, cutbacks, loss of staff and beds and mismanagement on a gigantic scale.

This action is not just about pay, it is also about the extremely poor working conditions faced by nursing staff as a consequence of the recruitment and retention crisis in our health service. The facts speak for themselves. There are today, according to the Irish Nurses and Midwives Organisation, 2,662 fewer nurses in the public health system than in 2007. This must be set against the fact of ongoing increased demand due to demographic and other factors. There was a 40% increase in vacancies in psychiatric nursing positions from November 2017 to September 2018. Everyone agrees that there is a need for more nursing staff and a much higher rate of retention of trained, qualified nurses. Part of the solution is to resolve the issues of low pay and the lack of parity between nurses and allied health professionals. The starting salary of a staff nurse or midwife is €28,768, compared with that of an allied health professional at €35,319. Neither of these can be considered good pay, especially given the training and qualifications involved, but there is a difference of €6,551, falling to €4,400 after 16 weeks' employment. Nurses and midwives also work a longer, 39-hour week.

There is a reality that Government needs to accept. Despite the threats of a withdrawal of the general pay increases, along with increases to address lower pay for new entrants and their loss of increments, 95% of nurses voted for strike action. The Government cannot ignore this. These strikes will go ahead. At some point the Government must change its stance and enter meaningful negotiations. As has been said, negotiations started yesterday.

I would like to know how meaningful they were. I will be contacting the INMO and the PNA to ask them. The Government should accept the nurses' claim for parity and agree a process as to how it will be achieved in a reasonable timeframe. There is a clause in the public service agreement which allowed for a review of recruitment and retention which would allow for not just talks but a solution to the issues in this dispute without collapsing the general agreement.

I find it quite repulsive to listen to some of the debate on the airwaves and in the media. Fine Gael Deputies who have accepted a €7,358 increase since 1 January 2017 under the restoration of pay and the unwinding of the financial emergency measures in the public interest, FEMPI, and general secretaries of unions who received the same sort of increase can come out and attack nurses for taking this action after going through all the industrial relations processes they could possibly go through. This is the last action workers can take if they know they are not being listened to. This Private Member's motion will be passed and rather than simply ignore it as just another lost vote, as the Government did with the Sinn Féin motion last year, it should take seriously the views of the majority in this House and of the public and patients and act accordingly and resolve the situation.

I have no hesitation in supporting the action taken by the nurses, not because I wish to see a strike but because if we listen to what the nurses are saying - I welcome them to the Gallery - it is not about pay and conditions but providing a safe health service. In the absence of sufficient staff a safe health service cannot be provided. In 1999 I had the privilege of being elected to the local council in Galway and I sat on a health forum. I find Fianna Fáil's attitude deeply unacceptable. It is very hard to take it seriously because it presided over the privatisation of the public health service and its systematic running down, which Fine Gael and the Labour Party unfortunately took over.

A safe health system cannot be provided with inadequate staff. I know that personally and professionally. My family knows on a personal level the pressure the staff are under in Galway. Looking at the context of the strike we see the figures for people on trolleys. Figures are thrown about here so I am going to repeat them because these are simply for Galway and Ballinasloe. There were 8,750 people on trolleys and chairs. An 80 year old woman was on a trolley for three days and on 11 April last year there were 58 people on trolleys. I can pick any figure or I can quote Dr. Hickey who has come out very honestly and openly to tell us that every year between 300 and 350 people die prematurely because of the time spent on trolleys. We have an unsafe health system despite the best efforts of nurses and doctors because we have systematically run that down. We are seeing the consequences of that every single day. Earlier, Deputy Adams read out a letter. I also got that letter, as did others, from a woman who is facing an essential test on the day of the nurses' strike and notwithstanding that she said she supports the nurses. It is an absolute disgrace that a junior Minister is here on his own in an empty Chamber with not a single Fine Gael colleague to support him. That tells a story of itself.

I am very glad to be here supporting the motion and the amendment because recent attempts on the national airwaves and by some Members of the Houses through the Sunday newspapers to control the narrative of the reality of the lives of nurses and midwives and their pay and working conditions and the reason they have been forced into industrial action have been largely discredited by the nurses and their union and in the minds of the general public who are lock, stock and barrel standing behind the nurses. The INMO is clear that this dispute is about safe staffing in the public health service, something that is very precious to all our citizens. The HSE has not been able to recruit and retain enough nurses and midwives on current pay scales. The narrative belongs to those directly affected. I do not have the time to tell their stories as they have done so eloquently themselves on social media but I will summarise one. She said all the nurses have stories like this, they go home sore and sad and tired. They do their best but they have had enough. They need more nurses and better pay and conditions and she asks that people please listen to them when they say they need help. That is the message that is coming out here loud and clear.

Since embarking on a programme of austerity successive Governments have undermined the health service and the professions of nursing and midwifery and there is a cost for that, not just on the shoulders of nurses but also on patients. The INMO has previously highlighted the fact that we are losing Irish trained staff to the UK and other mainly English-speaking countries. The HSE's response is to recruit from outside. It is not cost-effective to pay out over €100 million every year on agency staff when we should be using our resources to create good jobs and retain qualified people in the public service. We need action on this and we need it dealt with now.

I am happy to speak on this motion. I fully support the nurses' pay claims and welcome their representatives here today. As the INMO has made clear, its members can be comprehended within the Public Service Stability Agreement 2018-2020. As per section 3 of that agreement, the Public Service Pay Commission examined the underlying difficulties in the recruitment and retention of staff and issued its report in September 2018. Its purpose was to recommend measures to address the recruitment and retention difficulties. The proposals that came from the Public Service Pay Commission were considered at a special delegate conference of the INMO on 26 September 2018 and the decision of that conference was that the recommendations would not solve the difficulties in recruitment and retention and, therefore, that all public sector members should be balloted. As we all know, this is an action of last resort. It is indicative not just of the complete and utter failure of this incompetent and abysmal Minister for Health, it is also a sign that there is no political will to listen to the nurses. That applies also to the Minister of State, Deputy Finian McGrath. The Independent Alliance has a position and it should use it rather than talking about Santa Claus and knocking on doors on Christmas Eve. Its members are in government. In terms of the tail wagging the dog, they are not wagging anyone's tail. They have done nothing for the people. They have abandoned them.

The Psychiatric Nurses Association, PNA, has outlined the impact on service delivery and patient care as a result of the non-implementation of A Vision for Change, for example, the removal of 76% of beds and the development of only 30% of community services. It is appalling in Tipperary where there is not one long-stay psychiatric bed. According to the PNA, to currently maintain these inadequate and minimal services, the mental health services have an unsustainable reliance on agency nurses and overtime as a consequence of the inability to recruit and retain nurses. The HSE spends €1 million on agency nurses and €300,000 on overtime each week in the mental health services. This over-reliance on agency and overtime is detrimental to the provision of a comprehensive mental health service.

This is damning. What will it take for this atrocious Minister for Health, Deputy Harris, to resign or be fired? He is walking the Irish health service into total meltdown yet he remains in place when any other Minister with an ounce of political humility would have offered his resignation or be dragged or kicked out by his colleagues but there is not a peep out of them. When the Minister of State, Deputy Finian McGrath, was on this side of the House he was well able to jump up and down and there was nothing he would not do but now he has the price of power and he has abandoned the people.

As if this strike was not bad enough, I recently received an email from a paramedic with the national ambulance service, and a member of the PNA. This person wanted to make me aware of impending strike action within the national ambulance service on the 22 January. This will result in widespread disruption in the provision of services to the public, particularly in rural areas. There we have it. Abandon the people, let them die in the fields. Any of us who go into the accident and emergency departments in the hospitals know what the nurses do. We know how hard they work and their dedication to duty. It is a vocation for 99% of them. They do their best and we give them no support, only lipservice.

Last night I talked about the disgrace our health service has become. The INMO and PNA have served notice of industrial action for the weeks ahead. Both unions have been forced into taking such action in the interest of patients and everyone who uses the public health service. Nurses and midwives are the lowest paid graduate professionals in our health services. This is not acceptable. It is no wonder that the health service has difficulty in the recruitment and retention of nurses. The number of staff nurses fell by 6% between 2008 and 2018, but on the other hand, our health services experienced an increase in demand.

Not only does this have an adverse impact on patient care but the cost of agency nurses to the taxpayer is €1.4 million per week, which is a staggering €72.8 million per year. Our health service is haemorrhaging money that is badly needed in the health service to create more respite beds, reduce waiting times, provide new equipment and hire more permanent staff. All these factors would greatly improve the working conditions of nurses and encourage the recruitment of new nurses and the retention of current nurses. At present there is only one applicant for every four nursing and midwifery vacancies in the health service. The Government needs to see the seriousness of this and act quickly to tackle the problem.

I have criticised the Government before for putting its head in the sand and I am afraid it is doing it again. Figures released this week show the number of patients left waiting daily on trolleys in hospitals nationwide has already exceeded the 600 mark. The high trolley figures come just weeks before strikes by nurses. The Government needs to realise if we have a high number of people waiting on trolleys, the number will rise substantially when the nursing strike commences. Our nurses work extremely hard in very poor conditions. In my constituency of west Cork, I have seen first-hand the Trojan work that nurses carry out in nursing homes and community hospitals in Bandon, Kinsale, Clonakilty, Skibbereen, Bantry, Dunmanway and Castletownbere. I know from talking to nurses that no one wants to go on strike but in reality our nurses' hands have been tied and they have no option. I support our nurses as they deserve better pay and conditions. The Government asks where we will find the money. In the past number of years politicians have been accepting pay increases and nurses have been forgotten. That is the way with most politicians. I have not but others have. I call on the Government to engage immediately with the INMO and the PNA to resolve the dispute and address the demands of the nurses. They deserve parity in their pay with that of the other healthcare professionals. It is high time the Government listened to the people who elected them to power. The people and nurses of Ireland have a voice which needs to be heard.

I am glad to get the opportunity to talk on behalf of the nurses tonight. I recognise their pay claim and support it 100%. I am glad to see many nurses in the Gallery. There are some from Kerry. We are glad to see them here and we support them 100%. We have three Ministers and a Ministers of State with responsibility for health. Deputy Finian McGrath is one of them. I am sure they are all well paid. We cannot do without nurses. It is a fact that many young graduates are going abroad because they can get properly remunerated and work under better conditions. I was very sad the other evening when I met a girl who I knew very well wearing a neck brace. She will never work again because she was assaulted in her workplace where she worked as a nurse. She tried to go back to work twice but has been told she is in serious danger of being invalided if she tries to work again. That is her story after giving so much to patients and supporting and working for our health system. We all know how hard nurses work. There are too few of them on the ground. We know the kind of pressure they are under. I was in Tralee general hospital when my father was there. There are always patients pressing the button, which is their right, looking for help and assistance. Someone has to come to them and it is the nurse who has to do so. There are not enough of them at present in our hospitals. I especially thank the nurses who work in Tralee general hospital, Bon Secours, Killarney community hospital, Dingle, Bantry, Cahersiveen and Killarney, who work so hard to attend to patients. I see the pressure they are under when they take over the shift and do their rota. They have to do so much paperwork before they get going that they are then behind because there are patients in need of attention. We all know the pressure they are under. It is no problem for the Government to give three times as much to the children's hospital as was planned. It is three or four times the original cost. That is what is happening. The Government is not on top of its game at all. One thing we are sure-----

The other Deputy wants to contribute for 30 seconds.

The Government must pay the nurses properly.

Deputy Michael Healy-Rae has literally 30 seconds.

Literally. I want to put my shoulder to the wheel in support of the nurses. Every one of us has had family members who have benefitted from the care and attention they have received from nurses. It is only right that all of us in the House ask the Government to look after the nurses because it is the nurses who look after us and the people.

I am very happy to have the opportunity to speak in this debate and to discuss the issues and the looming crisis that is coming down the line in respect of the likely nurses' strike. I particularly want to pledge my support to the amendments to the motion which the Social Democrats are very happy to support. Those amendments relate to the issues raised by Sinn Féin in particular.

There is no need to recite the problems in our health service. We are all too familiar with them. There are very serious problems. We spend more in this country than most other countries spend on their health services yet there is a significant amount of unmet need. There is very poor access and in no other country do so many people have to pay upfront to access the most basic health services. We desperately need system change. Whether we are talking about trying to operate the existing system in a better way or reforming it and moving to a new and more modern public health service, there is one obstacle which it is impossible to see how we can overcome without drastic action. That is the obstacle and the serious problem of the crisis in recruitment and retention. It applies right across the board within the health service for most disciplines but it is particularly acute when it comes to all kinds of nurses. That is where the biggest crisis is. This crisis has been flagged for some time by both the INMO and the PNA. The Government has persisted in ignoring the looming crisis. The attitude of the Taoiseach and the flippant and dismissive tone he has been using when speaking about this issue are entirely unhelpful. It is insulting to the nurses at the centre of the dispute. It is time the Taoiseach, the Minister and the Cabinet woke up to the looming crisis coming down the tracks. It is very hard to see how we will avoid the crisis of a nurse's strike over multiple days unless Government takes urgent action to address the matter.

The undoubted general shortages that exist at the moment with nurses, particularly theatre nurses, are causing significant problems. It is not an issue of a shortage of beds, theatres, equipment or consultants. The main reason procedures are cancelled is as a result of a shortage of theatre nurses. Let us be clear about it. That is where the problem lies at present and that is what must be addressed before we talk about building more hospital beds or hospitals. Maternity services must be midwife-led. There are serious shortages there. Previously we had good quality, seamless services right across the community in terms of children's health, including vaccination programmes and developmental checks. All of those key services that are provided by public health nurses and basic services for children are not being provided as a result of a dire shortage of public health nurses particularly in the Dublin area.

That is how the system operates at present.

Theoretically, everybody in the House has signed up to the reform programme that is Sláintecare. The latter locates nurses at the very heart of the delivery of health services and that is how it should be. Irish nurses are highly qualified and, in the main, are capable of delivering public health services. We have talked for years about the need to reform the model of care to get away from the expensive hospital-based care system and to bring services locally into the community. Nurses are at the heart of those community services. We also talk about the need for an emphasis on prevention and early intervention, and again it is nurses who we need to deliver those services. For 20 years we have been talking about the need to address the major issue of chronic illness management within our health service. We know that up to 80% of the burden of the health service relates to chronic illness management, yet we have very few chronic illness programmes; it is nurses and senior nurse managers who are equipped to lead out on those programmes and who should be providing them. If the Minister and the Department of Health have any sense, they will realise that is the key to addressing the logjams within the health service. We need clinical nurse managers and nurses right across the board to deliver those services. We are also facing a massive challenge in respect of our ageing population and the need to provide community services to support people living in their own homes for as long as possible. The necessary supports in respect of home care supports, home help services and all of that should be overseen, managed and supervised by nurses. That is what the reform programme is about. It is about switching to a different model of care. It is about getting much better value for money and improving access to health services. We cannot do that unless we have sufficient nurses.

Nurses are voting with their feet. It is undeniable that at the root of this problem is the fact that pay is unacceptably low. There is no reason highly qualified nurses should be lowest among professionally qualified healthcare staff but that is the situation, both in the starting point of the pay scale and going up the pay scale and incremental improvements. At each stage, nurses earn €7,000 less per year than their counterparts - therapists and so on - in other health disciplines. That is an enormous gap which is insulting to nurses, who are just as highly qualified as other health professionals working at the coalface. They are just as highly qualified as the range of allied health professionals, yet they are lagging so far behind. There is a massive demand for nurses. There is a large market for well qualified English-speaking nurses such as ours. There are lots of different packages on offer in places where it can be much more pleasant and more affordable to live. Those packages are better than what is on offer here. We need to value our nurses. We need to recognise that we are facing a real crisis. We need to say that unless urgent action is taken to ensure that there is pay parity between nurses and other health professionals, we are going to continue to haemorrhage nurses. Our health service is in crisis. If we lose more nurses it will collapse and we are very close to that tipping point. I call on the Minister of State and the Taoiseach to wake up, see what is happening before their eyes and avert this crisis before it is too late.

I welcome the nurses and members of the INMO and the PNA to the Gallery. It is great to see them and I thank them for taking the time to listen to the debate. Our nurses and midwives are the backbone of our public service the length and breadth of the country. Cavan General Hospital and the Monaghan minor injuries unit are exceptional when it comes to energy, passion and dedication and are exemplary examples of service provided to patients in the north east of the region. Cavan General Hospital's emergency department sees over 30,000 patients per annum and patient numbers keep growing. Our nurses are the life blood of our hospitals but there is a huge problem with recruitment and retention. This issue must be addressed. Before Christmas, the RCSI hospital group informed me that there were 42 vacancies across Cavan General Hospital and Monaghan minor injuries unit, the majority of which are in the nursing profession. I appreciate that efforts are under way locally to try to attract nurses but this all leads back to the bigger issue of pay and conditions for nurses, midwives and psychiatric nurses.

The Government needs to examine why we cannot attract nurses. I am confident that the answer it will receive will be very similar to the one I get from nurses in Cavan and Monaghan, namely, stress and pay. The terms and conditions being offered by the HSE are significantly less attractive than those that are available abroad. It is creating a real human resources problem within our hospitals. In Cavan General Hospital and Monaghan minor injuries unit, the workload that is expected of professionals is untenable. Figures released to me via a recent parliamentary question show that over 25,000 people attended the emergency department in Cavan General Hospital in the first nine months of 2018, which was an increase of 2.9% on the same period in 2017. We have a fabulous facility in Monaghan minor injuries unit that provides top-class service. The staff tell me they want to expand that service. Currently, it is run from Monday to Friday, nine to five. They want to provide a 24-hour service. They have the enthusiasm, commitment, passion and capacity to do it. The biggest problem for them and for the Minister will be recruitment. The facility complements what goes on in Cavan General Hospital. The Government must address recruitment. To do so, it must address terms and conditions. I earnestly ask the Minister to listen to the professionals who are here in the Gallery. They know what they are talking about.

I welcome the nurses in the Gallery. I am glad the Minister for Finance and for Public Expenditure and Reform, Deputy Donohoe, has joined us. For much of this debate we have had no Fine Gael Member in the Chamber. Deputy Donohoe is the person in charge of the money and it is good that he is here to hear what is being said.

Nurses provide an essential service in our communities. I am not going to repeat what others have stated. We have all had experiences in hospitals. We cannot overvalue the services nurses give to their communities. This dispute is about pay and working conditions, as a number of speakers have said already. The conditions that nurses have to work in are bringing great stress to their lives, which is a large part of their grievances. Unfortunately, the two major hospitals that service my constituency, namely, South Tipperary General Hospital in Clonmel and University Hospital Limerick, are two varying examples of this. I visited University Hospital Limerick last weekend. The crowded and cramped conditions staff are being asked to work in are unreal. Anyone coming out from visiting a patient there would be exhausted. Trying to work there for a long shift and dealing with the number of patients they have to deal with puts extreme pressure on those in this valued profession.

It is no good stating that the nurses' pay claim is going to give rise to other such claims across the public sector. The nurses have balloted for strike action. We have to face up to that and deal with it head on. The basis of their case is crystal clear: they are underpaid. We are failing to recruit nurses into the service. We are finding it very difficult to maintain staff. We have to address the issues that have been raised by the nurses.

Nurses are witness to both the beginning and the end of life, dispensing care, compassion and comfort along the way.

They live very demanding lives and deserve our support and solidarity now more than ever. It is a scandal that nurses and midwives have the lowest core salary for graduate professionals in the health service. It is a scandal that it has taken so long for the Government to meet or engage with the Irish Nurses and Midwives Organisation. Nurse numbers are reducing while the population is increasing. The only way to address a recruiting and retention crisis in nursing and midwifery is to address the issue of pay. This is not just about pay. Nobody goes into nursing expecting to make a fortune, but the least they deserve is to have a decent standard of living for themselves and their families.

Four nursing jobs are available in Ireland for every qualified nurse applying, which is incredible. Intensive care units and operating theatres around the country are among the worst hit. I have checked that out with my local hospitals in Naas and Portlaoise. I spoke to two young nurses from my constituency this morning. One is now living and working in Dubai enjoying a far higher salary and far better working conditions. The other is still working in Ireland and is one of only two from her class of 80 who remained in Ireland. She has been back to college four times since then to further her nursing education and has only stayed in Ireland due to family commitments. She described her nursing colleagues as tired, worn out and stressed due to the understaffing issues in their hospital. A commitment to review nursing and midwifery salaries in 2006 remains to be honoured.

I support the motion tabled by my colleague, Deputy Donnelly. I welcome the representatives of the INMO and the PNA to the Gallery. It is unfortunate that the nurses felt it necessary to approve strike action in order to get a hearing. I support them fully in their calls.

We have a recruitment and retention crisis, and unless we do something about pay and conditions, we will not solve it. In December I submitted a parliamentary question on recruitment of psychiatric nurses. I asked how many contracts were awarded in 2018, broken down between permanent and temporary. I was informed that 176 contracts were awarded in 2018, of which 56, which is 33%, were temporary contracts. How are we going to solve a crisis by offering temporary contracts to a third of those we employ? If we want to hold onto people, we need to offer them training, education, decent pay and conditions, and permanency. The same figure could be applied to the INMO temporary contracts.

We need to deal with this crisis realistically. Pay is an extremely important issue and conditions are equally important. However, providing people with permanency so that they can plan their lives is just as important. I ask the Minister to include that in his negotiations in solving this issue, which we have to solve. We need to pay our nurses the money they deserve. We also need to give them the terms, recognition and contracts they also deserve.

I welcome Ms Phil Ní Sheaghdha and the other nurses' representatives to the Gallery. On behalf of the public I thank nurses for their Trojan work.

It is reflective of the Government's priorities that we find ourselves this evening debating another instance of pay parity in the public sector. I regularly come across nurses in my constituency of Cork South-West - indeed many of my closest friends are nurses. We all know how hard they work and the great responsibility on their shoulders. It is unacceptable that they have to take such drastic measures just to ensure their pay scale is in line with comparable colleagues.

There was great hope for the findings of the Public Service Pay Commission. I knew the unions, particularly the INMO, were hoping that the commission would reflect their plight. However, it is quite disconcerting that the unions were not engaged at all in any pay-review exercise. In fact, they were precluded from even recommending pay rises. In addition the commission made no reference to a crisis in the recruitment and retention of staff and other comparable medical professionals. That is not to mention the disparity between them and other front-line staff, which really makes them feel undervalued. Fair play is being requested and I sincerely believe that pay parity is the least these health professionals deserve. I cannot understand these findings when it comes to the well documented severe staff shortages in areas such as the child and adolescent mental health services. That such services need to rely so heavily on agency staff is indicative of the staff-shortage crisis. I ask the Minister to please support the nurses.

I will be sharing time with the Minister for Public Expenditure and Reform, Deputy Donohoe.

I thank the Deputies for raising this motion on such an important issue. It has been good to have an opportunity to debate concerns over this impending dispute strike by the INMO and PNA. The Government’s countermotion sets out the route for this dispute to be resolved, which is through engagement. I and my colleagues in the Independent Alliance appreciate the strength of feeling among nurses about their pay and conditions. Many of us have family members and friends who are nurses and we totally understand their concerns. However, we want solutions.

As has been mentioned repeatedly in the debate on this motion, the nursing profession is vital to the health sector. We all agree on that. A nursing strike will, therefore, have a huge impact on the health service and will affect the majority of patients in hospitals. Services will be affected not only on the day of the strike, but in the days leading up to the strike and afterwards. The Government acknowledges that an overwhelming majority of the membership of these unions voted to go on strike.

I heard some constructive suggestions on Sláintecare on the high cost of agency staff and the issue of permanency. I assure the Dáil that we are sincere in seeking a way to avoid this strike. The mechanisms exist to seek a resolution. The Government is willing to engage with the unions within the confines of the public service stability agreement, PSSA, to which the nursing unions committed in 2017. The PSSA is the deal in place for the entire public sector. The Government gave our commitment to that as did the nursing unions and other trade unions. Under the conditions of that agreement, we cannot make special provision for a pay deal only for the nursing unions.

Health sector management met representatives of the nursing unions yesterday to attempt to seek a solution to this dispute. These and other engagements are the way to seek a resolution. The Government is committed to finding a fair solution that will keep health services running. A meeting with the national oversight body will also take place later this week and health sector management will meet nursing unions again on Monday next week. We all want a resolution.

As already outlined, under the public sector stability agreement, nurses can expect to see significant increases in pay which I very much welcome. In addition the deal for new entrants, including nurses, will mean that nurses and midwives will start seeing the benefit of the deal from March of this year.

I take on board the points made by many Deputies that issues with recruitment and retention still require attention. However, gradual improvements are being made in nursing numbers. The Taoiseach spoke yesterday and gave some figures which are helpful for comparing how far we have come since the recession. The number of nurses employed in the public health service in the past five years increased by 2,330. From November 2017 to November 2018, the number of nurses increased by 860, not including student nurses. The original motion makes the comparison between 2008 and 2018. I do not need to remind Deputies that between these times, this country went through a serious economic downturn.

The Government supports the Public Service Pay Commission’s finding that a general pay increase will not solve recruitment and retention issues overnight. The Public Service Pay Commission made recommendations which would be of direct benefit to the nursing profession, including a 20% increase in local and qualification allowances for nurses, as well as accelerated promotion for nurses to senior staff nurse level. This represents a further investment of €20 million in our nursing workforce. These measures can support nurses in their essential day to day work and can create real opportunities for the profession into the future. Unfortunately, these proposals have been rejected by a vote of the membership of the nursing unions but the Government has encouraged them to reconsider and will continue to do so. I urge all Deputies to support the Government’s counter motion, which recognises that the best way forward to prevent this strike is for all parties to come together and to use the existing industrial relations machinery of the State. It is important that whatever solution is reached lies within the parameters of the public service stability agreement.

I will begin by acknowledging the immense contribution our nurses make in our hospitals and primary care centres every day, in every community in our country.

While I am very much aware of this contribution, I am equally aware of the contribution that many other public servants make to our economy and society. Deputy Cahill suggested in his contribution that we should go ahead and make additional pay available to nurses but not deal with the fact or the risk of knock-on claims. That is not an option for any government. Many Deputies have made reference to the fact that there are nurses in the Public Gallery this evening and that we must recognise the contribution they have made. However, the empty chairs in our Public Gallery would quickly be filled with other public servants who would ask why the same money cannot be made available to them. Agreements were made with public servants on the basis of integrity around our wage policy. We have said that a certain amount of money is available in any given year, of between one quarter and one third of what we spend each year, and that is set aside for pay. In addition to that, we have put in place a plan for €1.1 billion of additional wage changes and increases, all of which are deserved by our public servants. When we made that agreement with them, we as a Government, underscored by elements in this Dáil, said that this is the best that is available to them. On the basis of that, the agreement was made.

What would colleagues in the House say to those who are campaigning on and who care about the new entrant issue, particularly the teachers' unions? What would they say to the armed forces who are engaging with the Public Service Pay Commission? What would they say to all other civil and public servants who were told that this is the most the Government can pay them? That is the risk and the challenge the Government and the Oireachtas will have to address. If we say to a group that this is the most that is available, we will have to explain how that can be changed in the face of or on foot of industrial action. Let me be clear about two aspects of that industrial action. First, the Government will do all that can be done through the public service stability oversight group and the bilateral contact between the HSE and the nurses, to resolve this issue. The second point to be emphasised is that the scale and timing of this industrial action is designed to maximise the impact it will have on patients, on operations and on pre-planned activities-----

And on the Government.

-----all of which will have a big impact on those we care about and those we represent.

At the heart of this is our ability to strike a balance between public pay needs and the need to make service and capital investments. We must strike a balance between the two. In this Dáil, I as Minister for Public Expenditure and Reform had to deal with the last chain event, when a decision was made relating to one group of public servants and within 24 hours, the same needs crystallised with every other public servant. That is the great risk and challenge that we face.

Those members of Fianna Fáil who have spoken on this issue today have said that we should pay more to the nurses now. I can understand why they would say that, given the care that they see nurses providing, which I also see in my community and constituency. However, that is not what the motion before us calls for; rather it calls for the setting up of a commission. I have already dealt with the issue of the risks involved in doing more for one group. Equally, if we go down the route of setting up a commission in this instance, every other group within our public service would then ask for the same judge-led commission, the consequence of which would be an end to collective wage agreements. Fianna Fáil was a catalyst for collective wage agreements. As a party, it focused on how collective wage agreements can responsibly meet the needs of our society, while also meeting the needs of those who provide public services. That route will spell massive difficulty in terms of keeping the existing wage agreement in place and in terms of the ability for any future wage agreement to be negotiated at a time when we are facing such enormous risks to our economy.

I will end where I began by underscoring the huge respect and appreciation I have for the work our nurses do all over the country. However, I would ask everyone to consider how, in meeting the need they have articulated, we can deal with the consequences of doing so, especially given that the need expressed by the nursing unions amounts to a wage increase of 12%. How would colleagues respond to the raised expectations of the rest of those who work for the State? The challenge in meeting that is too great which is why, as the Minister of State has already said, we will do all we can but only within the current wage agreement. We will respect the wage agreement and we will not change it but we will see if the machinery of State can engage with those who work in the nursing profession to resolve outstanding issues.

We will have a strike and it will be the Minister's fault.

The INMO ballot was not just about wage increases but was also about patient safety. The HSE has not been able to recruit and retain sufficient nurses and midwives, meaning that the health service is understaffed. Nurses are working 12 hour shifts which sometimes run into 13 or 14 hours. They rarely get out of work on time and are constantly contacted on their days off to do overtime. They work exceptionally hard and it is often forgotten that they have families of their own to look after. They care for everyone and they are not rewarded in the way they should be. In Australia, the maximum number of patients in a nurse's care is six but in Ireland it can be between 15 and 20, which speaks for itself. Morale among nurses is at an all-time low at the moment.

After year one, a staff nurse earns approximately €31,000 while a garda earns €32,000. The equivalent salary for a respiratory technician or occupational therapist is €37,000 and for a teacher is almost €38,000. These salary scales came into effect in 2011. Nursing is the lowest paid of all of these professions, despite being a degree-only profession. Nursing is an increasingly complex role, especially given an ageing population with multiple co-morbidities and complex care needs as well as new technologies that are constantly being developed to keep people living longer, healthier lives. The hourly rate for new nurses in Ireland is 29% lower than in the US, 27% lower than in Canada, 28% lower than in Australia and 19% lower than the rate in England.

A number of years ago an issue arose with garda pay.

That was resolved by recognising that gardaí work unsociable hours, days, nights, weekends, holidays, Easter and Christmas - around the clock. Nurses are in the same category, they do the same hours and they should be treated the same. The situation could be resolved by using the principle that was used in the Garda pay claims.

I have spent more than 30 years in politics, and I have never received as many emails from patients supporting nurses. People who are too sick to come out and support the nurses are asking us to support nurses. I ask the Minister to do the same.

I thank my colleague, Deputy Donnelly, for putting forward the motion. The Minister for Public Expenditure and Reform is correct that the motion is narrowly tailored, but if what we are calling for was accepted by the Government, it could have a significant impact on this industrial relations dispute. Our motion states we agree that the strike is not in the best interests of patients but, as it notes, it is shocking that no substantive engagement has taken place, which needs to happen. I strongly urge the Minister to begin that engagement, listen to what nurses are saying and talk to them. In industrial relations, there is always room to talk, which I strongly encourage the Government to do.

The Minister has come to the Chamber with smooth mood music, but the truth is that some of his colleagues have not acted the same way, and they have set bad mood music for the strike by immediately attacking the INMO instead of leaving the industrial relations process to run its course and the Government to talk. The backbenchers attacked the nurses, as did the Minister for Employment Affairs and Social Protection, Deputy Regina Doherty. Whatever about their views, misrepresenting on television what nurses were saying is not helpful to the process. Rather, it would be helpful if the Ministers for Public Expenditure and Reform and Health set in motion what our motion demands, which Deputy Donnelly reasonably asked for.

Nurses are hard-working, and those who work in hospitals do not usually have breaks because they are simply unable to take them. Those who work in residential care units do not have any break in their 12-hour shift. They go into work early and leave late because they must hand over, for which they are not paid in some cases, and they must work unsocial hours. They know they signed up for that but the State needs to recognise that.

Tá mé anseo chun tacaíocht a thabhairt don rún seo. Níl ach dhá rud á lorg againn: go mbeadh coimisiún, agus breitheamh i gceannas air, curtha in áit chun dul i ngleic leis an bhfadhb seo; agus go mbeadh cainteanna idir an Rialtas agus na banaltraí agus na ceardchumainn. Sa chaoi sin, is féidir réiteach ar an bhfadhb seo a fháil agus is féidir a chinntiú nach mbeidh stailc ar siúl ag deireadh na míosa seo.

I welcome the president of the INMO, Ms Martina Harkin-Kelly, and its general secretary, Ms Phil Ni Sheaghdha, with their colleagues, and I thank them for taking the time.

The Minister gave some analogies but he did not compare like with like. We all know there are pay agreements and the INMO is well aware that €300 million is not available to deal with the issue in one go. It is incumbent upon us, however, to lay out a pathway to that, but the existing industrial relations apparatus will not do that. Equality of status is an old adage that has been around for many years. The Minister gave a flawed analogy of the Defence Forces, which requires more fair pay, but he compared 17 weeks in recruitment training to the four years in professional development that nurses have done. There are no allowances for the mentoring that goes on for someone who has just qualified and is brought along to develop his or her confidence to be an autonomous professional, which could be addressed.

The Minister of Health, who was in the Chamber earlier, made reference to a constructive engagement yesterday. The word around the campfire, however, is that it was not constructive at all but rather superficial, and the attitude was one of, "We have nothing for you. What are you doing here?" I hope that does not happen in the coming weeks. A pathway needs to be developed to show that the State values a four-year degree course and the professionalism shown by nurses, and that they will be put on the same wavelength and in the same ballpark or league, to which they are entitled, as other allied healthcare professionals. It is incumbent on the House to lay that out. Existing pay agreements are not the apparatus for that, and something different is required.

I wish to put nurses' minds at ease. Earlier, colleagues suggested the establishment of an expert commission. If one casts one's mind back to 1998 and the commission for nursing that was set up then, one will remember smoke and mirrors with little outcome. We want a short period to professionally examine the issue in order to give nurses parity to which they are entitled similar to other allied healthcare professionals. If minor actions are to be taken, one which the Minister could take is to tell the negotiators not to be superficial in their engagement at the next meeting, but rather indicate that allowances will be provided for mentoring, as a small olive branch to a broader intention to give nurses and their professional qualifications the recognition they deserve.

I acknowledge the two Ministers and the Minister of State who spoke in the debate and the constructive approach that was taken to the motion by various non-Government groups. I add to the welcome of the nurses, midwives, the INMO and the PNA for attending the debate.

Where are we after all the debate? A Minister and a Minister of State said the solution needs to be within the PSSA, and we agree. We tabled the motion carefully to ensure we can do that. The PSSA allows for measures targeting recruitment and retention. I reiterate that in Galway, one in three operating theatres is closed because theatre nurses cannot be hired, while only one in four vacancies is being applied for. The HSE's submission, which did not make it into the final report, stated the overall picture of nursing and midwifery workforce is one of a constant challenge to effectively recruit and retain to meet ever-increasing service demands, that the stability and sustainability of the workforce throughout the year is challenging, subject to peaks and troughs, particularly in the case of graduates, and that these challenges need to be viewed through a lens of increasing health service demand. It went on to discuss the issues of recruitment and retention.

The Department of Public Expenditure and Reform has insisted it will not bring forward proposals for additional pay as part of the moves to avert the strikes. The Minister for Health praised nurses and midwives in his contribution but having done so, the next word in his speech was "however". He stated he was "eager to come to a fair and satisfactory solution", yet he did not once address the unfair and unsatisfactory situation that exists, namely, that a 22 year old graduate nurse who walks in the front door of a hospital on his or her first day of work and stands beside a 22 year old graduate physiotherapist - both honours degree-level graduates - will be paid €7,000 less. If the Minister wants a fair and satisfactory solution, the Government must address the unfair and unsatisfactory reality, which the INMO is bringing to bear and which is causing the recruitment and retention problems, leading to a serious knock-on effect on patient care.

In my experience, the Government is not good at listening to those working in healthcare. It is not good at listening to doctors, consultants or dentists, and it is clear that it is not good at listening to nurses and midwives. In the debate, I did not hear a Government listening to what nurses and midwives are asking for, and I did not hear engagement with their arguments, but I heard many reasons that there cannot be engagement with their arguments. It is time the Government answered the reasonable questions put by the INMO. Why are graduates of the same level, such as a nurse and a physiotherapist, subject to a pay differential of €7,000? If the Government begins to engage and address the concerns, and sets up an independent commission to address these issues and many others, perhaps a strike can be averted. Critically, recruitment and retention can be addressed, patient care can be improved, and the nursing and midwifery professions can go from strength to strength.

Amendment put.

In accordance with Standing Order 70(2), the division is postponed until the weekly division time on Thursday, 17 January 2019.