Pay for Student Nurses and Midwives: Motion [Private Members]

Deputy Mick Barry

I move:

“That Dáil Éireann:

notes that:

— 4,000 student nurses and midwives have been working on the frontline in the midst of the Covid-19 pandemic;

— these students are carrying out essential work and are compensating for the long-term understaffing of our health service as well as covering for Covid-19-related absences of qualified staff;

— 11,369 health care workers have been infected with Covid-19, 16.6 per cent of all cases in Ireland, 59 of whom were admitted to Intensive Care Units;

— the chronic understaffing of our health service was a problem before the Covid-19 pandemic, and that the necessary measures to address this understaffing have not been addressed by successive Governments;

— these students were briefly paid the Health Care Assistant (HCA) rate in Spring in recognition of the essential nature of the work, but this payment has since ceased, and they now receive no payment for their work;

— the financial cost to the students of carrying out this essential work is sizeable, with many students paying well over and above their travel and accommodation allowances to simply be able to attend the workplace;

— the personal and mental health cost to student nurses and midwives working in such high stress and high-pressure jobs are enormous, as well as the obvious risks to their health and the health of their family and/or those they live with;

— even before the Covid-19 crisis, the role these students were playing in their placements was more essential work than training;

— these students are actually paying for the ‘privilege’ of doing unpaid work in their placements, with fees of between €3,000 and €7,500;

— the vast majority of these students are women and their exploitation is also a reflection of gender inequality;

— these students utterly refute the recent claim by the Minister for Health that his refusal to pay them for their placement work is in order to ‘protect their education’;

— student nurses and midwives assert their education has never been protected while on placement because of the burden of essential nursing and care work, alongside academic work, while simultaneously needing to do other jobs to survive financially;

— during the Covid-19 pandemic, the opportunity to work in other jobs to earn income and generally survive has been largely cut off because of the risk of bringing Covid-19 infection in or out of their hospital placement;

— the health services across the country have faced huge difficulties in recruiting and retaining staff for many years, due to the chaos and under-resourcing across the health service, the low pay and the long hours of work;

— many nurses, midwives and doctors emigrate to Australia and other countries, where the pay is higher, and conditions are more favourable; and

— a survey in 2018 showed that, 71 per cent of 4th year student nurses and midwives were considering leaving the country, 79 per cent of them identified increases in pay and improvements in staffing and working conditions as the required incentives to retain nurses and midwives in the public services, and 76 per cent of them found that staffing levels are not adequate to support the learning of student nurses and midwives in the clinical setting; and

calls on the Government to:

— immediately reinstate the payment of student nurses and midwives who are in placements during the Covid-19 pandemic at the HCA rate;

— urgently engage with student nurses and midwives and their union representatives to establish a bursary or payment system that will fully acknowledge the work they do in our health service and will cover the costs of travel and accommodation for the length of their placements;

— abolish all fees for students who are training to work on the frontline of the health service in order to stem the ‘brain drain’, and allow the Health Service Executive to recruit a sufficient number of staff to run our health service at safe and adequately staffed levels; and

— ensure parity of pay, conditions and esteem for nurses and midwives with all other paramedical graduates, including the 37-hour week.”

I will share time with Deputies Gino Kenny and Paul Murphy. I am moving this motion on behalf of Solidarity-People Before Profit, which has been campaigning on the issue to which it relates for quite some time now. We wanted to bring the motion before the Dáil this morning for a full debate. The purpose of the motion is to seek to end the non-payment of nurses and midwives for the work they perform in our hospitals. We appeal to all Deputies to support the motion and reject the Government's amendment.

What is the most dangerous job in Ireland in 2020? The most dangerous job is to be a healthcare worker. One in six Covid-19 cases relates to a healthcare worker. That is more than 11,000 individuals.

In June, the Oireachtas health committee heard that Ireland had the highest rate of infection among healthcare workers in the entire world. The Government amendment places a great deal of stress on the fact that the number of Covid-19 patients in the hospitals is less now than it was in the first wave in the springtime. It ignores, however, the fact that 50 nurses must still take sick leave every day because they have contracted the disease or because they are close contacts of someone else who has.

Student nurses and midwives know what it is like to be on the front line. More than 3,000 of them have been working in our hospitals in recent months alone. It is fair to say that without the effort and sacrifice of those people, our health system would have collapsed. It is also fair to say that for a student nurse or midwife, the issue of Covid-19 risk is very much an issue nowadays. Yet, these student nurses and midwives are paid precisely nothing. Think about that. Thousands of people without whose toil the health service would collapse are paid nothing. In the springtime, the Government appealed to people to come out of their houses and stand on their doorsteps to cheer and applaud our nurses. It described our healthcare workers as heroes, and yet thousands of those workers, student nurses and midwives are paid nothing. That is wrong, and Government Deputies know it is wrong.

Student nurses and midwives make big financial sacrifices just to come into the hospitals and work for nothing. Many held other jobs such as, for example, in nursing homes. They had to give up those jobs when the time came to go into the hospitals. For many, the income from those jobs they had to give up was the money that paid the rent. This is not to mention the fact that student nurse and midwives must pay fees, which are substantial and which range from €3,000 to €7,500 per year.

No doubt some Government Deputies will point to the issue of internship pay for fourth year nurses, but what about first, second and third year nurses? No doubt some of them will point to the allowance, but the allowance is modest at €50.79 per week. For many, it would not pay the parking costs in the hospitals in which they work, and only a minority of student nurses and midwives receive it.

In other countries, student nurses and midwives are paid. In Australia, student nurses and midwives are often paid more than €15 per hour. I Canada, they are paid more than €12 per hour. Here, however, a student nurse who received the allowance all year round would receive a little more than €2,500. A person would need to work for 140 years at that rate of compensation to make what the chief executive officer of the HSE makes in just one year. What does this say about our treatment of our young people? What does it say about our treatment of women? The majority of student nurses and midwives are young and the vast majority are women. Is their exploitation a reflection of gender inequality? Of course, it is; you bet your life it is.

The State has several tools at its disposal which could be used to tackle this injustice. For starters, it could immediately reinstate the payment of student nurses who are in placements during the pandemic at the healthcare assistant rate. This rate was paid to student nurses and midwives in the springtime. The arrangement has since been terminated. It can and should be reinstated. A second tool the State has at its disposal is to establish a student nurses and midwives bursary. In other words, a payment to students which would take full account of the contribution they make to our health services, and also the costs of their travel and allowance. A third tool would be to abolish student fees for those training to work on our health service's front line. There is no shortage of options.

The State will pay a price for treating student nurses and midwives in a mean fashion. Treating student nurses and midwives as skivvies might save the State some money in the short-term, but it is tremendously costly, both to our health service and our society, in the medium term or even the not-so-medium term.

In 2018, a survey was conducted which showed that 71% of all fourth year student nurses were considering leaving the country on completion of their courses and 79% identified increases in pay and improvements in staffing and conditions as required incentives for the retention of nurses and midwives within the public health services. The alienation of student midwives and nurses by the State, with its mean-minded policies, comes with a heavy price.

I understand that there are negotiations taking place between the Department and the Irish Nurses and Midwives Organisation, INMO, on the question of student nurse and midwife pay. I hope that those negotiations bear fruit soon. As I said, Solidarity-People Before Profit has been campaigning on this issue, as have student nurses. I think this is the first Dáil debate on the issue, but I stand to be corrected. If these issues are not addressed soon, I doubt very much that this will be the last debate on the matter.

Deputy Gino Kenny

We have clapped and saluted our front-line workers who have been at the coalface of this war against Covid-19. The vocation of nursing is facing its greatest challenge but it is also having its finest hour. When we, as a society, have needed them the most, healthcare workers have been there for us. The members of the nursing profession have a long, illustrious history of caring not only for their own profession, but also for society as a whole. They have seen the terrible impact that Covid-19 has had on their colleagues. Thousands upon thousands of healthcare workers across the world have died looking after people like us and anyone who is watching this debate. The pandemic has taken a terrible toll, not only physically but also psychologically. Imagine being in an intensive care unit, wearing personal protective equipment, PPE, and holding the hand of a person in their final moments. It is truly amazing and touching to think about. We are indebted to the people who are there during others' final moments, because the person who is dying could be any of our mothers, fathers, brothers or sisters.

It was just over a year ago that nurses were compelled to go on strike over pay and conditions. Nurses should never have to go on strike but they did for a number of reasons. It was not only for the sake of their own profession but related to wider aspects and the bigger picture of our health service and the direction it has taken. They were fighting for their profession, the retention of staff, pay and conditions, and all that goes with those things. These are the kinds of substantial questions about which we talk. Last year, more than 5,000 leaving certificate students showed their first preference was to study nursing and midwifery. There is an oversubscription of applicants who want to go into nursing. We are today raising the issue of what happens at the end of that process.

I know many student nurses because I have worked with many of them and have a lot of good friends who are nurses. They say that they love their job but are burnt out by the nature of the work and the way they are treated. That is particularly true of student nurses in their undergraduate years. They feel used and, in the words of the INMO, they feel exploited by what they have to do in wards. They recognise that they were given equivalent rates of pay to healthcare assistants, HCAs, in April and May but that has since been withdrawn for no good reason and even though they are obviously doing exactly the same work. That needs to be reviewed in a substantial way.

The Minister has spoken about placements and education training. Nurses are, of course, on wards and training but they also have to live. Pay of €50 per week is a pittance, and in the bigger picture, this is quite a wealthy country. We should have nurses who qualify and do not then feel compelled to emigrate. Some people might want to go to other countries after they graduate. However, a substantial number of nurses want to stay in this country but feel so burnt out after four years that they do not want to stay anymore. If even 50% of those nurses who go abroad were to stay in this country, there would not be a shortage of nurses here. There is, in fact, a worldwide shortage of nurses. We have to examine that. Why are student nurses and doctors leaving the State after being trained? They want to stay here but are compelled to leave. Covid-19 will be gone eventually, and when it is, we need to look deeply into why the medical professionals in this country want to emigrate once they are trained.

There are matters of legacy here for society and the Government. The lesson to be learned about student nurses is that health should be put before wealth. The legacy of student nurses is about remuneration, respect and retention. Those are the important three words. If we can concentrate on them, we can hold on to our nurses at a time when this Government and society need them the most.

Deputy Paul Murphy

In six minutes or so, the Minister of State will stand up and explain why the Government does not think that student nurses should be paid. She might say that they should not be paid to protect their education, but before she does, I would like her to listen to the words of a student nurse who has been on the front line of the fight against Covid-19. Ms Maeve Evans is a student nurse from Dublin South-West. She wrote to me and explained:

To choose a life of becoming a nurse or midwife is not easy. Many of us have worked throughout Ireland's first wave of Covid-19 when it struck our acute hospitals and various other healthcare facilities. We helped out in our already struggling healthcare system and yes, we were given a round of applause then, but now we are being hushed.

I worked as a Health Care Assistant for 12 weeks in a nursing home during the pandemic under the HSE student nurse contract. I was offered little to no supports and genuinely found this traumatising. I had to start anti-anxiety medications and seek mental health treatment after this experience.

I currently get 25 euro per week during my placement. This amounts to about 65 cents per hour worked.

I love nursing, trust me I would have dropped out by now if I didn't. But the way we are treated and valued right now is embarrassing. I am embarrassed that our government values us so little.

It is time to stop hushing these front-line workers. The Minister of State should agree to treat Maeve, and all student nurses, with respect. She should agree to pay student nurses a decent, living wage.

We were told by then Taoiseach, Deputy Leo Varadkar, that "not all heroes wear capes" but when it came to the student nurses fighting Covid-19, it seems that this Government believes that not all heroes deserve pay. That is perhaps part of the usefulness of the hero narrative. They are heroes rather than workers. Superman, Batman, Spiderman or whoever else does not have to be paid. It is a disgrace that this Government expects thousands of student nurses and midwives to work for free in our hospitals. The reality is that our hospitals are completely dependent on these front-line workers. They are putting their health and lives at risk to care for those in need.

The least they should get is a living wage but instead of being paid by this Government, they are expected to pay thousands of euro to the colleges for the privilege of working in our hospitals. In the past, many of them had to work a part-time job on top of working in our hospitals in order to make ends meet but due to Covid-19, they are not allowed to do that for fear of catching and spreading the virus. How then, are they supposed to survive? It is time to scrap the fees for these student nurses and pay them a living wage for their work.

It is interesting that in March, the Government recognised that student nurses deserve to be paid. Under pressure from the unions and the left, the Government offered them the healthcare assistant rate of €14 per hour but that plan was quickly scrapped. The Government is trying to return to the normal scenario of relying on their free labour. Many students are getting nothing and some tell me they get an allowance of €50 per week or so, a rate which amounts to €1.36 per hour. Even the fourth years are only getting minimum wage or less, despite doing skilled work in difficult conditions.

It is worth comparing and contrasting the treatment of student nurses with the treatment of Deputies and Ministers. A Deputy can get a travel and accommodation allowance of up to €650 per week on top of a bloated salary, while student nurses are told they are lucky to get €75 per week in allowances. How on earth can the Government justify this? What exactly is a student nurse who is working away from home supposed to do with a €50 per week accommodation allowance? It is an insult. I imagine that if the Minister of State was told that her accommodation allowance was being cut to €50 per week, she would be up in arms. Why is she not up in arms about the treatment of student nurses? Instead of these insulting allowances, we have to recognise the work that is done by student nurses and pay them a living wage.

We know, and it has been referred to, that over 3,000 healthcare workers got Covid-19. Nurses, doctors, healthcare assistants and student nurses literally put themselves in harm's way in order to help to fight the virus but they did not get the support they needed. Even to this day, the INMO is saying there is not full health and safety protection for student nurses. In particular, it highlights the need for payment if one has to go on Covid-related leave. It is time to listen to the nurses and other front-line workers and provide the support and protections that they need. In reality, it is part and parcel of a Government approach of tackling Covid-19 on the cheap, of doing healthcare on the cheap and of underfunding our public health service as part of promoting a two-tier health service.

I was recently contacted by junior doctors in Tallaght University Hospital who say they are doing shifts of 24 hours or more every weekend at the moment. They say that when the shift change is meant to happen in the morning, the staff simply are not available and it is those who have worked all evening who then have to do the new admissions, which could be 20 people per day. There is a real consequence to refusing to fund a public health service, which includes funding testing, tracing and isolating in terms of Covid-19. We are experiencing our inadequate public health service. As part of trying to build a properly funded, one-tier quality national health service, we must agree to pay the student nurses now.

An Leas-Cheann Comhairle

The Deputy identified somebody clearly and I made a presumption he had that person's permission to do so.

Deputy Paul Murphy

Yes.

Minister of State at the Department of Health (Deputy Anne Rabbitte)

I move amendment No. 1:

To delete all words after “Dáil Éireann” and substitute the following:

"notes:

— the exceptional contribution that nurses and midwives, including students, have made to the Covid-19 pandemic response;

— that this was particularly important during the first wave of Covid-19 due to the high number of hospitalisations and workforce pressures;

— the associated move to temporarily suspend clinical placements with students becoming healthcare assistants and paid accordingly;

— the difference at the present time with lower hospitalisations coupled with a larger workforce allowing for the protection of educational clinical placements;

— recent positive developments for the nursing and midwifery professions, including:

— safe staffing framework;

— enhanced nurse/midwife role;

— review of placement allowances and stakeholder engagement;

— specialist practice roles;

— advanced practice;

— Expert Review Body of Nursing and Midwifery; and

— national foundation education programmes for graduates;

— the importance of continuing to protect undergraduate clinical placements;

— the existing supports for student nurses and midwives on clinical placements, including:

— clinical placement allowance for accommodation of €50.79 per week of placement;

— reimbursement of additional travel costs for placements;

— Clinical Placement Coordinators at Clinical Nurse Manager 2 level (senior grade) with ratios of 1:30 in respect of student nurses and 1:15 in respect of student midwives;

— student allocations officers in all clinical sites;

— trained preceptors on all clinical placements (one per student);

— a 36-week paid internship placement in 4th year, paid at the approved rate, that is €22,229 on an annual basis for psychiatric nursing specialism and €21,749 for all other nursing disciplines and midwifery; and

— four hours per week protected for reflection on practice; and

— the progress for student nurses and midwives on additional supports due to Covid-19, including:

— payment of the Covid-19 Pandemic Unemployment Payment for those working in the health sector who may have lost their employment as a result of Covid-19, including students in these circumstances;

— occupational health supports equal to those for employees/qualified staff;

— weekly oversight, at senior multi-stakeholder level, of clinical placements and any challenges arising;

— a review of placement allowances, inclusive of independent appraisal and stakeholder engagement;

— commitment to early agreement on any potential changes to allowances; and

— new opportunities for students to achieve learning outcomes across a variety of settings, including remote environments and telehealth."

I welcome the opportunity to address the House on student nurses and midwives on behalf of the Minister for Health, Deputy Stephen Donnelly. The Minister has advised that he cannot accept the Private Members' motion and accordingly, asked that I move the Government's amendment on the continued commitment to the education programmes for our student nurses and midwives.

I want to pay tribute to the nurses and midwives, and all their healthcare colleagues, who have continued to deliver care across the system during this unprecedented time. The past nine months have demonstrated, more visibly than at any other time in our recent history, the dedication, skill and commitment of our healthcare workers and I am acutely aware that this was not without risk, particularly for everyone on the front line. There are, as of 31 October, 39,608 whole-time equivalent nurses and midwives working in the system.

I want to explain to the House some of the notable differences between surge 1 and surge 2 of Covid-19, particularly in terms of the response required. There are around 280 patients in hospital with Covid-19, compared with around 900 in April and May. In addition, it is estimated there will be an additional 4,176 staff employed across the health service by the end of 2020, with 991 of them in additional nursing and midwifery posts. Also, the absenteeism rate for nursing and midwifery is currently around 5.6%, which is much lower than the 9% rate in the first phase, which led to a workforce crisis. These combined factors have made a difference in managing surge 2. Fewer senior nursing and midwifery staff needed to be redeployed. Therefore, those who facilitate the supervision structure for clinical placements have largely remained in their roles, providing appropriate levels of supervision in surge 2.

During the first surge of Covid-19, it was not possible to maintain clinical placements for undergraduate students safely. Given the emergency, the students were offered temporary healthcare assistant contracts as an initiative to provide much-needed support for the HSE's response to Covid-19. Given the late stage in the academic year of surge 1, it was necessary to ensure that all students progressed to the next academic year. A mechanism was put in place so that students could gain clinical hours if they worked as healthcare assistants in appropriate care areas. For example, they would work in a medical ward if medical learning was required for completion of a student's course. This was supported by the regulator, the Nursing and Midwifery Board of Ireland, NMBI, the HSE, the chief nursing officer, the higher education institutes and the directors of nursing in each area. Unnecessarily standing down clinical placements at this stage in surge 2, when it is still possible to provide them safely, would have a significant negative impact on the students and their ability to catch up and gain suitable clinical experience. Clinical placements are scheduled throughout the year for each student and with 4,505 students to accommodate in all required care areas, there is little room for flexibility.

Nursing and midwifery offer an exciting and rewarding career. There are many options across a range of specialties for nurses and midwives on completion of their undergraduate programmes. Recent developments in the professions in Ireland include a safe staffing policy with evidence of positive outcomes for patients, staff and organisations. There is also an enhanced nurse and midwife role. Today's graduate nursing and midwifery students can, after one year and 16 weeks of suitable experience, apply for an enhanced nurse or midwife role with a starting salary of €37,161. That does not include those allowances or pay premiums that are also available. I mention advanced and specialist practice, where the policy of the development of the graduate to advance nursing and midwifery practice provides a framework for graduate nurses to draw upon their undergraduate programmes and translate their broad-based experience and knowledge into action.

The recent commencement of the expert review on nursing and midwifery is also an exciting development. It is expected to report with recommendations in 2021 and will be an important milestone in the evolution of the nursing profession in Ireland. We should be proud of the standards of education and practice that exist in this country. We have an excellent educational and clinical infrastructure for undergraduate student nurses and midwives. The purpose of the registration education programme is to ensure that upon successful completion, the graduate is equipped with the knowledge, understanding, professional attributes and skills necessary to practise as a competent and professional nurse.

Student nurses and midwives are not paid for clinical placements in their first three years or in the first three months of their fourth year. This supernumerary status is critical for learning in complex environments and is the optimum clinical learning environment. This places students on the front line in a learning capacity, additional to the workforce and fully supervised, for certain periods during each year of their training. This ensures that students can safely learn, observe and take part in the wide variety of clinical skills acquisition required for qualification. The wording "clinical placement" does not adequately capture the essence of what is required or expected of the students. Clinical placement represents 50% of the undergraduate programme, defined by the regulator, the NMBI.

Placements are essential for the development of skills, knowledge, professional behaviour and attitudes, representing a key component in the undergraduate students' attainment of competence to practice as a registered nurse or midwife.

During each clinical placement, nursing students must achieve all domains of competence and all indicators at the stated minimum level. Levels of competence vary each year and move through a complex learning process, from novice in year one, learning through exposure and-or participation in clinical care under direct supervision, to year four, where students are achieving a level of advanced beginner or competent practice under distant supervision.

I now want to focus on some key benefits of the undergraduate nursing and midwifery programme which, as the Government amendment points out, is second to none. Our four year degree level programme is one of the main reasons that Irish nurses and midwives are in great demand throughout the world. The move to the graduate programme level has created opportunities for nurses and midwives to extend practices and provides the necessary sustained change to operate in advanced and specialist practice roles. To facilitate this, graduate nurses have access to educational programmes that are funded by the Exchequer at foundation, diploma, masters and PhD levels. Paid study leave is also available. New graduates can continue to develop and acquire new knowledge and skills, applying evidence-based practice to real-world situations. This creates an environment that supports expanding scope of practice and the available evidence has shown this results in greater job satisfaction, better patient outcomes and improved service quality.

This year, €2.2 million was invested in new advanced practice posts. This not only creates more opportunities for graduate nurses and midwives to work in integrated care environments, but it also assists in responding to the increase in the complexity of healthcare needs and service reform. Advanced and specialist practice are daily demonstrating important impacts and outcomes for patients, such as timelier access to services, reduced waiting lists, hospital avoidance and better integration of services through enabling nurses and midwives to practice to the fullest extent of their licence.

Earlier this year, in response to the emerging pandemic, health sector management and trade unions, including nurse unions, convened weekly engagements focusing on the matters arising from Covid-19. This collaboration has been key in addressing many of the evolving important issues that were of concern to our front-line health workers, including PPE, redeployment and occupational health and well-being. I want to pay tribute to health sector trade unions and management for this engagement to date and thank them for this important work. Covid-19 is still with us and the Department and I are supportive of management and unions continuing with this forum for as long as necessary.

In March of this year, the Department engaged with the nurse unions on the Covid-19 emergency that was impacting on student nurse and midwife placements due to take place between April and May. Following intensive engagement, the Department and the HSE put in place a temporary arrangement for student nurses to apply for healthcare assistant, HCA, roles while placement was suspended. This temporary measure ended in August. On behalf of the Government, I want to express my gratitude for the contribution made by these students in providing support to our health service in times of acute need.

Yesterday, officials from the Department completed a review of the current placement accommodation and travel allowances for student nurses and midwives. The Minister is currently considering the output from that review and will outline his approach to this matter soon. It is likely that further engagement with the trade unions will be required before this matter concludes. In conclusion, I want to be clear that I do not underestimate the difficulties that student nurses and midwives have experienced over the past nine months.

Deputy Bríd Smith

I first want to note the absence of the Minister, Deputy Stephen Donnelly. We cannot be in two places at the one time but it is a bit of an insult that he is not here this morning to make a statement on this matter.

I want to tell him and the Minister of State that this Government amendment is among the most outrageous and misleading efforts I have seen in years, and it also has enraged the students, who know the reality of their situation. Perhaps the most outrageous idea is that their unpaid work in our hospitals and on the front line is not as important now as it was in April and May. The reasoning is threadbare and flies in the face of the experience of nurses themselves. They are working to plug the gaps caused by the huge strains on our health service now, as they did in April and May. The difference is not that things are much easier now because of better staffing or lower infection levels. The only difference is that now the Government is not paying them anything.

At the start of November, the Government told us a review of the allowances for placements was taking place. This amendment takes the fact that the Government still has not improved the €50 a week as some kind of positive. The sum of €50 is all that is given to these workers. They may have to travel or to live hundreds of miles from home in temporary accommodation, often with huge costs in getting to and from their jobs. It is astonishing that more than 4,000 workers on the front line in the fight against Covid are in this situation. The misleading amendment from the Government gives the impression that its motivation is to safeguard the education of these students. That assertion and the rest of the amendment has enraged those nurses. If the Government thinks a vote here is the end of the issue, it is very much mistaken because this campaign will continue.

I noticed yesterday, as I looked back at the coverage of the strike last year by the Irish Nurses and Midwives Organisation, the abundance of photographs of smiling Fianna Fáil and Green Party candidates pledging their support to the nurses' cause. This betrayal of the next generation will not be forgotten or forgiven by these workers or their families.

Part of this neglect and the outright abuse is because nurses are overwhelmingly women. If we think back over the years to the various strikes and battles that nurses have had, it has always been the case that the fact this was overwhelmingly a female profession meant they had to constantly fight for equality and parity with similar professionals. The last strike in 2019 was centred around that demand for equality with other degree-based professionals. Their treatment then and in previous disputes with governments and the HSE was based on a belief in blatant discrimination and also on downplaying the importance in general of the role of care and the caring professions in our society. It is no accident that these professions are still overwhelmingly female.

Over the years, in the debates in the Dáil, the issue of the treatment of student nurses has arisen time and again. In 1998, 2000, 2011 and 2013, well before the pandemic, student nurses and their representatives had to fight for basic provisions. Mary Harney and a previous Fianna Fáil Government at one stage wanted to remove all payments from student nurses in placement. Others tried to reduce it and, like many other public sector workers, they faced demands for cuts during the austerity years. Time and again, the State has shown a history of contempt and disregard for nurses, student nurses and the caring profession in general. There is a theme in that, for all the platitudes in recent months, nothing has changed.

The most laughable claim in this amendment centres around improved staffing. The reality is that much of this so-called improved staffing is temporary staffing and the increased of use of agency staff. In the October figures, we discovered there are now almost 200 fewer permanent nurses in our health system than there were pre-pandemic. There were 41,572 permanent nursing and midwifery staff working in the HSE last December and this has now decreased to 41,370. There were just 2,289 temporary midwives and nurses working in the HSE in December last year and this had almost doubled to 4,026 by August of this year. We know it was through the Be on call for Ireland plan that many were recruited via agencies, such as CPL, with inferior contracts that exclude proper sick pay and proper access to other standards and conditions. The Government's promise to provide 1,146 additional acute hospital beds cannot run without proper, full-time, permanent staffing levels. The numbers quoted by the Minister of State are temporary and agency staff, and will not address the ongoing staffing crisis in our hospitals.

The Government's treatment of student nurses nearly guarantees a continued haemorrhage of skilled staff from this country in the future. They will leave with bitter memories of their treatment and go to other countries where nurses are given the respect and the pay they deserve. It is not the case that the issue of safe staffing has been resolved.

The reality on the wards is not what is in the Minister of State's amendment, which sounds as if the life of a student nurse is wonderful and that they are able to concentrate solely on their education. They and the INMO know the reality. The Minister of State can stick her head in the sand and pretend otherwise but that does not change reality.

Additionally, we know that the high rate of Covid-19 infections among nurses has continued with 353 healthcare workers contracting Covid-19 between 15 and 21 November alone. The reality of the Government's decision to reopen from level 5 is that when the next lockdown arises we will see even greater numbers of healthcare workers infected. This will place even greater demands on the student nurses the Government is treating with shocking contempt. Its policies on the reopening from level 5 has yet again guaranteed that another lockdown, surge in infections and crisis on our wards is central to paying the price for the failure to wrestle with the virus. Central to that will be the efforts of those student nurses. The Government’s amendment confirms that its treatment of them is, once again, one of contempt. By January, no doubt the Government will be lauding the efforts of our healthcare staff. We will probably clap them again. In dealing with the failure of this Government, its words will ring hollow following its amendment today.

Green Party Members are not here but I wish to speak to them. It has become standard for us over the past number of months to appeal to that party on the basis of it having stood in the election for the desire for change and having stood on the INMO pickets in the past year when it fought for equality and a decent treatment of workers. It professed to support the demands to pay student nurses in March and April, before it entered Government. I am appealing to that party again today. All that has changed from April until now is that that party is in government now. The lives and the needs of student nurses, the vital work they do, the need to pay the bills and rent and to live their lives, has not changed. The Green Party is in government now but if it cannot use that position to advocate for the workers as part of that Government, what is the point in being there? Is it just to get so-called green policies passed that exclude the people who are at the heart of them. If one cannot save the planet other than by abandoning group after group of vulnerable people in our society, there is no point in being in government.

I will finish with a quote from a motion put to a city council recently:

It’s only fair and right that our student nurses are properly recognised and recompensed for the service to our communities during this pandemic. Right across the city we have Covid patients being tended to by NHS staff and their student nurse colleagues. The Health Minister must recognise their efforts at the most challenging of times with fair and proper wages.

I agree with that, and I hope all in this House agree with it, but this is a Green Party motion put to Belfast City Council. Does the Green Party here agree with its colleagues in Belfast? If student nurses in Belfast deserve decent treatment and payment, then student nurses throughout this country deserve likewise.

The Minister of State made a very interesting Freudian slip when reading her speech. She spoke of the nurses being "fully surprised" that for certain periods of the training of each of them that they would get the payment. She meant to say "fully supervised" but fully surprised indeed they are.

Deputy David Cullinane

I thank Solidarity-People Before Profit and Teachta Paul Murphy for bringing forward this motion which is very important. It is an issue many of us have been campaigning on for a number of months. I have had numerous engagements with the Irish Nurses and Midwives Organisation, INMO, and have received thousands of emails from nurses and midwives on a range of issues over the past number of months, in particular on this issue. I also note the solidarity of senior nurses and midwives with their student nurse and midwife colleagues and the overall support for the call that has been made in this motion and in the INMO’s campaign.

The Minister of State’s speech and the Government’s position on this rings very hollow. It is the same old rhetoric from the Government where it will say all the right things, it will clap the front-line workers on the back, tell them that they are heroes and essential front-line workers and that they are doing a great job, but when it comes to action I am afraid the Government is hiding before behind its fine words. The reality is that student nurses and midwives are, and have been, doing an incredible job. Long before Covid-19 came along, pay and increased supports for student nurses has been an issue. It has become more of an issue because of the very significant and exceptional work those on the front line have done during this Covid-19 crisis. Student nurses and midwives, like all those on the front line, have been the glue that has kept our health service together and kept people safe. Hospital managers, consultants and specialists would not have been able to do their job had they not been supported by those student nurses and midwives.

Their demands are very simple. The Minister of State knows what they are and they have been calling for them for some time. The INMO's call is very reasonable. It is that we should pay all final year interns the same rate as healthcare assistants. This should be done without delay. The Government’s amendment again mentions more processes and talks and that it will have to examine this, etc., which is the language the Government uses when it does not want to do something. The reality is that this can be done very quickly. In fact, it was done earlier this year and yet that payment was then removed for fourth year students. That should be immediately reinstated and those fourth year students should be on same rate as healthcare assistants.

The INMO is also calling for an increased and expanded clinical placement allowance for all other students. The Government's amendment to the motion states it will examine, look at, discuss and so forth, but it does not give any commitment. That is what I mean when I say that the Government’s statement and its contribution today rings hollow because this can be done very quickly. The only people who are stopping the Government doing this are the Government itself. If it really believes this issue should be dealt with and that first, second and third year students should have increased and expanded clinical placement allowances, then the Government can and should do it very quickly.

The INMO is calling for a provision of full health and safety protection to all students, including payment if they have to go on Covid-19-related leave. That is not the case at the moment, which I find extraordinary. We all know of the efforts that have been made by these workers over the past number of months. Many of them have experienced burnout given the work and the overtime they have done, and I am talking here about all nurses and midwives, including student nurses and midwives. The enormous trauma they have been through in dealing with a very difficult situation has to be acknowledged and commended but not just with fine words. It has to be backed up by action, substance and firm policy commitments by the Government and the State, saying that we recognise the work they do.

The Minister of State knows what the issues are and what is being asked of her Government. Fourth year interns should be paid the healthcare assistants' rate and first, second and third years should receive greater allowances and not the pittance they are paid at the moment, which is a disgrace. We need more action from the Government.

Deputy Louise O'Reilly

I often hear Deputies in the Chamber declare they have an interest in a matter that is under discussion. I declare my interest now which is that I very proudly represented nurses for a very long time. Usually when Deputies are declaring an interest it is because they own a pub but I am very proud of my work record and to have represented nurses.

I was very cross yesterday to hear the Leader of the Minister of State, Deputy Rabbitte’s party claim credit for the nursing degree. It took a great deal for me not to burst out laughing. We know well the biggest strike this State has ever seen in terms of the number involved and the duration was in 1999 and that it led to the nursing degree and the professionalisation of the work of nurses.

It was not gifted to them by the Fianna Fáil Party. To suggest that it was is quite frankly outrageous. The nurses themselves know exactly where it came from.

As has been pointed out previously, this campaign will not go away. These nurses are strong and they are determined. When I was a kid my granny told me, long ever before I joined the world of work, that if I worked for free, I would never be idle. The Government is asking these students to work for free. It is asking them to go into Covid wards to do the kind of work most of us would not be able to do or would not have the courage to do. In her speech, the Minister of State said we should be proud of the standards of nursing education. Of course we are. We do not need a lecture from her. We are damn proud of our nurses. However, when the Government gives them a round of applause and a pat on the back, that is hardly fair. Would the Minister of State like her kids to work all week for a pat on the back and a round of applause? That is not what I want for my daughter. I want something better.

The Minister of State also said the supernumerary status is critical for learning in complex environments. She is bang on. It absolutely is but these people are not supernumerary. Supernumerary means one is there but not counted as part of the roster. The people in question are actually working and are not supernumerary. They are actually going into Covid wards and working. Due to the state of our health service and its understaffing, they have no choice and have to work. They are effectively on the roster and part of the staffing complement.

Before I came into the Chamber I received this from a student nurse:

I have made sacrifices for my placement. I have chosen to feed my children before myself on 13-hour shifts, paid two rents, walked to and from hospital in the pitch black. I pay for the privilege of propping up an understaffed system.

In an ideal world, they would be only doing all of the learning to which the Minister of State referred but, in truth, they are working. The Minister of State said that our four-year degree level programme is one of the main reasons Irish nurses and midwives are in great demand throughout the world. She is dead right because they are of an absolutely high standard. Many of them are driven abroad by Government policy, however. Successive Governments have made our health service a deeply unattractive place for them to work. Many of them came home to sign up to Be on call for Ireland but they have been treated with nothing but disrespect.

We need these people. If we ever imagined for a moment that we did not need them, the past few months have shown us just how important this core group of workers is. They are the single largest group of workers in the health service. They happen to be predominantly women. It is not an accident that this predominantly female workforce, time and again, find itself at the back of the queue. That is simply not fair.

I urge the Minister to withdraw her amendment to the motion and to support the motion.

Deputy Mark Ward

I welcome the opportunity to speak on this motion on pay and conditions for student nurses and midwives. I thank Solidarity-People Before Profit for putting this important issue on the agenda today.

Members have all stood to give a round of applause to all front-line workers, including in this mutual appreciation, to student nurses and midwives. The Irish Nurses and Midwives Organisation has stated its student members are being exploited during Covid, however. Students on placements in hospitals are facing additional Covid risks and are effectively asked to work as staff for no pay. Many have also faced income loss as they are no longer able to work part-time as care assistants while studying due to the risk of Covid while working in a care home.

Melissa, a student midwife from my area in Clondalkin, is a single mother of two. Melissa, like many single mothers, has not only had to push against but break the glass ceiling in order to improve her and her family's life. She was accepted into Trinity College Dublin to study midwifery, in itself no mean feat. She has had to manage to juggle her kids, her home and her studies. In her first year, Melissa has had to do six weeks' work placement. This has increased to 14 weeks this year. She is expected to be a student, a mother and a nurse all rolled into one. Nursing placements are always tough but Covid has meant they are under incredible pressure. Melissa has had to work on a Covid ward and has had no choice in this matter. She has carried out all duties of a midwife and has been on the front line for 39 hours a week. Melissa receives no allowances or pay for this. She has had to pay her own travel costs and lunches on top of the everyday normal expenses that families have.

The Government has taken advantage of students like Melissa and their dedication to their vocation. Mothers do not stop giving birth during a pandemic. Just when students managed to break through the glass ceiling, the Government managed to put another barrier in their way. Instead of clapping, the Minister of State should put her hands deep down and reach into her pockets to pay these students what they are worth.

Deputy Mairéad Farrell

I commend Solidarity-People Before Profit on bringing forward this motion. It is scandalous that student nurses are not paid at the best of times. It is even more outrageous in the middle of a global pandemic. These student nurses have been central to our front-line response to this pandemic but have been left in financial hardship by the Government. Many students nurses from Galway have contacted me telling me how hard they have had it. One woman told me:

I have done 15 weeks unpaid placement each year. This consists of three 12-hour shifts each week, a total of 36 hours a week. The weeks when I have been on placement were extremely difficult. As the placement is unpaid, I also worked in the hospital at the weekends as a HCA through an agency. The shifts at the weekends were also 12 hours and some weeks I would work 60 hours in the hospital only to be getting paid at the weekends as a HCA.

The only time these students receive any financial support is when they work outside of the area that their college is in. That consists of €50 year a week to cover accommodation. One would not get accommodation with that in many places. For many, that does not even cover the cost of transport, let alone accommodation. One woman told me the best accommodation she could get beside her placement was for €85 a night. This is not even paid weekly but paid weeks later. It is only available if one travels a certain distance from college. Accordingly, in many cases students have been forced to commute from home due to Covid-19 and they receive nothing as this their placement is near the college.

Another nurse told me:

While in my third year, I had placements in Roscommon. The €50 a week did not even cover my train ticket - the bus would not get me there on time. I was getting up at 5.30 every morning because I could not stay up there.

The pandemic means that many student nurses cannot work their part-time job because of the risk of infection. How can they support themselves if they have no income? Some of them have children. How are they supposed to support their families? This is having an untold impact on their health. One woman told me:

Each time I have been put on clinical placement, I have been forced to work 54-hour weeks, 32 hours unpaid on a placement in the hospital and 22 hours in my weekend job. I cannot explain how many times I have considered dropping out because I cannot handle the financial stress.

The Minister of State needs to act urgently.

Deputy Donnchadh Ó Laoghaire

If nurses could be paid in applause and lip service, they would be truly wealthy. The fact is that they cannot. Lip service and applause does not put food on the table, clothe a family or pay the rent. We can call them heroes and thank them for all the wonderful work they do. Unless progress is made on these issues, however, then they are entitled to feel aggrieved.

The allowances some student nurses get vary wildly depending on their university, college or hospital. One nurse got in contact with us to say that her placement in St. Vincent's hospital was €22.70 a week, 62 cent per hour worked. It does not even remotely cover her transport costs, not to mind enough to keep herself.

In the final year of a nursing qualification, student nurses must go on a paid internship. The wage of that internship stood last year at €14 per hour, matching that of the healthcare assistant role. This year the wage has reduced. In the year of Covid-19 it has reduced to €9.48, which is below the minimum wage. One student has been in contact with us to say that:

We are not just students, we are fully integrated into our placements, and despite being a student every patient that I have ever met has called me 'nurse'. One can be sure that this is replicated right across the system. To my patient I am more than just a student, but to our Government I am no more than that.

Nurses are leaving the country when they graduate and this is another thing. Aside from the rights and wrongs of this, which are profound and very obvious, there is the foolishness of this. There is a global shortage of nurses, and Ireland has some of the best qualified nurses in the world. They are of a very high standard. Is it any wonder that they are going to the Middle East, Australia, Canada or wherever they are going at this time when they are treated this way? Not only is this profoundly wrong and not only is this making it far more difficult for people from a background where they do not have money to try to qualify as a nurse, it is profoundly foolish and stupid. It is costing us in the long run. We are losing some of the best nurses in the world because we are treating them poorly and we show them no gratitude. Is it any wonder that they are not staying here? We need to address that for the nurses and for their families, and we need to address it for everyone in this country too.

Deputy Rose Conway-Walsh

I welcome this motion being brought forward by Solidarity-People Before Profit. I absolutely condemn the amendment put forward by the Government. During the discussion this morning I was minded of the time I spent in London. Hundreds of thousands of our nurses were forced to emigrate there, and nothing has changed. All the camogie and football teams there were full of nurses that this country did not want. We are giving them the exact same message now. There is no justifiable reason anyone would oppose the payment of student nurses and midwives who are on the front line during the global pandemic. Because we put a label of "student" on nurses, we think that it is carte blanche to be able to exploit them in the way that we have exploited many other students around the accommodation crisis and everything else that has been done. We should not be here in December trying to shame the Government into doing the right thing.

Student nurses have stepped up heroically. So far, 3,179 healthcare workers have contracted Covid-19. That is more than 7% of all cases. They deserve to be paid for the work they are doing. They need to be paid for the work they are doing. Students on placements often worked weekends at various forms of care facilities. That is how they support themselves through college. Due to Covid-19 they have had to give up these part-time jobs due to the dangers of cross-contamination. The Government comes across as completely out of touch when it does not dawn on it that many of these students need an income to live on. They are not paid. They are unable to learn and on top of this they are expected to pay €3,000 in fees, and often multiples more in rent. We are telling them to give up their job, to work for free, and they still must pay the highest fees in the EU. Yet we wonder why we have problems retaining nurses if this is how they are treated. Something absolutely must be done about this. They are not asking for a handout. They are asking to be paid for the very hard work they do. My colleague was right in saying that nobody calls them students. They are called nurses because of the work they do. I thank them for the work they do, but we need to step up to the mark.

Deputy Alan Kelly

I have been spokesperson on health for several years and have sat in committees with the current Minister for Health. I put it to the Minister of State, Deputy Rabbitte, that it is very disappointing that the Minister, Deputy Donnelly, cannot be here for this debate, considering what he has said in the past on this issue, including having queried why so many of our nurses were abroad and would not work here in Ireland. I would like the Minister to dwell on what he has said on this issue and on the questions he asked in this regard in the past. It would have been good if the Minister was here to listen to what we have to tell him today in querying why so many nurses have left our shores for the UK, Australia, and Dubai. They are, however, still leaving. I have been contacted by people who are going to leave this country again. They came home to fight Covid but cannot get permanent jobs. Some of them are from the Leas-Cheann Comhairle's county. They are leaving again. That is madness. A Government has fundamental problems in this area if it allows this to transpire. The Minister of State, Deputy Rabbitte, might just take this back to Government.

Why are they leaving still? The answer is very much in the attitude of how the Government is replying to this motion. I thank the proposers of the motion. The unions, SIPTU and INMO, have been shouting from the rooftops about this for some time. Nurses are at breaking point. I must declare that a family member is in nursing and I have relations who are trying to become nurses, like many other people here. The nurses are at breaking point. They feel they are not being treated well. Student nurses feel they are being treated diabolically. They are having to act beyond what is in any way normal for a student nurse and they are effectively full-time nurses. They are put to the pin of their collars, being supported by their families to be able to go through this to become nurses. They are putting themselves at risk, many of them have got Covid and many have become very sick.

If this was to be measured against public opinion, I put it to the Minister of State that the public fully believes that nurses and student nurses should be paid appropriately. Student nurses are being treated disgracefully. The work they are doing is slave labour. What the Government is doing to them is morally wrong and morally unjustifiable. It is something the Government could sort our quickly and it would not cost a lot. We are coming up to Christmas. Just sort it out.

I have heard various people say that there is a worry about setting a precedent. There is no worry here about precedent. There is precedent about a whole range of other areas. I do not believe that anyone in the House or any member of the public would have an issue if student nurses were paid appropriately, given the way they have worked during the pandemic. If the Minister of State agrees, then let us make it happen. Why can the Minister of State not do this? The Minister of State did answer me.

They are putting themselves at risk, they have already paid €3,000 in fees for blended learning, and as we know they have had to give up part-time jobs because they cannot put other people at risk due to their work and the chances of getting Covid. Because of this, the process by which they pay their fees, accommodation, transport and everything else is way more difficult because they cannot get additional income. We have made various hulabaloos about how much we support them and recognise them, but coming up to Christmas I believe the Minister of State has only one choice to make.

I will now read out something from a nurse. Let us call her Sarah Jane, because then she will know who she is. She works in the most overcrowded hospital in Ireland, which is University Hospital Limerick, which is the main regional hospital in the area where I live:

The issue of pay is not because we the student nurses and midwives across Ireland are money hungry. The day I walked into nursing I knew I did not want to be anything else. It is a vocation. I have never asked for anything in return. The issue here is fair pay for fair work. In understaffed and underfunded hospitals we carry out many of the same tasks as qualified healthcare assistants, yet we receive no pay for it. Why are we being treated like this by a Government who say they cherish us?

All nurses across Ireland support student nurses like Sarah Jane. Student nurses and nurses who are qualified all support them. This Government really needs to feel the wrath of the nursing community. I say this quite publicly. The Government needs to feel the wrath of the nursing community and the healthcare community in general with regard to how we treat young people, how we are going to be understaffed again into the future and how we are pushing so many nurses throughout the country into actually leaving the State and going to Dubai, America and Britain again.

That is exactly what we are doing. If the Government is not going to deal with this, we in the Labour Party have a plan to make it do so. We will consider that after the vote on this motion.

This matter is unconscionable. As a party that represents workers, we will not stand and tolerate a Government that treats workers like this. It is effectively treating them as second class workers, telling them they have to work the same way as other nurses but will not be remunerated or treated with respect. It is also asking them to put their lives at risk. That is what the Government is doing. In any form of society, that is wrong. It is wrong to treat workers like this and we will not tolerate it. Other countries across the world are acknowledging healthcare staff in some form at Christmas time. It is very difficult to go past words but some form of recognition or remuneration would be helpful to all healthcare workers. However, I am sure many of them would give that up if the Government would deal with this issue now, before Christmas.

Another issue that has come to my attention is that nurses are being asked to renew their membership of the Nursing and Midwifery Board of Ireland, NMBI, for 2021. After everything healthcare workers and front-line heroes have done throughout 2020, they now have to pay for the privilege of working in our hospitals in 2021. Surely it is not too much to ask that this fee be waived. The Minister needs to examine this issue. These people gave up so much during Covid. They gave up annual leave and gave up time with their families in order to provide childcare. They did everything. Surely in the coming weeks the Government can waive this payment, for one year only, as an acknowledgement of their work.

Deputy Holly Cairns

Needless to say, we should not be having this debate. There should be no need for it. We should be paying our student nurses and midwives for the work they do in our overstretched and understaffed hospitals. Students on mandatory placements are effectively working as staff for no pay, which is simply unacceptable. The practical and vocational nature of nursing and midwifery means their education involves working on wards. They are a vital cog in our healthcare system and we need to recognise that. We need to recognise it with more than platitudes and social media posts. We need to pay them for their work.

This situation is exacerbated by the pandemic, as many student nurses cannot access part-time jobs to supplement their studies. Earlier this year, students in first to third year were paid as healthcare assistants for their placement and final year intern students were also paid at this rate. The Government must reinstate this payment immediately and make it permanent.

This motion highlights larger issues in the sector, where qualified nurses with years of experience do not receive pay that reflects their level of work, education and dedication. Responding to my question on the gender wage gap a few weeks ago, the Tánaiste pointed out that gardaí are paid more than nurses, "probably because of this tradition that one was seen to be a man's job and the other was seen to be a woman's job". We have to conclude that this rationale is a factor here as well. Student nurses and midwives are not paid properly or supported because of the occupation’s status. Many caring roles in our society, in which women are over-represented, from childcare to healthcare, are relatively low-paying. This is a sad reflection on our values.

There are no valid arguments for not paying our student nurses and midwives. The Government amendment acknowledges "the exceptional contribution that nurses and midwives, including students, have made to the Covid-19 pandemic response". Why then is the Government not willing to pay them for this work?

Deputy Róisín Shortall

It should bring shame upon the Minister for Health and the Government that our student nurses and midwives are being exploited for cheap labour under the current clinical placement scheme. There is no other way of describing it. This has been a glaring issue for many years now but the severe additional pressure placed on student nurses and midwives this year during the pandemic has brought it even more to the fore, and rightly so. There has been a public outcry over this exploitation. The Social Democrats fully supports today's motion and we thank the Solidarity-People Before Profit group for bringing it forward.

The fact of the matter is that essential work is expected of students on clinical placements, for which they are not duly compensated. That is what this issue boils down to. Major problems have been layered onto that central issue this year, which I will come to in a moment. The issue at the heart of this matter is ongoing and unaddressed and it is about cheap, exploited labour being used to fill essential work. A student nurse who was in touch with me recently said:

We are not just students. We are fully integrated into our placements and despite being a student, every patient I have ever met has called me ‘nurse.’ To my patients, I am more than just a student. But to our government, I am nothing more than that.

Student nurses and midwives work, on average, 15 weeks per year for the first three years of their degree. The students who are lucky enough to receive a clinical placement allowance get a meagre €50.79 per week, while others receive nothing in compensation. Even that €50 per week is nowhere near enough to cover the cost of transport to attend a placement, that is, the cost of going to work, let alone tuition fees, accommodation costs or living expenses. In their final year, these students complete 36-week internships as rostered staff members and are paid €15,056. That is very far below the minimum wage rate.

This is not about pay in isolation. It is also about the fact that these students are expected to fulfil the duties of staff nurses and midwives. Chronic understaffing in our health service has made this the reality for some time now but it has clearly been intensified this year because of our circumstances. Over 16% of Covid-19 cases have been among healthcare workers. The nature of their work has placed them at increased risk and led to higher than normal absences from clinical settings, with students expected to fill those gaps. The Minister has tried to defend the status quo and justified students' lack of pay because the placement is part of their education. This is what a student nurse said to me in response to that:

It is no longer just an education when we are filling staffing gaps, when we are taking up roles unsupervised, or staying back late to help out. It is no longer just an education when qualified nurses and midwives are too overwhelmed, when staffing levels are dangerous. It is no longer just an education when students are breaking down in changing rooms, forced to skip meals to afford transport or rent, or when their wellbeing is compromised.

It is shocking to consider that that is what we are doing to our student nurses. We try so hard to get people to stay in this country after training but is it any wonder we have a difficulty when this is the way the Government treats our valuable student nurses?

It is clear from students' first-hand experiences that this is not a purely academic exercise. They are filling critical roles in our health service. On top of that, the pandemic has prevented many nursing students from holding part-time jobs as they would normally, in particular as healthcare assistants, because of the risk of cross-infection. Students are expected to perform the essential roles and duties of rostered staff. They are severely underpaid and in many cases are not paid at all. Now, on top of that, they are prevented from holding any other employment that would help them cover their daily and weekly costs.

The increased level of pay awarded to final-year nursing students this year needs to be made the standard, but there is still no commitment to guarantee this pay for interns starting their placements this January.

I will conclude by raising the cost of registering for nurses. Given that nurses have been through what amounts to a war zone this year, that so many have contracted Covid and that we have absolutely depended on them to save lives and keep our health service going, the least that can be done is to waive the €100 NMBI registration charge this year. I ask the Minister to consider the points made.

Deputy Seán Canney

I thank the Members who brought the motion before the House. As a Deputy living in and representing Galway East, I have received many letters and emails from student nurses and midwives and their parents and families, brothers and sisters, because we are simply doing something that is wrong. Many of the nurses who have contacted me are young people. They are the youth of our country and our future. They took on the career of nursing because they are young, bright and brave. They want to contribute to our society and to our health service. They are also human and at risk of getting Covid-19. What do we do? We treat them with disrespect, and in a way that says they are different, but they are no different from any other child or young person in the country. They should be treated with the respect and dignity they deserve. They have to pay for student fees if they do not qualify for grants. They must pay for accommodation if their placement is elsewhere. They must pay for the cost of that and the expense of their travel to work. We all know this - the Minister and the Minister of State know it, and the Government knows it. We need to do the right thing. A fourth year apprentice carpenter receives 80% of the full-time rate of a qualified person. I ask the Minister to research that and examine the calculations of that. At the same time, we treat these student nurses with so much disrespect. If we are to retain these people and they are to have respect in government, politics and the health service, we need to ensure we treat them with dignity.

Sometimes the Government can hide behind precedent. We know that precedent has gone out the window with Covid. It is gone because if we have learned anything it is that we have made a call on Ireland to come together and to work together. We are all in this together and the student nurses and midwives need to be there too. We must ensure we treat them with the dignity they deserve.

I ask the Minister of State to tell the Minister for Health to pay the €100 NMBI registration fee as a small token of thanks to all the nurses who have done so much since the outbreak of the pandemic, and will continue to do so. It is a small investment in our future and shows a small bit of respect for the nurses.

I will conclude by referring to the healthcare workers who are paid under section 39. These fully qualified people are working but are not being properly paid. This is another disgrace that we have allowed to exist in society.

Deputy Peadar Tóibín

In March, the then Minister for Health, Deputy Harris, made a promise to student nurses and midwives. Now he is in the Department of Further and Higher Education, Research, Innovation and Science, but he still has influence in this regard. Let us call a spade a spade: when he made that promise, it was nothing but a PR stunt. It was incredible to see that following the announcement, the Minister was trending on Twitter because hundreds, if not thousands, of students were delighted that he had made this promise. What has happened is that the Minister has reneged on the promise. Student nurses were offered employment by the HSE and if they took that employment they were no longer considered student nurses. They were employed directly by the HSE and their work would not count towards their placement hours. The Minister, Deputy Harris, sought to pull the wool over those students' eyes. It was cheap for any Minister to promise to pay someone, especially anyone working on the front lines in some of the most difficult conditions in the State in the middle of a pandemic, and then to renege on that. It was tight-fisted and disgraceful. It was allowed to happen. It might be advisable for Twitter to fact-check the tweets that the Minister, Deputy Harris, puts out because there is no veracity there now.

We need to do right by those students. People who do a hard day's work demand and deserve a fair wage. The standards of the Oireachtas and in this State should be based on decent workers' rights, where a worker who puts in the hard yards is properly paid. If we do not have that standard for students and workers in the health service, we do not deserve that standard ourselves.

The second important issue, which any Minister with a little foresight should recognise, is that one of the key threats to our health service in the last 20 years has been our inability to retain key healthcare workers. It stands to reason that if one treats workers wrong - if they are stiffed on the proper income to which they are entitled - they will find a market or location that will value the work they do and they will move there. As a result, the State will find them very difficult to replace. Over the years, the loss of these key workers has meant the workload on the remaining nurses has become more difficult which in itself drives people out of work.

I ask the House to contrast the radical difference in treatment by the Irish and Scottish Governments. The Scottish Government recognises the work that nurses have done and is giving them a £500 bonus. The Irish Government goes on Twitter, virtue signals, stands up in the Dáil and applauds their work, and then demands €100 from them to retain their jobs for this year. The fact that the €100 is for retention should set alarm bells off in the Government. The Minister should do right by the student nurses and midwives and by the nurses and staff we have now.

Deputy Richard O'Donoghue

On my first day in the Dáil, I spoke about hospitals. I have said that every person training in this country, whether they are an apprentice blocklayer or an intern, should get paid. I ask the Minister to ensure the male and female student nurses on whom we depend are paid properly. They are the people on whom we have depended all our lives, and never more than during Covid-19.

I now turn to the €100 that the Government is seeking from the nurses. I would like to read a small extract from a letter I have received from a nurse:

The disrespect shown to us, especially today has tipped many of us over the edge. If the Irish government had one scrap of decency, they'd pay our retention fee this year.

Every other healthcare worker in the world is being rewarded for working through Covid but once again we're being punished.

A round of applause was all we are worth. Enough is enough.

I and so many more will spend Christmas in work and not with our families ... we sacrifice so much and get absolutely nothing in return.

That is from a nurse. This disrespect from the Government is what our student nurses have to look forward to. The Scottish Government has rewarded its front-line staff with £500 this Christmas, but the Irish Government says "No". Instead they are to be charged €100. That is serious disrespect.

Deputy Michael Collins

I fully support this motion. Nurses, student nurses and midwives have worked hard and deserve better. Their conditions are shocking, especially those of student nurses. I am inundated with emails on this issue from student nurses and their families. They work hard and pay their accommodation and student fees. They are front-line workers. Apparently the best thing the Government can do for them is to clap for them, pat them on the back and thank them. Empty promises and empty clapping are not delivery. The HSE has enough funds. It is top-heavy with managers. It should start dropping managers and direct some of that money to student nurses, who are paid little or nothing for the hard work they have done.

I pay tribute to nurses, who have worked very hard. Many nurses flew home from Australia, America and all over the world because their hearts and souls were in the job of protecting the people they had grown up with. They were very shoddily treated by this country. I pay tribute to the community hospitals in my own constituency at Schull, Castletownbere, Bantry, Dunmanway, Skibbereen, Clonakilty and Kinsale, and to all those working in nursing homes. Nurses and student nurses have worked tirelessly during this pandemic. I make particular reference to Bantry General Hospital.

Every Deputy here has mentioned the €100 registration fee. The Government could at least be seen to do something by waiving that fee. Even though €100 is a pittance, that would have shown respect. The Government should have left the clapping to us and focused on delivering for nurses and student nurses. They do not deserve to be treated like this.

We are losing patience with the HSE. The cross-border directive could be nearing its end and the Government is doing little or nothing about it. Instead it is trying to find ways to make cuts to services for ordinary people.

Deputy Michael Healy-Rae

I have continually condemned the Government and the HSE for their stupid ads and posters saluting front-line workers. I have said time and again that the Government should honour nurses' pay agreements, take care of student nurses and midwives and give them the pay they deserve. People working in the catering staff of hospitals throughout this country have not received a pay increase in 13 years. Moreover, student nurses are charged registration fees. These should have been waived. The young nurses we train feel they will not be adequately paid in this country so they are forced to go abroad. They work in Australia, England, America and around Europe. We want them to be able to see a future and start a family at home. We want them to be near their parents and grandparents. I want to stand up here today and speak on behalf of the student nurses from the county I represent, County Kerry. Student nurses and their parents have been in contact with me to ask me to make a case for them. That is exactly what I am doing today.

I plead with the Minister of State to forget about the posters. I do not want to see another ad paid for by the HSE and the Government saluting the front-line workers. I do not know who dreamt up the stupid clapping. That was probably the biggest insult. Finally, I refer to section 39 workers. I compliment Mr. Donie Doody from County Kerry, who represents the SouthDoc drivers and receptionists who have been affected by the provisions for section 39 workers. These workers have not been paid what they are entitled to and I wish to advocate on their behalf.

Deputy Danny Healy-Rae

I am glad to have the opportunity to support this very important motion. Our student nurses must be treated fairly and with respect and dignity. Electricians, plumbers, mechanics etc. are all paid as apprentices. Student nurses who serve on the front line need to be looked after, respected and paid. I also call for the €100 registration fee to be waived for this year. We should respect the nurses who did so much for the people of the country this year.

I call on the Government to restore parity to section 39 workers. I have also been asked by Mr. Donie Doody and the great workers who operate SouthDoc in Killarney and Kerry to advocate the restoration of their pay. Other section 39 workers whose pay was reduced in 2010 have had their pay restored since 2018. Why are these people neglected? They are preparing to go on strike. It is sad to think that these staff members, drivers and workers, who work late at night and give so much to the SouthDoc service in Killarney, are being left behind. I call on the Minister of State to ensure this matter is rectified immediately.

The risks faced by nurses on the front line must be taken into account. Like senior nurses and all others on the front line, student nurses are putting themselves and their families in jeopardy. They can contract the virus while working and take it home. I am pleading with the Minister of State. This is very important. The Government must restore pay to section 39 workers and respect student nurses.

Deputy Catherine Connolly

I thank People Before Profit, Solidarity and RISE for moving this motion. We have not discussed this matter since the beginning of the Covid-19 pandemic, although we have all raised it through oral and written parliamentary questions and Topical Issue debates. It was an urgent issue from day one. I thank the parties I have mentioned for using their Private Members' time to bring this motion when there were other things they wished to raise.

The Ministers of State, Deputies Butler and Rabbitte, have been sent into the fray when the senior Minister should be here to discuss this issue and many others. His absence is not acceptable. I have said this before. The Minister of State, Deputy Rabbitte, sat here all morning, and the Minister of State, Deputy Butler, is here now. I welcome their presence, but in view of the importance of this issue and its background, the senior Minister should be here.

Speaking of background, I spent ten years of my life on a regional health forum. I saw the public health system systematically undermined while every effort was made to further the private system. There is a background to this situation. Time does not allow me to deal with all of that and it is not necessary to do so. I will mention some snapshots of the situation in 2019, just before we went into Covid-19 with a health system that was not fit for purpose. As a result of this situation, the Government took actions which made things worse for people on waiting lists for operations. Our public system was utterly unfit for purpose following actions taken by various governments.

Irish hospitals were already working at almost full capacity. According to figures from the OECD, Ireland had a hospital occupancy rate of 95%, one of the highest in the OECD. This was about 20 percentage points above the OECD average of 75.2%. In other words we had very little spare capacity. As a consequence, dreadful decisions had to be made to keep hospital beds free and an agreement was made with private hospitals to leave their beds empty.

I can pick any statistics but I will pick only a few. By the end of November of 2019, just a few months before Covid, we had seen the highest number of patients on trolleys in any year since records began, with more than 100,000 people having gone without beds in the year to 29 November. According to the INMO, in 2019 there were 1,157 fewer nurses and midwives working in the HSE than in 2007. Some 40,000 nurses went on strike in 2019 over pay and staff shortages. According to the INMO at the time, and indeed some clinical directors of various hospitals, the dangers of overcrowding and chronic understaffing put patients at grave risk.

That was the background leading into Covid. Today we have a speech that I doubt the Minister of State, Deputy Butler, or the Minister of State, Deputy Rabbitte, wrote. It is five pages long and disingenuous in the extreme. It does not deal with the issues or the very brief request set out in the motion. The first page of the motion text is long but the second page has simply three very basic requests. The Minister of State's speech refers to excitement. It states: "Our four year degree level programme is one of the main reasons that Irish nurses and midwives are in great demand throughout the world." It refers to the "exciting" career of nursing and midwifery. I agree with that and I agree that nurses and midwives are in demand, but these five pages fail to explain why our nurses and midwives are in such demand throughout the world but not in demand in their own country. Surely at least a page of this speech might have focused on what we need to do to pay our nurses adequately while they are training and following their training, how we might retain them, and what package of actions are necessary for us to be able to cherish them.

I felt embarrassed about the clapping. I clapped for the nurses on two occasions. I did so with some shame. The hollowness of my clapping and all our clapping was deafening because at the same time we were in receipt of constant representations from nurses and student nurses who were not really being protected. There was the whole debacle over the protective gear and so on. They carried a huge burden without any payment. Then for a little while we brought in some payment for them and then took it away again, ostensibly because the situation had changed. The situation has not changed. It has changed to the extent that we are not using as many intensive care beds and there are not as many in hospitals, but we will face, as the Minister of State well knows, another surge in January or February.

What is being asked for here is a temporary Covid-related measure, as I understand it, and Covid is still very much with us. We talked about €18 billion in extra funding going to businesses and other organisations, and rightly so, but not to the student nurses and nurses on whom we depend. Any study in psychology that I ever read or looked at in a previous life showed that people got better more quickly as a result of interaction between nurses and the patient. I might add the porters and cleaners as well, whom we should treasure much better. That was the greatest predictor of a patient getting better, not the actual doctors. I pay tribute to them as well but they were not a predictor of patients getting better.

There are a number of practical problems here. The nurses could not work outside because they could not risk the spread of Covid when they went back into the hospital so they were deprived of that source of income. "Sorry" is the wrong word. Deputy Butler is a Minister of State. It is the senior Minister who should be in here looking at this and not giving us a five-and-a-half-page speech telling us how exciting this career is. We have listened today to all the contributors. Excitement is not something at the forefront of nurses' minds. They are trying to cope with Covid, struggling with mortgages and trying to raise children in a career that is not valued, despite the fact that they have degree status. I am not putting that forward as something that gives them status, but they wanted those degrees and worked for them themselves. We are not giving the right recognition to nurses at any level but today we are looking at giving them, during Covid, the payment they deserve.

Minister of State at the Department of Health (Deputy Mary Butler)

It is clear from the debate that Members right across the House share a gratitude and pay tribute to the student nurses and midwives and all their healthcare colleagues, who have provided and continue to provide care across the health service. All nursing and midwifery students, from first year to fourth year, have returned to full-time student capacity since the end of September. The final year interns will commence their 36-week clinical placements in accordance with the agreed pay and conditions of those placements. These students have agreed learning objectives to ensure that the final stages of learning remain supervised and supported. As the Minister of State, Deputy Rabbitte, explained earlier, while Covid-19 remains a presence affecting all health services, so much more is known about the virus now than was known at the beginning of its first surge. This is clear in the number of Covid-19-positive patients who currently require acute hospital care. All healthcare workers have access to PPE. While Covid-19 remains a serious threat, the situation now is not as it was in March. This has affected the management and deployment of healthcare workers.

Irish nursing and midwifery graduates are in great demand nationwide and worldwide. A main reason for this is our four-year degree programme. The clinical placement in the fourth and final year of study focuses on the development of skills, knowledge and professional behaviours for our future nurse and midwife graduates. An important element of the clinical placement is the four hours per week during which the student reflects on his or her placement. There are many opportunities for graduate nurses and midwives to further their careers by way of further education programmes that will develop their skills and knowledge. Additional funding of €2.2 million will provide for additional advanced nurse practitioners and advanced midwife practitioners. The numbers employed in these grades are continuing to increase.

The nursing and midwifery career path in Ireland continues to evolve. The Minister of State, Deputy Rabbitte, outlined many of these developments earlier. The expert review on nursing and midwifery is expected to report in 2021. I am sure that the recommendations of this report will provide the future roadmap for the development of the nursing and midwife professions.

It is important that proper engagement remains between health sector management, the student nurses and midwives and their representatives. Covid-19 has an impact on how we all do our work, but this is particularly true of our student nurses and midwives and all our healthcare workers. Such engagement will assist in addressing concerns as they emerge.

I again commend the student nurses and midwives on the role they provided when the pandemic struck the State. The way in which all of us live our lives has changed. The pandemic has shown the importance of supporting the work to protect our student nurses and midwives and their graduate education.

I have listened intently since arriving in the past hour to every single contribution that has been made and it has struck me that every single Deputy has raised the annual retention fee for the nurses. This €100 is the annual retention fee for the professional register and is part of being a regulated professional. I have taken plenty of notes and I will bring those thoughts back to the Minister. As I said, every single Member I have heard has raised the issue of the registration fee and how the nurses feel it is unfair after the effort, the work and the commitment they have shown over the past seven or eight months and the fact that they have really put their shoulder to the wheel. I take on board every point that has been made and I will feed those points back to the Minister.

Deputy Richard Boyd Barrett

I thank all those Deputies who rose to support the motion tabled by People Before Profit and Solidarity in support of the students and midwives and our call that they should have the healthcare assistant rate they were given earlier in the pandemic restored and that, more generally, they need to be paid for their placements because it is work, not simply education. The fact that they have to pay fees for the privilege of being exploited on the wards and while working on the front line, not just during the Covid pandemic but, more generally, while playing a role in holding our entire health service together on an ongoing basis, is an absolute scandal.

I do not say it lightly, but the absence of the Minister for Health, Deputy Stephen Donnelly, from the Chamber during a debate about thousands of student nurses and midwives who have protected us all, put themselves in harm's way and fought on the front line during this pandemic is nothing short of an insult. The speeches of the Ministers of State, Deputies Rabbitte and Butler, which were almost in the realm of fantasy in terms of depicting the reality of the work of student nurses and midwives and their role in the health service, were an insult. The amendment tabled by the Government is an insult. It all really exposes as the purest hypocrisy and as totally hollow and disingenuous all of the applause and praise the Government parties heaped upon student nurses and midwives earlier in the pandemic.

The decision to refuse the request of student nurses and midwives to pay them for their work has shown that the applause and praise meant nothing. It is a direct breach of a promise and commitment made by the Taoiseach on 20 October. I raised this issue with him on foot of conversations with Phil Ní Sheaghdha of the INMO, who brought it to my attention, and then with thousands of student nurses and midwives who contacted me and with whom I have held Zoom meetings and so on. I raised the matter with the Taoiseach and said it was completely unacceptable that the healthcare assistant rate that was given to student nurses and midwives in the early part of the pandemic - under pressure, it has to be said, from the student nurses and midwives and their unions and so on - was being removed. The Taoiseach agreed that it should be restored. He has since rolled back on that promise.

The Government amendment provides outrageous excuses for breaking that commitment and refusing to pay student nurses and midwives and show them the respect they deserve. The arguments put forward by the Government in the amendment are threadbare. They could be summed up as stating that the Government's refusal to make this payment is justified on the grounds that Covid is not as bad as it was in the early period of the pandemic and that the Government is protecting nurses' education. It is almost Orwellian doublespeak to suggest that is why the Government is not paying them. The amendment states this is justified by the great improvements the Government is apparently making in staffing levels in hospitals as well as supposedly reducing the dependence on student nurses and midwives to hold wards and healthcare settings together. Of course, the other excuse is the wonderful opportunities that exist for student nurses as a result of reforms and improvements the Government has made.

Rather than going through why I think the Government amendment is nonsense, disingenuous, hypocritical and fanciful, I would like to speak about Zara, who is one of the hundreds of people who have written to me or attended meetings as part of our recent "Behind the masks" online campaign. She read the Government amendment and her response to it covers most of the points I would seek to make on it. She states that the point the Government is making in the amendment is an absolute joke. She is a second year general nursing student who just finished a two-month placement last week. While she was on her placement, she and one staff nurse were responsible for 12 patients on multiple days. The ward did not bring in a healthcare assistant to work in the area as there was a student there. She states that to say there is safe staffing and that the Government is protecting the education of student nurses and midwives is an absolute joke. She makes that point that they are expected to work with Covid patients for free. While she was on placement, three wards in the hospital had Covid outbreaks and were shut down. Approximately 100 staff had tested positive for Covid in the hospital and her ward was turned into a Covid ward. She believes it is laughable for the Government to insinuate that because there are fewer hospitalisations now than in the first wave, there is no risk involved in student nurses and midwives working with Covid every day for their education. She also points out that most student nurses and midwives do not even get the miserable €50 allowance for accommodation which, in any event, would not go next or near to covering the cost of accommodation. As one student nurse put it, it literally would not cover the cost of a cardboard box.

I would like to refer to another heart-rending story of the many that I received. I will not mention a name in this case, which involves a lone parent with four children who had been homeless during her training. She did her unpaid placement in her third year, during Covid. She had to give up her job to do that placement and has subsequently had to drop out of her nursing course because of the cost of fees. She also got Covid-19. This is just scandalous. It is shocking beyond belief.

Áine, another student nurse, has said that they are not there purely for education. She has spoken of how they work 13-hour days as part of a team, taking on their own caseloads to cover staff shortages. She suggests that if those in government set foot in any public HSE hospital in Ireland, they would see that for themselves. She argues that student nurses and midwives should not be used to replace staff nurses if they are not being paid. The stories go on and on. I do not know who wrote the speeches of the Ministers of State but, as Áine said, it is clear that the person in question is either uninformed or is deliberately misrepresenting what is going on in hospitals not just during Covid but all of the time, including pre-Covid, in terms of the roles that student nurses and midwives are playing.

During one of the online meetings I had with the student nurses and midwives, Sarah said that when she is finished her training she would not work for the HSE in a fit. She said that she is leaving. One after another, the nurses and midwives echoed that sentiment. The point was borne out by a survey carried out by the INMO in 2018. More than 70% of the student nurses who took part in the survey said they intended or were likely to leave because of the terrible conditions and the experience of burnout. They also pointed to the direct impact of the work that is imposed on them during their education as contributing to that burnout, as well as the conditions they have to face as nurses when they are qualified.

Deputy Kelly referred to the emails that have been received today regarding the €100 registration fee for the NMBI. For nurses and midwives to be again asked, in the midst of a pandemic, to pay for the privilege of going in and working on the front line, endangering their health, is truly an insult. Is it any wonder that there was an enormous strike by nurses and midwives over the issue of the inability of the HSE to retain nurses and midwives who we need desperately? In the face of the pandemic, we need them now more than ever, but they are leaving in their droves because of the terrible conditions they face. Student nurses and midwives have to pay from €3,000 in fees, and up to €7,500 if they have previously done another degree, for the privilege of being exploited. It is shocking.

As many student nurses have pointed out, there is no doubt that if this was a majority male profession, they would not be treated in this way. There is a deep gender bias in this treatment of student nurses and midwives and their exploitation and it has to end.

I can tell the Minister of State, Deputy Butler, who is present, that the Government and the Government parties have engendered the fury of tens of thousands of nurses and midwives, as well as their healthcare colleagues, over the treatment of healthcare workers and student nurses and midwives during Covid and more generally, as well as over this insulting amendment. I appeal to the Government to withdraw the amendment.

The Government must end this exploitation by paying students nurses and midwives what they deserve for the critical role they play. I ask the Government to treat our healthcare workers properly and stop making them pay for the privilege of providing a service to our society and our health system by imposing extortionate fees on them.

Amendment put.

An Ceann Comhairle

In accordance with Standing Order 80(2), the division is postponed until the weekly division time tonight.

Dáil Éireann debate - Wednesday, 2 Dec 2020

Pay for Student Nurses and Midwives: Motion [Private Members]

Dáil Éireann debate -
Wednesday, 2 Dec 2020