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

I move:

"That Dáil Éireann:

notes that:

— the Government has commissioned two reviews of the pay of student nurses and midwives;

— the first review on pay for placements during the Covid-19 pandemic was completed and its main recommendations were published on Raidió Teilifís Éireann (RTÉ) before the report itself was published or issued to members of the Oireachtas; and

— the second review has yet to be concluded;

recognises that:

— there are more than 4,500 student nurses and midwives who must complete clinical placements which require them to work 12-hour shifts for no pay;

— student nurses and midwives regularly perform real work on wards, which is not recognised by the Government or formally recognised by the Health Service Executive;

— this work is not formally part of their degree but is necessitated by the chronic understaffing across the health service, and that students plug the gaps left by a failure to invest in safe staffing levels;

— this practice has led to student nurses and midwives, as well as other students, such as radiography students, performing pandemic-related work which places them in regular contact with Covid-19 positive patients and requires them to work on Covid-19 wards; and

— the €100 per week payment offered by the Government is inadequate and does not reflect the current reality in hospitals; and

calls on the Government to:

— immediately publish the Collins review of student nurse and midwife pay during the Covid-19 pandemic, which has been partially leaked to the media;

— immediately reinstate the March agreement as provided for in the review for students performing pandemic-related work to ensure that they are appropriately paid for their work on the frontline for the duration of the Covid-19 pandemic;

— urgently advance the second review to be conducted on the allowances of student nurses and midwives to ensure that new allowances are in place by the end of the

Covid-19 pandemic; and

— expand the second review to ascertain the extent to which students performing work in hospitals beyond the requirements of their degree occurs, and to ensure that where this occurs it is appropriately compensated."

This motion is about fair, reasonable and sustainable rates of pay and allowances for student nurses and midwives. I first raised this issue with the Minister for Health on the floor of the Dáil in July 2020. I raised it again in September, October and November. As the Minister is aware, other Members also raised the issue and brought forward a Private Members' motion, which was voted down and against by his party and colleagues in government.

I want to say from the outset, so that there is no confusion, that my party is not seeking to change the current model of education and training for student nurses and midwives. It is a model that serves us well. In my view, we turn out some of the best and most hard-working student nurses and midwives, who are the envy of the world. The problem is that they do not feel respected or valued. I have engaged with hundreds of student nurses and midwives over the last number of months. I have listened, at first hand, to what they have told me. To be clear for the Minister, they understand that there is an element of training, education and supervision to their placements. However, as the Minister is aware, they also understand and know that when they step onto a hospital ward, there is a strong element of work. They are doing real work and they want that to be respected and valued. They want the Minister to put fair and reasonable solutions on the table. What the Minister has put on the table so far has been completely unacceptable. An allowance of €100 per week for first, second and third years has been quite rightly been regarded as a slap in the face and far from adequate. It is not fair and reasonable. That approach should be contrasted with the approach the Minister took in respect of the most senior civil servant in his Department. He sat down with two of his ministerial colleagues and hatched a plan to give that individual a pay rise of €81,000 upon the post becoming permanent. I am not referring to a salary of €81,000 but to a pay rise of €81,000, bringing the individual's salary close to €300,000 a year. How can the Minister say that is fair and reasonable, and shows that he values the work that those on the front line, including student nurses and midwives, do in our hospitals?

How is that fair? Student nurses and midwives are looking at this, as are others, and they are saying that what the Minister did over the past number of months is prioritise that individual over the needs of the thousands of student nurses and midwives who have done such huge and Trojan work in our hospitals since this pandemic struck.

I want to outline to the Minister some of the experiences that have been recounted to me by those student nurses and midwives. One of them said:

I was diagnosed with Covid-19 during my placement. I had to put my entire family at risk because of the work that I do. For all of that, I got nothing. An allowance of €50 per week and a travel allowance of 25 cent a mile paid two months after placement finished or, if you lived close by, nothing at all.

Another told me:

It is ten months since I got Covid while working for free and I am still not better. I will either emigrate or return to college because it is not worth working as a nurse in this country.

I want the Minister to listen to those words because they show why this motion is so important. If we do not value the work that student nurses and midwives do, they will leave. We are putting them through what is, as I said earlier, one of the best training and education programmes in the world, yet they are leaving in droves because, they are telling me, they do not feel valued and respected by the Minister and the Government.

This is an issue that should not divide us. It is an issue on which this House should be united that we do what is right, that we right a wrong here and that we make sure we pay student nurses and midwives reasonable and fair rates of pay and allowances. That is all they are looking for. I am calling on the Minister to support this motion. I am calling on him to do what is right. I am calling on him to send a powerful message to student nurses and midwives that we want them to stay here working in the Irish healthcare system, not emigrating, and that we value the work they are doing on a daily basis. I ask the Minister to listen to and support this motion.

It is time now to pay student nurses and midwives. A payment of €100 is an absolute insult to the hard work put in by student nurses on the front line. Student nurses and midwives did not go into hiding when they were called upon. They have put themselves at daily risk for the common good. They have gone above and beyond what they were asked to do. These students were working, they were needed to work and they should be paid for working. It is as simple as that. The €100 the Government has offered will not cover transport, lunches or childcare. It is an insight into how the Government values our student workers, and workers is what they are.

As Deputy Cullinane said, it is no wonder that so many are leaving our shores once they qualify. This is about fairness and €100 is an insult and just will not cut it. The decision to pay student nurses and midwives lies with the Minister for Health but the Minister for Further and Higher Education, Research, Innovation and Science, Deputy Harris, is also responsible for protecting students from exploitation. The two Ministers need to step up to the plate and pay student nurses and midwives now. There should be no more empty promises and no more delays. If my colleague, Deputy Cullinane, was Minister for Health, I have no doubt that he would pay student nurses and midwives now. The decision to suspend placements for student nurses is just another attempt to kick this issue down the road and muddy the waters. I spoke with students in my own area in Dublin Mid-West and they tell me that suspending student places does not make sense during a staffing crisis.

This motion also includes students who are performing essential pandemic-related work in hospital settings. This includes student radiographers, one of whom told me:

Every student radiographer, while on placement, has been face to face with Covid patients from day one. The first thing a Covid patient gets done when admitted to hospital is they get a chest X-ray.

Every day, our student radiographers go into Covid ICU units to take X-rays and they also take CT scans and assist physicians in ICU units if their assistance is required. We believe that any student performing pandemic-related work in hospitals during the Covid-19 period should be paid appropriately.

The initial review commissioned by the Minister falls short of the expectations and needs of student midwives. Moreover, the Minister chose not to examine the circumstances of other students who work in hospitals. We need to pay these student workers now. We need to do it without delay. We need to stop making excuses and get on with the job.

I urge all Deputies in the Chamber to support the motion and, for once, to put their money where their mouths are. Student nurses and midwives, along with everyone else who works in the health services, do not want us standing up in the Chamber clapping. That is actually an insult to them. It is patronising and demeaning. What they actually want is fairness and respect.

The situation has not been good in our hospitals in recent years. That is due to the under-investment not only of this Government but of previous Governments as well. It has become far worse since Covid-19 - we are all aware of that.

For me and my colleagues in Sinn Féin this is an easy and straightforward decision. It is about fairness and respect. A sum of €100 is an insult and will not cut it. Where students are needed to work, they should be paid. The decision not only lies with the Minister. There is a responsibility on the Minister for Further and Higher Education, Research, Innovation and Science, Deputy Harris, too. Ironically, he was the Minister for Health before the current Minister and, of all people, he should know about this situation and should be well aware of it.

We cannot see any more empty promises or delays in respect of this. I wish to take this opportunity to make a point in respect of the health services. The staff are exhausted and at breaking point, if they have not already gone past that point. If our colleague, Deputy David Cullinane, was the Minister for Health, he would ensure that student nurses and midwives were paid. It is a reality that our hospitals were understaffed badly before the pandemic. We simply could not function without the valuable work the student nurses and midwives do. No one wants to put students at risk but the Government has been failing to invest in health, has failed to put in place enough staff and has failed to keep this virus under control as a result. Throughout the pandemic, student nurses and midwives have been working bravely and tirelessly every day to protect our families and community from Covid-19.

I will finish because we are tight on time. People are sick of talk, promises and claims from those who say they have sympathy and empathy for others. They really want to see action. For once, I appeal to the Minister to ensure he does the right thing.

The strength of our response to Covid-19 has been the concept of solidarity. It is a concept we have seen in every community throughout the country. However, it is a concept that appears alien to Government. We are in a situation now where Deputy David Cullinane has to bring a motion before the House. It is the second motion relating to the demand, request and plea that student nurses would get paid for the work they do.

That we are even discussing the motion at all is incredibly disappointing. That we are discussing it in a week when Government is defending its decision to increase the salary of the Secretary General of the Department of Health to €292,000 per annum shows how perverse Government thinking is. The proposed salary for Robert Watt marks an increase of €81,000. That is more than front-line workers get paid in totality. Let us compare that with the offer that is apparently being made to student nurses of €100 per week for the work they do. After all the testimony we have heard and the reality they have spelt out to us an offer of €100 per week is insulting, patronising and really sums up this Government. People may wonder why our newly-qualified nurses are found in every corner of the world and treasured by almost every other health service in the world. It boils down to one thing: lack of respect.

The Minister for Health, Deputy Donnelly, defended the proposed increase in Robert Watt's salary by €81,000 to €292,000 per annum. His logic is incredibly interesting. He says that this pay hike is in recognition of the unique challenges and significant responsibilities attached to this role. That spells and sets it out in the clearest possible terms.

This Government, the Minister and the leaders of Fianna Fáil, Fine Gael and the Green Party recognise the unique challenges and very significant responsibilities of bureaucrats and officials but do not recognise the unique challenges and significant responsibilities that have been undertaken by the front line of the front line, our student nurses and midwives.

I commend the motion to the House, I commend Deputy Cullinane on tabling it and I beg and plead with every Member of the House to stand by those who have stood by us.

Can Members imagine getting a pay rise of €81,000? That is two or three wages for most working families. It is the amount the new Secretary General of the Department of Health can look forward to. That is the shocking backdrop to any debate on pay for student nurses and midwives. Three Ministers went off by themselves, colluded, if you like, ignored existing pay structures and agreed State mechanisms and then decided among themselves that someone earning well over €200,000 was not being paid enough and agreed collectively to give him an increase of €81,000. At the same time, the Government of these three wise men says student nurses are worth only €100 per week. The Secretary General's pay rise alone would cover a student nurse for almost 16 years if the Government got its way.

The lack of respect and appreciation this Government has and the Fine Gael-led one before it had for our healthcare workers is staggering. The Government drove nurses out onto the picket line in 2019 and its attitude has not changed one iota since. We have a broken system that depends on students stepping into danger to fill the gaps caused by colleagues falling ill to Covid or having to self-isolate. We have a Government that demonstrates a complete lack of compassion, understanding and gratitude. Student nurses and midwives should not be seen by the State as cheap or free labour but they are and always have been. We know it has always been this way but, again, that is no reason to allow an unfair and exploitative system to continue. If this Government thinks handing a gift of €81,000 to a Secretary General who is already on more than €200,000 is okay and then expects student nurses to survive on €100 a week, then it has a problem and clearly does not live on the same planet as the rest of us.

In 2019 nurses kicked off and went on strike. The then Taoiseach, Deputy Varadkar, said, "We are happy to find that money in the Budget because we want to pay our public servants better, but there is a limit to what we can afford." Clearly, he was referring to those on the top of the pile and not to those on the front line who look after our sick and our vulnerable. Shame on him.

I too thank Deputy Cullinane for bringing forward this motion. It is often said that nursing is a vocation, but this pandemic has proven this much more. I have been contacted by many student nurses over recent months and the stories I have heard are shocking. Many student nurses work for free during the day and then work nights and weekends as care staff to pay for their fees and expenses while they are on placement. While they work in hospitals they might receive up to €50 per week if their placement is far enough away from their university. This is not enough to cover bus fares and lunches, let alone other expenses. Our student nurses are burnt out and this Government has the cheek to say they do not do real work. They have held the hands of the sick, the lonely and, sadly, now, the dying.

I sometimes get anxious when I see the number of cases, which is high at the moment. Our death toll is particularly high. Although I have heard many harrowing stories, I can only imagine how anxious those on the front line must feel. On top of that, they have to worry about passing on the virus to their loved ones, all the while trying to make ends meet. One student nurse told me recently that while helping a patient to shower, the patient's toe came off in his sock. The student nurse was on her own and could not leave the patient alone. She had to finish the patient's shower and then find a nurse to seek help. I ask the House to imagine that and to imagine she does not get paid for that. Another student nurse told me how they were left alone, without care staff, to dress and lay out a deceased patient to give the person a little dignity in death.

The Government thinks that the nurses do not deserve to be paid.

Many families have also been in contact and have told me about the difference that our student nurses are making. One family told me of the lengths to which one of these student nurses went, by staying behind after work to help a patient to unlock a phone SIM card that had somehow become blocked. The student nurse restored the family's only way of communicating with their father because no visits were allowed and they had not seen their father since he had been recently diagnosed with cancer. As far as this family is concerned, these nurses are angels.

Finally, I commend the work of the Muiríosa Foundation, based in Moore Abbey in Monasterevin in County Kildare. It has a long and proud history in assisting service users and their families in the area of intellectual disability. Each year, their students undertake 70 placements. They and all of our student nurses need proper pay and terms and conditions. We do not want any more token gestures or false promises. Enough is enough. It is time to do the right thing and it is time to pay our student nurses. I ask all Members to support this motion.

Táimid ag dul ar ais go dtí an Rialtas. Tá deich nóiméad ag an Aire.

I welcome the opportunity to address the House on student nurses and midwives. I would like to take this opportunity to thank all nurses and midwives, and indeed all healthcare workers, for their dedication and commitment as we continue to deal with the Covid-19 pandemic.

I begin by noting that nursing and midwifery have been graduate professions in Ireland since 2004. It is important to focus on the benefits of our undergraduate nursing and midwifery programme, which is second to none. This degree-level programme is run over four academic years and offers the full student experience. Unlike the UK and other international graduate degree programmes, it includes an internship period with a salary for the final 36 weeks. The programme supports the optimal learning environment where students actively take part in patient care while building competence throughout each stage of training.

Student placements in our hospitals are a vital part of nursing and midwifery education. They enable students to develop the practical knowledge, clinical skills and professional behaviours required to attain competence to qualify and be eligible to join the professional register. As students rather than employees, clinical student placements ensure learning takes place on the front line in a supervised and protected environment.

Student nurses and midwives gain practice experience under the supervision of a registered nurse or midwife. The move to the graduate programme has created exciting and attractive career opportunities for nurses and midwives. Graduate training has enabled extended practices and provides the necessary sustained change to operate in advanced and specialist practice roles. The evidence shows that those opportunities have been seized in the intervening years and this is very much a tribute to all of those involved.

I am sure that every Member of this House will agree that Irish nurses and midwives are internationally sought-after graduates. This is a testament to the very high standards of the graduate education programme. I have engaged directly with group directors of nursing and midwifery in the HSE. I was heartened to see how important student education is to the group directors and how connected they are to the placement sites. Every site has a joint working group between the higher education institution involved and the placement sites. There is student representation on these groups. This allows for feedback so that local issues can be resolved speedily and efficiently. It also allows for feedback up to the level of group directors, if necessary.

Students also have access to their mentors, to clinical placement co-ordinators and to higher education institution, HEI, personal tutor support throughout the placements. Since the beginning of the pandemic, a national clinical placement oversight group has been formed to monitor the safe continuation of clinical placements during the Covid-19 pandemic. The remit of this group involves developing solutions to minimise the impact of any deferrals, delays or suspensions on students' academic progress.

There is no doubt that training for healthcare students during a pandemic is challenging. Recognising these challenges, I secured additional supports and protections for student nurses and midwives. This includes specific access to pandemic unemployment payments and additional occupational health supports equal to employees while on clinical placement. Student nurses and midwives also have access to appropriate training and occupational health support on the sites in which they are learning.

I was happy to see our student nurses and midwives being vaccinated this week. They are, of course, included in the priority group.

To assist student nurses and midwives while on clinical placement, I appointed Professor Tom Collins to carry out an independent review of clinical placement allowances. I received his report on 31 December. Its key recommendation is to implement a pandemic placement grant of €100 per week for each supernumerary placement week during the pandemic. I have accepted the recommendations and I am keen to progress this additional support. I would also like to see it backdated to the beginning of the academic year, which was last September.

My Department and I are closely monitoring the Covid-19 situation nationally, including the context of its impact on student nurses and midwives. The oversight group, with representatives from my Department, the higher education institutes, the Nursing and Midwifery Board of Ireland, NMBI, and the HSE, is meeting weekly. Student representation is included as an important source of feedback on the experience of clinical placements in the current situation. The primary focus is to ensure that the education of students is safe and protected to support progression.

Following a request from the HSE on 15 January to release senior qualified staff to provide direct patient care in the current Covid-19 surge, supernumerary clinical placements were suspended for first, second and third year student nurses and midwives for at least two weeks from Monday, 18 January. The request was directly related to the increasing demand on care and critical care and the requirement at this time to maximise the number of qualified staff available to assist.

My Department is working with the HSE, the higher education institutes, the NMBI and clinical partners to ensure that students will not be disadvantaged in completing their educational programmes. I want to protect their status as students and protect their graduate programme, which has delivered many benefits. This week, we have shown, through the necessary decision to suspend placements, that to protect the educational aspect of placements, we will not allow them to continue when support structures are not in place.

I do not underestimate the difficulty that student nurses and midwives have experienced in the past ten months. Without question it has been a difficult time. In conjunction with the HSE, the higher education institutes, the NMBI and clinical partners, my Department and I will continue to focus on keeping our students safe and ensuring that their academic progress is not unduly impeded.

I commend my party colleague, Deputy Cullinane, on tabling this motion. It is a disgrace that we are here again debating student nurses and midwives getting paid. I raised this matter in the Dáil last March. It took us weeks before we could get the then Minister for Health, Deputy Harris, to acknowledge the work that student nurses and midwives were doing on the front line. He put in place a payment for them. The then Taoiseach also recognised that student nurses were working on the front line. Fast forward a number of months and we got a new Taoiseach and Minister for Health.

I do not want to be in here arguing with the Minister. We want to be constructive and supportive. That is why I am pleading with him. If he understands the health system and acknowledges and respects the work that student nurses and midwives are doing, for the love of God, why are we not putting in place a fair payment for their work? I have been in hospital in recent months and I have seen at first hand the work that these people are doing. For the Government not to respect them and acknowledge their work is shameful.

I spoke to a student nurse. I will give the House a sense of the situation for a student nurse in UCC. I spoke to a girl who went back as a mature student to become a nurse. She lives in Glanmire. She travels to the Bon Secours Hospital, but because it is next to UCC, she gets no travel allowance.

Another girl from Glanmire travels to Cork University Hospital, CUH, but the travel allowance is only calculated from UCC to CUH so she is getting €15 a week. A young woman who is a student nurse contacted me. During the summer, before the payment came in, she was travelling from Ballyhea to Bantry.

As the Minister said, we are talking about backdating the payment. We need to respect the student workforce and finally to resolve this issue. There is so much more I could say. There are so many stories about what nurses are actually doing. For the love of God, it is time now for the Minister to bite the bullet. If he really respected student nurses, he would deliver for them.

I thank Deputy Cullinane for bringing forward the motion. It is timely and important. It is a motion about fairness and equality, about a decent day's pay for a decent day's work, but most of all it is about recognition and respect.

Student nurses will forgive me for using my time to speak on behalf of their front-line colleagues in the laboratory, medical scientists, because like student nurses, all nurses, public health doctors and so many across the health service, medical scientists are knocking at the Minister for Health's door and at the door of the Minister for Public Expenditure and Reform, Deputy Michael McGrath, looking for recognition and respect. Medical scientists have performed heroics during Covid-19 and they have done it while delivering an uninterrupted routine and emergency service 24-7, 365 days a year. Despite this heroic effort, a headline in the media less than a week ago announced the threat of strike action from this group of workers. The chairperson of their union said the last thing any medical scientist wants is to be forced into this situation.

Laboratory services are hanging on by a thread. Medical scientists want recognition of their qualification, ability and contribution. I outlined this to the Minister before. All have degrees and many have masters degrees as standard. Others go further and do PhDs or take the fellow of the Royal College of Pathologists, FRC, path, largely for their own personal development. The truth is that the Department of Health, the Department of Public Expenditure and Reform and their respective Ministers ensure a glass ceiling is imposed. Fifteen years into a 40-year career, they say a person can go no further. There is no opportunity for career progression and, as a result, significant potential goes untapped. While colleagues in Britain and elsewhere are taking on senior clinical and academic responsibilities up to and including consultant grade, medical scientists here are stymied. To add insult to injury, medical scientists have lived with the disrespect of pay inequality for decades. They work side by side doing the exact same work as clinical biochemists but are paid less. We wonder why we have a recruitment and retention crisis and the threat of strike action. There is major opportunity here.

There is significant investment by the State in the public health service but we are not using it wisely. We have the equipment and the technology, but most of all we have the people, to be a world leader in medical and biomedical research and practice. We have scientists champing at the bit to take on advanced clinical roles, but the Government and departmental bureaucracy stops them in their tracks. I urge the Minister not to look this gift horse in the mouth and to grasp the opportunity, engage and address the needs of medical scientists.

This motion is about fairness and respect for student nurses and midwives. We have systemic understaffing in the health service. This predates Covid, but Covid has exacerbated the difficulty. Nowhere is this problem more evident than in my local hospital, University Hospital Limerick, UHL, in the constituency of Limerick City. Twice so far in 2021 we have had 66 patients being treated on hospital trolleys and at no stage this year has the trolley number fallen below 35. The pre-existing staffing and capacity issues at the hospital are compounded by the absence of staff who have been forced to isolate for Covid reasons. We wish them well in their recovery and isolation periods.

In UHL, like in many hospitals throughout the State, it is the student nurses who have stepped into the breach. They have stepped up. They have truly entered the bearna baoil. They have been brave. Since the start of the pandemic, the work they have done has gone beyond their educational requirements. To be fair, these nurses are filling the gaps in the health service and they are doing it for no pay. I have had the opportunity to speak to hospital staff and they are in no doubt about the important function the student nurses have served. The feedback I received is that the behaviour and performance of the students in general has been exemplary.

The frightening post-Christmas rise in infection has put significant pressure on staff in the health service. Healthcare staff are exhausted, both physically and mentally. We must be cognisant of the mental strain this pandemic is putting them under.

Due to the need for visitor restrictions, it is nurses and student nurses who are now the only human contact that patients have. This is a heavy burden for pre-graduate personnel to carry.

This is what the family of one student nurse had to say to me:

My daughter is on a Covid ward. Because of staff shortages, [she] and two other staff members were on the ward alone. She was assigned over ten Covid patients. She has been working long hours. She tells me the hospital has been wonderful to her but given the risks she is exposed to, she feels she should be paid the healthcare assistant rate at the very least.

These students have answered Ireland's call but now it is time for us to answer their call. It is time to pay these people for the work they do. A payment of €100 per week for clinical placement during the Covid-19 pandemic is clearly not enough. The applause and appreciation we offer is important but it is simply not enough either. Our appreciation of their work and the risks they face must be shown in a more tangible way. We can offer those students that tangible recognition.

The healthcare assistant arrangement from the start of the pandemic can and should be reinstated to ensure students are appropriately paid for their work on the front line during the pandemic. The opportunity to do this is now. The next generation of health professionals is watching and if the Minister wants them to work in our health service when this pandemic ends, we need to treat them with respect and give them deserved pay now.

It has been said here that we describe our front-line health workers as heroes and they have done absolutely heroic work, and nobody would deny that. Nevertheless, we are debating in this House once again a lack of respect and equality. It would have been absolutely straightforward for the Government to reintroduce the healthcare assistant rate and it would have been fair, given our current circumstances. Placements have been postponed and there are concerns from the INMO and SIPTU about this matter, as our already stretched health sector is under severe pressure due to the huge numbers of patients affected by Covid-19.

We request fair payment and respect for the people out there doing all the heavy lifting. The Government has the power to do this and it is straightforward. We accept there are difficulties relating to vaccinations but we want transparency, clarity and to ensure fairness in the process. Although €100 is not sufficient for the work done by student nurses, I request that the allowance be paid upfront. That request was made to me by student nurses at Dundalk Institute of Technology.

Nobody in the House denies the Minister has a difficult job. I particularly notice accusations from the Opposition and his own Government Members that are not truthful and that could be extremely frustrating for the Minister. I heard a Member from the Opposition state we are at the bottom of the European table when it comes to vaccination, which is not true, and a Member from the Government - the Minister's own party - stated that vaccinations are only happening from Monday to Friday, and again that is not true. I know that in the Minister's position, he must battle through many political accusations and misinformation.

However, I know if the Minister were standing where I am now, he would make the exact speech I am about to make. I know if he were still in his role as part of the Opposition, he would not find any way to justify the treatment of student nurses and midwives. I know he would rail against it. I know he would connect the new pay deal for the Secretary General at the Department of Health with this matter. I know he would probably pick up the speech the Minister would have just made and dismiss it out of hand as being tone deaf to the reality of the work being done by those who are putting their health and lives at risk.

The Minister does not need to be reminded of this but I will do so anyway. Yesterday, 93 people were recorded as having died from this virus.

The youngest was 41 years of age, and yet student nurses and midwives are working in this scenario for poverty pay.

My Labour Party colleague, Senator Hoey, has published a Bill, the intent of which is to link the pay of student nurses and midwives to the rate paid to healthcare assistants in recognition of the increased workload and risk. The INMO has also called for healthcare assistant contracts for all students whose placements were suspended and clarity on what will happen to placements over the coming months. The Minister mentioned his own review, but as the INMO has stated, it is quite clear that this review is out of date and is not going to cut it. It is not good enough. The Minister would not accept it if he was in my position, and the student nurses and midwives should not accept it either. They need to be paid at the healthcare assistant rate to reflect the higher levels of risk in the health service, as proposed in the Labour Party Bill.

There are other outstanding issues that need to be addressed, including the fact that nurses are being asked to pay for the privilege of renewing their membership of the Nursing and Midwifery Board of Ireland, NMBI, for 2021. I put it to the Minister quite baldly that we are all being told that we are in this together, that all of the old received wisdom and legacies are being challenged, and that there is nothing that will not be done to address the situation, but that patently is not true.

I wish that student nurses and midwives had the same power as other lobby groups who seem to be able to influence Government policy. I wish they had the same power as the hospitality industry and that they had the ability to change completely the methodology and mechanisms being used by the Government to address this problem. I wish the Minister had bent the advice he got from within his Department to facilitate student nurses as he did to facilitate hospitality and home visits simultaneously in December. I wish that student nurses and midwives had the same power as the private hospital sector, which seems to be a sacred cow in this country and one that must be pussyfooted around. Robust engagement with that sector seems to be impossible for some reason.

Apparently people like me, standing where I stand, just do not understand the complexity of the situation, how delicate and difficult it is or the fact that it is not at all simple. However, when it comes to student nurses and midwives, the Department conducts a review, which is already out of date, and recommends a payment of €100 which it believes will suffice. At the same time the Department believes that the new Secretary General of the Department of Health is fully worth an extra €81,000. None of this adds up.

The problem here, as far as the Irish public is concerned, is that there is a deep unfairness at the heart of all of this. When it comes down to it, for those on the front line who are putting their own health and lives at risk as well as the health and lives of their families, there is a barrier or a line which the Government will not cross, unless it involves rounds of applause.

I know that the Minister for Health would be saying the very same thing if he was standing where I am standing now. I have some advice for him from his friends and colleagues in the Labour Party. I suggest that he thinks of the speech he would make if he was still an Opposition health spokesperson.

I suggest that he realise the depth of feeling regarding this issue within hospitals and healthcare settings and among student nurses themselves. I ask him to reflect on how embittered people are and on the length of time for which this issue will affect their mindsets as they look forward to a career in this area. I also ask him to reflect on the amount of money this would actually cost in the overall scheme of things. I ask him to reflect on how he can justify the pay increase of €81,000 for the Secretary General of the Department of Health and on the reasons he has given for this increase, which include that the job is difficult, high-powered and responsible. Reflecting on that, he might consider how those superlatives and adjectives might apply to the role of the student nurses and midwives who are asking to be paid and how they will have to register this year and pay for that privilege. I ask him to reflect on all these matters.

I know, as the Minister knows, that these things are not simple and that it would take some manoeuvring and action on his part but, if anything has been proven over the course of this pandemic it is that if Government really wants to do something it can do it. What I learned from my time in government is that, when a group is important and strong enough and when the political will is strong enough, anything can be achieved. The problem is that the will is just not there. Perhaps this is because departmental officials are advising the Minister that this may set an unwanted precedent and that it may open a Pandora's box that it would not be possible to close but, in the fullness of time when this pandemic is over, this will be a black mark on the Minister's own record and that of the Government. It will be felt that when it came down to it these people were just not worth more than €100. If the Minister was standing where I am, he would be saying the exact same thing.

The Labour Party supports this motion. We have not just been drafting motions, but have published legislation. We want these payments to be given so that these people can have the dignity they deserve and we want the Minister to live up to the rhetoric he used in opposition now that he is in his current position. I ask him not to stand behind speeches which he would have decried if he were standing where I am.

Over the weekend, I heard a Minister talk on the radio about how we all need to be on team Ireland during the Covid-19 pandemic. Many young people, however, will feel that they have effectively been left off that team. The pandemic has impacted everyone but the disproportionate effect on young people has not been discussed properly. It has led to cancelled plans and deferred dreams and has caused increased isolation. Young people feel abandoned by the Government. Ministers seem to take hardly any interest in the issues affecting teenagers, young adults, renters and new parents. Of particular relevance to this generation is the absence of a meaningful mental health response to deal with the fallout of the pandemic but neither has there been any meaningful preparation to deal with the unemployment crisis which many young people will face after it. The hospitality and arts sectors are major employers for young people, especially in rural areas, but for almost a year now this vital source of not only income, but professional experience has been denied to them. This Government refuses to take young people into consideration. Instead, it lurches from crisis to crisis with no emphasis on, or empathy for, our young people.

The treatment of student nurses, midwives, occupational therapists, speech and language therapists, radiographers and others is a glaring example of the Government's utter indifference. It is proof of its disregard for the worth of young people. The Taoiseach has argued that student nurses should not get paid because, in fact, they should not have been working in the first place, when we all know that student nurses are on the front line of the front line. The same goes for midwives, therapists and other healthcare workers who are performing vital services for all of us, including the elderly and those in need of care.

This type of comment effectively gaslighted our student nurses by denying them the realities of their own experience. A Taoiseach who tells them that the work they are doing is not real work is deliberately and intentionally not listening, but it should not be a surprise because this is a Government which has effectively gaslighted an entire generation.

I come from the generation who came of age during the financial crash. We know what it is like to have our plans dashed and to see our neighbours, our friends and our loved ones scattered across the world. Every generation in Ireland has had to face an emigration crisis and every time, we as a country have lost the ideas, passion and energy of the young people who depart.

Even prior to the Covid-19 pandemic, the cracks had appeared. It is very clear that the Government expects young people to accept a standard of living which is not as good as their parents. It believes that they should expect no better than what is on offer, that perpetual renting and uncertain tenancy is a norm, that the precarity of the gig economy is a good thing and that childcare which is more expensive than a mortgage is acceptable. That is the gaslighting of a generation.

However, things are changing. Our young people want more than the Government is willing to offer. They want more than rounds of applause. They want a society where they can have a future. Will the Government condemn another generation to emigration, or will it take action? Will it agree today to pay the student nurses, midwives, therapists and others as workers? Will it take meaningful action to address the looming unemployment crisis? What will the Government do to ensure that our healthcare graduates, whom we need to run the health service, will get jobs here? Are we just training more staff for the British NHS, Canada, or Australia?

We need change. Young people are demanding change. The pandemic is a time for change. There is a growing sense of solidarity. Large numbers of people who are not student nurses support their cause. On issues we are now confronting as a society, such as mother and baby homes, direct provision and climate change, young people no longer want to see matters being brushed under the carpet, ignored or treated with indifference. This is the generation that is seeking justice, not just for themselves but for everybody. They are more connected, more passionate and more active. The Government would be wise to catch up. It should listen to the student nurses, midwives and others, who have so brilliantly driven this campaign, and pay them properly. The Government also needs to listen to leaving cert students, climate campaigners and new parents.

I previously outlined to the House some of the crucial work that our student nurses and midwives are doing on the front line. Today, I am saying to student radiologists, therapists, midwives and nurses that they do not need to prove themselves again. The case has been made, and they have made it crystal clear. If anyone sitting here today does not get it and does not support them, it is because they are choosing not to listen.

We are now back to where we were last March, and the Government needs to bring our student nurses and others who are working in hospitals back to where they were last March as a bare minimum. We need certainty for students in healthcare on their placements, and we need contracts as healthcare assistants for these students. I remind Ministers who are making tributes to the work of healthcare students that they cannot eat tributes, buy clothes with empty words or save up on empty platitudes.

I pay tribute to the nurses and other healthcare staff throughout the country who have campaigned, lobbied and fought for their rights. They have refused to be silent. They know their own worth and they know their own value. The Government needs to step up now, treat them not with platitudes but with respect, and pay them properly. Young people are watching the Government and its actions will be remembered. There is still time to do the right thing.

I am sharing time with Deputies Paul Murphy and Barry.

Last week the victims of the mother and baby home scandal were insulted. The insult centred on the Government's refusal to value the direct testimony of those victims and instead to follow an official narrative from institutions. This week we have the same pattern of insulting the student nurses and midwives, refusing to listen to their direct testimony and instead listening to the official and, quite honestly, dishonest narrative that it is getting from the health authorities about what they do.

Hundreds of student nurses had their testimonies read out and circulated all over social media.

They attended meetings where they spelled out what was happening in detail. People Before Profit brought a motion last year calling for the payment of student nurses and midwives. The Minister for Health simply dismissed that testimony. The testimony continues to come in, however. It explains, sometimes in shocking and graphic detail, the work the student nurses and midwives do, the risks they take and the pivotal role they play and have always played - not just during the Covid-19 crisis - in making up for chronic staff shortages and working during their placements. Instead of acknowledging and respecting that testimony, the Government insults those student nurses and midwives by suggesting that it is protecting their education.

To be honest, I nearly choked when I heard the Minister speaking again about protecting their education and referring to the "full student experience". How can the Minister trot out those phrases again? For student nurses and midwives, the "full student experience" is paying fees of €3,000, or €7,000 in some cases, for the privilege of working on the front line of our health services. That is even more the case in these dire conditions of the pandemic, when they are playing a critical role in helping us to combat the virus. The Minister, because he was forced, then offered them a miserable €2.50 an hour for the work they do, in the same week that he bumped up the salary of Secretary General of the Department of Health from €210,000 to €290,000.

It is shameful and an insult on so many different levels. It is an insult to women. I do not believe it is a coincidence that this involves a mostly female profession. It is an insult to students to treat them in this way. It is also an insult to young people, as Deputy Cairns said, 70% of whom have said that they are seriously considering leaving the profession, and many will leave after their training because they are treated so badly. They are treated badly as students, and then they will also be treated badly when they come to work in the health service. Nurses are being made to work free hours in the form of the Croke Park hours, when they are fighting to protect all our lives on the front line. The Minister offers these student nurses and midwives an allowance that will not even pay their bus fares or parking costs, in most cases. It is an absolute insult.

I disagree with Deputy Cullinane when he says that he does not want to fundamentally change the structure of nurse training. We need to do that to stop the drain of talented nurses and midwives out of this country that is happening now. In Britain, the Government was forced to acknowledge that it needed to pay student nurses £10,000 a year because of the drain of nurses out of the NHS and out of Britain. We should be doing that too. When the Minister says it is not possible to pay the student nurses and midwives and for them to have a degree, as I pointed out to him last week construction engineers get paid €12 an hour for doing their degrees. Student paramedics get paid, in some cases, €28,000 a year for doing their degrees. It can be done, therefore, and it should be done. Fees should also be abolished, not just for the student nurses and midwives, but for all students.

I am old enough to remember a month and a half ago when all Government Deputies united to vote down our motion to pay the student nurses and midwives. I remember, as I am sure the Government Deputies do, the public backlash against that decision. We had reports on that aspect of the matter from the Fianna Fáil and Fine Gael parliamentary parties, but I am not sure if we got one from the Green Party. My constituency colleague and Minister of State, Deputy Brophy, is reported to have said at the Fine Gael parliamentary party meeting that even die-hard Fine Gael members believed that what the Government had done was "nasty and mean". I am sure the same was said at the Fianna Fáil parliamentary party meeting.

I have a bit of advice for Fianna Fáil, Fine Gael and Green Party Deputies, and especially for those who suggested that in some way the decision the last time was a mistake. If they do not want to be seen as a nasty and mean Government then do not vote in nasty and mean ways. Vote to pay the student nurses instead of not paying them. Last March the Government accepted that student nurses deserved to be paid €14 per hour for their work, but now they are being told to live on €100 a week. How can that be justified? If anything, their work is even more dangerous and difficult during the current peak. There are 4,500 student nurses and midwives working day in and day out to keep our hospitals from collapse. They have had to give up their other part-time jobs to protect patients. How on earth does the Government expect them to pay their bills and cover their rent with €100 per week?

It is worth contrasting the treatment of the student nurses with the position of the Secretary General of the Department of Health who is getting a raise of nearly €90,000 per year while student nurses are expected to be happy with €100 per week. It sums up this Government of the rich for the rich. The Government has said that student nurses should be praised but not paid, applauded but not rewarded. According to the Government, nursing is a vocation, a good deed, and that this is a reward in itself. It is clear, however, that the Government does not take the same attitude to itself. The Government is not happy with claps or a vocation or pats on the back for itself. It rewards itself with very substantial pay.

I put it to the Minister that this is the most challenging week in the history of Ireland's health service. There are 2,000 Covid patients in our hospitals with 200 Covid patients in our intensive care units. There were 93 deaths yesterday. Last weekend there was the death of a nurse in a Kilkenny nursing home. With all of this going on, the Minister has decided that fourth year students, who are mostly female and young, should risk their lives and health to go into wards in hospitals that are raging with Covid-19 and that they should be paid less than €10 per hour and less than the minimum wage. I do not carefully watch the psychology or personality of Government Members, but insofar as I have a sense of the way the Minister for Health projects himself, I often get the impression that he is a chap who is sometimes rather pleased with himself. I hope the Minister is pleased with this decision. Young workers, who are in the main women, are getting less than €10 per hour in hospitals that are ravaged with Covid. What a scandal that is.

Oscar Wilde's character, Lord Darlington, once defined a cynic as someone who knew the price of everything and the value of nothing. If we take the Wildean definition of a cynic, then the Minister has made a very cynical decision. It should be reversed and it is not too late to be reversed. The student nurses have been paid the healthcare assistant rate before and the Minister should do it again. He knows it is the right thing to do.

I welcome and support the motion. We all remember when, just before Christmas, the Government voted against paying student nurses and the wave of disappointment and anger that rolled across the country the days after the vote. Young student nurses, some with their faces still bearing the marks of the face masks they wore on 12-hour shifts, looked at their TV screens as Fianna Fáil, Fine Gael and Green Party votes, one after another, torpedoed their chance of getting paid.

Numbered among those who voted against student nurses getting paid was the Minister for Further and Higher Education, Research, Innovation and Science, Deputy Harris, who back in March had issued a press statement saying they would get paid. It is one thing not to pay student nurses and to make them work on the front line without pay in extremely hazardous conditions in daily fear of their health and that of their parents and grandparents at home, but it is another cruelty entirely to promise to pay them and then to come into this Chamber and vote against it, just as the Minister, Deputy Harris, did before Christmas.

For any student nurses or midwives watching this debate, I will outline exactly why they have not been paid yet. There are 72 of us in this Chamber who want to pay them but there are 77 Members of this House, namely, Fianna Fáil, Fine Gael and Green Deputies, who do not want to pay them. They should learn the names of these 77 Deputies and repay their arrogance and greed at the ballot box in the next election.

We in Aontú have been speaking to many students on the front lines and it has been incredibly moving to witness the selflessness of their work. They will not strike, simply because they do not want that to result in their patients suffering or dying. When they phone me, they spend the majority of the phone call expressing concern for their patients. They tell me of the wards on which they are working and of the heartache of seeing patients take a bad turn. They tell me of ringing the bell looking for senior staff to help them and coming to the realisation that there are very few senior staff on that ward to do so. When student nurses and midwives get talking to a Deputy on the phone, the priority of their conversation is the welfare of the vulnerable. It is only at the very end of the conversation that they turn to the economic circumstances they are in. These are ordinary men and women - mostly women - around the country who are doing extraordinary things for us.

When Deputy Harris was Minister for Health, he wasted billions of euro in overspend on the black hole that is called the national children's hospital. Many other Ministers wasted billions in overspend on broadband, and millions were spent on the Dáil printer and on faulty PPE that is now deemed unusable. We should compare and contrast this issue with the Fine Gael, Fianna Fáil and Green Party proposal to increase the salary of the Department of Health's Secretary General by €81,000. That is not €81,000 as a full salary but as an increase on top of a salary of about €210,000. That means there is an income inequality in this situation of 55:1. The new Secretary General will earn 55 times the income of student nurses and student staff on the front lines of our hospitals in the most critical health crisis this country has ever witnessed. Annually, the Minister for Health earns 34 times the income of a student nurse working on the front line. Many people watching this debate will feel that ratio should be reversed if fairness was in place. If the Minister realised or experienced for one minute what student nurses are enduring mentally, physically and psychologically on a daily basis, he would not be putting forward the amendment he is bringing before this House today. That amendment has the objective of destroying the opportunity of paying student nurses and student midwives a proper wage. I ask the Minister, Fianna Fáil, Fine Gael and the Green Party to cut out the cheap words and the patronising hand-clapping and actually to pay student nurses and student midwives what they are entitled to, which they are earning every day in the service of the people of this country.

I am grateful for the opportunity to speak. I thank the Members who brought this motion to the House and in the main, I fully support it. Student nurses and midwives must be treated fairly, with respect and above all, with dignity. Student nurses and midwives who are working on the front line are no different to other essential workers on the front line and this has never been more apparent than during the current pandemic. The bottom line is that they are front-line workers and as such, must be treated as front-line workers in all aspects, including that of pay. In other industries, apprentices in professions like those of electrician and plumber are paid as they train. A fourth-year apprentice electrician or plumber is paid 80% of the full rate of pay. Student nurses, at the very least, deserve to be treated in the same manner. We can all stand here in the Dáil and applaud them, which I know the healthcare sector appreciates, but we must also stand up and demand they are treated fairly. This is not happening at present and I challenge anyone in this House to prove otherwise. Words are cheap and it is actions that matter.

The Government must stand up and be counted on this issue. Without further delay, it must introduce measures to ensure that our student nurses and midwives are treated fairly. These students nurses are already paying substantial fees if they do not qualify for grants. They also must pay for their accommodation during placements, along with any travel expenses. To cap it all off, they have been asked to pay a €100 registration fee for the Nursing and Midwifery Board of Ireland because they have gone to the front line to help prevent the health system from collapsing during the Covid pandemic. This Government must get real and support our student nurses.

Looking at this another way, the Government could be accused of exploiting cheap labour under the current scheme. As has been said before in this House, there is no other way of describing this. It is a case of cheap labour being used to carry out essential front-line healthcare. Let us look at the facts. Student nurses work on average 15 weeks per year for the first three years of their degree. These student nurses on clinical placements receive an allowance of €50.75 per week. It should be noted that student nurses who are not on clinical placement receive nothing. I put it to the Government that the allowance granted to those who are fortunate enough to receive it does not even cover the cost of travel expenses, never mind the cost of tuition fees and accommodation costs. Yet these student nurses have been put directly on the front line during the past 12 months while we have been fighting this terrible pandemic. Let us be clear. Student nurses and midwives are being asked to fill essential roles in our health system at this most critical time. The very least we owe these wonderful people is that they be treated equally as other members of their profession. An apprentice electrician or plumber is entitled to a rate of pay that is 80% of a fully qualified tradesman. Surely the very least a student nurse or midwife deserves is to be treated the same as an apprentice tradesperson.

I have spoken to many student nurses over the past six to eight months and the message is clear: they are at breaking point and feel that they are not being treated fairly or with due respect. The bottom line is that they are working beyond what is normal for student nurses. They are in fact working as full-time nurses. It is also not surprising that not one of the student nurses whom I spoke to has considered leaving the profession. They are not in it for the money. They have a genuine passion for their work and want to help people to the best of their ability. Many can only continue to study with the help of their families and friends. That is disgraceful in this day and age.

The Minister thanked all nurses, midwives and healthcare workers for their dedication and commitment as we continue to deal with the Covid-19 pandemic. He noted that Irish nurses and midwives are internationally sought-after graduates and are included in the priority group for vaccination. The student nurses and midwives need the support of the Minister now, more than ever. I fully support any measures that will ensure that our student nurses and midwives are treated fairly and with proper respect during their studies. Surely this is not much to ask for, considering the heroic efforts these students have made to keep our health service from collapsing during the greatest crisis that this country has ever experienced. I ask the Government to support our student nurses and midwives at a time when they need it most. When I speak of supporting them, I mean that they should be treated in same manner as their peers in other countries.

I am delighted to speak in support of this motion. I know that the student nurses have been exploited to a large extent during this pandemic. They have had to work long shifts, some up to 13 hours a day, and have been exposed to traumatic scenes in the hospitals, including treating seriously ill patients and comforting the dying and their families. Despite all that, these student nurses were not paid.

Student nurses work amid a tsunami and are utterly under-resourced. Meanwhile, the Government has approved an €81,000 salary top-up for the new head of the Department of Health. Surely that extravagant increase could have been set aside for a number of years so that the Government could look after the student nurses first. It was reported that the Minister was bringing a proposal to Cabinet to pay GPs and pharmacists €60 per Covid vaccine administered. If this is the case, the total cost of the roll out of the vaccine to 1.5 million citizens via pharmacies and primary care centres would be a staggering €91 million. The €60 per dose payment is over 400% higher than the €14.15 paid per two shots administered in the UK. Why is the payment to GPs and pharmacists here four times higher here for exactly the same job? The point I am making here is that money can be found for everyone but the student nurses.

The abuse of these students continues right through their years of studying. I was contacted by a fourth year general nursing student who was due to start their internship recently. They told me that at the start of the pandemic, the Government increased the wage of nursing interns to €14.10 per hour, and rightly so. However, they were told recently that because the pandemic was apparently under control, their wages were being cut to €10.60 per hour. Good God, it is clear that the pandemic is far from under control at the moment. Even worse, these nurses were going to work in hospitals at the forefront of this crisis. They were appointed because many of the other nurses were absent due to Covid-related issues. It is only fair that they are paid the correct wage for putting themselves on the front line. These students are more than willing to play their part for the health service and the people. They are just looking for a fair wage for doing so.

The treatment of those at the forefront of our health service must be looked at closely. Those working in home help services in west Cork are calling door to door to look after those who desperately need help. These home helps, whether they are from Schull, Castletownbere, right through to Dunmanway, Clonakilty, Bandon or Ballinadee, need to be respected, by being offered the vaccine immediately, or they should at least know the exact date on which they will be offered the vaccine. At the moment, they go from door to door, putting themselves and the patients they care for so professionally at risk. I urge the Minister to let us know today in the House when these home helps are going to be offered the vaccine. They are probably as at risk as doctors and nurses, or even at greater risk, as they are on the move every day in carrying out their duties. The student nurses should be treated in a just and fair way when working on the front line during the Covid-19 pandemic. They should receive a just rate of pay per hour. The recommended rate of pay of €100 per week is nothing but an insult to them.

I note that the Minister has left the Chamber. With no disrespect to the Minister of State, Deputy Butler, this happens all the time when my group speaks. She is not interested in what we have to say.

I am interested in the humanity of it. The Government does not respect nurses in general, let alone the student nurses. We saw Fianna Fáil, Fine Gael and the Green Party voting down a motion to pay and recognise the gallant work done by those angels of mercy. We are so fortunate to have those young ladies and gentlemen who go into the profession of nursing. It is a noble profession in Ireland. The Taoiseach has told us about how a new model and system for training nurses has been set up. I wonder if it is any better than when we had matrons. I do not think it is. Nonetheless, this Government does not respect nurses.

The Minister has returned. He is welcome. I withdraw my remark. He is back and I hope he listens to us. He has a habit of leaving when our group speaks, as do the other Ministers. It is yet another insult. If they insult elected Members of Parliament, why would they not insult the nurses? We have seen what has happened with Mr. Watt, the new interim Secretary General of the Department of Health. He has been given a pay rise of €81,000 a year, bringing his salary to almost €300,000. We have seen what has happened with the procurement scandal which has been going on day in, day out, especially during the pandemic. Procurement contracts have been handed out without tendering. Contractors can pay what they like. We have faulty PPE and so much other stuff. We have seen the mess, scandal and black hole that is the children's hospital and that may never rise out of the ashes. The Minister was happy to go along with it, even though he voiced criticism of it when he was in opposition. However, he would not vote against it and support our motions. Fianna Fáil and Fine Gael have behaved recklessly towards the health service.

Student nurses have been mistreated. It is an unbelievable scandal. A good friend of mine, Niamh, is a student nurse on placement in Sligo. She has gone into every situation in the Covid crisis, as they all have. The have gone to the front line to help out and to work, despite the hours, the pressure, the danger and the risk. As other speakers have said, they have often done this without senior members of staff to help them, because some of them have been on sick leave or have been self-isolating. It is a crisis. We can deal with everything by throwing billions of euro at it, yet we cannot pay the student nurses. I believe in the saying "mol an óige agus tiocfaidh siad". Praise the young people and they will come with us and work with us. The Government wants to stamp down on them, persecute them and show its disdain for them.

Mr. Watt has been given a pay rise of €81,000 in the middle of a pandemic, when he does not have such a good record coming from the Department of Public Expenditure and Reform. One would wonder what he has to offer here. It is nothing personal. There is money to appoint three extra super-junior Ministers. There is money for everything, but not for the student nurses, nurses, or front-line workers in any shape or form. The Minister and the Minister of State should hang their heads in shame. Look what has been done to St. Brigid's Hospital in Carrick-on-Suir. It is on the Minister of State's doorstep. It is shameful.

First, I thank Sinn Féin and its Members for bringing forward this very important motion on the pay, or lack of it, of student nurses and midwives.

I want, first, to acknowledge the work they have been doing. However, in keeping with what I have continually said in this Chamber, I do not want praise for these people who are doing excellent work; I want them to be paid. One of the most insulting things was when front-line workers saw politicians and others standing up and applauding them. That was ridiculous. It was actually an insult because what the Government should be doing is paying people for their work, not praising them.

My office is inundated with this issue at present, which is being brought to us by student nurses and their families. To think of the workload and burden that is being placed upon them, while, at the same time, the Department, Minister and Government do not see fit to pay them for the work they are doing, is unbelievable. At a time when we are struggling and when we need people to work with us, it is outrageous that they cannot be paid fairly, honestly and properly. Is it any wonder that young people, when they get their qualifications, look at going abroad because they see the possibility of a better way of life and they see governments, departments and politicians elsewhere willing to accept that they have worked and put effort into their education and getting qualified? Here in this country, they will not be paid for that. They will go abroad, we will lose all that talent and I am very sorry about that. I ask the Government to respond positively to this motion and to all our efforts on this issue.

I thank Sinn Féin for giving us the opportunity to speak on this important matter. Young boys and girls, when they choose to become a nurse, see it as more than a career. It is a vocation for them and they deserve fairness and respect. A payment of €100 for a young nurse when his or her work is so demanding is not fair. We hear stories that many of them have to choose between the bus fare or food. That is not right and we cannot allow it to continue. Other tradespeople, including plumbers, plasterers, mechanics and electricians, all get paid as apprentices. We see what student nurses have to go through, working with all the different health problems patients present with, including cancer, heart problems, respiratory problems and people who are broken up and mangled after an accident. It must be very traumatic for those young nurses to see people dying in their arms. They have to go home and keep all of that within themselves because confidentiality does not allow them to discuss their job or their work with family members or other people.

I am pleading with the Minister and the Government to ensure that fairness will apply. The €100 the Minister is thinking of giving student nurses is not adequate. He will have to stand up to the mark and pay these people for doing the very important work they are doing on our behalf, especially during the Covid crisis, and the sacrifices they are making and have made on behalf of each and every one of us. I ask the Minister to read the motion and not to go against it.

I thank Sinn Féin for bringing this motion to the House. I also thank the People Before Profit Members who brought a Bill before us on 2 December last. On both occasions, and particularly today, the Government speeches utterly failed to deal with the proposals that were presented. I cannot imagine how one could disagree with the motion that is before us today. What is the problem with publishing the Collins review immediately, as is proposed? The motion also proposes that the March agreement be reinstated while the Covid crisis lasts. I am not sure what the problem is with that. I understand that the Collins review, part of which was leaked, makes the same recommendation. How could one disagree with the proposal to advance the second review urgently? The motion further proposes that the second review be expanded to ascertain the extent to which students performing their work are doing extra work. How could one possible disagree with that? If the Minister, Deputy Stephen Donnelly, disagrees with it, I cannot understand how the Minister of State, Deputy Butler, would not take a different view given the gender of the people we are talking about, a factor with which we are very familiar.

The Minister talked once again today, as he did in the speech he gave on the previous occasion, about the exciting and attractive career that is nursing. He used his time to talk about that but he did not address at all the despair, despondence and disgust felt by nurses in our hospitals. The message from the Government from day one of the Covid crisis was that we were all in this together. I welcomed that message. Indeed, the Government did well in rolling out supports for businesses and unemployed people. That gave the message that we were all in it together and it gave a sense of solidarity. That has gone completely. It went in the way that the Government dealt with the nursing homes and direct provision facilities. We knew then that we were no longer in it together and that some were more important than others.

That has really been brought into focus this week and last with the news that the salary of the new Secretary General of the Department of Health, which is currently held as an interim role, will be increased by €81,000, as referred to by other speakers. Really and truly, what kind of message is that to give out when we are all in this together? The nurses certainly are being treated utterly differently. This week, we learned that GPs are going to be paid a set fee for rolling out the vaccines. Interestingly, they will be paid more than pharmacists for doing so. That is a reflection of the market. I understood we were changing all of that in terms of the market, learning from the Covid crisis and learning how important society is. I understood there would be transformative change. There has been no transformative change.

In the case of the nurses, particularly the student nurses, and how they have been treated, they have put forward very basic requests. They are an essential part of the health service, as are all the other nurses and doctors. So too are the cleaners and porters. However, we have seen from the vaccines roll-out that some healthcare workers are treated differently. We have seen family members of doctors, in one instance, getting the vaccine before anybody else. That particular doctor apologised and that is welcome, but I am not sure why he is apologising. He made a very considered decision on the night in question in the absence of information from the Government. I am not sure of the nature of that apology.

The figures are astounding in terms of people on waiting lists. Galway is a disaster zone. I want to put that on the record. In 2017, two theatres were leaking. One was re-established and the other was not, and here we are in 2021. The figures for orthopaedics are nothing short of shocking. People are waiting one year, two years, three years or four years to get a first appointment, not to mention surgery. All of that was known to the Minister because he was in opposition at the time and he was fully familiar with the figures. He knows the nurses went out on strike in 2019. He knows we had one of the worst performances in Europe in terms of capacity for beds and services. We knew all of that. The epidemic, which became a pandemic, came on top of that inadequate service.

I am really tired of the speeches telling us that this or that has been done. They are the most basic things that would have to be done in a pandemic. We are looking for transformative action. Today, however, we a are simply looking for a recognition of what the student nurses have done on behalf of all of us. I was one of those who stood up and clapped for our health service staff. I have said publicly that I am ashamed of that clapping. I did it because I felt they needed a clap but what they really need is action. We do not need any more reflection, as the Labour Party has asked for. We need action.

I am delighted to speak briefly on the Sinn Féin Private Members' motion regarding pay for student nurses and midwives. The Covid-19 crisis has shone a spotlight on our health service and front-line workers. Last year, we had a number of debates and discussions on the issue of the pay and conditions of student nurses and midwives, who have been putting their lives on the line during this unprecedented global pandemic. On 10 December 2020, the Tánaiste said during Leaders' Questions:

I do think that student nurses should be paid where they are acting up, filling in for staff nurses or doing the work of staff nurses because wards or clinical areas are understaffed.

During oral parliamentary questions on the same date, in answer to a question from Deputy Gino Kenny on the cancellation of supervision for student placements, the Minister said that during the first surge of Covid-19 it was not possible to facilitate student placements from April onwards. This was due to the redeployment of staff, including senior nurses who would ordinarily be supervising the students. There was a particularly high rate of absenteeism and the directors of nursing in the HSE said they could not ensure clinical placements were protected. There were fears hospitals could be over-run. At the time, there were up to 900 Covid-19 patients in hospitals. Thankfully, the situation improved and, as of Sunday, 6 December, there were 232 patients in hospital. It is now 20 January 2021 and we are still in the grip of our expected third wave of the pandemic. On Monday of this week the number of people in hospitals with Covid-19 surpassed 2,000 with almost 200 in intensive care units throughout the country. There have been reports that approximately 7,000 healthcare workers were out of work due to Covid-19 and that people who were asymptomatic but identified as close contacts were told to come back to work in hospitals. The situation is far more dire than it was last year. Maybe the Minister will use that as an excuse for the supervision of student nurses to be curtailed as well as the rise in numbers.

The expression "all in this together" has been the mantra for the Government since the start of this unprecedented pandemic in March last year. However, "all in this together" has been found to have a hollow ring to it. As the business lobbyists pushed for the economy to be reopened despite ongoing health risks to the public, to our most vulnerable and to front-line workers, the Government ignored the advice of the National Public Health Emergency Team prior to Christmas. Ireland is now being used as a cautionary tale internationally for valuing business over health services and the health of the public.

The Government commissioned two reviews into the pay of student nurses and midwives. The form of this Government is to leak information before allowing for proper debate, scrutiny or discussion. We first heard about the recommendations of the review on pay for placements during the Covid-19 pandemic carried out by Dr. Tom Collins on RTÉ, where we see all business done in respect of the Dáil.

In the meantime, there are over 4,500 student nurses and midwives completing clinical placements that require them to work 12-hour shifts per day for no pay. The Government is reportedly to offer €100 per week payment based on this review. How can the Opposition, unions and interested parties examine this recommendation when we have not seen the review?

People putting their lives on the line might be given a €100 per week payment. At the same time, as has been said previously, the new Secretary General of the Department of Health is reportedly receiving a €81,000 pay rise, increasing the salary for this position to €292,000. Who sanctioned this? Where did this idea come from? Why is it being pursued when Mr. Watt has already been working as Secretary General in the interim? The Department said it was a highly complex role with a challenging brief, especially in the midst of a global pandemic. Was this increase requested as part of the contract negotiations? We need to know that.

Has the Secretary General of the Department been involved in the vaccination strategy? This week has seen reports of family members of hospital management, construction workers and others receiving leftover vaccinations. What involvement has the Secretary General and the Department had in the vaccination strategies?

I am also wondering about the €14.1 million paid out to a company called Roqu for ventilators from China that have not been and will not be used - a waste of vital resources. The Tánaiste talked recently about all these ventilators and said we have them but we do not have the personnel to use them. Was the Tánaiste referring to a warehouse full of usable ventilators? I understand that globally we have been experiencing an unprecedented pandemic, but it is amazing that such money can be found when deemed necessary within this Government.

While major pay increases are being discussed at Cabinet, like the Tories, Fine Gael and Fianna Fáil last year encouraged the public to clap for our healthcare workers. Applause will not pay rent, put food on the table or pay for transport to and from work. Maybe the Minister could ask his landlord friends whether they would accept bualadh bos in lieu of the rent from their tenants who are student nurses and midwives. Rather than simply and simplistically applauding our front-line staff, we must support, appreciate and value our workers and listen to the unions. I saw a tweet the other day stating that Ireland responded more coherently to the Covid-19 pandemic at the start when we had no Government. The consistent undermining of people from within Government ranks has shown the public that we are most certainly not all in this together.

It is clear from the debate this morning that Members across the House share the gratitude to, and have paid extraordinary tribute to, student nurses and midwives and all their healthcare colleagues who have provided, and continue to provide, care across the entire service. The Government will not be opposing this motion.

I wish to offer my deepest sympathies to everyone who has lost a loved one. In particular my thoughts are with the families of the 93 people whose deaths were notified yesterday.

We all know that Irish nurse and midwife graduates are in great demand worldwide. As we have heard today, the main reason for this is our four-year degree programme. As the Minister for Health, Deputy Stephen Donnelly, stated earlier, the graduate education approach these programmes offer to our student nurses and midwives is a hands-on learning approach as students. An essential part of their learning and the approach to building their skills is actively taking part in patient care. Clinical placement learning is on a supernumerary basis for years 1 to 3 and the first part of year 4. The placements of between eight and 15 weeks in each year of the programme cover the wide variety of clinical environments students need to learn in. The clinical placement in the fourth and final year of study is through an internship paid placement. This unique learning period focuses on the assimilation of skills, knowledge and professional behaviours learned over the programme to enable the critical thinking and decision-making required to be a nurse or midwife. In addition, an important element of this clinical placement is the built-in four-hour period of reflective learning per week for the student to reflect on the placement. Clinical placement for all student nurses and midwives is the clinical learning environment in which they gain, incrementally, the practical experience, necessary skills and professional behaviours required to become members of the nursing and midwifery professions.

Members will be aware that this clinical placement education time comprises 50% of the student nurse and midwife undergraduate programme. This significant proportion of learning time is prescribed by an EU directive and translated into the education and training standards and requirements by the Nursing and Midwifery Board of Ireland. Maintaining a student's supernumerary status and offering the full student experience to achieve these standards is a proven success factor of all the nursing and midwifery programmes.

Members will be aware that due to the current pressures on the health service as a result of the latest surge of Covid-19, in particular on critical care, a decision was made to suspend all supernumerary clinical placements for first to third year nursing and midwifery students. This suspension is for a period of at least two weeks from 18 January 2021. This was a necessary decision and, as with so many decisions in managing care through a pandemic, it was in immediate response to the particular clinical care demands at the time and the requirement for qualified staff.

It is regrettable that placements had to be suspended. We are aware it will cause an unavoidable temporary delay and inconvenience for many nursing and midwifery students. The staff who support student placements are experienced and have the skills and knowledge to support the current surge requirements. The Department is currently working with the HSE, the higher education institutes, the Nursing and Midwifery Board of Ireland and clinical partners to ensure students affected by the decision to suspend clinical placements will not be disadvantaged in the completion of their educational programmes on time.

The clinical oversight group in place since the beginning of the pandemic will continue to review the impacts of Covid-19 on the provision of clinical placements. This group will be an important part of supporting the safe reintroduction of supernumerary placements as soon as possible.

In September 2020, following the first surge, when all placements for all healthcare students, not only nurses and midwives, were suspended, clinical placements for all nursing and midwifery students were fully reinstated. As the Minister for Health explained earlier, while Covid-19 continues to impact our communities and health services, each surge has impacted on the students' clinical placement education differently.

Prior to this current surge, additional supports had been put in place for students to assist them in maintaining their clinical placements and continuing this key part of their learning. The additional supports are in recognition that there are additional demands on students due to Covid-19 and the need to comply with public health requirements. Such demands may include getting additional and alternative modes of travel to and from placement locations, finding alternative accommodation in some instances and making changes to living arrangements.

I will outline the relevant supports in a moment.

All healthcare workers have access to PPE, training and occupational health supports. Students are also fully supervised on placement by qualified staff with the skills and knowledge to support their safety in the clinical environment. There has been ongoing engagement between health sector management, the student nurses and midwives and their representatives unions, and this continues, including with the oversight group. Maintaining student nurses and midwives on their education programmes and protecting their student status remains a priority. I wish to reiterate the supports currently available to student nurses and midwives. They include access to the pandemic unemployment payment for those students who may have lost part-time employment due to Covid-19. This is a specific exemption the Minister, Deputy Donnelly, secured for our student nurses and midwives. The supports also include enhanced illness benefit for those students who work part-time but who have fallen ill due to Covid-19. The accommodation allowance of €50 per week towards alternative accommodation while on placement in clinical sites away from the base hospital is maintained. Additional travel expenses associated with clinical placements are also reimbursed. Other welfare schemes to assist with financial hardship due to illness, subject to qualifying criteria, include the supplementary welfare allowance and the urgent needs payment. There is also access for eligible students to the national access plan and the student assistance fund. There is a €250 top-up for those in receipt of the SUSI grant or a €250 contribution to fees for eligible students.

We have heard the Minister tell us that in order to ensure supports were in place for student nurses and midwives while on clinical placement during this time, he appointed Professor Tom Collins to carry out a short-term independent review of clinical placement allowances. He received this report on 31 December 2020. The key recommendation in the report is to implement a pandemic placement grant of €100 per week for each supernumerary placement week during the pandemic. This is on top of the supports in place for all clinical placements and the additional supports referred to a moment ago. The Minister has accepted the recommendations and is keen to progress the implementation of this additional support. In addition, the Minister has committed to a longer-term review of allowances for student nurse and midwife placements and work on this is due to commence.

The collective feedback we have heard from the students, the clinical placement support staff, the group directors of nursing and the heads of school in the higher institutes of education reflect the investment by the profession in educating their students and the importance to them all of supporting the education programme. We have also heard the challenges outlined, the difficulties and, in particular, the impact the pandemic is having on students and their education. The variety of supports in place, financial and non-financial, to continue to support students at this time remain under review to ensure safety and maintenance of the learning environment.

I again commend the student nurses and midwives on their commitment to continuing their education to becoming nurses and midwives. The pandemic has shown us all the importance of having a highly trained, highly skilled and adaptable health workforce. Supporting our students to continue their education, protecting the graduate programme and maintaining their student status to do so remains a priority for the Government, the Minister and the professions.

Towards the end of last year I asked the Minister for Health the number of unpaid hours worked by our student nurses and midwives since the outbreak of the Covid virus here. I also requested a breakdown of the percentage of student nurses who worked in Covid-19-related care and for his views as to why so many feel so unappreciated that they opt to work abroad. The response indicated the Government's policy of downplaying the contribution these healthcare workers make towards our understaffed and under-resourced health services. Instead of answering these questions, the Minister opted to hide behind a comment on how reviews on nursing and midwifery were taking place. At the time I suggested that if the true extent of their contribution to keeping the poorly resourced health services afloat were clarified, the Government would be admitting to its own failure.

Today I want the Minister to hear the reality of what he tried to ignore. These are the words of a nurse who was working as a fourth year intern during the first wave: "I will either emigrate or return to college because it is not worth working as a nurse in this country because the government does not value my work nor my health." We know that students have been performing pandemic-related work with others, filling either staffing gaps or related work as part of placements in hospitals. As I speak there are seven fourth year students in South Tipperary General Hospital doing clinical placements. We are now demanding clarity on this and the extent to which it is beyond the requirements of their degree and that they are appropriately compensated. With this in mind, the Collins review of student nurse and midwife pay during the pandemic must be published immediately. Hiding behind unpublished reports in order to avoid acknowledging the long hours and the physical and emotionally draining work with which they are faced ends now. The decision to pay students lies with the Minister for Health. Suggesting they be paid €100 per week is an insult to those who are playing a vital role in keeping our health system functioning. This penny-pinching does not apply to the Department of Health Secretary General, for whom the Government has sanctioned an €81,000 pay rise.

To provide some context, I wish to return to the nurse to whom I referred earlier. She spoke of how she was paid even after having contracted Covid-19: "For all of that, I got nothing," she said. "An allowance of €50 per week and a travel allowance of 25 cents a mile paid two months after placement finished or, if you lived close by, nothing at all." The Minister can address this and must do so now. Vaccines started to be made available in Nenagh hospital after the staff shamed the Government into getting the programme running properly. That is an example of how an unacceptable situation can be resolved if the political will is there. This is why we are demanding an immediate assurance is given that the March pay agreement returns in order to pay fourth year interns at the healthcare assistant rate, to allow first to third years work on temporary healthcare assistant contracts and to ensure that those who do not take up temporary healthcare assistant roles are paid a fair intern allowance which recognises the work they do on placement. The Covid crisis does not wait for the Government to act; neither should our student nurses and midwives. I call on everybody here to support the Bill.

Many stories will be told in the coming years about 2020 and 2021. This pandemic is a time of fierce challenges, loss and sadness. We must not, however, let it go down in the annals as a time of unfairness and inequality. I ask the House to imagine how we will be judged by future generations if we do not help the very people who put their lives at risk for our sake and theirs. Instead we turned our backs and refused to help them with a small financial reward and suspended placement. This is what the Government is doing by failing to pay student nurses and midwives. It is entirely unacceptable. The 18 students on placement in Wexford General Hospital and the other 4,000 deserve better. Throughout this pandemic student nurses and midwives have worked hard and tirelessly every day to protect our families and communities from Covid-19 while coping with a healthcare service hampered by years and years of austerity cuts. These problems are down to chronic underinvestment that began long before this pandemic and illustrate the type of pressured environment in which our student nurses, midwives and radiographers are coping. It is no wonder we have a recruitment and retention crisis and so many of our young nurses and midwives emigrate to Australia, New Zealand and Canada.

Let us remember too those on the front line who have paid the ultimate price. Only this week we have had the death from Covid-19 of a nurse in County Wexford. Our thoughts are first and foremost with his wife and young child. We cannot imagine the grief they are going through. Anyone who took the time to read the way he was spoken about in the local media reports will see he was a much-loved and respected family man.

We cannot lose sight of what our people are facing out there and the truly unimaginable suffering and loss. This is why we are putting forward Deputy Cullinane's motion today. The public are ahead of the Government. They are calling for our student nurses and midwives, who are giving everything they have in this most unequal contest, to be paid for their work. It is not too late for the Government to change the chartered course in order that we can look back and say that at least we properly paid those on the front line for the personal sacrifices they made to protect us all. The Minister should not forget that we will all be remembered by the tracks we leave behind. I urge all Deputies in the House, including my fellow Deputies from Wexford, to support the motion.

I will finish where I started my first contribution by again reading to the Minister some of the first-hand testimonies I have received. When I read them out I want him to bear in mind that I have spoken to hundreds of student nurses and midwives directly.

I am not sure how many the Minister has spoken to. The following are some of these accounts and the first reads:

In three weeks, I will find myself yet again in a ward rampant with Covid and severely understaffed for nothing. I left a paid job because I could not put my children at risk of having no one to take care of them if I got sick and now I am being asked to do so for €3 a week. Micheál Martin wants to talk about real work and how we should pull up anyone expecting us to do anything on our own. Well, as you already know, the healthcare system would be even more on its knees without the free work of student nurses and it is not fair.

A second contribution reads:

We are highly insulted by the proposed €100 weekly payment that has been proposed as payment for our time on placement. As we work 31 hours per week this payment equates the value of our work as being worth €3.22 an hour. It only adds further insult to injury. This does not equate adequate pay for adequate work.

A third student said:

It is important to progress as a country in order to keep the already lack of healthcare staff we have from becoming an even more critical crisis. Most of the people I know are refusing to stay in this State once they are qualified, which means once the nurses who are working now retire, most of the younger generation of nurses will have no choice but to leave if we are not treated fairly.

The final contribution was a plea from someone who said:

I love my job. I always have and I always will. I love being there for people during those dark and difficult times in their lives. I love being able to care for and to look after the sick and frightened people. It is a blessing and I feel privileged. It truly shocks me how our Government and our Minister for Health still think it is acceptable to deprive an adequate allowance and a fair wage for those interns, and those first, second, and third years.

That is what I am hearing first hand from student nurses and midwives.

A previous Taoiseach and a previous Minister for Health once described the Department of Health as Angola. It has always been seen by Fianna Fáil and Fine Gael as a poisoned chalice. The reason for that is that none of them are interested in building a world-class public health service, a free and equal health service so that people can be treated fair and equally, a national health service. I have a message for the Minister. I do not see the health service as Angola or as a poisoned chalice. I see it as a unique opportunity to transform healthcare in this State and to build a much better, decent, world-class and egalitarian health service. If the Minister and the parties in government are not in the business of building that health service or do not want to treat those on the front line with respect, then I ask them to move over and to leave it to somebody who does want to do that job.

I have already said to the Minister, and I say it again in speaking directly to all of those wonderful student nurses and midwives that I have spoken to who are hugely talented people, our country is in safe hands when one listens to what they are telling us of their experiences and what they want to do in our healthcare system. They will not be here to do it, however, if the Minister does not act. They will emigrate. Listen to this message and pay them. The Minister said he would support this motion. I ask him then to go further than that and to meet with the Irish Nurses and Midwives Organisation, with SIPTU and with others and resolve this issue now. With the stroke of a pen the Minister can do this. There should be no more excuses, hiding behind reports or talk. People want to see us act.

The Minister and his party have an opportunity today to deliver and to be the Minister for Health who speaks directly to those student nurses and midwives and tells them that they are respected, valued, wanted and paid fairly and reasonably for the work they do during their internships and placements.

Question put and agreed to.
Sitting suspended at 11.55 a.m. and resumed at 12 noon.