Dáil Éireann debate -
Tuesday, 2 Nov 2021

Vol. 1013 No. 2

Nurses and Midwives: Motion [Private Members]

Deputy David Cullinane

I move:

That Dáil Éireann:

notes:

— the trojan work and sacrifice of healthcare workers during the Covid-19 pandemic;

— that there have been 28,912 confirmed cases of Covid-19 in healthcare workers, with nearly 400 infections in the last month in nurses and midwives alone;

— that healthcare workers, particularly frontline patient-facing staff, have been overworked since before the pandemic, and have reached a point of exhaustion beyond burnout;

— that there is significant evidence of waning vaccine protection after 6 months and that healthcare workers were mainly vaccinated with AstraZeneca nearly a year ago; and

— the need to ensure fair treatment, protection and support for healthcare workers as they face into yet another difficult winter, with added strain from chronic hospital overcrowding and emergency department overflows;

further notes that:

— the Department of Health has yet to publish or act on the independent review of clinical placement allowances for student nurses and student midwives, conducted by Sean McHugh (McHugh Review); and

— prolonged inaction on waiting lists and workplace disputes, including, but not limited to, pay, and particularly in terms of battling for personal protective equipment, air hygiene in the workspace, long hours, and constraints on in-sourcing and supporting staff, along with understaffing and underinvestment, have contributed significantly to low morale and moral injury in the health service; and

calls on the Government to:

— immediately begin offering a Covid-19 booster vaccine to healthcare workers and frontline staff;

— publish and act on the McHugh Review, and pay a fair allowance to student nurses and midwives for the work that they do;

— waive the Nursing and Midwifery Board of Ireland registration and retention fees which are coming due;

— engage meaningfully and positively with health and social care trade unions in a spirit of generosity, to deliver recognition of their particular sacrifice during the Covid-19 pandemic;

— publish and implement a fully costed and timelined delivery plan to reach safe staffing levels with improved staff-to-patient ratios, realise the commitments of the framework on staffing and skill mix, and implement real measures which will retain our valued healthcare workers and provide higher quality and safer healthcare; and

— ramp up mental health supports for healthcare workers.

I am sharing time with colleagues. I am proud to be proposing the motion. I am calling on the Minister, first and foremost, to publish immediately the McHugh review on pay and allowances for student nurses and midwives. Whatever the decision of the Minister, the student nurses and midwives who were outside the gates of Leinster House earlier today deserve to know what is in the report.

I welcome the measures for fourth year interns announced through The Irish Times but the manner in which that was announced is disappointing to say the least. I have met representatives of the Irish Nurses and Midwives Organisation, INMO, the Psychiatric Nurses Association, PNA, and SIPTU, and they are all very angry and disappointed that there was no direct engagement with the Minister and the HSE regarding the McHugh report and the contents of the memorandum he intends to bring to the Cabinet. As usual with this Government, the information ends up in The Irish Times or elsewhere in the media before those who are affected by this hear about it. This is an industrial relations issue. It is a show of bad faith and it affects the student nurses and midwives who are part of the defence against Covid that the House discussed earlier but have been treated so badly.

From what I have read, I am concerned that there is no real detail regarding first, second and third year student nurses and midwives and their unpaid clinical placement. It seems that the emergency €1 payment will continue for a bit longer, but there is a need for more detail in respect of what exactly will be put in place on a permanent basis for those first, second and third year students. It has to be real and substantial because they have rent to pay and other living expenses just like everybody else and they need to be properly supported as they work in hospitals as part of their placement and in their training.

There is a responsibility on the Minister to ensure that all student nurses and midwives are paid a fair allowance. I call on him to act on this urgently, as actions speak louder than words. The issue of payments for student nurses is a litmus test for this Government's recognition of the contribution of those who worked in our healthcare system throughout the pandemic. I have met many of them, in fact, hundreds of them, over the course of the last number of months. What really concerns me is how undervalued they feel. I do not know if the Minister appreciates that or if he has engaged with them to the same level. It is really frightening, at a time when we know that we have to recruit and retain staff in our health service, that young people are coming through training, doing placements in hospitals and feeling so undervalued and under-appreciated to the point that many of them are telling me they will not stay - they will leave the first chance they get. My message to them is not to leave and to stay, because we need them in our public healthcare system. If the Minister is sending the same message to them, he needs to underpin it by taking firm and clear action.

I also want to ask the Minister about the recognition payment for front-line workers that we heard so much about. It was an issue that was brought up before the budget. The Taoiseach and the Tánaiste were talking about it. It was expanding by the day and the minute. Every time a Minister spoke, it was announced that more people would get it and more public sector workers would be covered. Those on the front line were certainly led to believe that something would happen. It did not happen before the budget. There was then an expectation that something would be announced in the budget. Of course, the budget came and went and there was no announcement of a recognition, bonus or payment. Since then, over the last number of weeks, I have not heard a peep from the Government. For all of the speculation, the talk and the mixed messages that came from some members of the Government, it is as if the issue fell of a cliff and nobody has heard about it since. That must be dealt with. The WRC has stated that the Minister and the Government needs to engage with it to resolve the issue.

My final point relates to safe staffing levels in our hospitals. It is an area of work that I want to support over the next while. I am engaging with healthcare trade unions, training bodies and others to ensure that my response in this area is fit for purpose. We must put in place the strongest and most robust policies and clearly think out how it is that we are going to recruit, train and retain more nurses, GPs, doctors and consultants. We must do that to ensure we have safe staffing levels. We do not have enough GPs, there are still far too many vacant consultant posts and there are many nurses who are telling me that they are going to leave the profession. We need a proper strategic workforce planning strategy that is underpinned by the need to train staff more and also to value them more and treat them better. We must tell them that the Irish public health service we want to build is going to be a world-class one and also one that we want them to come and work in. We must tell them that we value them and want them. That is the message they should hear from the Minister and the Government.

Deputy Maurice Quinlivan

Throughout the worst period of the pandemic, when uncertainty reigned and before so many of us got the vaccine, our hospitals were the front line in the battle against the virus. Healthcare workers, nurses and midwives came in to work day after day, shift after shift, putting themselves at real risk of contracting the virus. They were very tough times for our healthcare workers and their families. Since the widespread uptake of the vaccine, we have seen immense overcrowding return to our hospitals. The pandemic remains, but as restrictions are being relaxed, inevitably, we are seeing an increase in hospital presentations. An overcrowded hospital is a Petri dish for infections.

While our healthcare workers have been vaccinated, we need to ensure they are given every possible protection against this debilitating virus. I welcome the announcement made last night that these key workers are in line to receive a booster vaccination. It is an important first step in protecting our healthcare workers. Beyond that, we need to start delivering better working conditions. It is not acceptable for our nurses and other staff, such as porters and cleaners, to be working in overcrowded hospitals. It is not acceptable that nurses and other staff in my local hospital, University Hospital Limerick, are reluctant to take annual leave, as they fear there is not enough staff to cover for them when they are off. It is not good enough that we put such a burden on student nurses without paying them adequately for the important work they have done. I am pleased to see that there will be some movement on this issue. However, more clarity is definitely needed. The McHugh report remained unpublished and unacted on for too long. When the student nurses saw patients in distress, they acted. When there were healthcare workers absent due to Covid, the student nurses stepped up. Reports suggest that the Government will act in relation to fourth year student nurses, but there is no suggestion that similar action will be taken in respect to those in the first to third years of their studies. We need clarity from the Government and a timetable for when recognition will be offered to some of our student nurses.

The large number of healthcare workers who have been out of work due to coronavirus illness is stark. Others continue to battle with the long-term impact of the virus on their bodies. Worryingly, the level of infections is increasing across the State.

In the time that is left, I wish to raise the issue of overcrowding, which is a massive problem in my own local hospital. There were 75 people on trolleys there today. The conditions of overcrowding are unbelievable. Last week, I spoke to officials at University Hospital Limerick with my colleague, Deputy Cullinane. They are concerned about the huge number of presentations to the emergency department, which has increased by 22% since 2019. I ask the Minister to intervene personally.

Deputy Rose Conway-Walsh

Why would someone who is not working be asked to do a 12-hour shift, unless they really are working? The fact is that students plug the gaps left by a failure to invest in staffing levels. Political pressure played a key role at the beginning of the summer in securing just €100 a week to pay student nurses for the work they did during the pandemic. I wish to commend all of the students who have tirelessly campaigned, and the INMO and the Union of Students in Ireland, USI, for the work they have done on this issue.

I met with two nurses from Limerick today who described the work they do. They told me that they are not allowed to work in other healthcare settings due to fears of cross-contamination and described how they have been driven into poverty by the high fees they have to pay and the high costs involved in qualifying as a nurse. I thought one of the slogans I saw today summed it all up. It read: "Why are nurses priceless, but penniless?". We must value our nurses. They have earned that.

On top of that, the WHO has warned of a global shortage of nurses that could impact on our ability to rely on international recruitment. We must ensure that we train and retrain as many nurses as possible into the future. Key to that is how we treat and respect nurses and midwives. That must start with students. We not only need to provide a fair allowance for student nurses; we also need to increase the number of places available for people who want to study nursing. The Government needs to join the dots on the nursing shortages and the lack of places available in colleges for young people.

There is an alarming lack of planning and forward thinking. It is testament to our young people that each year, over 5,000 leaving certificate students pick nursing or midwifery as their first preference on the CAO form, yet, we can only accommodate around 2,000. We have both a need and demand for these courses and places. Sinn Féin has been calling on the Government to increase the number of places available by 250 this year and to continue to increase the numbers until we reach 2,500 annual new entrants.

Almost 4,000 students enrol in pre-nursing courses every year, but less than 5% of them get access to a degree course in nursing. Sinn Féin would also ensure that a larger number of these places are reserved for students in pre-nursing levels in the State, and that nurses have a clear educational and career path. There are many areas that need to be addressed.

Deputy Pa Daly

I support this motion. The thing that strikes me most when I speak to nurses is how undervalued they feel. Is it any wonder? There are staff shortages. Nurses are exhausted and stressed and did not receive childcare support at the beginning of the pandemic when they were crying out for it. They did not have access to support staff in pharmacies, adequate security, occupational therapists, physiotherapists, or even adequate catering. Some that I spoke to were just told to get on with it.

There seems to be no strategic vision and strategy in the hospital groups. This can clearly be demonstrated in the example of a haematologist, recently employed in University Hospital Kerry, who was not even supplied with a microscope when he started work. Essential services must be kept, but you can only centralise so much. I ask the Minister to listen to what the nurses are saying. The consultants in University Hospital Kerry, in an unprecedented move, wrote a five-page letter to the South/South West Hospital Group demanding change in the hospital. Too many nurses are doing non-nursing duties.

I ask the Minister to employ more nurses and keep the existing staff that have been there for many years by valuing them. I ask the Minister to be flexible with those who want to work, but want to work fewer hours. We must build isolation rooms, more beds and wards, cath labs and an oncology unit at the hospital. Having just four nurses in a 30-bed ward is unsafe.

If the Minister cannot do any of this, will he at least get them a proper staffroom and changing rooms? The current situation is unsafe.

Deputy Sorca Clarke

When people clapped for front-line workers, including student nurses and midwives, that clap did not pay a bill, it did not pay for a crèche and it did not pay the rent. That public display of support must be reflected by the Government in meaningful pay and allowances. The payment for student nurses and midwives will be the litmus test of the Minister. The contribution they made and continue to make as we work our way through Covid must be acknowledged and reflected by the Government. It also tells us on whose side the Government is standing. While words matter, actions speak louder than any word ever will.

Earlier, I spoke with student nurses and midwives outside. What they told me was difficult to hear. They told me that they are tired, frustrated and exhausted and that they do not feel heard, valued or supported. More frighteningly, they told me they are thinking of leaving the country. Student nurses and midwives have been waiting for far too long for this recognition. We have tabled this motion to ensure the Government stops the vague promises and delivers for student nurses and midwives. We will need them when they are fully trained. We cannot have a haemorrhage of these valued workers out of the country. There can be no further delays and no further excuses. It is time to stop with the lip service and put in place what these workers need to ensure they will be assets in our health service in the future.

Deputy Seán Crowe

The debt of gratitude we owe our front-line healthcare workers is immeasurable. The sacrifices made were immense and the cost has been great. These are people who went into work at a time of great danger, not knowing what they might be exposed to or bring home to their families. This was all done against the backdrop of understaffing and underinvestment by successive Governments, leading to low morale in the health service.

Almost 30,000 healthcare workers have contracted Covid-19 in their attempts to help those afflicted by the virus. There have been almost 400 infections in the past month among nurses and midwives alone. The Government must begin offering booster vaccinations to healthcare workers immediately. It has been more than six months since many healthcare workers receive their vaccinations and they may have fallen outside the window of effectiveness. We must offer the highest level of protection to those fighting on the front lines. It is the very least we can do. We must also look at how we can recognise particular work and sacrifices of our front-line healthcare workers. We should waive the NMBI registration and retention fees, which are due soon. As a matter of principle, we must pay a fair allowance to student nurses and midwives for the work they do. A fair day's pay for a day's work must apply to all.

Staff have been overworked since before the pandemic and have reached a point of exhaustion beyond burnout. As a matter of urgency, the physical and mental health supports for healthcare workers must be ramped up. With hundreds of nurses suffering the lingering effects of long Covid, a pat on the back and a cheery congratulation is insulting and adds to their frustration. The Government is not taking long Covid seriously. As other countries have moved forward with supports for those who are left with long-term symptoms such as chronic fatigue, pain and the loss of lung function, the HSE still talks around it. By not saying it out loud, does it think that nurses who can hardly climb a flight of stairs or are losing their hair will somehow get better? At a minimum we need to put in place a clinical definition of "long Covid" and put in place proactive measures to support sufferers in the medium and long term.

Deputy Brian Stanley

I welcome the opportunity to speak on the motion, which is about delivering fairness to young nurses and midwives in our hospitals and improving staff-patient ratios. Sinn Féin wants our front-line healthcare workers to be recognised for the contribution they have made, particularly during the Covid-19 pandemic. The motion calls for student nurses and midwives to receive fair pay allowances immediately and for the Government to engage meaningfully with the health and social care trade unions to deliver on pay and conditions.

Nurses and midwives deliver incredible front-line services in very difficult conditions. Only two weeks ago, along with Deputy Cullinane, I met the management of Portlaoise hospital and nurses' unions to discuss access to care and chronic overcapacity in the hospital. Unfortunately, this is mirrored throughout the State. Covid admissions at Portlaoise hospital doubled between 1 October and 1 November. Capacity issues are causing serious and severe problems in service provision. They are also putting a lot of pressure on staff. This is impacting negatively on retention because of staff burnout, overwork, long shifts and few breaks. Nurses will go elsewhere, unfortunately. According to the HSE's website, no ICU or HDU beds were available at Portlaoise hospital on 1 November. There were no free beds in those units. There were also no ICU or HDU beds available in Tullamore hospital. In fact, Portlaoise hospital's ICU was at full capacity for all of October except for four days. There were only four days when there was spare capacity in the ICU.

Hospitals in the midlands are operating at 100% occupancy much of the time. Some of them are operating at slightly over this. We have to address this. There is a range of worrying statistics. A range of reports, including the 2018 Sláintecare health service review, recommend capacity of 80%. My understanding is that 80% capacity is an internationally recognised figure throughout the OECD. We should be at approximately 80% hospital capacity and there should always be that much slack. We are one of the highest spending countries per capita in the OECD on healthcare. Therefore, it is very frustrating that consecutive Governments have failed to address the chronic capacity issues. Sinn Féin wants to deliver a healthcare system that works for patients and a system in which nurses and midwives can build careers and have a future. To do this we need fair pay for student nurses and midwives and adequate hospital capacity.

Minister for Health (Deputy Stephen Donnelly)

I very much welcome the opportunity to address the House on the motion. I thank the Deputies for tabling the motion, which the Government will not oppose. I would like to take this opportunity, as I am sure we all do, to thank nurses and midwives, including students, and all healthcare workers for their ongoing dedication, commitment and professionalism as we continue to deal with Covid-19. I meet many nurses, midwives and students, and many other healthcare workers throughout our healthcare system, on a regular basis. Many of them are tired. Many of them have had a difficult time. We have to do everything we can to support our healthcare workers. At the same time, while many are tired, they also discuss a sense of immense pride in the work they have done and the work their colleagues have done, and in how our healthcare community has stepped up in the face of the biggest healthcare crisis and challenge we have faced in living memory. The Government is committed to recognising the dedication that front-line healthcare workers have shown during the pandemic. Work is ongoing to determine how best this can be done.

The contribution of our nurses and midwives, and our student nurses and midwives while on clinical placements, has been, and continues to be, exceptional. Student placements in hospitals are a feature of training and education across a range of disciplines in the health sector. The placements give students practical experience to meet the educational and regulatory requirements of the programmes and ensure they are in a better position to get jobs after graduation. Clinical placements are a necessary part of the degree programme for nurses and midwives who gain invaluable practical experience and develop their clinical skills. Of course, part of the result of this is that our graduates are sought all over the world because of the quality of the training they have had and the degree programmes they have come through.

As many of the Members here will know, we have introduced a number of measures to help support our student nurses and midwives during the pandemic. First, we ensured they could access the pandemic unemployment payment if they ceased part-time work in, for example, a nursing home or another healthcare facility because of infection prevention and control considerations. This was a special exemption for student nurses and midwives.

I commissioned a report from Professor Tom Collins who recommended a specific pandemic payment grant of €100 per week of supernumerary placement. There was an option put in place also to backdate that to the start of last year's academic term in September.

Following the completion of the Short-Term Review of Clinical Placement Allowances for Student Nurses and Midwives by Professor Tom Collins, the Collins Report, in December 2020, a longer-term independent review was commissioned to examine multiple issues as follows: first, the existing clinical placement allowances payable to student nurses and midwives on supernumerary clinical placement for first, second and third years; second, the pandemic placement grant as specified in Professor Collins’s report; and third, pay for fourth year nurses and midwives on the paid internship placement. Mr. Seán McHugh was appointed to carry out this independent review. He invited submissions from a number of stakeholders, including the HSE, higher education institutes and students. I was pleased to receive a report on this matter from Mr. McHugh and my officials and I have completed our review of his report. I agree with his recommendation to increase the pay of interns. I intend to extend payment of the pandemic placement grant. I will also be supporting additional recommendations that were made in the report and will be requesting Cabinet approval for increased financial supports to this end.

Covid-19 brought a range of serious challenges to our nation and to our health service in respect of capacity and staffing. We have worked hard to increase both in order to respond to the pandemic and to deliver a better resourced health service for the future. Both budgets 2021 and 2022 provide very significant amounts of funding for a large, permanent expansion of the health service workforce.

This year, we have recruited an additional 4,462 staff so far, including many more nurses and midwives. The year-to-date whole-time-equivalent growth for 2021 is the second largest increase since the foundation of the HSE, the largest increase being last year. The Department and the HSE deserve great credit for achieving this during a pandemic. Budget 2022 continues the significant investment in the health sector workforce, with funding for an estimated 141,491 full-time staff to be in place at the end of 2022. This would be a further increase of 10,855 from the current staffing numbers, equating to an increase of 8%.

I am acutely aware of the impact that the recent Covid-19 surge is having on our health service, on our patients and, of course, on our healthcare workers. I know that many of our healthcare workers were increasingly concerned about the waning immunity of the vaccines. I was very pleased to authorise yesterday evening the roll-out of booster vaccines to approximately 300,000 healthcare workers. I received updated recommendations from the National Immunisation Advisory Committee, which recommended that a booster dose of an mRNA vaccine is offered to healthcare workers who have completed a primary vaccination course of any Covid-19 vaccine. The additional vaccination of healthcare workers will further protect them and, in turn, the vulnerable patients under their care. Reducing the level of breakthrough infections among healthcare workers will help ensure the continuity of healthcare services particularly during the winter, which have been seriously curtailed by higher rates of transmission of this virus and the pressure that Covid-19 is putting on our entire healthcare system.

My Department, the HSE and the National Treatment Purchase Fund are focusing on improving access to elective care in order to reduce waiting times for patients. These plans include funding weekend and evening work in public hospitals, funding “see and treat” services where minor procedures are provided at the same time as outpatient consultations, providing virtual clinics, increasing capacity in the public hospital system, as well as increased use of the private system.

We have a budget of €350 million available to support vital initiatives to help us to address the waiting lists. These have disimproved during the pandemic but, let us be clear, they were unacceptably high for a long time before Covid-19 arrived here. This causes great stress and anxiety for patients and their families, as well as the healthcare staff who are trying to care for them in what are sometimes suboptimal conditions.

I also acknowledge the distress overcrowded emergency departments are also causing to patients, to their families and to frontline staff who are working in very challenging conditions in hospitals throughout the country. I thank all of our frontline workers for their ongoing work and professionalism. I recognise that this winter will be a difficult one for patients, for their families, for our health system and for our healthcare workers.

The Government has funded significant initiatives across the health service in the acute, community care and primary care sectors to reduce demand on emergency care by providing alternative care pathways outside the acute sector, additional capacity within the acute sector and additional discharge options in the community sector for patients who were admitted through emergency.

The winter plan will provide for the appropriate, safe and timely care of patients by ensuring, insofar as possible, that effective levels of capacity and resources are in place to meet the expected growth in activity levels.

In conclusion, I want to state that I do not underestimate the difficulty that nurses and midwives and their healthcare colleagues have experienced throughout the course of the pandemic. Without question it has been a difficult and often brutal time. In conjunction with the HSE, the higher education institutes, the Nursing and Midwifery Board of Ireland, NMBI, and clinical partners, my Department and I will continue to focus on keeping our nurses, midwives and their colleagues safe.

I will have to leave before the end of the debate for a meeting on epidemiology and the Minister of State, Deputy Butler, will be here for the wrap-up on behalf of the Government. Gabhaim buíochas.

An Ceann Comhairle

Deputy Carthy is sharing with his colleagues, Deputies Mitchell, Brady and Munster.

Deputy Matt Carthy

Gabhaim buíochas. Because this motion is about priorities, I was reminded today that since my election for the first time to this House in February 2020, on three different occasions I have had to sign a form to tell the Houses of the Oireachtas that I was not accepting a pay rise that I had never asked for and that I did not need. On the same number of occasions, three times, this House has debated motions in respect of providing proper remuneration for our student nurses and midwives and on three occasions the Government has failed to act.

This Chamber clapped in unison at the height of the pandemic in recognition, in solidarity and in appreciation of our frontline workers. Actions, however, speak louder than words. The actions that needed to follow were that we recognised that the pandemic, above all else, exposed deficiencies which go to the core of our health services. Unfortunately, rather than the pandemic being used as a vehicle to undo those deficiencies, it is now the excuse for those deficiencies remaining in place.

When we talk about the difficulties in capacity, the pandemic is the reason, despite the fact that in the Minister's budget this year there was not a single additional acute hospital or community bed delivered above what had already been committed to, which is approximately one half of the intensive care unit, ICU, beds that are actually required. Nothing from the Minister's party, since the Minister has taken over this Department, has been provided for the rebuilding of our smaller hospitals such as Monaghan Hospital, despite pre-election commitments from his party that he would ensure that that would be the case. To my mind, the very fact that we are again debating a motion in respect of our student nurses and midwives shows me that the Government has still not got that issue sorted on behalf of those people who stood by us through some of our darkest days. This tells me quite clearly that what is needed here is not just a shift in policy emphasis but a change in government.

I firmly believe that these issues will only be adequately addressed when we have someone such as Deputy Cullinane in the Minister's office. I commend the motion to the House.

Deputy Denise Mitchell

I welcome the opportunity to speak on this important motion. We are facing into another winter in which our hospitals will be overrun and the reality of the Covid crisis must be faced. We need to start getting vaccine boosters to front-line staff. I welcome the announcement in that regard by the Minister last night. Healthcare workers must be protected. He will be judged on his actions in the next few weeks and he needs to deliver on the commitments given.

Student nurses have been promised the sun, moon and stars by the Government. The Minister has been saying all the right things about improving their pay and conditions but, as always, action speaks louder than words. In fact, he has sat on his hands and delayed improvements for student nurses at every opportunity. They are all too aware that they are not the top priority, but the Government is making sure there is no doubt left in their minds in that regard. We are calling for the publication of the McHugh review, which has been sitting on the Minister's desk for weeks. It is time that report was made public. There is much talk about bringing proposals to Cabinet this week. However, looking at what was leaked to the media today, those proposals will not come close to meeting student nurses' requests, particularly for first-, second- and third-year students. It is a pity the Minister did not engage with their unions on these matters.

The current situation is completely unfair and it has gone on for far too long. Student nurses deserve fair allowances that reflect the hard work they do to keep our hospitals moving. This applies to all student nurses, not just those in their final year. Anything short of an improvement for all of them is unacceptable. I hope the Minister will see sense on this.

Deputy John Brady

Over the past 20 months or thereabouts, countless student nurses and midwives were sent into harm's way, alongside all our front-line workers, to fight the pandemic that came to our shores. There have been almost 29,000 Covid cases among healthcare workers and a large number made the ultimate sacrifice in defence of their communities. My family and I have felt the full impact of this. My daughter, who is a student nurse, contracted Covid while on placement and brought it into our home, which wreaked devastation throughout the household. My father-in-law, her grandfather, ended up in ICU and it was only due to the heroic action of healthcare workers in St. Vincent's University Hospital that his life was saved, for which we are eternally grateful.

Every country in the world wants to hire Irish nurses, yet the Minister seems to be doing his best to give them a one-way ticket abroad and push them towards a life of eternal servitude in foreign lands. Many of them are left wondering why they are deemed priceless yet forced to remain penniless. In what can only be described as a cynical attempt to deflect from the Government's indifference to the welfare of student nurses and midwives, the Minister offered them a paltry €100 earlier this year. He also agreed to a more long-term review of payments to student nurses on clinical placement, which was to be led by Sean McHugh. Those recommendations were to go to the Minister in June, in the hope that they would be in place for the current academic year. However, the report has been sitting on his desk since 12 August and only parts of it have been seen by a select few journalists, not by those who made contributions to, and took part in, the review.

The Minister must publish that report immediately. He needs to pay a fair allowance to student nurses and midwives for the work they do. When he says he is not going to oppose this motion, that does not mean he should do nothing; it means he must implement the contents of the report. He has been found out and he will continue to be found out if he persists in sitting on his hands and failing our health service and our student nurses and midwives.

Deputy Imelda Munster

Healthcare staff have done Trojan work since Covid first hit and their contribution can never be quantified. The entire country owes them a debt of gratitude. Their hard work and dedication got us through this crisis and they continue to carry out that work in exceptionally difficult circumstances. Levels of burnout and exhaustion are at an all-time high as healthcare workers face into another long, hard winter. Public hospitals are under enormous pressure, with personnel working in conditions of staff shortages, long working hours and low morale.

Working conditions were difficult in the public health service long before this crisis. Underinvestment in the healthcare system has meant overcrowding, waiting lists and enormous workloads for many years. There has been inaction on waiting lists, which are at their worst-ever levels, with 900,000 people waiting for treatment. When the CEO of the HSE appeared before the Committee of Public Accounts some weeks ago, I asked him what the chances were of that figure reaching 1 million by Christmas or shortly thereafter. He could not say it would not happen. This is an appalling legacy after ten years of Fine Gael in government, with Fianna Fáil propping it up previously and now working with it in government.

There is also inaction on workplace disputes, including pay, access to personal protective equipment, PPE, proper air hygiene in the workplace, long working hours and understaffing. Every day, we hear about the difficulties for nurses. I sometimes wonder whether members of the Government ever stop to think about the work our healthcare staff have done and continue to do. Does the Minister ever stop for a moment and consider that he is in a position to put this right by standing by the workers who have looked after us right through the pandemic and continue to do so under enormous pressure? Does he never say to himself that he will move mountains to give those staff, including nurses, student nurses and midwives, the fair pay allowance they deserve? Does he never once resolve to do all that is necessary to relieve the pressure they are under? I can only imagine that if Deputy Cullinane were in the Minister's chair, he would start at it straight away and we would not have staff having to leave busy shifts and come up to Leinster House to picket and beg for a fair pay allowance. It is a disgrace.

Deputy Duncan Smith

I am finding it hard to separate the two debates taking place today in the House, namely, this one and the one we had before it. It is like an old-fashioned revue, where we had the first act, the actors went off for a short interval and now they have come back and taken up different parts. I cannot understand how any proposer of this motion, which is an excellent motion in itself that is supportive of student nurses and midwives and other healthcare workers, could vehemently oppose the extension of emergency powers on a day when case numbers are at 3,700.

Deputy Stephen Donnelly

Hear, hear.

Deputy Duncan Smith

I have been sitting here for the past 30 minutes listening to the debate and wondering how that can be the case.

When this is boiled down, why exactly are these emergency powers being introduced? They are not politically popular; nobody likes them or wants to support them. Why, then, are they being extended? Their extension is happening because the case numbers are five times higher than they were this day last year, when we had 748 cases. We are heading into an uncertain winter, with 90% of people aged over 12 vaccinated and 3,700 cases. The one thing we have learned about this pandemic is that when case numbers rise, hospitalisations and ICU admissions follow. The emergency powers, at their essence, are certainly not designed to make the Government popular or help businesses and workers, to whom they are damaging; they are designed to ease pressure on our health services. Ultimately, if they have to be used, they are designed to save lives. They are also designed to help student nurses and midwives by easing the pressure on the wards on which they work.

Listening to what has been going on for the past couple of hours in the previous debate and this one, it is so inconsistent because what is written in this motion-----

Deputy David Cullinane

That is because the Deputy did not listen to a word we said.

Deputy Duncan Smith

I have listened; I have listened to the entire debate. The Deputy can respond to me later.

Deputy David Cullinane

I will respond later.

Deputy Duncan Smith

It is the Deputy's motion and I am sure he will respond. This is my contribution. This is a very good motion because it speaks to what-----

Deputy David Cullinane

The Deputy has not spoken to it yet.

Deputy Duncan Smith

I am speaking to it now. We are being told that Deputy Cullinane is the greatest health Minister in waiting, so he is setting himself up for a major fall. If he cannot get through the past couple of hours with any consistency, I wonder how he will get through a term as a Minister for Health.

It is 11 months since Senator Annie Hoey of the Labour Party presented a Bill on student nurses' pay. Student nurses and student midwives have been among the lowest in terms of how they have been respected during this pandemic. There is no doubt about that, and that is why this motion is a good stand-alone motion. It speaks to that in a real way. We see the impact it is having from the surveys that have been done for student nurses. The motion refers to "beyond burnout". It is beyond burnout. Some 62% of respondents to the nurses and midwives survey have cared for patients who have died from Covid-19, 91% have felt mentally exhausted when off duty and 97% believe it has had a negative psychological impact on their colleagues. I have been in this House and in the convention centre for the past year and a half and have heard the moaning and cribbing of our colleagues about being housed in a world-class convention centre. Compared to what real workers are doing on the front line of this pandemic, it is embarrassing. It has been embarrassing to be a politician at this time. We are clapping at a time student nurses are not getting paid.

I welcome what the Minister said about the McHugh review, but it is too late. It has been on his desk for a number of months. Everything has taken far too long. The student nurses and midwives who gathered outside the Dáil today are exasperated and exhausted. This is not the first time they have been outside the Dáil. They do not want to be there. They want to be either studying or learning their craft, and they have not been able to do that with the respect that they deserve. That has been a huge regret of this pandemic. We cannot ignore the fact that two thirds of nurses and midwives tell us that they are considering leaving the profession due to the impact of Covid-19. Yesterday, we saw on the television news people arriving through the arrivals gate of Sydney airport. We know what is going to happen if we do not improve the terms and working conditions of healthcare workers, be they nurses, midwives, radiographers or social care workers. They will be going through those arrival halls next year to better paid jobs, career diversity and progression and a quality of life they are not getting here.

These are the fundamentals, and this predates Covid-19. That is just Australia. There are also the Emirates, which are providing large, tax-free wages for these workers. They can go there to work for three or four years and then return. The UK is a more attractive option. Ireland should be the most attractive place for any healthcare worker to work in but, unfortunately, it is the opposite. We have seen what our healthcare workers can do. Ireland is a world leader in its vaccination roll-out. The healthcare workers have been doing that. It is nurses, student nurses, retired nurses and everybody in between who have been vaccinating us and keeping us as safe as possible. There is a fundamental problem that this Government and any future Government will have to tackle.

Regarding the booster vaccine, today's announcement that it will be rolled out is welcome. Again, however, it is weeks too late. Why did NIAC take so long? The science is there. The Minister and I have spoken to clinicians; every spokesperson and Member has been speaking to clinicians and scientists about the efficacy of vaccines. With 3,500 healthcare workers out sick, the fact that it has taken until 2 November to announce that the booster campaign for healthcare workers is going to continue is frankly unacceptable. We will also have a situation where vaccinators are going to return to facilities such as nursing homes to administer the booster shots, the same facilities they visited in previous weeks to administer it to people over 80 years old and so forth. It is an inefficiency we could have done without.

On the stand-alone motion and the need to show respect to the student workers who were outside the House on this cold November day, it deserves support and implementation.

Deputy Róisín Shortall

I welcome the motion, which is timely. It is about time serious consideration was given to the role that nurses have played in this country generally and particularly over the past two years. It is a shocking indictment that nurses have to take to the streets and protest for what they have long been promised and for the recognition they deserve.

I welcome the Minister's announcement that the booster vaccine will be extended to healthcare workers. Like other Members, I do not know why there was a delay in this. It is an obvious move. They should be very much at the top of the queue. Apart from the fact that so many nurses put themselves in danger each day, we know that as a result of their contact with patients with Covid-19 approximately 3,500 healthcare workers are off due to Covid-19 and approximately 10% of those will have the effects of long Covid. The fact that the booster vaccine will be provided to them over the coming weeks will undoubtedly protect them and will also protect the capacity of the health service.

However, I reiterate the point I made earlier that vaccines alone will not protect nurses or healthcare workers generally. I believe we are repeating the mistakes that were made over the past year, whereby all the concentration was put on the vaccine programme. It is fantastic that there was the breakthrough with vaccines and that they were developed so quickly. The roll-out in this country was exceptionally good. However, all the emphasis was put on the vaccination programme, and other measures that could have been put in place more easily and in addition to the programme were more or less overlooked and neglected. To look back at what happened, we were late to adopt the recommendation to wear masks and we were late with regard to antigen testing. Antigen tests were recommended last March and it took a second expert group to recommend them six months later, but we are only starting to use them now in a minor way when other countries have been using them for more than a year on a widespread basis. We have been exceptionally late in recognising that Covid-19 is an airborne virus. I cannot understand why the Government has not acted on this. It has been known since the summer of last year that Covid-19 is an airborne virus. Straightforward measures could have been taken, which would have substantially reduced the spread of Covid-19 but for some unknown reason those measures were not taken.

We are now at a point of facing into the winter with a complete underestimation of the impact of seasonal conditions on the virus. The Minister announced more than 3,700 cases this evening. That figure far exceeds the projections made by NPHET under the most pessimistic scenario, and it is far earlier than NPHET predicted any such numbers.

It predicted under a pessimistic scenario 2,500 to 3,000 cases per day during November. Today on 2 November, we have far exceeded that prediction. What steps will be taken now to reverse those figures or even to contain them? I am not hearing that from the Minister, nor am I hearing it from NPHET. Many practical measures could be taken, particularly with ventilation. I cannot understand why the Government is ignoring those. This has been established as good practice in many other countries.

The Government has done the minimal amount in schools by providing CO2 monitors very late in the day. It has refused to provide any kind of air purification systems. Equally, in hospitality there is no requirement to have proper standards of ventilation. In most European countries, hospitality settings are required to display the reading from the CO2 monitor in the front window, and people can choose whether to go into unsafe circumstances.

Last month, people were advised to go back to work in the complete absence of any kind of guidelines or limits in respect of how to measure CO2 levels, how to ensure proper ventilation, and what steps to take when the air is infected and unsafe. I cannot understand why the Government is not doing that and, equally, I cannot understand why it has not adopted antigen testing.

It is great that healthcare workers will get the booster vaccination, but if the Government repeats the mistake of putting all the eggs in the basket of vaccination, this will not work. Unfortunately, we know that vaccinations have disappointed. I fully accept that was not known six months ago. There are breakthroughs. We also know at this point that vaccination does not help to stop transmission.

For nurses and healthcare workers generally, as well as the booster vaccines, steps need to be taken to ensure the air in hospitals, many of which are very old buildings, and other healthcare facilities is safe. We need to ensure infected air is dealt with in hospitals particularly, but also in all the other settings I have mentioned.

I ask the Minister to consider arranging urgent briefings for the Opposition on the steps that will be taken. We have not had a briefing for many months and there have hardly been any this year. I appeal to him to bring in the Opposition spokespersons or party leaders and provide a thorough briefing on the plans to deal with the unfolding dire situation.

I repeat the points others made about the enormous impact of Covid highlighted in the IMO survey. The burnout that was common pre-pandemic is now rampant in many healthcare settings. ICU nurses in St. Vincent's hospital report that they are at breaking point due to staff shortages. They are forced to use a baby monitor to watch patients in ICU because they do not have enough staff. Is it any wonder such a high proportion of nurses are saying they intend to emigrate to go to work in healthcare systems that actually work and where governments are serious about reform?

The long-fingering of Sláintecare is a significant factor in this regard. Nurses and other healthcare workers are waiting for reform that has not been delivered and they will lose further confidence in the Irish healthcare system. We were promised more healthcare staff but only a fraction of those have been recruited this year. Nurses feel very unsupported by Government, something we will pay an enormous price for unless it is addressed as a matter of urgency. We need to get to a point where we have safe and adequate staffing levels. We are very far from that at this point. Nurses deserve better, patients deserve better and the public deserves better.

Deputy Gino Kenny

I express our gratitude to those in the nursing profession and healthcare workers who kept us all safe in this terrible time. Those in the nursing profession, not only in Ireland but across the world, have never been as challenged. They lost colleagues in a battle to protect all of us. Over the past 17 to 18 months, many things have changed, some for the good and some for the bad. We have seen how the vocation of nursing has been undervalued in Ireland, especially student nurses. That was exposed last year regarding student nurses in a placement not getting paid. That needs to be addressed immediately or else nurses who are highly qualified will graduate and leave this country. We do not want that situation. These people are highly motivated and highly skilled and want to work in our health system. However, they are burnt out. Not all nurses want to do that, but a minority want to leave because of pay and conditions.

The Minister can fix that through recognition, respect and remuneration, which is very important for student nurses on work placement. We spoke to them outside the gates of Leinster House today. They are highly motivated and doing an extremely difficult job but they feel they are not being paid for the work they do. All they are asking is that when they are on placement for 18 weeks in second year or third year, they get recognition for travel costs or something. That will go a long way to recognising the profession. The nursing vocation is in its golden age. There has never been so much interest in this country. There is an oversupply of people applying for nursing courses through the CAO, indicating that a large number of people are interested in this. The Government needs to look after them, and once it looks after them, they will look after all of us.

Deputy Paul Murphy

The central issue here is simple. When Covid hit, student nurses and midwives stepped up to the mark and went above and beyond the call of duty in the fight against Covid. Last year, under pressure from student nurses, from the left and from People Before Profit, the Government finally recognised they deserved to be paid and gave them the healthcare assistant rate of €14 an hour. However, then Scrooge-like it took the money back, offering only a pitiful €100 a week support, which is less than €3 an hour. Workers in our hospitals, caring for our families, our friends and perhaps even ourselves, are getting only €3 an hour for it. That is exploitation, pure and simple.

Student nurses and midwives should be paid a living wage for their work. It is the very least they deserve. Today, the Minister, Deputy Donnelly, has announced he will increase it by 12.5%. That is a consequence of the pressure from below because he knew the kinds of crowds that would be in front of Leinster House today demanding proper pay.

What about the others? What about the student nurses who are not in fourth year? There is still nothing for them.

That says a lot about the attitude of the Government towards the health service, which is to run it down and on the cheap as opposed to investing in a properly funded national health service. It says a lot about the attitude to those students who do work, which is not just limited to the health service and is across the board. Many students do work and all should be paid for it. Postgraduate researchers should be paid. This also speaks to the general attitude towards workers, paying lip service and empty sorts of thanks for the sacrifices of workers. What is reported is about the meanest thing possible for all workers, which is one bank holiday for one year. Even if we had one extra bank holiday every year we would still be below the European average. It is simply not good enough for all that workers have sacrificed.

Deputy Richard Boyd Barrett

We are 18 months into the pandemic and it is just under a year since People Before Profit brought the first motion to the Dáil calling for payments to student nurses and midwives because of the incredible work they have done on placement during Covid-19 especially but which they do all the time.

The Government must get this. This is not just about what student nurses and midwives do on placement during the pandemic, although the pandemic highlighted the extent to which they work and help knit together our chronically understaffed and under-resourced health services. The Government had to recognise it with the healthcare assistant rate it provided at the beginning of the pandemic but then it pulled it back. After that they were given an insulting €100 per week. The unions still have not seen the detail of the review that followed, although we are told fourth years will get a bit of a pay increase because they put pressure on the Government, but there will only be a miserable €100 for student nurses and midwives.

This is just not good enough and I am amazed the Minister does not understand it. I spoke to student nurses and midwives at meetings and the demonstration when we were putting together this motion last year. Talking to them, they tell us something very simple. The experience they have as a student means they will probably leave the country. They cannot afford to pay the rent. The €100 is barely covering travel and subsistence costs when they are on placement, if it covers it at all. They cannot work when they are on placement, although they need a job and income to pay the rent. Many of these student nurses have kids and they cannot live on the pittance they are being given.

In Britain they used to pay £15,000 per year to student nurses and midwives. When they withdrew that payment, the number of people going into nursing collapsed. Even British Prime Minister Boris Johnson, Tory that he is, had to bring in a bursary of £10,000 for student nurses and midwives to get more people into nursing. The Government is nowhere near what is necessary to keep nurses and midwives in this country and our health service or stop them from emigrating.

Deputy Mick Barry

The best protest placard of the year outside Dáil Éireann was held by a student nurse today. It stated, "Why are nurses priceless but penniless?" It is a brilliant placard.

The Minister has left the room but he needed to read the room because he has got it wrong on student nurses' pay. He must stop, look and listen and he needs to make some changes. Students are going back into hospitals, working in Covid-19 wards and other wards with Covid-19 patients. The numbers in intensive care units and hospitals will increase. Could they double or treble? Already the system is leaning heavily and relying on those student nurses, and that will increase in the days and weeks ahead.

The Minister proposes to extend the €100 per week payment for first, second and third year student nurses and increase the pay of fourth year interns by 12.5%. That is not enough and it does not take account of the fact these student nurses are wearing personal protective equipment, PPE, or the financial pressures that have come on them on the back of the pandemic. There are students with vulnerable immunocompromised parents or siblings at home who had to move out and pay rent while rental costs are so high, as we know. Some have had to give up a part-time job because they cannot go from working in a Covid-19 ward straight to a part-time job. They do that to protect their workmates.

The payment is €100 per week for those in first, second and third year, which equates to €2.50 per hour or less than a quarter of the minimum wage. It is an insult and these students should be paid the healthcare assistant rate. They were paid that rate at the start of the pandemic and that should be done again now. The other figure is the 12.5% for those in fourth year. The key figure is not 12.5% but 20%, as they are being paid 20% less than first-year qualified nurses. They should be paid the same rate and that should be done now.

This is really a no-brainer and practically everyone in society agrees with the points I make. The people who are completely out of kilter are the Minister and the members of his Government. They need to read the room and change the policy.

Deputy Peadar Tóibín

I met a large number of protestors today outside the Dáil and spoke to them about what is happening in the nursing sector, which is absolutely shocking. We in Aontú were one of the first political parties to bring to a discussion the matter of student nurses being properly paid. It is also interesting that the Minister at the time, Deputy Harris, said he would pay them and then reneged on that promise. Now they are being offered a quarter of the minimum wage to work on the front line in very difficult circumstances.

There is also much information coming from today's protest. One point is that there is currently a crisis in the sustainability of nursing in this State. An Irish Nurses and Midwives Organisation, INMO, survey has stated 68% of nurses are considering getting out of the profession as a consequence of the conditions and because of Covid-19. I also understand there are fewer people coming from college into the service than are leaving at the other end. We are getting to a position where we will see a reduction in the numbers of nurses available to fill those jobs.

It reminds me that in education we have concepts such as teacher-student ratios but there are no such ratios for nurses to patients. I remember reading a document a couple of years ago indicating that the more patients a nurse has to deal with, the higher the level of morbidity and mortality in the ward in the question. There is a direct correlation between the number of patients and nurses on a ward. That document was released when Deputy Harris was Minister for Health, which demonstrates the pressure being put on nurses. Their ability to function in that environment is a life and death matter.

I spoke to a large number of student nurses today, including Caitríona, Sonia, Miriam and Mairéad. One of them spoke about how an older man fell in a nursing home, and because he had Covid-19, other staff did not want to pick him up. She told me how she had to pick him from the floor and was the only person willing to do it. Another student nurse told me she had never been present at a death in her life, but when she was a student nurse, she found herself on her own when four people passed away. She was thrown into one of the most difficult and traumatic experiences a person could have, on her own and without anybody to guide her in dealing with that.

I spoke to a number of other individuals, including a lady I will call Mary. She was a nurse manager in a nursing home in the west of the country. In a famous case, all but two of her staff tested positive for the virus one morning. She rang the HSE seeking staff to support her but she did not receive any extra staff for two days. In those two days, the two staff worked for 48 hours on adrenaline. I touched base with Mary months later to see how she was doing and she broke down on the phone. Through tears, she told me she just does not want to do nursing anymore.

My office has also spoken to the whistleblower at St. Mary's nursing home in the Phoenix Park. It was a short conversation because a patient had just had a stroke and an ambulance had been called. She told me she was broken-hearted about what she had witnessed. The next time people are speaking to nurses, midwives or student nurses, they might ask when they last had a holiday or a lunch break.

We need to do better on this issue if we are to have a health service that functions in the future, and to do right by the workers in that sector. They are entitled to a decent working environment.

I refer to the nurses in Our Lady's Hospital, Navan, who were out in force at a march this week in Navan. Some 10,000 people took to the streets in what was a cross-community cross-party rally. I note one political party did not put forward a Deputy to attend, which was Fine Gael. The Minister of State, Deputy Damien English, did not arrive to speak at the rally unfortunately, and that was a major mistake. At present, beds in the accident and emergency department and the ICU are being closed by the HSE at a time when ICU beds are at the front line of the battle against Covid. It is mind-blowing that we are listening to the rhetoric about the need for ICU capacity while at the same time the HSE is looking to close beds. There has been a stay of execution on this, which we welcome. However, it is not good enough that it remains open for just three or four months. I will wrap up with this point: people are waiting 11 hours for ICU and accident and emergency services in Drogheda, yet the Government is looking to close accident and emergency services in Navan. It is important that the Minister of State sends a message to the HSE that this cannot be done. We must keep our accident and emergency services.

Deputy Verona Murphy

We have not resourced our ICUs as we should. We have not expanded ICU capacity as required. Long before Covid we had staff shortages. In key areas of the HSE, beds are closing, corridors are full of patients on trolleys and waiting lists are expanding. The Government has put all its eggs in the vaccination basket and believes so much in the vaccination that it is trying to coerce people to take it. It makes sense, therefore, that the booster shots are offered to the 3,500 nursing staff. I do not suggest that nurses be compelled to take a booster vaccine, as is done in other countries. Instead, it should be offered to those who want to keep our health service show on the road. Offering that would be consistent with Government vaccination policy. It is a pity it took so long to be introduced. In light of the facts presented in this motion, I support the decision to offer the booster programme to nurses, but I equally want the Government to stop the divisive rhetoric against any nurse or, indeed, anyone who decides not to take it.

On a broader level, we must examine why we have issues with recruiting the required number of staff to operate our health services as effectively as possible. First, they must be paid at a level that will encourage our graduates to remain in the country. The working conditions must allow nurses to work effectively without being expected to operate consistently for extended hours in understaffed and overcrowded wards. We must also ensure that pay and conditions match what is on offer with competitors. Otherwise, this will continue to be a problem. With that in mind, the McHugh report needs careful attention. Are we giving our student nurses a good first impression of the Irish health service if we expect them to perform front-line nursing activities without pay? It is as if the current policy is designed to turn nurses off pursuing their careers in our health service.

This weekend, I met a lovely trainee nurse called Sarah, from New Ross, at her uncle's funeral. She raved about nursing. She just loves it and wants to specialise in respiratory nursing. Covid has not put her off this one bit. I was in awe of her enthusiasm. As she spoke, all I could think was that I hope the system does not suck the life out of her. It is clear that nursing is a vocation and not just a job. We should be glad of this because it equates to extra dedication that no amount of money can pay for. Just ask the patients who have been in receipt of such care and attention. This is not an attribute that the Government should take advantage of, but one it should nourish and pay for accordingly.

I have almost lost count of the number of times I have raised staffing issues in the child and adolescent mental health service, CAMHS, facility in Wexford. There have been some improvements, which is obviously welcome, but the fact still remains that the unit is understaffed. It is not fair to blame any individual Minister for this; it has been caused by a long-standing problem of mismanagement and cuts to staff pay and conditions across the board in the health service. It means that there are parents whose children are not receiving the services when they need to access them. I will continue to ask for this service to be fully staffed until it is. I have raised numerous times the issue of the continued absence of an MRI scanner in Wexford General Hospital, which the people of Wexford generously raised the funds to buy. One excuse given for why it has not been installed yet is that there are staffing issues that need to be addressed. I ask that the staffing issues be addressed to allow the €250,000 which the people of Wexford raised to be used.

I refer to the delivery of a 24-hour cardiac care service in the Minister of State's county at Waterford University Hospital. The funds to ensure the staff are recruited to run the 24-hour cardiac care service have not yet been provided. This service takes care of the 600,000 people in the community healthcare organisation, CHO, department. I do not wish to be dramatic, but each of the issues I have raised can make the difference between life and death.

This motion calls on the Government to ramp up the provision of mental health supports. I am in favour of improved mental health supports for nurses, in what is a stressful and pressurised job. However, while I stand here speaking, a search operation is continuing in the New Ross area for a young man missing since Wednesday, which is devastating for his family. Such situations happen weekly, if not daily, and I want that to end.

An Ceann Comhairle

We now go to the Rural Independent Group where Deputy Michael Collins is sharing time with Deputies Carol Nolan, Richard O'Donoghue, Danny Healy-Rae and Michael Healy-Rae.

Deputy Michael Collins

Nurses and midwives are the cornerstone of our public healthcare system. Therefore, urgent action is needed to resolve this gigantic crisis situation. We are told by nurses who contact us that occupational health services are simply not available nationwide. Nurses report that there are long waiting times for appointments. This situation is a clear indication that our public healthcare system is under-resourced in regard to staffing. We need an urgent and planned funding allocation for the implementation of safe staffing throughout the health service and the introduction of measures to reduce pressure on hospitals. There were 688 patients on trolleys in October in Cork University Hospital. At the start of the pandemic, the HSE stated there would be zero tolerance of overcrowding, but here we are in a situation where our hospitals are no longer just full, but are completely overcrowded. We have not seen a detailed winter plan from the HSE. Winter is no longer a time coming down the tracks; it is already upon us. Having spoken to many doctors in recent months, it has become clear that almost all of them would not be surprised if the number of people on waiting lists increases to well beyond 1 million in the coming months. This indicates that we have little confidence in the approach of the Minister or the HSE in tackling these waiting lists.

There is a lack of chiropody and dental services in towns, with Bantry being without these services for different reasons. The provision of chiropody services for public patients has ceased because the chiropodist who retired has not been replaced as a result of funding issues between the HSE and chiropodists. Dental services are no longer available to public patients either. Bantry is not the only area experiencing these difficulties and it is a matter that must be urgently addressed.

The motion being debated relates to nurses and midwives. We must pay tribute to them for the excellent and hard work they have done with the people and for saving many lives. They deserve our utmost praise in this House.

Deputy Carol Nolan

Our nurses are fantastic; they do great work. We do not need to repeat that over and again. They do not want a clap on the back, rather they want to be respected and given proper pay and conditions, which is only minimal and right. I support this motion and, in particular, the provision to have the registration and retention fee waived. This must happen because we cannot simply allow the Government to pay lip service. It is a shame the Minister, Deputy Stephen Donnelly, is no longer in the Chamber, because there are a number of issues I would have liked to raise with him tonight. I thank the Minister of State, Deputy Butler, for being here. However, there are other issues I would have liked to have raised with the Minister, which I will raise in due course.

On the lack of psychiatric nurses, their recruitment remains stagnant at present. This has a desperate knock-on effect on our mental health services. I was contacted by guardians dealing with a desperate situation involving a teenager who has made several attempts to commit suicide. I do not know how long they are waiting on a plan to be drawn up for this teenager. I do not want to be the person who receives bad news over the phone. Action needs to be taken in this desperate situation.

There are thousands of those desperate situations around this country and action must be taken. Given that we are speaking on health, I will end by calling on the Minister of State to give certainty to the people of Portlaoise and the wider Laois area that the future of Portlaoise hospital remains safe and secure. The Minister of State needs to give them that certainty. I support the local action group, which has been very vocal on the issue of the hospital. Will the Minister of State confirm that the future of Portlaoise hospital is secure?

Deputy Richard O'Donoghue

University Hospital Limerick, UHL, recorded the highest number of patients on trolleys in the country for October according to monthly trolley watch figures compiled by the INMO. UHL saw 1,349 patients on trolleys over the month of October and was followed by Letterkenny University Hospital with 943, University Hospital Galway with 829 and Cork University Hospital with 688. UHL has experienced some of the worst overcrowding in recent times with a total of 1,080 people being treated on trolleys. How can we talk about data protection and the general data protection regulation, GDPR, in these conditions?

The only way for the Government to help the nurses is to pay them appropriately. It has spent millions upon millions on hospital buildings but has not invested a penny in the nurses and student nurses. It is a bit like the Minister, Deputy Eamon Ryan, who wants everyone to go electric when we have no electricity to run the car. We have nurses who want to nurse and to care for the vulnerable people in this country but all the Government does is hire manager after manager. It should invest the money in the nursing staff. They are the ones who looked after us during the pandemic and who look after us, and everyone in our families, every day. Despite this, the Government came forward with only a small token. It is not good enough. The Government must think outside the box. The engine of this country's hospitals are the nurses. The Government must invest in them and treat them fairly. It must also stop thinking up the out-of-this-world things it comes up with but does not provide backing for. The Government must trust the nurses.

Deputy Danny Healy-Rae

I am glad to have a chance to talk on this very important motion. I thank Sinn Féin for allowing us to do so. We have to support our nurses. It is very clear that nurses are leaving their places of work every day. On one particular day in Tralee hospital, six nurses left together. Donie Doody of SIPTU says that we need 100 new nursing posts to be filled in University Hospital Kerry. There has been no elective surgery carried out since the first week of September. Can the Minister of State imagine that? The corridors of Tralee hospital are lined with elderly people who are waiting for two or three days. That is not acceptable. This Government and Deputies here in the Dáil have been praising the nurses but what we must do is pay them properly. They are not being paid properly at present. They should be allowed to register for free. They are being charged €100 to register. What are we doing for them? We are charging them to go to work by charging more carbon tax on the petrol and diesel their cars use. At the same time, the Taoiseach is in Scotland promising €200 million or more. He pulled €200 million out of his pocket yesterday to help with climate change. If he is there saecula saeculorum, he will not change the weather or do anything to improve it. We are after having a bad week in Kerry but he will do nothing to improve the weather. On top of that, €200 million or more is promised towards combating climate change for the next ten years while we cannot pay our nurses in Tralee hospital or around the country and yet expect them to work. They are driven down to the ground. Nursing is a vocation. Nurses have to be caring and have to be trained to the last to do the job. Despite this, we will not train them properly.

Deputy Michael Healy-Rae

I thank the Minister of State, Deputy Butler, personally for her recent trip to Kerry. She made a great impression and was highly regarded personally. She was very welcome and will be welcomed again. If she does as she did the last time and comes with her bags full, we will be delighted to see her.

I thank Sinn Féin sincerely for its excellent motion. I was glad to meet with the young student nurses and other members of the nursing profession who came here today. It is a big ordeal for people to leave their places of work, their families and their homes and to come by car, train or other modes of transport to protest at the Dáil. I welcome them.

In our hospital, University Hospital Kerry, we need 100 nurses. That is a matter of fact. In Kenmare Community Hospital and the district hospitals in Killarney, Cahersiveen, Tralee and Listowel, we need more investment in people. In Killarney, we need a new district hospital which - please God - we will get, but we need more investment not just in bricks and mortar, but in personnel. I will say again what I have said over and over again; one of the most stupid things I ever saw any group of people do was to stand up to praise and applaud the people working in our nursing profession. It was childish nonsensical behaviour. They did not want praise or claps. They want proper recognition and to be shown respect through the remuneration they receive. In other words, they want to be paid properly.

In a very significant move, the consultants in University Hospital Kerry, who are highly regarded people, have written to public representatives to say they have lost confidence in the management of the HSE. I will sit down after saying the following. The Ceann Comhairle often tells us not to mention anyone in a derogatory way and he knows I never would. However, I can do the opposite. I am allowed to. I will be very focused in saying this. There are certain people in HSE South who have done Trojan work. I am not a bit ashamed to acknowledge one particular individual, a gentleman - and I mean a gentleman - by the name of Michael Fitzgerald. He is a very senior officer in the HSE and does Trojan work in our county and beyond. I compliment him and others among the senior staff. I also compliment our nurses, the doctors, the people who keep the thing together and the consultants. We must make a proper effort to do our job right.

An Ceann Comhairle

I thought the Deputy was going to do the litany of the saints.

Deputy Catherine Connolly

Fáiltím roimh an deis a bheith páirteach sa díospóireacht seo. Gabhaim buíochas le Sinn Féin. Tá an t-ábhar seo agus an rún seo thar a bheith tábhachtach. Baineann sé le cúrsaí sláinte, le heaspa foirne agus leis an gcruachás ina bhfuil ár seirbhísí sláinte faoi láthair. Tá a fhios agam go bhfuil croí an Aire Stáit san áit cheart agus go bhfuil a dícheall á dhéanamh aici chuile lá. Níl aon amhras faoi sin ach tá géarchéim ann le fada an lá. Ní dóigh liom gurb é "géarchéim" an focal ceart i ndáiríre mar tá sé ann chomh fada sin. Tá sé deacair glacadh leis. Is é sin an fáth go raibh coiste traspháirtí i gceist agus is é sin an fáth gur foilsíodh tuarascáil chun dul i ngleic leis na fadhbanna ar bhonn córasach ionas nach mbeidh muid anseo chuile sheachtain ag gearán faoi chomh dona is atá rudaí ar an talamh. Táim ag smaoineamh ar Ghaillimh agus tiocfaidh mé ar ais go dtí na pointí ginearálta. Inniu, bhí 46 duine ar thralaithe i nGaillimh, Ina measc siúd, bhí 16 páiste. Cúpla lá ó shin, bhí 54 othar ar thralaithe. Níl aon athrú ann ach, b'fhéidir, figiúr beag. Tá an fhadhb chéanna ann lá i ndiaidh lae de bharr na géarchéime atá ann agus de bharr easpa tola ar leibhéal an chórais chun dul i ngleic leis an bhfadhb i mbealach inmharthana, bealach atá tuillte ag gach duine sa tír. Tá sé tuillte againn seirbhís sláinte a bheith againn mar bhuncheart.

I have thanked Sinn Féin and I will not repeat my thanks. It is a very important motion. I look at it in the context of Galway, as we all look at matters in the context of our constituencies when we stand up here, but I will also make some general points.

On the very first day I was elected and Independent Members were negotiating for an extra facility in Waterford or Wexford, I made the point that a heartbeat there is equally as important as a heartbeat in Galway and that we are not here to fight our corner. Rather we are here to provide public services, hold the system to account and ensure every single county has the appropriate services.

We are far from that in Galway, even though it is often said we are the centre of excellence for cancer care services. We serve a population of almost 1 million people from Donegal down. We have a system that is creaking at the seams. The previous clinical director in the hospital, whose name escapes me – perhaps it would not be appropriate to name the person in any event – was on the record as saying he could not stand over any more cutbacks because they were simply too dangerous and a threat to patient safety. That person has gone on to different things, but the situation has not changed.

On a general level, we need a proper plan. We have so many problems, assets and solutions that it is sometimes very difficult to make decisions. I am sure the Minister of State finds it difficult, given her hands-on approach. Merlin Park University Hospital comprises 150 acres. We have what I would describe as a higgledy-piggledy development of further services without an overall master plan. One would think we would have learned our lesson from the congested regional site, but we have not. We are still progressing in that manner, notwithstanding the fact I and various colleagues here put pressure on the system in respect of the publication of the options report. We got an options report which recommended a brand new hospital in Merlin Park in Galway. Theoretically, that is a wonderful idea. However, we went ahead with bits and pieces.

I spoke about the analogy of the Russian dolls and a temporary accident and emergency department within a temporary building, with a view to having an accident and emergency department in 2026. If my memory serves me correctly, that was almost the same spriocdháta, or time, that we would have built a new hospital in Merlin Park. That is the background and system.

I have a letter here which outlines why hospitals, nurses and staff are under pressure. I have always been uncomfortable with standing up and clapping, and I regret that. It was something I joined in with. We should have paid tribute to everybody. The cleaners and porters in hospitals should be at the top of the list when we thank anyone, along with the nursing staff and doctors. When we distinguish, we divide. We need to give meaning to the phrase "We are all in this together". If we are all in this together, let us look at all of the analyses and reports we have received.

The hospital in Galway is under pressure for many reasons. It is too old and congested. On top of that, there are people in hospital who should not be there. I received an answer as Gaeilge. I do not often thank the Minister, Deputy Donnelly, but through his intercession we have received replies. The reply tells me that i lár na Gaeltachta i gConamara, in the middle of the Gaeltacht in Connemara, there are no respite services and day care at the moment, for different reasons. There is no day care because it is in the process of re-registering. We learned there has been no day care in the public facility since March 2019. I had to push and push, and the Minister got the reply for me and so on. That puts extraordinary pressure not just on the families who are caring for their loved ones but also on the hospital system.

The primary care system has caused great problems. It led to the departure of Deputy Shortall from the Labour Party because of the utter failure to roll out primary care in a just and fair manner. We are still in exactly the same, if not worse, spot. We are dealing with Covid. The motion is about nurses, a motion we could not but agree with.

What does the language mean when the Government says it does not disagree with the motion? There are five bullet points in the motion. One refers to the booster programme. I hear clearly that will be made available to staff if they wish to have it. The motion also calls for the Government to publish and act on the McHugh review. Is there a clear answer on that? Will the Government publish the McHugh report? Is that what it means when it says it accepts the motion? Is it waiving the registration and retention fees which are due?

The motion refers to engaging meaningfully and positively. I gather that is what the Government is going to do. I cannot see how the Government will wrap up mental health supports for healthcare workers, although I fully support that, because the state of mental health services inherited by the Minister of State is, as she knows, at an all-time low. We might come back to that on another day.

There have been repeated motions. I am grateful for the opportunity to discuss these issues, but these motions become tiresome to those listening to us because they ask us what the Government is doing. It took the Sinn Féin motion, the support of all of the Dáil and a protest outside today to find out that the Government is going to follow some of the recommendations.

I listened carefully when the Minister was speaking. How many recommendations were there? We do not know how many recommendations there are. When he tells us he is going to implement some of them, I would like to judge that. More importantly, the nurses and student nurses would like to judge that so that we can see it in context. What jumps out at me today in the INMO press release is the statement that, "Today’s demonstration is not just about the pay and conditions for student nurses and midwives – it is about the future of our healthcare system." This is about the future of our healthcare system and not just about pay and conditions, which need to change and be improved.

We can never go back to where we were. Climate catastrophe and Covid are facing us. We have repeatedly heard wonderful language from the spin doctors. I wish there were more people like the Minister of State who say it as it is. I have seen major changes with one or two Ministers, but the rest are resorting to spin.

We had a discussion last week on reconstructing and reconnecting, when really we should have been talking about human rights in respect of the Covid restrictions and so on. Language means nothing. The most frustrating thing for people and the most dangerous thing for democracy is when language means nothing. We will be on the side of the Minister of State because she is working hard. I might not agree with the ideology or certain things, but it is my job to set that out and say why.

I have listened to the debate and I hope the Minister of State brings some clarity to this. Is the McHugh report going to be published tomorrow? Will the fees be waived? What about the other requests? Is that the result of the motion, so that words and democracy mean something?

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

I very much welcome the opportunity to address the House on the important motion brought forward by my constituency colleague, Deputy Cullinane, on nurses and midwives. I would like to thank all Deputies who have contributed to this debate.

I would also like to take this opportunity to thank all nurses and midwives, including students, and all healthcare workers for their unwavering dedication and commitment as we continue to deal with the Covid-19 pandemic. There is no doubt healthcare workers have made enormous sacrifices during what has been an extraordinarily challenging and difficult time. In the past couple of months, before there was a spike in Covid cases, I managed to visit quite a few community hospitals in Thurles, Kerry, Galway and Waterford, among other areas, and was able to speak to nurses who have worked extremely hard over the past 18 to 20 months and beyond. I heard from them first hand about how challenging it has been, especially in regard to older people and Covid prevention and control measures. It has been difficult.

I note the Minister, Deputy Donnelly, advised the House that the Government is committed to recognising the great dedication front-line healthcare workers have shown during the pandemic, and work is ongoing to determine how best we can do that. This matter is important but complex because the pandemic is still ongoing, and workers in areas beyond the health service and public service, such as those in private nursing homes, have also made a significant contribution to the national effort to tackle the pandemic.

As Minister of State with responsibility for mental health and older people, I fully recognise the importance of having strong mental health supports for healthcare workers. A range of expertise, advice and other supports are in place for the staff of our health services. They are provided by the HSE's workplace health and well-being unit, a division of HSE national human resources, and through the national health and safety function.

The HSE's occupational health service provides specialised medical advice and guidance to employees. It assists managers in the health service in securing supports for their staff where needed and provides information to employees on other supports available to them, such as the HSE employee assistance programme. This is a free confidential support service that provides well-being supports and interventions for staff and service managers when they are needed, including counselling and consultations on staff well-being issues. This programme has been an increased level of support throughout the pandemic. Additional psychosocial supports, including those specifically tailored to healthcare staff, have continued to be delivered in response to Covid-19. These include free online counselling supports for healthcare workers nationwide. These are not only healthcare workers in the HSE but also healthcare workers who work for private and voluntary bodies. MyMind, for example, is an organisation that provides online counselling free of charge - 4,000 hours a month in 17 different languages - to support nurses who may not originally have come from Ireland. It is important to acknowledge that that support is there.

As part of budget 2022, mental health services will continue to be developed, with funding of €1.149 billion. This funding will provide for 350 new mental health staff across our services. I also welcome the decision of the Minister, Deputy Stephen Donnelly, to extend the booster vaccine programme to all healthcare workers, including those in nursing homes. I chaired an inter-agency meeting recently with HIQA, the HSE, public health, the HPSC and the Department to discuss ongoing nursing home preparedness, and this was one of the key issues considered. I also wish to clarify that all mental health service staff and all healthcare workers working in the home will also be offered the booster vaccine. This decision, along with the progress made to date on boosters, will add further to the protections afforded to front-line health staff and the people under their care. Preparations are being made to commence the roll-out as soon as possible, and the Department will continue to engage with the HSE to ensure timely roll-out. I believe everyone will be in agreement that this cannot come soon enough.

Nurses and midwives play a vital role in health promotion and in the prevention and management of communicable and non-communicable diseases. Their contribution is key to enabling the full economic value of healthcare provision across multiple care settings. For the purpose of enhancing the nursing and midwifery workforce, many new initiatives and advance roles are being progressed. Nurse-led community virtual wards are being developed to provide a single point of contact for patients living with chronic diseases such as chronic obstructive pulmonary disease, COPD, and heart failure. Care is delivered in the community, in the person's home, through enhanced co-ordination and shared pathways of care.

I recognise that this winter will be a difficult one for our healthcare workers. The Government has funded significant initiatives through the 2021 winter plan and budgets 2021 and 2022, across the health service, in the acute, community care and primary care sectors, to reduce demand on emergency care by providing alternative care pathways outside the acute sector in line with Sláintecare. The 2021-22 winter plan will provide for appropriate, safe and timely care for patients by ensuring insofar as possible that effective levels of capacity and resources are in place to meet the expected growth in activity levels. The 2021-22 influenza vaccination programme, which is an important part of winter preparation, was launched on 4 October 2021. Vaccinations have been made available free of charge to adults in specified at-risk groups and children aged from two to 17 years of age, and I encourage all those to avail of this vaccine if they so wish.

It is recognised that waiting times for scheduled appointments and procedures have been impacted in the past 19 months as a direct result of the pandemic and, more recently, as a result of the ransomware attack. The Department of Health, the HSE and the National Treatment Purchase Fund are focusing on improving access to elective care in order to reduce waiting times for patients. These plans include increased use of private hospitals; funding weekend and evening work in public hospitals; funding see-and-treat services, whereby minor procedures are provided at the same time as outpatient consultations; providing virtual clinics; and increasing capacity in the public hospital system.

For 2022 an additional allocation of €250 million, comprising €200 million to the HSE and €50 million to the National Treatment Purchase Fund, has been provided to reduce hospital and community waiting lists. As part of this initiative, I expect there will be an opportunity to consider whether available funding could support the development of a more sustainable primary care psychology service through the recruitment of additional permanent staff. This follows the announcement of €4 million in August to reduce the number of children and young people under 18 waiting more than 12 months to be seen by primary care psychology for the remainder of this year.

Building on the significant growth in the number of healthcare staff, with an additional 4,462 staff this year, initiatives to enhance graduate to specialist and advanced nursing and midwifery practice will maximise nursing responses at senior level. The policy on graduate to specialist and advanced nursing and midwifery practice provides a framework that enables the development of a critical mass of advanced nurse and midwife practitioners. Creating a critical mass of advanced practitioners has demonstrated effective and efficient patient care and can target care across a range of population health needs. The evidence demonstrates high levels of positive patient outcomes, including patient satisfaction, patient education, care continuity, admission avoidance and reduction in the development of condition-related complications. The impacts also include a reduction in waiting lists across a range of specialties and a reduction in the number of hospital admissions. I understand that the Minister, Deputy Stephen Donnelly, has asked the Department to work with the HSE on this proposal to increase the numbers of advanced practitioners across the nursing and midwifery workforce by adjusting the target from 2% to 3% over the next three years. This will provide a total of 1,200 advanced practitioners. Currently, there are only 500 in post.

Nurses and midwives, including students, have made an exceptional contribution to the Covid pandemic response. There are about 7,000 student nurses and midwives at present and half of these students are on placement at any given time. The Minister for Health has implemented a number of measures to support student nurses and midwives, including provision of the pandemic unemployment payment in addition to payment of a pandemic placement grant. As the Minister has already stated, he agrees with the recommendation that the pay of interns be increased and will request approval from the Cabinet to make provision for increased financial supports for 2022. He also intends to extend payment of the pandemic placement grant.

I do not underestimate the huge challenges nurses and midwives have experienced throughout the course of the pandemic. Without question, it has been an extraordinarily difficult time. In conjunction with the HSE, the higher education institutes, the Nursing and Midwifery Board of Ireland and clinical partners, the Department will continue to focus on providing the necessary supports to ensure a sustainable nursing and midwifery workforce.

Deputy Louise O'Reilly

I thank my colleague, an Teachta Cullinane, for bringing forward this very important motion and join others in thanking not just our nurses and midwives but all the workers in our health service and those who have gone above and beyond during the Covid-19 pandemic to keep us safe. They went voluntarily into dangerous situations and to where we needed them to be to keep us safe. We can never praise them highly enough for what they did but, of course, we could pay them. Nothing says "I value you" like payment.

I take issue with a number of Deputies' use of the term "vocation" in respect of nursing. Nursing is a job. Nurses are not angels; they are workers. They do not have a calling; they are trained. We absolutely need them, but they do not float in on clouds to work. Unfortunately, they must trudge through the traffic like the rest of us. We absolutely need to recognise that. The Government fails to grasp the importance of the work nurses do because it is sometimes tinged with that vocation talk, which is deeply unhelpful and indeed somewhat disrespectful to the men and women who are, as we all say, on the front line.

I wish to refer specifically to the provision in the motion regarding mental health and to refer to the INMO survey. As I said, nursing is a job. It is a bloody tough job. It will absolutely take it out of you on a normal day. Pre-Covid, I represented nurses and midwives and I was never, ever short of admiration for the work they do. I do not know how they put themselves into those situations. During the Covid pandemic it has been multiple times worse. The INMO survey shows that 22% of our nursing workforce contracted Covid and that 62% cared for people who died with Covid.

They will be dealing with that for years. Given what they saw and what they were forced to endure to keep us safe, the least the Government can and should do is pay them when they are working. Pay them; it is not a hobby and it is not a vocation. I understand that a member of the Labour Party was in here to give out to us as the lead party of opposition. That Deputy would do well to reflect on the fact that the very same nurses and midwives we laud in here had their sick pay entitlement cut in half the last time that Deputy's party had the chance. That is how they treat public service workers and we will not take a lecture from that party.

Deputy Dessie Ellis

Anyone who has had the unfortunate experience of having to spend time in a hospital or those who have a relative in a hospital will agree the one thing that stands out is the dedication and care that young student nurses give to all of their charges. The burden of work and responsibility that is laid on their shoulders is immense, and it should not be underestimated. They face huge workloads even as they are being exposed to potential Covid infection. The failure to deliver on Sláintecare and to deliver a public healthcare system fit for purpose is a disaster and an indictment of this and previous Governments.

Young student nurses and midwives are the bedrock of our health service now and will be in the future, and we should do everything to ensure they maintain their commitment and dedication to our health service. Unfortunately, the treatment of student nurses and midwives has led to a brain drain. It is shameful that the years of training and experience that the student nurses acquire in Ireland will be of benefit to hospitals abroad. It is understandable that a newly qualified nurse or midwife would want to emigrate and utilise his or her talents in a country where they would receive proper pay and respect. There are approximately 4,500 student nurses in the State. Currently, fourth-year student nurses receive the equivalent of an annual salary of between €21,749 and €22,249 for their 36-week placement in hospitals. The Government has suggested that fourth-year student nurses would now be in line for a 12.5% increase. The student nurses in the years below them are no less dedicated and no less hard-working, and they also have helped the overstretched health services in the fight against Covid 19. They also should be valued for their work, and as employees they should receive proper remuneration for the long hours they have spent, and are spending each day, in hospitals in the State looking after the sick and injured. At the moment most receive nothing or are paid a small and inadequate allowance. Protecting our front-line staff is crucial and the roll-out of a booster vaccination campaign for them is essential and welcome. Student nurses are doing indispensable work, and despite this they are getting no proper financial recognition for this work. There are also substantial costs relating to placements, which results in an additional financial burden on students. Student nurses should not be used as a stopgap measure for the shortfalls in our healthcare system.

Deputy David Cullinane

First, I thank all of the speakers who have made contributions, It is a very important motion. I will respond to some of the contributions, starting with Teachta Duncan Smith of the Labour Party who spent half of his contribution attacking Sinn Féin on the false assumption that we were against the remaining public health restrictions. In fact, we are against giving emergency powers to a Minister where he makes regulations that have never come back into this Dáil for any proper scrutiny or debate. We are seeking proper accountability and transparency. It strikes me there is a pattern from the Labour Party speakers. They come in and spend most of their time attacking the Opposition, looking for a pat on the head from the Minister, the Taoiseach, the Tánaiste, or whoever happens to be in the Chamber. All it shows is that they are a weak and ineffective opposition.

I refer back to the motion and some of the points that were made in the Minister for Health's speech. His comments on the McHugh report were disappointing on the issue of student nurses and midwives. As Deputy Catherine Connolly pointed out, what matters now is what the Government is going to do. Again, this is becoming a pattern whereby the Government does not oppose a motion but does not implement it either. This is disingenuous. There is nothing in the Minister's speech about when he will publish the McHugh report. There is nothing in his speech to indicate when he will publish the report, if indeed he will. He said that he would seek Cabinet approval to increase the pay of interns but he did not say when that is going to Cabinet. He also said that he will seek approval to extend payment of the pandemic placement grant and will also support additional recommendations. We have no idea what those additional recommendations are. It is not just us; it is also the student nurses and midwives and the INMO, who were disrespected by not being talked to, and in having negotiations with the Government they are as much in the dark on this as anybody else. This is very disrespectful.

The Minister talked about what is happening in our hospitals at the moment. I had a lengthy exchange with him earlier about the real crisis, with emergency department attendance up, trolley counts up, and huge waiting lists. In his speech the Minister said that the winter plan will provide for the appropriate, safe and timely care for patients but it will not. There is nothing in this winter plan that will deal with crisis in our hospitals. It is a crisis=driven response. Every year we come to the winter, we have a real crisis in our hospitals, the Government comes out with a plan that cannot be implemented because one cannot magic up staff, magic up beds or magic up capacity in the winter when we are in the throes of a crisis. All of this is just window dressing. It is a head-in-the-sand approach. This will not substantially increase capacity and it will not reduce waiting lists.

With the head-in-the-sand approach we are actually seeing the cancellation of procedures right across the board, left right and centre. In every hospital I have visited they are cancelling elective procedures and in some cases cancelling time-sensitive care. This will drive up the waiting lists. There is an ostrich-like head-in-the-sand approach from the Minister for Health. He can come in here and say that his winter plan is going to provide appropriate, safe and timely care, but one only has to talk to anybody who works on the front line in any hospital in the State and they will tell us this is simply not the case.

I will conclude by echoing what Deputy Connolly said in her contribution. It is very important that if the Government does not oppose a motion, they will implement it. I would like the Minister for Health to indicate if and when he will publish the McHugh report. More importantly, I want to see what exactly he is going to do. We have some sense of what he will do for fourth-year student nurse interns. We have some sense of what he will do for the first, second- and third-year students with the €100 payment, which is unsatisfactory. There is no sense, however, that this is going to be permanent or what other measures are going to be put in place. I certainly do not believe that the winter plan for hospitals and the waiting list strategy he has put in place is going to work. It is more of a glossy brochure approach to Government where we are presented with all of these plans but in reality does not add up to anything of substance. I do not believe it will make the difference that it needs to make.

Question put and agreed to.