Public Health Service Staffing: Motion [Private Members]

Deputy Duncan Smith

I move:

That Dáil Éireann:

acknowledges that:

— understaffing in the public health service is impacting the ability of staff to provide safe care and this will put patients at risk and damage efforts to retain existing staff;

— the health recruitment moratorium has continued through new recruitment caps, and positions are being left vacant in acute hospitals and community care; and

— thousands of frontline health positions that were suppressed during the recruitment moratorium were "decommissioned" by the Pay and Numbers Strategy in July 2024, and, in effect, abolished;

notes that:

— hospitals are already seeing record overcrowding before the winter surge, and more than 700,000 people were on hospital waiting lists at the end of September;

— nearly €650 million, or 3 per cent, of the entire health budget was spent on agency staff in 2023, and further substantial sums go to overtime costs and external management consultants;

— positions that become vacant due to retirement, a person leaving the health service, or maternity leave, are not being ringfenced for backfilling; and

— Health Service Executive (HSE) Health Regions are allocated a total number of positions to fill, with no clear plan for which positions will be prioritised;

further notes that:

— the derogations that had existed for areas like emergency department nurses and midwives have been removed and, instead of six months, it is now taking up to a year to fill nursing and midwifery roles;

— the Irish Nurses and Midwives Organisation says many nursing posts in cancer, palliative, paediatric, and rehab care are being left vacant;

— a survey of 4,000 members of Fórsa's Health and Welfare Division showed 88 per cent of respondents said there was a vacancy in their department, and 73 per cent said it had a very negative impact on staff;

— the failure to recruit enough therapists into children's disability network teams is compounding waiting lists for assessment of needs and therapies;

— SIPTU has highlighted that 30 per cent more radiation therapists are needed, and that the staffing crisis is causing delays in cancer treatment; and

— staff deficits also exist in the National Ambulance Service, radiography, support services, the Health Care Support Assistant workforce and other critical areas;

supports the decision of health trade unions to protest over the Pay and Numbers Strategy and condemns the failure of the Minister for Health and the HSE to consult with health trade unions; and

calls on the Minister for Health to:

— lift the new recruitment moratorium under the HSE's Pay and Numbers Strategy and commit to restoring the staff positions abolished in 2023 and 2024;

— fund the additional recruitment needed for appropriate staffing and the expansion of services to account for demographic changes and the implementation of Sláintecare;

— ensure that vacancies that arise in the health service due to normal retirement, career progression and maternity leave, can be filled by local clinical management;

— pass the Patient Safety (Licensing) Bill to introduce safe staffing ratios that will be enforced by the Health Information and Quality Authority, and resource the recruitment of staff to comply with the Framework for Safe Nurse Staffing and Skill Mix; and

— commit to engaging with unions on a safe staffing framework for all departments and grades.

I am sharing the initial slot with Deputy Bacik.

This will be the last Private Members' business that the Labour Party has in this Dáil unless something totally unforeseen happens. We have returned to an area we have been focusing on for this entire Dáil term and that is the issue of staffing in our healthcare system. We all know the experience of Covid at the start of this Dáil term. For those two years, our healthcare workers were quite rightly celebrated and recognised by the Government, the Opposition and people up and down the country for the heroic work that they did, that they have always done and that they continue to do. Unfortunately, our healthcare workers feel that that moment has passed and that they have been forgotten.

At the end of September, 700,000 people were on hospital waiting lists. As of yesterday, 461 people were on trolleys. I note the extensive amendment the Minister has tabled in response to our motion, but nothing in that amendment deals with these stark truths and realities. These are hard facts and no evasion will get around them. The Government, despite its efforts, has failed to ensure we have adequate staffing in our healthcare service, from primary care to acute hospitals, community care and everywhere in between. Healthcare staff remain overworked and underpaid and many of them are burnt out. It is the Government's job to support them and not just with claps during the Covid pandemic, but with proper terms and conditions, pay and career paths that respect and honour what they do for our country.

What they do not need and what should never have happened is the disastrous recruitment moratorium which savaged the delivery of healthcare in our health service. When that was ended, we had the recruitment freeze which continues to this day. Despite what the Minister states in the amendment to our motion, our health service remains drastically under-resourced and understaffed. With that level of understaffing, it is the staff who are in position who are suffering by having to work even harder. When they are stretched, as they would say, ultimately it is patients who suffer.

The Minister has stated that the recruitment moratorium has been lifted and that there is no recruitment freeze in place at the moment. However, we have heard in the last couple of weeks that in Beaumont Hospital, only eight positions will be made available to mental health nursing graduates, of whom there are 20. I met a group of retired mental health workers earlier this week who told me that the mental health services have always been the Cinderella of our health service. When we see issues like this, with our mental health nursing graduates being unable to get full-time jobs, it is clear that it remains the same.

The health portfolio seems to be this Government's runaway train. Last year's budget disaster was just the tip of the iceberg. It laid bare the lack of planning that follows the Department of Health which unfortunately this Government has been unable to rein in and get ahead of. The Minister said we needed a recruitment embargo last year because of cost overruns and yet the Government continued to spend €650 million, or 3% of the entire health budget, on agency staff in 2023 with further substantial sums going on overtime costs and external management consultants. Our regional health areas are allocated a total number of positions to fill but with no clear plan as to which positions will be prioritised. Our concern in the Labour Party is that by all accounts our services only get focused Government attention when there is a crisis. Anyone who listened to "Morning Ireland" this morning and heard my colleague Alan Kelly, who is in the Chamber, discuss the terrible situation and challenges in UHL knows that this is the truth.

There is no indication that solid forward planning is coming with this budget either. This is nothing short of neglect by the Minister and his Government. As stated by the IMO, our health service has become overly reliant on international medical graduates. These graduates do great work but this is not a sustainable model for our health service. We need to be not only training our talented people but also keeping them. When he looks at the IMO report on why so many of our professionals are leaving, can the Minister honestly say he has done anything to ease this issue? Its report cites research that states the lack of progression opportunities, fear of deskilling, poor quality of training, excessive work hours and poor working conditions are among the many reasons that doctors seek to leave Ireland. Nothing has changed in the last four and a half years. In a survey of 4,000 members of Fórsa's health and welfare division, 88% said there was a vacancy in their department and 73% said it had a very negative impact on staff. The Government's inaction has led to these workers having to operate in a pressure-cooker work environment, leading to burnout and staff leaving much-needed positions.

Some 10,000 children have been waiting for more than 12 months to see a community disability network team, CDNT. Those teams are nowhere close to being properly staffed countrywide. Across the 12 CDNTs within my own CHO of Dublin north city and county, there are huge levels of understaffing. Where 285 whole-time equivalents are allocated, we are getting 208. That has remained right through to the most recent figures in July where the number of staff allocated was 286 but the number of positions filled was 202. The stress and anxiety this causes parents of children with complex needs is absolutely huge. When it is boiled down, it all comes back to the lack of staffing.

As chair of the all-party Oireachtas group on cancer, I have consistently called for increased funding for our national cancer strategy. While I acknowledge that funding has been allocated in this budget, without staffing levels rising any efforts in the national cancer strategy will come a cropper. SIPTU has highlighted that 30% more radiation therapists are needed across the country and obviously because of that, care is being delayed due to these shortages. Staff deficits also exist in the national ambulance service, radiography, support services, the healthcare support assistant workforce and across other critical areas. The INMO stated that posts are being left vacant in cancer, palliative, paediatric and rehab care. Even when we are filling positions, for example with emergency department nurses and midwives, instead of six months they are now taking up to a year to fill. This is simply not good enough.

Public health nursing is under severe strain. Anxious new parents have been getting letters stating that their babies will likely not be seen by a public health nurse because of shortages. This is very scary for parents, particularly new parents who are entering the great unknown of parenthood. Without the support they get from a public health nurse, it just makes it even scarier. A recent INMO survey of public health nurses showed that 70% of them working in the community reported a rise in workloads since the recruitment moratorium. A further 83%, in addition to their own job, are compelled to cover for colleagues due to short staffing. This is not down to the staff who are absolute troopers, but they are working in a broken system and ultimately the buck stops with the Minister.

In tandem with the need for increased staffing levels, we need a commitment from Government to build and extend our hospitals and to support primary care in our communities. Over 11 years ago the Minister's colleagues in government, Fine Gael, promised the people of my constituency in the town of Swords a primary care centre. Where there should be a primary care centre, there is a field. That is absolutely unforgivable for a town of that size, especially as Swords is so close to Beaumont Hospital, which we know is in desperate need of increased resourcing. I have tabled parliamentary questions about capital investment at Beaumont Hospital to expand the accident and emergency department, resuscitation and ICU. While I got a reply last week, the staff on the ground do not believe they are any closer to getting these much-needed facilities.

We are walking into yet another election where the health system will be a major issue.

The Minister can dress it up anyway he likes in his response and countermotion but the facts remain as I set out. We have far too many people on waiting lists. A total of 100,000 people will have been on trolleys this year, 87,000 people are on inpatient waiting lists, specialist posts to allow cancer treatments to take place in a timely and safe manner are not being filled, and children are being denied life-changing care across a range of areas. We are about to enter winter where the same old problems will hit us but things are only getting worse. Healthcare workers cannot afford to pour from an empty cup. There is a lot of fanfare in this House about mental health but this remains the Cinderella of our system. The lack of planning in terms of mental health professionals is a testament to that. Doctors, nurses, midwives, physiotherapists, healthcare assistants, radiographers, medical lab assistants, scientists, porters - the entire gamut of healthcare workers - need support from the Government and from the HSE. We need proper management, healthcare staff and healthcare planning. We do not have it with this Government. It is to be hoped we will have it with the next.

Deputy Ivana Bacik

I pay tribute to my colleague Deputy Duncan Smith who has led for us on this important motion. As Deputy Smith has said, this is the last Labour Party Private Member's motion in the lifetime of this Dáil. It might even be last Private Member's motion. In any case we thought it was vitally important we would put it down on the issue of healthcare and especially healthcare staffing. We are all conscious what a crisis exists. Notwithstanding the very lengthy Government amendment, which is about four times as long as our original motion, you could boil it down to saying there are simply not enough staff to provide the adequate and decent level of patient care all of us would hope to have for ourselves and for our family members.

The healthcare system is an issue. Problems with healthcare come up in every constituency across the country. I was in Tipperary on Friday with Deputy Alan Kelly and I heard there from so many people in Nenagh about their concerns and about their own experiences and their families' experiences with overcrowding, with lack of access to treatments and lack of access to GPs in the area. I was in Limerick on Monday with Councillor Conor Sheehan and heard the huge concerns and huge issues there with University Hospital Limerick. All of us think of the dreadful and tragic death of Aoife Johnston in UHL, and again we extend our deepest sympathies to her parents and family. Concerns about access to healthcare are deeply held across the country.

I also pay tribute to the heroism of healthcare workers who are providing services in an underfunded, understaffed and overcrowded environment, to our nurses doctors and carers but also all those who keep hospitals, surgeries and clinics going, to cleaners, catering staff and porters, many of whom across the healthcare system, as the Minister will be well aware, come from other countries to provide us with the benefit of their skills and expertise, even as we are exporting so many of our own healthcare workers and healthcare professionals. As we face into the winter season, and, as Deputy Smith said, there is a real concern about that, we know we will see additional problems and additional difficulties exacerbated by a lack of clinical staff . It does come down to funding. Last year the Government announced a health budget with a €2 billion hole in it. Bernard Gloster, the CEO of the HSE, said at the time that the moneys allocated were inadequate. Indeed, that was when the Minister announced a recruitment freeze during a staffing crisis. This year, we appreciate the cuts have been more subtle. Last year's recruitment freeze has been called other names. In the Government's amendment to our motion the Minister says the pay and numbers strategy is not a recruitment moratorium. It is called things like a ceiling, but the reality is we are facing a real shortage of vital front-line healthcare workers, and this is at a time when we are already seeing record overcrowding before the winter surge, when 700,000 people are languishing on waiting lists, and when we see a serious over-reliance on agency staff.

I was interested to note that, right at the end of the Government amendment, the Minister acknowledges that the agency spend in recent years has been higher than the Government would have liked. That is an understatement. At this time, having begged doctors, nurses, midwives and healthcare assistants not to leave us for Australia, the Government has effectively turned around and said, "We still can't hire you here." The INMO is repeatedly warning that embargoes, freezes and ceilings on recruitment will send healthcare into free fall. We are also hearing about serious problems even where sanction is given to fill vacancies. The time it is taking to fill them is too long and it can take up to a year. When someone retires, leaves for another position or takes leave for any reason, positions are not ring-fenced for backfilling. Far too many people are having to act up and are having to do more work than they have capacity for. Clinical managers with no local autonomy are competing with all other requests in regional health areas. We have serious concerns about workforce planning, which is one of the issues addressed in our motion.

Government representatives are at pains to tell us that recruitment is happening, and the Minister has set this out at length in the amendment. Of course, it should be happening and we acknowledge there is some recruitment happening, but the deficit is enormous. It is a projected deficit of 49,000 nurses by 2041 and thousands of positions vacant at a time when we see a growing population and an ageing population, with medical needs becoming more complex. We need to recruit more staff. Any of us can go into any accident and emergency department and talk to anyone who has been waiting for appointments and who cannot even get to see their GP. It is plain to see there are simply not enough healthcare workers in this country, and it is having real impacts on people. I see it in my own community. I have spoken about the mid-west and the huge issues there, but in Dublin Bay South, those who attend the accident and emergency department at St. Vincent's or St. James's hospitals speak of their experience waiting long hours. I speak to those who work in healthcare. I spoke to one agency healthcare worker who would love a permanent job but cannot get one because of the freeze. He said, "Every day is like your first day on the job. It doesn't make sense to move around all the time. We are paid the same and a private company takes the cream off the top." The Minister says there has been additional investment in health services under this Government and he has set out some detail in his amendment, but tell that to the people languishing on hospital trolleys, to the people who have been turned away from scheduled appointments at hospitals likes St. Vincent's, or to the people who are turned away for DEXA scans at the same hospital because there are no staff to run the scanner. That kind of thing does not happen in an adequately resourced health service. Patient safety should be the marker for success.

If we want to talk about money and cost benefits, I return to that point about agency staff, which we focus on in our motion. The cost of hiring healthcare staff from for-profit agencies increased by 139% between 2015 and 2022, the sum being €619 million. Last year the HSE spent €650 million on agency staff, which was 3% of the entire health budget. This is a huge issue when we see workers like the worker I quoted who want a permanent job but cannot get one and continue, therefore, to be paid through the agency. This issue with staffing is not the fault or the responsibility of the healthcare workers who are desperately trying to provide a decent service and clearly it is not the fault of patients who are presenting at hospitals looking for help. The blame lies squarely at the feet of the Government and we need to see adequate resourcing in place and adequate workforce planning to ensure we will have sufficient staff to run decent services through the winter.

These problems go beyond shortages in emergency departments. It is often easy to focus on hospitals and difficulties with emergency departments because this is all very starkly visible, but there are also problems within the primary care system and the Minister is well aware of this. There is a particular issue in Dublin with public health nurse shortages, meaning children are missing key developmental checks. There is lack of access to paediatric speech and language therapists, and there are long delays in initial psychological assessments and follow-up with specialist teams. These are causing real problems for children by delaying the necessary treatments and the necessary services that should be provided. These checkups really matter to catch issues early enough to ensure intervention can be effective. Many parents come to us and speak to all of us about their huge concerns and fears for their children. We need to see better planning on child healthcare provision in those primary services too.

I will speak a little about how visible the dysfunction in the healthcare service can be. I am reminded of this every day when I cycle past the former Baggot Street hospital. I was there yesterday for an event outside the hospital and every single person outside the hospital was looking at this beautiful and iconic building in the heart of the city. It is a HSE-owned property that has been lying empty for far too long at a time when nurses and doctors cannot find accommodation. We are all aware that one of the issues with staffing and recruitment is connected to the housing crisis and the lack of affordable housing for our healthcare staff, yet the former Baggot Street hospital lies empty. Our hospitals are overcrowded and this hospital building lies empty. I have a family member who worked there until the recent past providing care to people who needed it. It is really sad to see it still sitting idle and vacant when we see such shortfalls in housing and accommodation provision for healthcare workers and when we see such shortfalls in staffing in our hospitals and in our primary care services. When positions are left vacant, people are deprived of care, the care that could be provided by those who want to help. In an economic boom, there is no excuse for Government policies that underline and reinforce hardship and lack of access.

We need to lift the cap under the pay and numbers strategy, or whatever it is called, we must give local directors of nursing and midwifery the sanction to fill and recruit for a vacant post, and we must legislate for safe staffing in our health services. Patient safety should be the absolute priority in workforce planning, healthcare planning and budgetary planning.

Níl rud ar bith níos tábhachtaí ná sláinte ár bpobail. Tá mé ag iarraidh ar an Rialtas maoiniú ceart a thabhairt don chóras sláinte. Is fearr an sláinte ná an táinte.

Dáil Éireann debate - Wednesday, 23 Oct 2024