Protection and Support for Covid-19 Front-line Workers: Discussion

I welcome the witnesses: Dr. Gabrielle Colleran, vice president, Irish Hospital Consultants Association, IHCA; Professor Robert Landers, vice president, IHCA; Mr. Martin Varley, secretary general, IHCA; Ms Vanessa Hetherington, assistant director, policy and international affairs, Irish Medical Organisation, IMO; Dr. Peadar Gilligan, consultant committee, IMO; Mr. Anthony Owens, director of industrial relations, consultant and non-consultant hospital doctors; Ms. Karen McGowan, president, Irish Nurses and Midwives Organisation, INMO; Ms. Phil Ní Sheaghdha, general secretary, INMO; and Mr. Tony Fitzpatrick, director of industrial relations, INMO.

Before we hear the opening statements I point out to the witnesses that there is uncertainty as to whether parliamentary privilege applies to evidence given from a location outside the parliamentary precincts of Leinster House. Therefore, if witnesses are directed by me to cease giving evidence in relation to a particular matter, they must respect that direction.

I call Professor Landers to make his opening remarks. He has five minutes. I appeal to everyone to try to keep to the time allocated.

Professor Robert Landers

I am grateful for the opportunity to join in today's discussion. As members are aware, the IHCA represents more than 3,200 hospital consultants, around 95% of the total number in the country. First, I will address the current staffing situation, including the level of absenteeism. There is a severe shortage of hospital consultants in our public health service. We have the lowest number of medical specialists on a population basis in the EU. We are 41% below the EU average. We have a serious recruitment and retention crisis, with more than 700 permanent hospital consultant posts vacant or not filled as needed. This in large part has been caused by a flawed Government decision in 2012 to cut the pay of newly appointed consultants. Our younger consultants, who are being discriminated against, have been front and centre in providing care in the ongoing Covid crisis. They have carried an extremely heavy burden of work during this period and will continue to do so.

The leaders of all the parties have agreed that ending the discrimination against consultants appointed since 2012 is essential to attract and retain the number of consultants we need. The Government's failure to address the recruitment crisis and restore pay parity is bordering on negligence and only serves to exacerbate the extremely challenging task in dealing post Covid with the massive backlogs and waiting lists that are accumulating across all specialties.

In a survey of members last week, more than half said there are moderate or high staff absentee levels that are having an adverse impact on service delivery. Of the medical and dental staff, we had an absence rate of just 2.3%, around a quarter of the rate of other staff categories. However, more than half of the absences were due to Covid, which is the largest proportion for any staff category. The closure of schools is impacting on the availability for work of healthcare workers and it is increasing workloads and stress levels for those at work.

I will move on quickly to Covid transmission within hospitals. In the survey, around half of all respondents confirmed that improvements are needed to increase the number of single-occupancy rooms and beds in dedicated isolation wards. Our members also expressed concerns about the lack of regular testing and screening of staff. In the nine weeks to the end of January, more than 12,000 healthcare workers had been infected with the virus, including more than 560 doctors.

A total of over 1,400 confirmed cases were linked with hospital outbreaks in the same period. Four in ten of those infected in the hospital outbreaks were healthcare workers. Of the 1,400 cases linked with the hospitals, 30 were admitted to the intensive care unit, ICU, and, sadly, 124 died. When community transmission rates are at such high levels, it is almost inevitable that there will be outbreaks in hospitals. However, more must be done to prevent Covid infections being acquired in hospital settings. It is clear for infection control purposes that our pre-Covid bed occupancy rate of around 95% needs to be reduced to between 80% and 85%. To put that in perspective, this requires approximately 2,000 additional hospital beds to maintain current service levels.

In terms of long Covid, the Irish Hospital Consultants Association is concerned about the effects of long Covid and believes a HSE policy on long Covid is required for healthcare workers. Regarding the availability of protective equipment, IHCA members in our survey reported high levels of availability of personal protective equipment, PPE, of an appropriate grade, albeit there are some small glitches at individual sites. As regards the mental well-being of staff arising from the Covid crisis, a large majority of consultants in our survey said that Covid-19 has had a moderate or severe impact on their workload, general well-being and mental health. More than one-fifth of respondents are experiencing symptoms of burnout and work-related stress. Two in five doctors in Ireland now say their mental well-being is worse compared with what it was at the start of the pandemic. Worryingly, there is a high risk that when the pandemic eases there will be increased mental health issues impacting on our health staff. Returning to the stressful overstretched business-as-usual model is not an option if we are to avoid an even worse workforce crisis than was the case before Covid-19.

Regarding additional staffing requirements to deal with the non-Covid backlog, over 70% of our respondents confirmed that low numbers of consultants available to deliver care will have a moderate or severe adverse impact on the capacity to deal with the backlog in non-Covid care. More than 840,000 people are on some form of hospital waiting list. With over 700 permanent consultant posts vacant, our acute hospitals are very poorly positioned to provide timely care to patients. While the Government has committed record funding levels for health in 2021, until this money is channelled effectively and speedily to where it will make the most difference for patients, through the recruitment of additional consultants with supporting teams and infrastructure, public hospitals will continue to have record waiting lists and struggle to address the backlog of treatment due to Covid-19.

The Government can no longer ignore the fundamental requirement that essential treatment is delivered by consultants and that no amount of investment in hospital services will reduce waiting lists unless we recruit and retain the necessary number of hospital consultants to deliver timely care.

I invite Mr. Owens to make his opening remarks.

Mr. Anthony Owens

There can be no doubt that the Covid-19 pandemic has had a tremendous impact on our already overstretched front-line health service staff. In a recent survey that was carried out among the thousands of members of the IMO we sought to determine the exact impact. The three main impacts cited were preexisting staffing shortages exacerbated by Covid illnesses and requirements to self-isolate; the growing backlog of waiting patients; and the impact on doctors' personal health and wellbeing. However, we should be under no illusion, as these issues existed long before the pandemic struck. What is deplorable is that it is now almost one year since the first case of Covid-19 was diagnosed in Ireland, yet no substantial and systemic action has been taken to date to address the crises in recruitment and retention of medical expertise across our health system.

As a consequence, waiting lists have grown and stress and burnout are prevalent among the medical workforce. In an as yet unpublished IMO survey, 80% of doctors across all grades cited feelings of depression, anxiety and stress, particularly emotional stress.

Although public health medicine is the first line of defence we have against Covid-19, we have 60 public health specialists compared to 180 in Scotland and New Zealand where the population is of a similar size and is similarly dispersed. Public health specialists have the expertise and training to carry out risk assessments and manage and control outbreaks of infection in our healthcare settings and in the wider community and yet public health specialists have still not been provided with a consultant contract and the resources necessary to allow them to carry out their statutory duties. It beggars belief and should be a cause of considerable shame that these doctors, who are our front line in this battle, had to ballot for industrial action in the midst of a pandemic to have their long-running grievances considered in a serious fashion.

In the past year, hospital waiting lists have grown by approximately 70,000 or 9% and now stand at 838,000, yet the number of vacant consultant posts or posts filled on a temporary or non-substantive basis has risen to 730, more or less. The supply of medical specialists simply fails to meet demand. The HSE itself estimates that we require a minimum of 1,600 additional hospital consultants to meet the needs of our current population. If we include psychiatry and public health specialists, and we should, the shortfall is closer to 2,000. Still, however, no concrete measures have been taken to address the twotier pay structure among hospital consultants, which is the major factor contributing to the consultant recruitment and retention crisis.

There is no doubt that staffing shortages are impacting significantly on the mental health of our medical workforce and we have surveyed to establish that. Long working hours, excessive workloads, redeployment, requirements to cover for absent colleagues, the inability to get proper rest and take proper breaks and difficulties in accessing childcare are all contributing to high rates of stress and burnout among doctors. This is particularly evident among non-consultant hospital doctors, NCHDs, or doctors in training, who are seeing their training eroded by Covid-19. It is also the case among public health specialists where morale is at an all-time low.

General practice is not without its capacity issues. Some 600 GPs are due to retire over the next five years while the HSE's national doctors training and planning unit estimates that up to 1,660 additional GPs will be required by 2028. GPs are encountering difficulties in recruiting additional practice staff and accessing locum cover. Young GPs are finding it prohibitively expensive to establish themselves and build their own practices.

What can we do to address these matters? We must urgently strengthen public health medicine services through the immediate awarding of a consultant contract to specialists in public health medicine, as recommended by the Crowe Horwath report, the Scally report and the report of the Covid-19 nursing homes expert panel. We must ensure that adequate risk assessments are carried out across all healthcare settings. We must complete the vaccination of all front-line healthcare workers as a matter of absolute national priority. We must ensure that adequate supplies of quality personal protective equipment, PPE, for all front-line healthcare workers are available for hospital and community staff. We must encourage continued adherence to National Public Health Emergency Team, NPHET, guidelines through public education campaigns. All healthcare workers should have access to appropriately resourced and consultant-led occupational health services, including necessary mental health supports. In addition, all healthcare workers should be aware of their occupational rights and entitlements during this pandemic. This is not the time for fighting employers; this is the time to be on the same side.

We cannot hope to address the backlog of nonCovid patients on waiting lists, running at nearly 850,000, without addressing the recruitment and retention crisis as it affects hospital consultants. This is a longstanding issue that now requires an urgent solution. The Government needs to urgently address the twotier consultant pay issue. The HSE is not an employer of choice as the Public Service Pay Commission, among others, has found. Health service leaders know that to be the case and we suspect that many of our politicians also recognise that fact.

In the meantime, all higher specialist trainees, SpRs, who have finished training should be offered a temporary consultant locum post to get us through this crisis. We must also ensure a sufficient number of intern posts and training posts for those who wish to come into the service and contribute at this time. Once we get them in, it absolutely behoves the service to ensure that the working hours of our exhausted non-consultant hospital doctors comply with the European working time directive and the Organisation of Working Time Act. We know that they do not.

Finally, we need to provide additional support for established GPs to allow them to recruit the staff they will need. We also need to provide supports for newly establishing GPs to allow them to get through the difficult first few years.

I thank Mr. Owens. Finally, I invite Ms Ní Sheaghdha to give her opening statement and she has five minutes to do so.

Ms Phil Ní Sheaghdha

I thank the Chairman and members of the committee for the opportunity to make a presentation on behalf of the Irish Nurses and Midwives Organisation. We set out in our submission to cover the matters that we were asked to deal with, namely, issues to do with Covid infections and healthcare workers. The first issue to which we draw attention is the rate of infections among healthcare workers. This week, the International Council of Nurses confirmed that the rate of infection among Ireland's healthcare worker population, at 12%, is the highest it has recorded. This is a worrying trend which we have raised previously with the committee. We believe that the delay in the introduction of protection for workers by ensuring that the Health and Safety Authority, HSA, has a role to play in examining workplaces has certainly contributed to this high rate of infections. The INMO and the Irish Congress of Trade Unions, ICTU, sought for the HSA to amend regulations and that the Government would insist that they be regulated from the time that the pandemic was declared on 11 March last year. Unfortunately, that did not happen until the biological hazard directive was introduced by the European Union on 24 November. That interim period led to a lack of focus on the principle of preventing infections among healthcare workers. These workers are in the eye of the storm. The settings in which they work are workplaces and the HSA must conduct inspections where we know there are continuing clusters of Covid-19 infections in workplaces.

The data show that the prevalence of infection among females is highest in the health service because the number of female worker is higher than in other sectors. The reports from the HSA confirm that if one is a woman working in the health service, one is at the highest risk of contracting Covid-19. The issue is huge for us because a large portion of our members are women. Stress levels and mental health issues surrounding the provision of childcare and the difficulties in attempting to secure childcare, when decisions have been made, for example, to close schools, are combined with the difficulties of going to work in a high-risk environment and fighting to have personal protective equipment, PPE, provided that is adequate. That equipment is continually being assessed for its efficacy. We had to do so again in January, unfortunately, having previously, last April, sought a policy change to allow all healthcare workers to wear surgical masks. We had to repeat that process and seek the upgrade of those masks as what we know about the virus showed there was a higher risk. We were tracking the numbers of infections rates and this demonstrated that the new variant was far more infectious than existing variants. It took almost three weeks for the HSE policy to change to allow healthcare workers the right to wear the higher-grade mask.

Many other issues in our submission point to the fact of the precautionary principle and healthcare worker protection not being to the forefront. We are and have been very critical of this. It is a real issue for our members, who are putting themselves at risk on a daily basis in moving past all the obstacles to get to work, including incurring additional personal costs for the provision of childcare, in order to provide a service. We believe that their health and safety has not been protected to the level that it should and must be.

In regard to the vaccine roll-out, we point out in our submission that the trajectory and statistics we have from the HSE show that some counties, including, for example, the Border counties of Louth, Donegal, Cavan and Sligo, had very high population incidences, yet vaccine administration was not concentrated in, and prioritised for, those areas.

Our members in those areas were absolutely devastated when they were not prioritised for the vaccine roll-out. Today the HSE portal to allow healthcare workers register for vaccination opened and we are very worried that the same thing might happen again. We hope it will not. We have worked hard with the HSE on a sequencing document, which was issued on 19 January, to ensure that front-line, patient-facing healthcare workers are prioritised for the vaccine that is available because clearly this is their line of defence.

The long-term Covid effects are another issue on which we believe the committee must comment. The long-term Covid effects are real. Many of our members report to us that they have not recovered, that they continue to fight Covid at home, that they have long-term fatigue or long-term neurological or cardiac presentations post infection at work. There is simply no fast-tracking or clinical pathway for them, despite numerous requests for same. We believe that, as an employer, the health service has to do better and that there must be real precautionary and preventative measures in place. There must also be very real measures now to deal with the long Covid effects.

In addition, we know from all the studies we have done or which other health services across the globe have looked at that the mental health effects post pandemic will be of huge significance. More than 80% of our members have said their mental health has been affected by working in these conditions. Now we have to prepare for that and make sure we are putting in place supports to allow recuperation and to allow the healthcare workers who have been working at 120%, 140% and 150% to recuperate when, it is to be hoped, the vaccine is fully rolled out and we have a reprieve.

I thank Ms Ní Sheaghdha. We have gone over time. As members are attending virtually from their offices and therefore cannot see the clock to monitor their speaking time, I will try to advise them when they have a minute remaining. I ask them again to stick to their time allocations in order to facilitate all members' participation in the meeting. I think most of them have experience at this stage of how it works. There are ten minutes for the first questioners and as part of that, we ask witnesses when replying to try to be as concise as possible and to stay within the time limit. Our first questioner this morning is Senator Kyne.

I thank the witnesses for their attendance and their presentations and welcome them all. I will start by thanking all healthcare workers for their diligent and compassionate work and care for people during this pandemic, the likes of which none of us have seen on this scale before. Obviously, top of that queue are nurses, consultants and GPs but also all healthcare staff - cleaning staff, cooks, catering staff, maintenance staff, secretarial staff, administrative staff, porters, nursing assistants, managers, social workers, chaplains, pharmacists and physiotherapists - who have had front-line roles. The importance of caring has been recognised more now than ever before.

I recognise that resources are not endless and that spending more in one sector always means spending less in another. Perhaps all witnesses could comment on the €21 billion budget, which is the highest ever, with an additional €4 billion this year. That is certainly very welcome. I think Professor Landers has stated that that money is not being spent effectively. Perhaps he could advise how it should be spent, whether more should be spent or what he suggests we should not spend money on within the health sector. That is important. As I said, money is not endless.

What percentage of members of the witnesses' organisations have not been vaccinated? They should have been. That was, and should still be, the priority. What are the reasons for them not being vaccinated? Some were missed because, when their hospitals, HSE nursing homes or whatever were vaccinating, they were out, isolating or had Covid and that caused a delay. What is the relationship in that regard? Front-line workers must be the first priority.

Professor Landers and Ms Ní Sheaghdha made reference to the benefits of single-occupancy rooms. Will they expand on that? How do single-occupancy en suite rooms protect patients and staff? The new 75-bed unit in Galway is an example.

There are consultancy posts being advertised that are not being taken up. Does that suggest it is just about pay or are there also certain hospitals that are not as attractive as others, if I can say that, because of their size, location or so on?

Professor Robert Landers

I will answer some of the Senator's direct questions. This year's money is being spent in an emergency situation and with little in the way of planning. That has been necessary, but we now need to plan into the future. As I alluded to in my presentation, we need at least 2,000 additional beds. We also need to examine the infrastructure. In other words, the majority of facilities need to be single-room accommodation, which would bring us into line with the modern, developed world. Any new hospital being built these days is all single-room accommodation. The virus will spread in any congregated setting, be that a two-bed, three-bed, five-bed or six-bed ward. Single-room accommodation greatly cuts down the virus's ability to spread.

Consultancy post vacancies exist across all model 2, 3 and 4 hospitals. It is true that some consultant posts are not as attractive as others depending on someone's interests, but there are vacancies across all specialties and hospitals. This issue needs to be sorted out and we need to make consultant posts more attractive so that we can attract and retain consultants. We do not have a hope of matching the demand for post-Covid care until we sort that out.

Ms Phil Ní Sheaghdha

If I might answer Senator Kyne's question in respect of healthcare workers-----

(Interruptions).

Ms Ní Sheaghdha is on mute.

Ms Phil Ní Sheaghdha

Okay. The number in question is 49,500 healthcare workers, but we do not have a breakdown by grade. There is a long way to go, given that people must have a first and then a second vaccination. There are nurses and midwives working in ICUs and emergency departments today who have not had their first vaccinations. They must be prioritised.

We worked hard to get the sequencing document, which has been in place since 12 January and was reiterated on 19 January. It is key. Those who are patient-facing, front-line healthcare workers have to be prioritised for a vaccine. It is a health and safety measure to ensure that their risk is mitigated. In our view, the State, through the HSA must have an involvement in ensuring that happens. Under the European directive, the HSA has a legal imperative to ensure that workplaces are safe. To date, we have been critical of the lack of focus on that imperative in respect of healthcare workers. Just because they are working in the health service does not mean their environment is safe. In fact, it is the opposite. We know that the rate of infection among workers in the health service is very high.

Those working on the front line of the health service, particularly women, are at higher risk. This is very problematic, and we must find out why it is. We cannot just look at it as we have been doing with the trolley count for years, nod our heads and say, "Yes, isn't it terrible?" This is very real. It is high risk. The after-effects of contracting Covid will be with us for a long time.

In respect of the service plan, we have had an agreement since 2016 that the HSE would sign off the service plan with the union in respect of the funded workforce plan for nursing and midwifery every November. It happened once in 2017. This year we still do not have a service plan for the health service, a funded workforce plan or otherwise, signed by the Minister. Today is 9 February. It is imperative to focus on how we staff the health service, what is funded and how we recruit, particularly now in a pandemic when we know that more than 6,000 staff are unable to come to work because of being affected themselves. It is a matter this committee should raise with the Minister for Health. Why is the service plan not signed off by 9 February?

Can we hear from the IMO?

Mr. Anthony Owens

Could I come in? I thank the Senator for his questions. He asked about vacant consultant posts in certain sites. I would overlay that because we have many vacant consultant posts in certain specialties. Right now, we need emergency medicine consultants and ICU consultants where we have many vacant posts. We also need mental health consultants, psychiatrists, and they will be particularly needed when, touch wood, we get out of this. We also have many vacant posts there. Therefore, it is sites and specialties.

The Senator also mentioned the vaccine roll-out. Many of our non-consultant hospital doctors came to us with a particular issue. As he knows, non-consultant hospital doctors have a rotational pattern and quite a few will rotate from one location to another in January every year. This year we had a particular problem. Many of them who were leaving site A to go to site B were told in site A to hang on and get the vaccine in site B and others were told when they got to site B to go back to site A to get their second dose. There are issues which affect numbers of doctors. In the great scheme of things, it might seem relatively small but the fact of the matter is a vaccination campaign, which is our way out of this, should not make our doctors anxious and should not give them concerns or pause for thought. It should not give us reasons to approach the HSE and ask, "Would you please vaccinate front-line healthcare workers?" That should just be happening.

I believe Dr. Colleran has indicated.

Dr. Gabrielle Colleran

Senator Kyne asked about the empty posts. We currently have 728 consultant posts that are not filled on a permanent basis, which is 20% of our current consultant numbers. The national doctors training programme estimates that we need to increase the number of acute hospital consultants by 51% by 2028. It is critical that we not only fill those posts, but then recruit another 50%. Those calculations are all pre-pandemic and, as we all know, the 840,000 people waiting for care is only growing. The Senator asked what would help to fix it. The reality is that for many of my peers, with whom I have considerable contact in my role, the 2012 decision makes working abroad more attractive. It is simple as that. As long as we are paying two people differently for doing the same work, people who are away will not come home.

Members of the committee, as public representatives, need to see that there is value for money and that people are delivering the care. That is something we are doing every day. If we look to what we have shown in the past year, the leadership, the innovation, the agility, the commitment shown by our members, we have shown what is possible and how we can turn around how we deliver care during a pandemic. Where people previously thought that the health service could not change and could not be agile, that has all been turned on its head. It has been down to the local teams and the local services, the doctors, nurses, the health and social care professionals, and the porters. All of us working together have delivered for patients.

As long as we have the 2012 cut and a 30% pay differential, we will continue to have trouble filling those 728 or 1,100 or 650 posts. The Senator is right; it is not just pay but also conditions. People have too much call and too much workload. They are filling the gap for the consultants who are not in post. It all fills in together and ultimately it is our patients, particularly our poorest and most disadvantaged patients, who are affected most.

I welcome all our witnesses and pass on my best wishes to all of those operating on the front line in very difficult and challenging circumstances. I will make a few points and then put a few questions to a number of witnesses. All of the opening statements made for very difficult listening and should be for all of us but there is a very clear relationship between the burnout facing front-line staff and low morale on the one hand and the lack of capacity across the system, the failure to deal with the two-tier pay inequality issues that have been in play for a long time and the lack of supports in terms of occupational health on the other. If we do not sort out these problems, we will lose more nurses, doctors, consultants and front-line staff. It is as simple as that. Student nurses and midwives have been campaigning for the past number of months - years in fact. The public health specialists have pay demands, as do hospital consultants operating on lower two-tier contracts, so we need to sort out all of these issues.

I will make a number of points about occupational health. It is outrageous to learn from the opening statements that there is no serial testing for front-line staff in hospitals. If there is any place to use testing to hunt down the virus, it should be the front line in hospitals. I cannot believe that serial testing is not being done or is only being done when there is an outbreak. The fact that the roll-out of the vaccine has been haphazard and did not follow the infection rates is deeply troubling, as is the fact that there have been very few inspections by the Health and Safety Authority. I make all of these points because staff are exhausted and facing burnout, their morale is low, they want us to fix these problems and they are facing into what, in my view, will be a tsunami of missed care that must be caught up with in the time ahead. We cannot expect all of those people who have been through very difficult circumstances with all of the challenges they faced over the past year to face into all of that catch-up care if we do not support them.

Ms Ní Sheaghdha stated that the lack of routine testing and monitoring for exposed nurses, midwives and other front-line workers had exposed them to a greater risk of infection. She said that, put simply, if we cannot see a problem, we cannot deal with it. What was the response of the HSE when told by the INMO that serial testing was not happening? We should bear in mind that over 50% of front-line staff who have been infected with Covid have been nurses and healthcare assistants, mostly women. What was the response of the HSE when the INMO raised issues relating to testing?

Ms Phil Ní Sheaghdha

The HSE has consistently said it will test only where there are outbreaks. There is serial testing in long-term care but there is none in the acute hospital system or in the community outside long-term care. The study undertaken in Tallaght and Galway demonstrates that this means we do not pick up asymptomatic presentation and 34% of the asymptomatic presentation was not picked up. According to that study, this means that people were going to work with Covid-19 but without any symptoms. We have been very critical of that. Our members have sought serial testing. To date, the HSE has been unable to give us a satisfactory answer. It is now saying that antigen testing may be introduced. Again, there is a lot of information around the efficacy and accuracy of antigen testing. We believe that until the vaccine is rolled out completely with both doses, it is imperative that we know the status of healthcare workers when they are at work and this requires a routine testing regime to be in place. We believe this is the role of the Health and Safety Authority. It must look at the staff and the areas with the highest level of infection and where outbreaks continue to occur. We know from staff that the acute hospital system continues to have a very high infection rate.

Evidence suggests that some policies of the HSE such as the derogation for staff who were close contacts to return to work did not assist in reducing infection levels and may have actually increased the infection rate. Those policies must be tested from the point of view of the safety of the worker.

In terms of staffing, I agree with my consultant colleagues on the issue of the two-tier system and I am glad the Deputy raised the issue of student nurses because not only are student nurses going into the eye of the storm, they are not being paid at all. They are on zero salary and this committee must make a stand on this. We met the Minister last evening and he is still standing by the position that that is okay. Frankly-----

In terms of student nurses and midwives, is what we are seeing at the moment exploitation? I have met hundreds of these students and what they are telling me is that fourth years are still in the hospitals and have been since the pandemic struck. There was a pause in the placements for some of the first, second and third years but not for all. Is it the case that the pay and allowance issues have not been resolved, despite the recommendations of the independent report? Those recommendations have not been implemented but the reality is they do not go far enough. I ask Ms Ní Sheaghdha about the level of anger among student nurses and midwives. In her view, is what we are seeing clear exploitation?

Ms Phil Ní Sheaghdha

We are on the record and have said from the outset that when we have 6,000 staff out sick and we have an unpaid workforce of 1,500, what do people think they are doing? I do not accept, nor do they, that they are standing in a supervisory capacity and not engaged in the business of work. Of course they are working and they are not getting paid. The Collins report looked at the period between September and December and concluded that if the situation in the health service changed, it was open to the Minister to revert to the situation that was put in place by his predecessor last March. We asked the Minister last night if he was going to do that but his answer was "No". Nobody can argue that the situation has not changed. Since January the situation has been, by any examination, much worse than it was last March. Many students had three weeks of their placements suspended but fourth years have not had their placements suspended. The Department of Health has advised that student nurses in first, second and third year will gradually return to clinical placement but it is extraordinarily haphazard. The higher education institutes cannot tell us if those students will have to redo the placements that they could not do because their training was suspended. Not only are they not paid, they will actually be the only students in the country for whom the higher education institutes did not provide an alternative learning option.

My time is almost up so I would like to put a question to Mr. Landers and to the IMO if I may. We cannot do justice to all of these issues today. We have only ten minutes to go through them all. Obviously, I accept the constraints but it is very difficult, given the number of issues involved, including the haphazard roll-out of the vaccine and the battle that healthcare unions are having to wage to secure access to PPE for their members, which is ridiculous. It is crazy and the fact that there have been very few, if any, inspections by the Health and Safety Authority, HSA, in hospitals is a scandal. We need to hear from the HSE, the HSA and others. All of the opening statements today are harrowing and that is the reality for those on the front line.

Mr. Landers made reference in his opening statement to an issue that I have also spoken about, namely the tsunami of missed care that is facing our healthcare services. A huge volume of care, described as non-essential, was paused but that care becomes essential very quickly. This will put enormous pressure on staff on the front line. What needs to be done to best position us to deal with that missed care, given the burnout and low morale among staff, not to mention the lack of capacity in our hospitals? I ask Mr. Landers and the IMO if it is the case that we are facing a tsunami of missed care and to outline what needs to be done.

Professor Robert Landers

There is no doubt that we are facing a tsunami of missed or late care.

Unlike the Covid crisis, we know exactly the scale of this. It is huge and it will stretch our health services to the absolute limit. Equally, there is no doubt the public health system as structured does not have the capacity, either in terms of personnel or in terms of infrastructure and beds, to deal in a timely fashion with the tsunami. In the short term, we will have to work with private providers to address care. In the medium and long term, we need to start planning now. We need to put this capacity into our system to build up the number of consultants and the number of public hospital beds available so that people will not wait. As I have said, this was entirely predictable. We can go through it specialty by specialty in terms of the numbers but we need to act now. There is no point in waiting for six months on this. We need to start planning now and we need engagement with the Department of Health and the Minister on this.

Mr. Anthony Owens

We know what is coming down the track. It has been coming down the track for a number of years. It is just picking up speed. When I started in the IMO there might have been 100,000 people on waiting lists and we now have well over 800,000 people. We need to get serious about tackling this. We need to get the 720 or 730 vacant posts filled properly. We need to take advantage of the fact that at present we have the biggest intern cohort we have ever had. We need to keep these doctors here. We need to get them working on the patients they should be working on. We should also be paying our student nurses, by the way. We need to take advantage of the circumstances. They are not great but what we have we should take advantage of. There is goodwill towards the health service. We have more doctors than we have had previously because they cannot leave the country. Let us look to get them in and then we can begin addressing these huge waiting lists.

We are having difficulties and the camera keeps fading in and out. For people watching at home, there is a technical glitch in our system.

Can the Chairman hear me?

We can hear you and we can see you.

All of my questions are for Ms Ní Sheaghdha. I echo the comments of previous speakers. Will Ms Ní Sheaghdha give us some kind of taste of what life has been like for nurses in hospitals with the third surge?

Ms Phil Ní Sheaghdha

I can, and our president, Ms Karen McGowan, who is an advanced nurse practitioner in Beaumont, can give the Deputy a first-hand account. The winter of 2019 was very busy. We had a lot of overcrowding and our members were very tired coming into February and March 2020 when the pandemic struck. When we hear the account by the HSE of changing capacity and surge capacity, what does it mean? It means nurses and midwives in the main changed their roles. Many of them moved from the areas where they practised and worked and went to work in intensive care surge capacity areas and changed their shifts and their attendance. They worked extra shifts and continued long after their shifts ended to make sure the patients were cared for. That is the reality.

Now, in the third surge, it has been more difficult because the requirement to provide high-level intensive care outside of intensive care units, with a total of 13 intensivists in the country, has put an enormous strain on the expertise of ICU nurses, who are in short supply, and on those who have assisted in recovery rooms and theatres. There are also Covid wards with very high dependency patients. Again, there is a high level of skill required. It is the perfect storm of very low staffing to begin with, high levels of sickness and the requirement for the same pool to provide continuously the extraordinary work they have been providing. This coupled with childcare means there are very real issues.

When our members heard about school closures they wondered how they were going to get to work. It is unfortunate that this is the second time decisions have been made at that level without taking into consideration the effect that would have on this population of essential workers.

What has happened regarding childcare?

Ms Phil Ní Sheaghdha

Very little. It is largely up to nurses and midwives to provide.

What have the nurses and midwives done?

Ms Phil Ní Sheaghdha

Many secured childcare at an additional cost. That cost has been their own. Many have changed their shifts or, with the assistance of family members and partners, come to all sorts of arrangements. There are myriad arrangements. People have made extraordinary efforts to ensure they can go to work. There has been an additional cost to them in terms of personal out-of-pocket expenses in order to make sure they can come to work. That is a significant issue.

The numbers in our survey who cited childcare as a matter of huge stress for them were very high. When school closures were announced during the third wave no provision was made for the largely female workforce that comprises nursing and midwifery. I will ask Ms McGowan to outline the front-line experience.

Ms Karen McGowan

It is horrendous. As Ms Ní Sheaghdha has stated, staff have experienced different scenarios, often not very desirable ones, such as arrangements with colleagues to mind other children. The mixing of households and so on complicates everything. It is extremely difficult. A lot of our members have elderly parents who would have normally looked after their children, but are not in a position to do so now because they need to cocoon. This has resulted in a significant cost for them. They have had to hire people to take care of their children privately so that they can make sure they can go to work. It is a significant burden for our members. I am hearing day in and day out that it is a huge problem.

Mr. Tony Fitzpatrick

We received correspondence yesterday from the Department of Health - it was sent to all unions - that states the issues for front-line healthcare workers with regard to the additional costs of childcare is their problem and that it was not doing anything about it. It stated that it pulled together the Departments for Children, Equality, Disability, Integration and Youth, Health, Public Expenditure and Reform, etc. and they are not going to do anything about it. The Department does not care about the additional costs that people incur to ensure that they can go to work on the front line of the fight against the pandemic because it is not going to do anything about it. That is the correspondence that all unions received from the Department of Health yesterday, which is an absolute disgrace.

The schools closed. Healthcare workers had childcare arrangements that did not cover school hours. They went out of their way to do whatever they could. The workforce is 75% female, with a lot of childcare issues. Some 92% of nurses and 98% of midwives are female. The Department of Health did not care. Those people did what they could, put arrangements in place in a very difficult scenario and went to work. They turned up for their patients, but unfortunately the Government and HSE have not turned up for healthcare workers in that scenario.

Mr. Fitzpatrick might share that correspondence with the committee if it has not been sought already. That would be helpful.

Mr. Tony Fitzpatrick

Absolutely. I will share it immediately.

I share in the comment that it is scandalous. I ask Ms Ní Sheaghdha to outline the impact of long Covid on nursing staff.

Ms Phil Ní Sheaghdha

We had meetings with the HSE in October last year where we set out the information we had at that point. We heard from and spoke to a number of our members who have not recovered from Covid. One of the nurses, Ms Siobhán Murphy, gave evidence to this committee last year and described being one of 11 nurses who were infected on a Covid ward in a Dublin hospital, the long-term effects and her delayed recovery.

We have sought a clinical pathway. In other words, if I am a healthcare worker who is infected at work, there should be a specific pathway from a clinical perspective to help me rehabilitate and get the correct and most up-to-date help for me in order to assist my recovery. That has not happened.

Have nurses with long Covid come back to work?

Ms Phil Ní Sheaghdha

Some have but some have not. Unfortunately, we are seeing in this wave that the number of people out for more than 14 weeks has increased.

I have a final question on student nurses. Will Ms Ní Sheaghdha give us a snapshot of the difference between the work that student nurses do - it should not be work, of course, if it is a placement - and the responsibilities they are given over and above what they would normally be given in a normal student nurse placement, if such a thing exists?

Ms Phil Ní Sheaghdha

Again, student nurses in first, second and third year spend between 12 and 14 weeks every year in the health service observing and learning the craft of nursing and midwifery. Since the pandemic commenced, they have advised us very clearly that they do not have that luxury. They go into work and are assigned patients, and the person assigning them has no choice because the workforce is not there. There are over 6,000 healthcare professionals out sick with Covid or through being close contacts. When they turn up, these student nurses are a pair of hands and assisting in the delivery of healthcare. They are not paid.

Fourth year student nurses are paid €10.70 per hour for 36 weeks but they advise us that what they are doing is way beyond what is in the learning contract they have with their employer. In March 2020, an arrangement was arrived at that they would be paid as healthcare assistants, with a rate of €14 per hour, while student nurses in first, second and third year would get contracts as healthcare assistants while their learning would also be credited. We are saying to the Minister for Health that this arrangement should now be in place and there should be recognition that it is. There is only one definition for somebody who goes into a workplace during a pandemic and does not get paid for the work; it is exploitation. We simply cannot accept that the matter is not being addressed by the Government.

We met the Minister for Health last evening and the provision is unchanged. We appeal to the committee to make very clear representations on that matter. It is simply not good enough. We want these people to stay in Ireland when they qualify and we have been battling with measures to retain qualified nurses for years. Now we have this, which is an own goal by the Government.

It should be an urgent recommendation of this committee. I will ask that the committee look at this as a matter of urgency. I thank the witnesses.

I thank all the witnesses for coming before the committee and I thank them and the members of their organisations for the extraordinary work they do in such difficult and stressful circumstances. The country owes a huge debt of gratitude to them, which makes the circumstances in which they are expected to work all the more shocking. Their conditions have not improved, instead they have worsened significantly over the past year.

All the witnesses have been before this committee previously. In the earlier part of last summer, they came before the Special Committee on Covid-19 Response and spelled out in stark terms just what was facing the health service and the country. It seems that no progress has been made since they outlined those problems. Is there anybody at any level in any Department who is focusing on the crisis being faced by the health service from a recruitment perspective? We have heard about vaccines and the management of Covid-19, which are really important, but who is addressing the matter of recruitment? I fail to see where it is being addressed by the Government at any level.

I hope I am wrong but I would like to hear the views of the witnesses on the engagement they have had. Is any work ongoing at Government level in respect of this crisis? It is a vicious cycle because for years the service has been understaffed and under-resourced in terms of facilities and beds in particular. I ask each of the organisations about this in turn. What engagement, if any, is taking place on this? Who is taking responsibility for this recruitment crisis?

It seems to me that the number of hospital consultant vacancies is increasing all the time. We are now talking about over 700 vacancies and another 1,000 Sláintecare contracts were also promised. Is there any progress in either of these areas? Who is taking responsibility?

I will ask the IMO representatives specifically about public health doctors. It beggars belief that, in the context of a pandemic, the Government has not responded to the three reports in the past three years on the shortage of public health specialists and the failure to upgrade those roles.

I will ask Ms Ní Sheaghdha about the nurse experience. We have talked about the lack of a funded workforce plan. Has there been any discussion with the INMO on the service plan? We are still waiting to see that.

There is another point relating to childcare. What is the position in respect of an allowance? Mr. Fitzpatrick said that has been ruled out. Has the INMO made a specific proposal to the Department on a specific allowance for childcare? It is madness that this issue, which is fundamental to the workforce, has not been addressed.

Deputy Shortall has less than three minutes left to have those five or six questions answered.

Dr. Gabrielle Colleran

I will take the first question for the IHCA. Unfortunately, the short answer is that there has been a lack of engagement by the Government and management despite our best efforts. We are seeking practical workable solutions. As Deputy Shortall outlined, when I was before the health committee some years ago there were 500 vacancies. There are now 728 vacancies. We are also facing a glut of retirements in the coming two or three years because of the way posts came on in the late 1990s. Those retirements are coming. The national doctors training and planning unit of the HSE is telling us we need a 51% increase in acute hospital posts. I look to the excellent trainees I am involved in supervising and training. They look to me and ask whether there is a solution coming and whether they will have enough colleagues for manageable workloads and safe call rosters. They ask whether they will have to work in a system where there is consistent moral injury from the lack of capacity. I am concerned we will see them leave once travel opens up again.

My thanks to Dr. Colleran. I wish to confirm one point. She is saying there is no engagement on the issue of recruitment. Is that correct?

Dr. Gabrielle Colleran

There has been no meaningful engagement and no progress.

What about the IMO?

Dr. Peadar Gilligan

There has been a significant lack of engagement with regard to public health - that is absolutely the case. It is really concerning that in the midst of a pandemic our colleagues in public health are not being given a consultant contract commensurate with their specialist training. That has to be addressed as a matter of urgency.

We were asked about the recruitment of future consultants. It is absolutely the case that the 30% cut is the major barrier to our ability to be able to recruit the specialists the country needs. Our non-consultant hospital doctors are our doctors in training. We have 250 additional interns in the system currently, but there has been no commitment to date to provide training posts to expand that number and make these posts available for these staff.

Time is short and this committee wants to make a recommendation arising from this session. We would like to take this up with the Minister for Health as soon as possible. I want confirmation from the witnesses on whether there has been any engagement of any meaningful type in respect of this crisis of recruitment.

Mr. Anthony Owens

No, there has not been. Any engagement consultants have had has been engagement via press release. We have not had meaningful negotiations with the employer or management side.

In the case of non-consultant hospital doctors, we have almost looked into a situation whereby we have more NCHDs and posts than we had planned to have.

Unless we take steps to keep them, we will lose them once international borders reopen. On public health doctors, there has been no progress whatsoever.

In spite of three reports and promises from the previous two Ministers.

Mr. Anthony Owens

Absolutely.

Ms Phil Ní Sheaghdha

As I said at the outset, we have an agreement in place which requires the HSE to agree a funded workforce plan with us each November. That has not happened since 2017. There have been public announcements that there will be recruitment of more than 6,000 staff into the health service but we have no details. In the last engagement we had with the HSE, we were told the Minister has not yet signed off on the service plan for it for 2021, and today is 9 February. A service plan for this year has not been signed of at Department level yet so it is difficult to get engagement when that is the case. This is hugely problematic because-----

Mr. Tony Fitzpatrick

Ms Ní Sheaghdha has gone on mute. Deputy Shortall asked about childcare. The unions collectively wrote to the Ministers for Education, Children, Equality, Disability, Integration and Youth and Health, Deputies Foley, O'Gorman and Stephen Donnelly, respectively, on that issue. We have had no response from the Department of Education. We asked that schools consider opening for healthcare workers to allow them to continue to go to work. A nurse in Cavan does not have that facility but a nurse in Enniskillen, County Fermanagh, does because they have kept the schools open for healthcare workers in that jurisdiction.

On the Deputy's specific asks, the unions have asked that if healthcare workers secure childcare within their bubble or anywhere else and there is a cost associated with that, the cost would be reimbursed to them in order to allow them to go to work, care for their patients and have the security that childcare costs will be covered, particularly as the day is much longer now that the schools are closed. We asked for this before the new year. Up to last week, we were told it was under consideration by three Departments. Yesterday, it was confirmed that those involved would not do anything about it.

I am filling in for Deputy Gino Kenny, who is staying away because he has to have a Covid test. I thank the witnesses. It is humbling to hear about the superhuman sacrifices our healthcare workers have made. That rings hollow because we could spend half a year clapping them and then spend the next year and a half insulting them with the sort of letter they got yesterday stating that childcare was their own business and the Department would not do anything about it. That is quite shocking. We should published the letter and show how disrespectful the Department of Health is to all front-line workers in the healthcare service. It is outrageous.

There are some things which jump out at me that have not been asked. One relates to the Be on Call for Ireland initiative. All of us remember that last year something of the order of 73,000 people responded to that initiative and that only 7,000 were interviewed. Of those, only a few hundred have started work. Has that been frustrating for the witnesses? Do they believe the matter was handled badly?

References were made, I think by the INMO, to the way recruitment takes place to the effect that it is cumbersome, that it is a burden and that it should be changed. I would like to tease that matter out, if possible, because it is shocking to see the number of vacancies that exist, including the 728 relating to consultant posts. Our public health system just does not function. I think it was the CMO who replied to a question last week by stating that the public health system would not be able to handle this surge we have in the virus. If it is not able to handle it, then serious questions need to be asked of those who administer our health services. Will the consultants comment on what is required for a decent public health system that can control the virus, administer vaccines and give control and power to the consultants to lead on these matters?

My final question is for Ms Ní Sheaghdha from the INMO. In light of her comments on long Covid, the psychological impact on nurses of having worked through three surges in our health system and the numbers out sick, should we still recognise Covid as an occupational disease, particularly given the impact it has had on nurses and midwives, including student nurses and midwives?

Dr. Gabrielle Colleran

I am happy to address the consultant question. It comes down to capacity and is about having enough beds and staff. We have the lowest number of specialists in Europe, with 728 unfilled posts and significant unmet need. We are asking for there to be enough colleagues for management workloads and safe call rosters, that is, just the basics so that we can do our jobs. As for the infrastructure, what we have seen in terms of nosocomial infections is that our hospitals are just not fit for modern infection control, so we need rapidly to replace many of the acute beds in our system with single-room hospitals, that is, modern hospitals for modern infection control. We know from history that it takes too long to provide public beds in the Irish system. It takes seven to eight years, while it is turned around much faster in the private sector. Some of that is tied up with tendering and processes. We have a great deal of public land and we need to get new beds into the system that are built for modern infection control.

The 30% pay cut is the big barrier; we know that from talking to consultants who are on fellowship abroad. Fairness is important in every aspect of life. If two people are being treated differently and one is being paid 30% more than the other, it is not a recruitment and retention strategy. That is the biggest barrier. If that is addressed and more staff come in, people will be able to get through the work. I cannot describe to the committee what it is like when one sees the impact on a child or adult who has been waiting so long on a list that he or she has a worse outcome. There is a moral injury with that and it damages doctors, nurses and health professionals. We need to remove it from our systems because when trainees who grow up in the system go away to Australia, New Zealand or America, as I did, and they work in systems where they can consistently feel proud and they do not have that moral injury and damage, they do not want to feel it again. That is part of why they stay away. If we fix the system so that it works for patients, and if we have capacity to meet need, that is when we will attract and retain people because of that feeling of being part of something excellent.

In many pockets of our health service, people are very satisfied with the care when they get in because we have excellent teams. We saw that in the way that our healthcare workers responded to this crisis and stepped up, but too many people wait too long for access to scheduled care. "Elective" care makes it sound as if it is not urgent, but if an elderly person cannot walk to the shops or to mass because he or she has hip pain, or if he or she cannot drive because he or she has not had a cataract operation, that elective care is essential. We have to get the capacity into our system. The belief that, somehow, our public health system cannot be fixed has to be tackled.

While I have this opportunity, I must talk about psychiatry. There is a critical lack of beds in the psychiatric system. When psychiatric consultants are on call, they do not have beds even for people who are suicidal. They ring around trying to beg and borrow beds for people who acutely need admission with suicidal ideation or psychotic episodes. We are discriminating against psychiatric patients and people with mental health issues. We allocate 6% of the total health budget to mental health, whereas it is 12% in the UK and it still has issues. There is an urgent need for parity of esteem for mental health in this country. We are letting down a generation of Irish people. We are seeing the impact of the pandemic on our children. There has been an increase in the number of presentations with mental health issues to our paediatric emergency departments. We really have to address this issue.

When I look to the trainees coming behind me, I want to fix the system so that they see a future leading and innovating in it and so that they will want to stay in the system. As soon as the world opens back up, we will see an exodus because of the trauma of what has happened during this pandemic to our trainees and because of what they are seeing in terms of how our healthcare workers are being treated. As Ms Ní Sheaghdha so eloquently articulated, we were abandoned when the schools were closed, with no plan for us. In Northern Ireland and Britain, children of healthcare workers are going to school, whereas my children and my colleagues' children are being traumatised. They are falling behind and we are too tired and burned out to help them with homeschooling when we get home. I got home at 9.15 p.m. on Monday last and my seven-year-old was sitting there with her Abair Liom on the table, waiting to do her Irish homework with me.

I burst into tears. I had nothing left to give. She is stressed because she is falling behind. The anxiety is through the roof. We are not working from home, so we are not there to support our children. We feel we have been abandoned by the State at exactly the time when we have all stepped up. We went into work every day before we were vaccinated, putting our own lives on the line, seeing colleagues getting sick, seeing colleagues being out with long Covid and not coming back, knowing that we were at risk of that ourselves, but there was no plan for us. The schools just shut and there was nothing to help us, but it was our problem and our cost to absorb.

I do not have time to call Dr. Colleran's colleagues. I will move on to the next questioner.

May I get an answer from Ms Ní Sheaghdha on long Covid and Covid as an occupational disease?

The Deputy is stretching now because she has gone over her time. Will Ms Ní Sheaghdha reply quickly?

Ms Phil Ní Sheaghdha

I will be brief. The HSA has had responsibility for this area since 24 November. One of the joint committee's recommendations must ask what the HSA is doing to protect healthcare workers on the front line in all of these areas. If someone contracts Covid at work, it most certainly is an occupational disease and an occupational injury.

I thank Ms Ní Sheaghdha.

Ms Phil Ní Sheaghdha

I might finish by saying that, as well as recruitment, retention will be a major issue for the health service. Everything that the committee just heard is absolutely the case. In light of the manner in which our trainee student nurses are being treated, what does the committee believe the legacy and their memory will be of how their employer dealt with them when they turned up during a pandemic for free?

I thank Ms Ní Sheaghdha, but I cannot allow anyone else to reply. I call Senator Conway.

Like other members, I express my heartfelt thanks to all of the witnesses and the people they represent for the work they have done.

Regarding education, and compared to the North of Ireland, where the children of essential workers are going to school, this issue has not been addressed appropriately. What are Ms Ní Sheaghdha's thoughts on it? Does she believe as I do that the children of essential workers should be going to school? Given what her members had been doing for the past 12 months, how did they feel when they saw unions reluctant to go into classrooms? There seemed to be a contrast between the two-----

(Interruptions).

Deputy Bríd Smith's microphone is on.

Perhaps Ms Ní Sheaghdha will give us her thoughts on that matter.

Ms Phil Ní Sheaghdha

I acknowledge the Senator's note of thanks. To address Deputy Bríd Smith's question, none of our members will hear it as a hollow gesture. They appreciate the supports they get from the public and all parties who say that their contribution has been extraordinary. We ask that the committee support our call, which was lodged last November, for compensation for them for how they have gone over and above and delivered in excess even when doing so was very difficult for them.

The point we make about schools is that, when a decision was made by the Government to close them based on public health advice and for a variety of reasons, that was fine. We are not making comment on that. Rather, we are saying that the Government cannot make that decision and then abandon a force of what it calls "essential workers" and require them to turn up to work without providing a plan B. It has not been thought through. That is our criticism. Many in the healthcare workforce have family responsibilities - 72% are female, and in our case 92% of nurses and 97% of midwives are female.

When schools are removed at short enough notice, it is simply irresponsible. It abandons the workforce and actually imposes a cost on them. As my colleague, Mr. Fitzpatrick, pointed out, this has now very definitely been presented as, "That is your own problem. Sort it out."

We would not necessarily disagree with that analysis. When there were proposals to bring back special needs students, we saw the kickback from the unions. How did INMO members feel given that they are rolling up their sleeves risking their lives day in, day out?

Ms Phil Ní Sheaghdha

Our members understand their job is an essential front-line role. There is a distinction between what is an essential front-line role and a non-essential role. Those in front-line essential roles should be compensated. That is our members' ask. Their ask is that the claim lodged on their behalf last November be addressed by the Government.

How many INMO members are out with Covid today?

Ms Phil Ní Sheaghdha

The statistics we have show that of all the healthcare workers with an infection, 25% are nurses and midwives. That does not include those who are isolating because they have been close contacts.

Given that INMO members are working extraordinary hours in terrible circumstances, has Ms Ní Sheaghdha noticed whether they are out with other illnesses, including being run down and mental health challenges? Has she seen an increase in the percentage of INMO members out with other illnesses this year by comparison with last year and other years?

Ms Phil Ní Sheaghdha

The statistics show there is an absence rate of just over 7% right now but Covid explains the increase from 3%. It is largely Covid-related illnesses that have caused the additional absence from the front line but it is a fact – we quote the HSE's information – that the highest incidence of infection in any single occupational health group is among nurses and midwives. The second highest is among healthcare assistants. Therefore, the groups that are patient-facing and closest to the patient comprise between them 50% of all the infections with Covid-19. That is very high.

On the roll-out of vaccines, I would like Ms Ní Sheaghdha's thoughts on the mid-west, in particular. I represent Clare. Many INMO members in Clare were quite upset and annoyed about how the vaccine was rolled out in the mid-west by comparison with other regions. In the first allocation, 3,500 were allocated to the mid-west hospital group. In west Cork, including Kerry, 19,000 vaccines were made available. Has Ms Ní Sheaghdha any views on how the roll-out was handled and the lessons that have been learned?

Ms Phil Ní Sheaghdha

In our submission, we make the point that the vaccine roll-out was haphazard and did not follow the highest incidence rates of Covid-19 in the community. I have the statistics. In week 53, for example, there were 506 cases per 100,000 of the population in Cavan. In Clare, there were 397.2 cases, in Donegal there were 554 cases, in Limerick there were 613 cases, in Louth there were 773 and in Monaghan there were 858 per 100,000, but those counties were not prioritised. That is the point we are making. Where the incidence rate was highest, the vaccine should have been prioritised. We got calls from our members in Louth and Letterkenny. The Senator might recall that the ambulances were backing up at the time in Letterkenny General Hospital. Nurses and doctors were going into the ambulances and they had not been vaccinated. The point was that the roll-out was haphazard. I hope we have got over that and that the sequencing document we produced subsequently, through negotiations with HSE, on 12 January and 19 January, should prevent it from happening. However-----

That brings me to my final question.

The Senator's time has come to an end.

I will be only a minute.

I am sorry, but the Senator's time is up.

With respect, part of my time was taken up in answering the question from Deputy Bríd Smith. My question will be quick. Regarding moving forward, we are being told that there could be ebbs and flows with the roll-out of the vaccine. In respect of engagement with the HSE, and the sequencing document, is there confidence that proper protocols and structures are in place to deal with those ebbs and flows and future difficulties which may present? Is Ms Ní Sheaghdha satisfied with the arrangements in place?

Ms Phil Ní Sheaghdha

The arrangements in place are focused on the front-line healthcare, patient-facing workforce getting vaccinated as a priority. We are absolutely adamant that those arrangements must be adhered to. We are stating that the HSA, which is the statutory authority responsible for ensuring the welfare and safety of workers, must also provide commentary on this process. It cannot just be left to chance, as it was with there being no plan B in place when we got more dosages out of a vial than we originally thought would be possible. In that case, we had no plan B for who should be vaccinated, and we saw what happened and what decisions were made.

I thank Ms Ní Sheaghdha. We must get representatives from the HSA to appear before this committee.

I thank the witnesses for being here and for all the work that they and their colleagues are having to do at this difficult time. I have been in this job for less than a year, and I am already becoming weary of the constant conversations about how the system was not able to deal with things before the onset of Covid-19. Given the way things are now, and considering I am already weary of it, I can only imagine how utterly wearying and draining it is to be working in the system.

I cannot get over the stark situation regarding the low numbers of staff and their low morale. As everyone has remarked, the information we have and which we are discussing is all from before Covid-19 struck. We now have this explosion of chaos, if I can put it so delicately. Not only were the numbers short before this, we now have appalling treatment, if I could be so bold as to put it that way, of the staff in the system. We have as a result the double whammy of trying to keep people in the system, while also trying to recruit people into the same system. Arguably, people would have to be mad to come into a system like this one. It seems incredibly bleak. I commend wholeheartedly, therefore, all the work being done by staff.

It is fair to say that the conditions in which work is being undertaken by these staff include being overworked, underpaid, stressed and burnt out in respect of mental health. In respect of several articles and studies having been published on this aspect, I also think it is fair to say that many people will exit the system at the other side of this crisis. People here have referred to that prospect already. We not only have a problem, therefore, with getting people into a system which is already drastically understaffed, but we are also going to have people scarpering out the door as soon as it is reasonably safe to do so. I think that would be a fair enough assessment.

Is the answer to addressing this situation an extremely aggressive recruitment strategy, involving elements such as pay parity and improvements in conditions? It seems to me that the solution on paper is quite simple, namely, better conditions, better pay and getting going pretty lively in recruiting people into the system before other people head out the door when it is safe to travel again. How do we get all of that happening, though? It seems these committees have Ms Ní Sheaghdha coming in repeatedly to lay out the details of these bleak situations, but we are not moving anywhere in addressing them. We are not going anywhere with getting solutions to these problems. I do not know what to do as a public representative in order to bring these solutions about. I am at my wits' end, and I am only here a few months. What is it that needs to happen?

Turning to the issue of student nurses, which is my favourite topic to talk about, some 93% of student nurses in 2014 said that they were considering emigrating. I would not be surprised if 100% of student nurses were now considering emigrating. Again, here we have another problem coming down the line. It seems that we are constantly talking about this problem coming down the line, but that we have already jumped over it because we have now been landed with Covid-19. I am so flabbergasted as to how we are supposed to deal with this issue.

I am astonished by the patience of those presenting today and their ability to keep their decorum, as it were, when this situation is so ridiculous. Many here have spoken about student nurses. The Labour Party has published a Bill to pay student nurses and midwives. I am really excited to see the appearance of the cross-party support that would be needed to get it over the line. It seems to me that everyone nods and agrees that student nurses need to be paid and the situation is not good enough, but people are not willing to put their money where their mouths are and support changes in the legislation to do that.

Those are observations that Dr. Colleran or Ms Ní Sheaghdha might respond to.

Dr. Gabrielle Colleran

The Senator has hit the nail on the head. Many of us here today are saying the same as we said before, but it is actually worse. With time, one does start to lose the belief that people will listen meaningfully and then act. Sometimes we come here and speak but we do not feel heard when we do not see action. We have to see engagement and action and that is what is missing. Those of us on the consultant front just want to have enough colleagues for safe manageable workloads, for call rosters that are safe to be able to provide the care for all the patients that need to see us. I just want for anyone who needs to see a consultant to see them within six weeks so that no patient has a worse outcome because of the wait. These are basic things. We are not asking to have the highest number of consultants in the EU. We are just asking that we can aim to be average.

We know from our consultants that they go above and beyond but I will say, without being too pointed, that sometimes we are our own worst enemy. We take a vocational approach and, as a result, it is used as an excuse to treat us badly and breach our contract. The same applies to the other healthcare workers here too, and that is just not good enough. We have seen the agility and the innovation and commitment shown during the pandemic. We do not want claps; we do not want nice words. What we want is a system with capacity to meet need so that we can do our jobs safely and our patients get an excellent service. Supporting us is the thanks we want. Talk is cheap but support requires resources.

Mr. Anthony Owens

First, to the Senator, I would say try to keep the faith. That is what we are doing. She is right that we do need a recruitment strategy, but at the moment we have something more like a removal strategy. The safest and surest way to build up the consultant capacity that we need is to train our own consultants. We are not doing that. We do not have enough training places and we are not bringing people through who could get into those consultant posts. This is something that will become very real. We took in the biggest ever intern cohort last year and the system has not put training places in place to get those people going through the system to be trained to be consultants. We are going to lose many of them. That is a removal strategy; they are going to go.

When people come to a consultant post, if they have had experience abroad, as Dr. Colleran said, they will not come back to work here for 30% less than their colleagues. They are not going to do the same work. Why would they? Why would they not stay in Australia or the NHS and be treated with respect and dignity in a system that actually values their contribution? That needs to be addressed and reversed. There are 728 consultant posts vacant or not filled substantively. That is incredible. These posts used to be like Olympic gold medals. We are not doing that properly.

I have referred numerous times today to the fact that public health medicine is our insurance policy. We have one third the number of the public health specialists who should be consultants as there are in Scotland, which has a similar population size and similar geographic dispersal of population. By virtue of the age profile, we will also lose a lot of people there and we will not be able to replace them. The next time this happens, if it happens again, we will not get away with it. We need to stop the removal strategy and move to a proper, sustained and focused recruitment strategy.

Ms Phil Ní Sheaghdha

The Senator asked what the Joint Committee on Health can do. The first thing it can do is make sure that there is a policy decision that the moratorium on recruitment, if and when it is reintroduced, can never apply to nursing and midwifery, as it has in each of the moratoriums that have happened since 2008. It has not applied to consultants but it has applied to nurses and midwives.

We have, therefore, been constantly running to try and undo the damage done by the moratorium. One should remember that we are still very reliant on overseas recruitment from non-EU countries. That is a major issue right now, because we have a lot more evidence that this pandemic affects communities from the black, Asian and ethnic minority groupings to a greater extent. We have to look at that and put specific protections in place because we are very reliant on that community of healthcare workers in Ireland and that will continue into the future because there is a global shortage of nurses and midwives. The first ask, therefore, is policy to ensure that moratoriums cannot apply. Thankfully, we now have a scientific tool as part of Government policy to determine how many nurses we need but that must be funded and rolled out across the health service. We cannot just decide how many nurses and midwives we need based on the available resources. There will be science behind it and it will be based on the patient dependency. The framework on nursing and midwifery staffing is accepted as Government policy, but it has to be funded to be rolled out. If one wants to open one ICU bed, seven ICU nurses are needed. That is not possible to do overnight, so one has to pre-plan and put a lot of planning in place.

The health and well-being of all front-line health workers who have been battling this pandemic will be severely compromised. We have lodged a claim to have respite for them, hopefully when the number of admissions to hospitals and community care areas reduces, the workload reduces and the vaccines take hold and reduce infection rates. That must be addressed. The committee should promote that. We should do what other countries have done. We should show appreciation for the extra give in response to the ask. Compensation must be afforded to the health service workforce for that. Senator Hoey is very familiar with the student nurse issue. I have heard her speak on it previously but this committee must comment on it. It cannot be silent on it because it is exploitation. This is 2021 and we are in a pandemic and there is no excuse for trying to portray what student nurses have contributed as not being work. It is simply not credible.

I confirm at the outset that I am on the Leinster House campus so I am able to participate in the committee meeting with parliamentary privilege. I join others in thanking all the front-line health service staff for everything they have done. We are approaching a year of this crisis and it looks very much like the situation will be prolonged for a number of months to come. We are certainly not out of the woods and yet there is some cause for hope with the roll-out of the vaccine, albeit it at a slower pace than everyone in the country would like, but it is progressing nonetheless. The situation should improve. As the witnesses have articulated, staff on the front line are still exposed to the ferocity of the situation and the risk involved every day. That must be acknowledged, appreciated and supported in terms of responsive actions by the Government and partners.

In recent weeks, Hazel Hartigan has been on "Operation Transformation". She is a nurse and a member of Ms Ní Sheaghdha's union. She has flown the flag so well for the nursing profession. We have had a glimpse behind the scenes each week as she bares her soul on RTÉ. We can see the stresses that it has put on her and her colleagues. The stresses do not stay behind in the hospital when staff close the door and sit into the car; they are carried home with them.

I wish to put a number of questions. The first relates to the vaccination of mental health staff. We continue to see real difficulties in the mid-west region. A fortnight or three weeks ago I put a number of questions to the Minister for Health.

He advised me there has been a devolved function in terms of vaccination roll-out for front-line staff, that each hospital group has received a certain number of batches of the vaccine and, using the disbursal criteria, the groups are ensuring their staff are vaccinated. In the mid-west and particularly in Ennis General Hospital the mental health nurses have been passed over. The front-line medical nurses have all been vaccinated and vaccination has moved down through other elements of the staff, including administrative staff, ground staff and people who during their working day, even though they are in a risk environment, have some mitigation measures around them such as perspex and the like. However, the mental health nurses continue to circulate and go into homes without the benefit of vaccination. Is the INMO aware of that? It is not to blame, of course, but is it aware that some of its members continue to be outliers and have been passed over in the chain on command?

I saw with great interest about two weeks ago that Bantry General Hospital in west Cork was a poster boy for vaccination. It had gone through all its staff and had started calling in the local GPs. The mid-west does not appear to be at that point. Will Ms Ní Sheaghdha comment on that? Is she aware of that breakdown of the chain of command there?

Ms Phil Ní Sheaghdha

Again, we said the initial roll-out of the vaccine was very unsatisfactory. That is why we have the agreed sequencing document which will see patient-facing healthcare workers prioritised. We believe independent scrutiny of that is necessary. Mental health nurses, public heath nurses and community registered general nurses, RGNs, were going into people's homes, but not being prioritised for the vaccine. There is much criticism from the front line of nursing and midwifery in respect of the manner in which the initial roll-out of the vaccine was organised.

I have a question for Mr. Owens in a similar vein. Many doctors have been in contact with me and told me about the early days when the portal opened in which they had to register for vaccination. Many of them went through the first and second pages of inputting data, but then the system crashed several times. Some of them did not get around to it a second time because of the immense workload they take on each day, or when they did, a week had elapsed. Some of them tried a second time, but again the same technical glitches were encountered. Basically, they did not get to register properly and by the time they did, they are of the view that it set them back in the roll-out calendar, as it were. They have fallen further back. I note that Dr. Colleran has her hand up, so perhaps one of the witnesses can deal with that.

Mr. Anthony Owens

I will comment on it. Absolutely, there was a design flaw in the roll-out of the vaccine. The sequencing document is the document that ought to be followed, but I am not entirely clear that it was interfacing with the portal on which one would go and register one's interest in getting the vaccine. We are told that it has been fixed, that the sequencing document has been brought up to date and it is now fixed with the portal. There are still issues in terms of getting registered for vaccination.

The Deputy referred to mental health. I will say a few words on mental health, which is important. We have been contacted by doctors, both NCHDs and consultants, who are mental health doctors, psychiatrists and trainee psychiatrists and are employed by one arm of the HSE but who work in the acute hospitals. They have experienced difficulties in getting their names put on a list in an acute hospital by virtue of the fact that their payroll is somewhere else. Those are the types of issues we are still trying to iron out. They have damaged the confidence we can have in this vaccination campaign. Hopefully, we are approaching the end of such problems. We need to be because the psychiatrists I mentioned have unscheduled care commitments and see patients who present through emergency departments and wards. They absolutely need to be vaccinated.

I thank Dr. Owens. Dr. Colleran might intervene in a moment, but I wish to make a final point and she can respond to the points generally. My last point relates to long Covid, which a number of people have mentioned today. Typically, in a work environment if one is out for a long period, one is referred to Medmark Occupational Healthcare and there could be certain screening barriers to somebody returning to work or remaining out of work. Are front-line staff encountering any of those barriers? Is it accepted that one may not present with antibodies but one still has the symptoms of long Covid? Is that generally accepted across all strata of the health service or are people being referred to Medmark Occupational healthcare, being scrutinised and having those barriers put before them?

The final thing I will say is that the vaccination of healthcare staff, across all spectrums, is important. There are ancillary or therapeutic staff who enable children with learning and physical difficulties to attend education as best they can. I was teacher until the general election. There are still many services, such as the child and adolescent mental health services, CAMHS, that are not engaging with children online or face to face. It is not for our guests to solve but, as some of those staff are members of some of our guests' unions, we need to see those people out there and offering supports to children at this time.

Dr. Gabrielle Colleran

There are very high levels of Covid-19 among mental health workers and consultants. Services are under extreme pressure because of the number of acute presentations and the lack of beds. It is essential that they are prioritised.

I want to take this opportunity to emphasise something that is key for us to talk about, that is, our public health specialists and infrastructure. People sometimes get confused between the acute public hospitals and the public health infrastructure and the staff who provide it. As the IHCA does not represent public health specialists, I cannot be accused of having a vested interest in this matter, other than the same vested interest that we should all have in having a public health system that works. We do not give consultant status to public health specialists in this country. We are an outlier in that regard and it massively impacts our ability to manage pandemics and to plan healthcare. It is essential for that to be addressed and all of the outbreak management and contact tracing falls under the auspices of, and is led by, public health consultants.

The elephant in the room is that vaccine roll-out is hampered by the fact that we do not have a universal health identifier for people. We do not have public health IT that is fit for purpose, compared with the UK and other countries. Those other countries are well able to prioritise people and have back-up lists because they have a universal health identifier and the required IT infrastructure. We have the specialists. Public health specialists are trained to consultant level in public health. If we actually pay them properly, give them the tools that consultants have in terms of teams and software resources, they will optimise our response and we will reap those benefits, societally and economically. It is incredible to me, as an individual watching this, that 11 months into the pandemic, there are only 60 public health specialists in the country, as Mr. Owens earlier outlined. In Scotland, which has a similar population, there are 180. That we have not addressed that and upped the numbers of public health trainees, given them proleptic appointments with consultant status at the end of it, is incredible and must be addressed. This is not the last pandemic. We may not even be experiencing the last surge of this one. Until we tackle climate change, we are going to have more and more pandemics and our ability to respond to them without locking down our society is dependent on having the public health infrastructure, including the people, IT and structures. If this committee takes just one lesson from this meeting, that is it. It is essential. It is what has hampered us and is a part of why we are rolling from one lockdown to another. We do not have the public health capacity.

I will direct my first question to everybody. Has a deadline been set for the roll-out of vaccines for all front-line staff who are in contact with patients or potential patients? If not, why not?

My second point relates to student nurses. Has the emergency nature of the call to student nurses to work in extraordinary circumstances in which they would not normally have to work been established? They are putting their health and lives at risk to a large extent. Has the emergency nature of the need to respond been conveyed to the HSE and the Minister? If not, why not?

How should the concerns raised today be relayed through the system to the appropriate authorities? Delays have taken place and I understand why all of the people concerned are upset and annoyed at the delay that follows the need for action in any particular area. I do not want to go into particular details. We, as a committee, need to know how best we can deal with that in order to bring it to the attention of the powers that be.

Have any of the witnesses been told the reason for the delay in the service plan? Will that become a job for us in this committee?

What is happening with the consultant posts to which people have been recruited but whose training has not been progressed in the meantime? Is there a cost to the system as delays continue to occur in this regard and, if so, what is that cost?

Finally, I congratulate all involved in the delivery of health services. It has been all hands to the pump. The health service providers in this country, as represented by the witnesses, did very much better than counterparts in many other countries, even though they were coming from a position of there being serious gaps in the system.

Dr. Peadar Gilligan

I will address the Deputy's initial question on when all healthcare workers will be vaccinated. We have been meeting with the HSE on a weekly basis on this matter. As it stands, only 49,000 are fully vaccinated. I know figures are thrown out about so many doses, so many vaccines etc., but that is the reality. The figure I gave refers to those who have received their first and second doses.

It is nearly by chance that healthcare workers are getting the vaccines this week. If the decision had not made regarding the AstraZeneca vaccine, healthcare workers' access to vaccines would probably be delayed until next week or the week after. When the decision was made in regard to the over-65s and over-70s, it meant that the vaccines in question were available to healthcare workers this week. We understand the portal is open and live today. We understand that front-line healthcare workers began to be vaccinated yesterday and are being vaccinated today. That refers to first doses; they will have to get a second dose in 21 to 28 days and, in the case of AstraZeneca, after a longer timeframe. It is going to be a significant period down the line, into March and April, before those healthcare workers are fully vaccinated. The understanding from the HSE at the moment is that by the end of February, all of those staff will have got their first doses and some of them will start getting their second doses.

I know my colleagues would like to respond on the other matters raised by Deputy Durkan but I have a couple of other points to make. We have said all along that the vaccination portal, which is only working today, or at least we hope it is working today, was meant to be in operation from 28 December last. Six weeks later, it has only begun working from today. That has been a major failing on the part of the HSE in terms of its IT infrastructure. The portal was meant to be up and running when the vaccinations were up and running. It is clear that healthcare workers have delivered. Nurses and doctors on the front line administering the vaccines have delivered. They have done so across seven-day weeks and covering long hours. Some of them have gone in voluntarily in their own time to get the vaccines rolled out. Front-line healthcare workers have rolled up their sleeves and really delivered in that regard as well as trying to provide a Covid service and a normal healthcare service.

In regard to student nurses, the dithering that has gone on by the Minister and the Department of Health is completely unacceptable. I am not making any political points here, because I am completely apolitical, but when the situation was bad last March and April, the former Minister made a clear decision to utilise the student nurses to allow the health service to respond to the crisis. No one can doubt that January this year was much worse than the scenario that existed last March and April. Why the dithering? The Government must make the decision to utilise these valuable, skilled individuals to allow the health service to respond in a situation where we have had 7,000 to 8,000 people absent from work.

An issue that we have not focused on at all is the situation in long-term care facilities. The reality is that we talk about the numbers in ICU and in our acute hospitals but many patients with Covid-19 are in our long-term care facilities. Many of them are not even going to acute hospitals. Many of them are on syringes and are receiving a high level of care at a time when staffing is decimated in those services. We have had staff from across the public service redeploy into our long-term care facilities in order to care for those patients. That situation has been overlooked. It is time to start publishing the figures for Covid-19 patients in our 582 long-term care facilities as well.

Professor Robert Landers

Deputy Durkan mentioned costs to the system. There is no cost to the system; the cost is to the patients if we do not address the issues. The cost is to our brothers, sisters, fathers and mothers. It is not just cancer care. It is the cataract operations and hip operations.

It is like the child who has got publicity in the past day or two and who is waiting until 2024 for an MRI scan. There will be a scandalous, unsustainable cost to patients unless we address the issues. The solutions are hidden in plain sight. We must sort out the recruitment crisis by ending the discrimination, and we have to do so now. There is no point waiting six to 12 months for this. We know what to do. Let us get on and do it. Let us get engagement from the Minister and the Department on this and then we can begin to make progress.

Could I have written replies, if possible, to the rest of the queries I raised?

I thank all the guests here and all the health staff for their contribution and real commitment and dedication to their jobs over the past 12 months. They went way beyond the call of duty. I know this full well because members of my family were involved in the healthcare sector in a number of different areas.

I will start by asking just three or four questions. The first is to Ms Ní Sheaghdha. She spoke at the very start about the failure to respond quickly enough to the demands of the nursing staff. Nursing staff are on the front line. They know sooner than anyone else when change is required. I was looking at the HR report from the HSE. There are 7,800 nurse managers. Nurses, obviously, will go to the nurse managers. Is it the case that nurse managers are not getting the response quickly enough from the administrative level of the HSE to make the changes that are required?

My second question concerns nurses who have retired from the system and now want to get back in. I understand that the Nursing and Midwifery Board is looking for a fee of €350 for such nurses to re-register. Has the INMO engaged with the Nursing and Midwifery Board on this issue? It sounds like an extremely high charge to impose on people who want to come back in and give assistance at present, when there are huge demands.

My third question concerns consultants. We have seen the figures for the number of GPs who are due to retire over the next few years. There are around 600. Have we any idea of the number of medical consultants who are to retire over the next three to five years? Are there particular areas where we do not even have people in training to fill those vacancies? The second issue I wish to ask the consultants about concerns the number of specialist registrars who are in training at present. What is the total number per annum across all areas who are in training? What kind of increase do we need to put in place in order that we have an adequate number of people to take on the vacancies as they arise?

Finally-----

Deputy Burke has less than three minutes left and he has asked a number of questions.

All right. I will leave it at that if I may get some answers to those questions.

Ms Phil Ní Sheaghdha

If I may respond to some of them, one of the issues we have been raising for some time is that there needs to be devolved authority to nurse managers. There is not at present. The WHO and the European Centre for Disease Prevention and Control, for example, were advocating that we look at the wearing of FFP2 masks for greater protection in early January. We had to lobby the HSE and wait for a national circular from it before the practice was allowed to change across the health service. Nurse managers gave a testimony to us that they went and sought these masks and their release to staff when they asked and they were refused. In one location staff were threatened with disciplinary sanction if they continued to ask for those masks. Eventually, we got a letter from the HSE which opened the door and allowed the policy change in respect of what was appropriate to wear during the third wave and, obviously, with the higher contagion of the new variant.

I hope that answers the Deputy's question. It illustrates how bureaucratic the system is. There is a significant amount of national control.

Health and safety measures have to be put in place much more quickly. It cannot be a case of always waiting for an incident to occur. Preventative measures have to be in place and thought about because this pandemic is changing all the time. With new variants, we will need agile and quick responses to protect workers. That is simply what is missing.

On the issue of the availability of staff etc., I refer to the whole area of Sláintecare and the fact that 82% of care of older persons services are privatised. There are many waiting lists etc., but there is 30% availability of private hospitals. Surely the committee can comment on that, considering that there is bed capacity of 1,900 beds, a large proportion of which are single rooms, in the private sector. They should be playing a greater role during a pandemic.

Professor Robert Landers

To answer the points raised by the Deputy in respect of the retirement of consultants, we expect between 15% and 20% of current consultants to retire in the next five years. That will add to our recruitment problems. It is not just retirements. We anticipate there will be an exodus of younger consultants abroad as a result of the working conditions they are being offered here unless we sort that issue out. In addition, workforce planning indicates that we need an increase of 51% in the number of consultants. That equates to approximately 1,600 extra consultants needed in the system to match the current demand. There is no sign of that happening, apart from some promises in the Sláintecare proposals. We need to recruit significant numbers of consultants, we need to do it fast and we need to do it on attractive terms and conditions to be able to deliver the care required. If that is not done, we will be in very serious trouble.

Mr. Anthony Owens

Each year, approximately 700 non-consultant hospital doctors, NCHDs, enter basic specialist training. The number is whittled down a little such that approximately 500 get into higher specialist training. That is the kind of number with which we are dealing over several years. We will need an additional 600 GPs to cover those who retire as well as 1,600 more GPs to meet demand. We will need more than 2,000 consultants if public health specialists are included. We are facing into a yawning chasm and deficit and we need to address it quite quickly.

I must call an end to the meeting. My apologies to anyone who wished to contribute further. I thank our witnesses for the sacrifices they and their colleagues have made. I am particularly conscious of the sacrifices their families are making. I have spoken to healthcare workers. One of their significant concerns is that they may bring infection into their own homes. The committee has listened today to information that will help us to respond to some of the challenges that are facing the witnesses and their cohort of workers.

As a committee, we have a strong view in respect of student nurses. It is wrong and unfair that they are not being paid during the pandemic, especially given the fact that they are doing work. That needs to be addressed.

It is clear that vaccines for front-line workers need to be fast-tracked. We are 11 months into the pandemic and we are still talking about PPE. The response in that regard needs to be upgraded. The Health and Safety Authority needs to step up to the challenge and be more proactive in protecting workers in that area. All members of the committee were shocked to hear this morning about the letter regarding additional childcare costs. We will follow that issue up as a committee. We certainly agree with the submission in respect of additional beds. A policy in respect of long Covid is needed. The committee will take that issue up with the Minister and the Department. Doctors and consultants should not have to threaten to go on strike during a pandemic.

It is totally wrong that it is necessary for them to do so . There is also the fact that there was no meaningful engagement. We heard about staff being burned out. People are tired, frustrated and feel let down. There is an expectation that support should be in place for the witnesses and for other workers on the front line.

The committee will discuss this matter later in private session. It is to be hoped that we can put some of the practical ideas the witnesses have put forward through the system and bring about some meaningful changes. I again thank the witnesses and apologise for cutting them off during some of the submissions. I look forward to meeting them again and I thank them very much for all their work.

The joint committee adjourned at 12.05 p.m. until 4 p.m. on Tuesday, 16 February 2021.