Student Nurses (Pay) Bill 2021: Second Stage

I move: "That the Bill be now read a Second Time."

I am sharing time with Senator Sherlock. I am proud that today a student issue is the subject of the first Bill I have brought to this House. I hope that the Senator for students is earning her stripes.

The Bill is very simple. Its purpose is to ensure a rate of pay for student nurses when they are working commensurate to the rate of pay of a healthcare assistant. Since being elected to the Seanad in April 2020, in the midst of a global health crisis, I have been imploring the Ministers for Health and Further and Higher Education, Research, Innovation and Science to recognise the role being played by our student nurses and midwives. I have raised the matter in the Chamber numerous times. I have raised it at the health committee. I have asked the HSE and both Ministers about the matter in writing. I have done everything I can to keep this issue on the agenda. I have said it previously but it bears repeating that a bualadh bos mór is not enough for our student nurses and midwives. They have been working at the coalface of this pandemic and caring for vulnerable patients on Covid-19 wards. What is more, they have done all of that while knowing that being on those very wards puts themselves far and above the average risk of contracting Covid-19.

I will also take a moment to address an issue that has been raised with me. Despite working - yes, I believe that what student nurses and midwives do is actual work and I will not be shifted from that view - according to reports given to me by student nurses and midwives, the vaccine roll-out has not included student nurses and midwives in their first, second and third years. Not only are we expecting them to work for free during a global pandemic, we are also adding insult to injury by not including the first, second and third years in the early vaccination roll-out. That is disgraceful.

That is not true. They are included.

Student nurses have said to me that they were told they were unable to avail of the vaccine because they were students in their first, second or third year of study. There could be a miscommunication where some student nurses have been told they cannot avail of it.

We will certainly check that out.

I thank the Minister. Even now that their placements have been suspended, many student nurses and midwives are back in hospitals working as healthcare assistants. When offered the opportunity to stay at home or find work elsewhere, many have gone back into hospitals, which is incredibly admirable. A student described it to me as:

Terrifying, stressful, feel unsupported, feel as if I am a staff nurse and not an intern - 8 of my patients tested positive for covid, all staff nurses present were identified as close contacts and told to isolate - I was not. I had to continue to work for the 2 weeks of the ward outbreak. In A&E placement as supernumerary student 7 staff nurses were out sick due to Covid, myself and 4 other students had to take their place ignoring our supernumerary status especially in a specialised area.

It is not just during Covid that student nurses have played their role. They have been an essential part of the healthcare system for years. It should not have taken us reaching this point in a global health crisis to recognise their contribution, but to refuse to do so now would be shameful.

All work should be paid. I cannot believe that in 2021 as a Labour Party Senator, trade union activist and citizen, that still needs to be said, but here we are. No part of our public service system should be built on the back of unpaid labour and I will brook no argument from the Government that what student nurses and midwives do is not work. Nor, by the way, would their colleagues, their patients or the INMO, so let us put that idea to bed. If it walks like a duck and talks like a duck, then it is a student nurse doing actual, life-saving work for free. For the Government to say otherwise is simply gaslighting a whole cohort of student nurses and midwives.

This Government is fond of praising our student nurses but in the same breath it uses to acknowledge the work they are doing, it refuses to commit to paying them. One of the many straw man arguments I hear is that nurses are taking part in a university degree, not an apprenticeship, and that we do not want to devalue their qualifications. This argument is nonsense and tosh. There is nothing at all undermining about paying students for work they complete as part of their training. What is undermining is to say to student nurses that they will remain unpaid while they work in hospitals, to somehow protect them and their qualifications. That does not protect them at the end of the month when they have rent to pay; it does not protect them from Covid-19; it does not protect their well-being; and it does not protect the Irish healthcare system from a reputation of undervaluing its nurses, which starts from the beginning of their careers as students. Another student nurse said to me:

My biggest issue throughout most of this year is feeling like I'm more like a HCA rather then a student nurse, the nurses are walking angels but they are tied up in the endless work. Are teaching and learning has been pushed to the side because of covid and not getting the supports needed from the government.

I also want to speak about the nature of education and what requiring students to work for no pay does to the system. I have said this in the House previously and I will say it again. We have an obligation to ask who is not here, who is not in the room and who is not partaking in these educational opportunities. When it comes to nursing and midwifery, who is not able to undertake this course of study? Many people, due to their socio-economic background, their family obligations and their needs outside of education, must work throughout college. I know first-hand what that is like, having worked more hours for many years in college than I spent in lecture halls. When a service requirement is placed on students, as is done with nursing, it reduces the number of hours available to a student to earn a wage elsewhere in paid employment. This is a factor in people’s decision-making when applying to college and so we have put people in a position where they are asking themselves whether they can actually afford to become a nurse. That is not how we should approach this vocation and this educational opportunity. We have a nursing shortage in Ireland. When talking about this issue, we need to remember that we are not discussing an abstract idea. We are talking about real people on the front-line of the health service, year in, year out.

In the run-up to today's debate, I asked student nurses and midwives to share their experiences of working across wards in Ireland. I received a large number of responses and I am happy to share them with anyone who is interested. The first states:

As a 19-year-old, I have witnessed more people die in the past 12 months than I can count. I have sat beside them holding their hands, head to toe in PPE, in the exact moment they passed away. I think this is something that is extremely overlooked. 18 and 19 year olds have to look someone in the eyes at the exact moment they die. It is something that has kept me awake for many months. Supervision and support has crumbled despite staff's best efforts due to high absence rates. Learning is taking a backseat to get the basic care needs fulfilled. Academic aspects of the training have become much more difficult with inequality and access to online learning plus the pressure of isolation, parenting, etc., during the pandemic.

Another student who is in second year got in touch with me:

At the moment us second years are moving placement settings every two weeks. This is obviously dangerous during Covid but it is still happening. In January they refused to test us for Covid before we moved placement even if we had been caring for Covid patients. Students begged for tests as they did not want to spread the disease into other hospitals. It has been hell on earth so far. I always feel like I was put into the deep end of the pool. Sometimes you feel as if you have no support at all. While all of this was happening the Government are telling us that we do not do real work, that we are being educated. I have been doing real work on wards since first year but even more so this year when the wards and hospitals were being propped up by students.

When I asked a student what her experience had been over the past 12 months, she said to me:

It has been significantly worse than previous years. I feel like there is a lot more expected of me. As a supernumerary student, over the past 12 months I have always been counted as a member of staff on the ward. I have been delegated a minimum of six patients a day, and it has gone up to 12, to care for with little or no supervision or support. Not only am I under severe financial strain but I am also emotionally drained and stressed from the experiences on placement. It really upsets me how much we are taken for granted and not provided with basic supports.

Another student has said:

I had to move out of home to avoid the risk of my family contracting Covid so I am now paying rent on an apartment. I have to get taxis more often as a result of the reduced public transport service schedule and the irregular work hours that I have to work.

Another student said to me:

It feels like I am never off duty. There has been a drastic increase in responsibility due to the pandemic and the staffing issue as a result of this pandemic.

Another student said:

Full of uncertainty. I am uncertain that I chose the right career path. We can't have student nurses feeling that they chose the wrong career path because of how we are treating them. I am considering moving abroad when I finish my degree due to poor pay and working conditions. I constantly feel underappreciated and sometimes I feel like I am a burden when I am on placement. Nurses on the ward do not have enough time to give me to help me achieve my learning goals. I feel like I am just another number to help out when staff are under pressure.

One final story states:

It is hard to break it down for other people to understand the stress and heartache we have experienced. The main experience of me was being the only person in the room with the Covid-positive patient when he passed from the virus. I was the only one holding his hand and talking to him as he slipped away, not his family, not as friends, just me as a student nurse. This has had a huge effect on me as I had built a bond with him over the week and to see him go so downhill so quickly was hard to process. Afterwards I helped prepare his body and that was how he will be buried. I had to help transfer them over to the morgue as we were short-staffed from all sides. When I returned from the morgue I was expected to go on with my day as if nothing had happened.

Those are just some of the stories from student nurses and midwives on the front line and these are student nurses all the way from first year up to supernumerary year. It is not fair to say that the workload is just falling on fourth year students. It is falling on first second and third year students as well.

The campaign to see student nurses paid for their work did not start with me. The Irish Nurses and Midwives Organisation has been fighting for years for their members' work to be recognised. I thank them, especially Phil Ní Sheaghdha, for their tireless work on behalf of their members. The Union Students in Ireland, my alma mater and my stomping ground to politics, has also been working tirelessly on this issue for years and it is how I got involved in this campaign. I also thank all the student nurses who have taken their time to talk to me about this Bill, and for sharing their very honest, real and painful insights with me.

It was implied this week in the media that the Government plans to allow this Bill to pass and then die out on Committee Stage. I want to put the Government, the Minster for Health, and the Minister for Further and Higher Education, Research, Innovation and Science on notice that the Labour Party, the unions which represent these students, the student nurses who are affected by this and, I can assure the House, I will not be letting this issue die. I thank the House.

Gabhaim buíochas leis an gCathaoirleach. It is good to have the Minister in the Chamber for this very important Bill and I am delighted to be seconding it. I take a very simple approach to the issue of student nurses.

At the heart of this Bill is the fundamental question of what constitutes work. If we define work as a contribution by a person to the operation or functioning of a service or a facility, or the production of a good, then that gives us some insight into the situation of student nurses at this point. By definition, no worker should ever be put in a situation where he or she is forced to work without pay or without recognition of the contribution he or she has made to the particular workplace he or she finds himself or herself in.

It is also important to recognise there is a very significant distinction between a placement where somebody is shadowing a trained, experienced worker and a situation where somebody is actually working in his or her own right. The reality in Irish hospitals is that there are first-, second-, third- and fourth-year student nurses who are working. From the hundreds of stories that have come to the attention of Senator Hoey and the Senators and Deputies in the Labour Party, the reality is that these students are working on wards in this country. Students tell us about having to tend to patients on their own. A third-year student talked about having to sit and explain to a dementia patient why staff are wearing masks and having to spend time with that patient. Another said she felt she was being treated as just another number and was there to help out when staff are under pressure. A second-year student talked about being told to break the bad news to a family. A third-year student said she was given the responsibilities of a qualified midwife.

There is a reason for all of this, namely, the huge staff shortages in hospitals at this time. Over the past 12 weeks, we have had 14,322 instances of Covid among healthcare workers in our hospitals. Nurses and healthcare assistants comprise more than 50% of that number. These are figures the Minister knows well. The one to which I refer means that more 7,000 workers and their close contacts are isolating, with the vast majority having to stay out of work for a period and this is obviously putting enormous pressure on the health system. It is not realistic to expect that student nurses have the luxury of being able to shadow trained workers. They are having to work and contribute to what is being done.

The Government faces a choice of either saying that student nurses should not be working and to take a black-and-white view of this or recognising the reality that student nurses are working in hospitals because of the shortage in numbers. What I find ironic is that last March the then Government saw the need to offer healthcare assistant contracts to student nurses whose placements were suspended in recognition of the need to put as many resources as possible into the Irish hospital system. Of course, that system has ended and we now have this middle ground where student nurses are working but are being told by the Government that they are not really working.

The Minister finds himself in a situation whereby he has inherited a huge staffing deficit within the hospital system. That deficit has been massively exacerbated by the pandemic. We know there will be pressures within the hospital system over the coming years and that, because of ageing and the incidence of chronic disease, the staffing demand will be enormous. There have been repeated calls for many years by SIPTU, the Irish Nurses and Midwives Organisation and other unions working in the health sector, calling for a significant ramping up of recruitment, yet the pace of progress has been way too slow. The reality of why student nurses are working at the moment is that we do not have enough people working in the hospitals. We are asking the Minister to recognise that reality and to pay student nurses in the here and now.

I welcome the Minister. This is a very important debate. It is worth pointing out that the approximately 4,000 student nurses and midwives are female in the main. The value of work done by women has been historically undervalued and there is a gender pay gap, as we all know.

This may be why there has been a reluctance for so long to deal with the issue of pay for student nurses. Ógra Fianna Fáil ran a campaign on the payment of student nurses. I have spoken to them about the campaign and it is one I am in agreement with.

I have spoken to many student nurses over recent months. They recalled the very difficult situations, work environments and work practices they are now dealing with. When the majority of those students put nursing on their CAO forms, they did not expect to be working like this and in these circumstances. They are dealing with death, stress, falling ill, their colleagues falling ill, and the ever-evolving pandemic situation. The majority of these student nurses are 18 to 20 years old. My colleague, Deputy Lahart, has said that if this virus is a war situation, the student nurses are the conscripts and we should be paying them.

I have heard from student nurses about their difficult living conditions in shared accommodation and the stress of trying to self-isolate, including the effect this has on their relationships with their housemates. The student nurses are working in very Covid-sensitive environments. Due to reduced public transport services, they have had to get private transport.

I have heard the argument that student nurses are on work placements like many other third level students. I believe that in the current situation, they are not the same as other students on work placements from college. Other students have not faced the very difficult situations the student nurses and student midwives have faced. I have also heard the argument from many nurses and other senior people in the profession that they are very conscious of the strides that have been made in the past 20 years in professionalising the sector. I understand where they are coming from. I am eager that the professionalisation of their profession would remain and that the aims they work towards would continue. I feel, however, that an ex gratia payment for a defined 12-month period would be the happy medium. It would give the student nurses and student midwives the support they need at the moment, while respecting the professionalism of nursing and respecting the model that nurses fought so very hard to achieve, and without setting back the profession. I believe we can come up with a creative solution. The student nurses I have spoken to are very eager that the professional model is maintained.

We need to come up with something. How we treat student nurses and student midwives now will reflect on their attitude towards the Irish health service. It will help to inform their decisions when they graduate with their degrees in a few years' time. Ireland has a shortage of nurses and midwives. We are the fastest growing country in Europe and we need to recruit more healthcare staff. It would be far more cost-effective to pay student nurses now and not engage down the line in trying to recruit people from abroad with expensive campaigns to attract Irish nurses and nurses of other nationalities back to these shores to deal with our very young population and our ageing population.

I hope that some middle ground can be found here that respects the integrity of the profession, acknowledges the situation we are in and acknowledges the very difficult situation faced by the 4,000 student nurses and student midwives.

I thank Senator Hoey for tabling this Bill. Given the Senator's years of dedication to student politics with the Union of Students in Ireland, it is appropriate that it would be a students' pay Bill she would bring to the House as, hopefully, the first of many Bills she will bring to the Houses of the Oireachtas.

I also welcome the Minister to the House. He is doing a very difficult job. I have no doubt that he is putting every hour he can find or muster into his role in dealing with the pandemic. To be fair, I believe he appreciates the enormous commitment of student nurses during this pandemic. It is my considered view that we would be lost without them because they stepped up to the plate and played a significant role. They did it willingly and there was no issue. They were quite happy to do it. It is appropriate that they were paid for this work. It is my view that they should continue to be paid when they are working. They have been working and, I have no doubt, will be working during the course of this pandemic. That is appropriate.

Professor Tom Collins was hired to carry out a short snappy review. He probably had to complete it too quickly to come to an overall considered view but pandemics move fast and the Minister needed a body of opinion. Professor Collins gave a view although it was not universally accepted. It was, however, a good starting point.

I wish this Bill well. Like most Private Members' Bills that come before the House, it is once it passes Second Stage that the real work starts. That is when engagement starts and when the discussions and collaborations take place. Everybody in this House wants a resolution to this issue. The Bill provides a framework for finding such a resolution. I know the Minister's officials are very busy at the moment but perhaps they might be able to find time to engage with Senator Hoey and her researchers to find common ground so we can continue in the spirit of not dividing on such an important issue.

We need to have a conversation about the overall working conditions of nurses, midwives, student nurses and other people who work in the healthcare profession over the coming months and years. I stay in a hotel in Dublin when I am up in the city and a number of nurses stay in the same hotel. The difference is that they are living there. They are doing so for safety reasons. They are away from their families and away from normal life. They are dedicating themselves to remaining safe and in a position to work. They are defining and designing their off time around that goal. It is easy to forget how lonely it can be for some of these people living in a hotel on their days off when they are not working. It is not the most pleasant environment.

The healthcare workers in the health system have also gone above and beyond the call of duty in providing essential services. The people who clean the hospitals have an absolutely critical role to play, a role they have been playing for a long time and particularly during this pandemic. The porters have also played a very important role. The whole healthcare community has been elevated significantly in the public's admiration. That now needs to be reflected in better working conditions. The last thing we want to see is nurses qualifying in this country and then taking flight to Australia and other countries. Every young person wants to travel and it is good for them that they do so, but we want them to come back within a reasonable period and not just as a pandemic descends upon us and we run campaigns around the world begging them to come home. They should want to come home. They should feel they are respected, wanted and appreciated. That is something everybody wants in life but, sadly, it has not been the case. The other major issue relates to overcrowding in accident and emergency units and so on.

It is not just pay, which is important, but working conditions as well.

When the Minister gets a chance perhaps he would update us on where we are with the 90-bed modular unit for University Hospital Limerick. I know it is in the capital plan but perhaps there is a timeline. I do not expect him to have the answer today but he might communicate with me in writing and provide me with an update. Some capital projects are in the programme for Government. They are recognised by all parties as being critical and we should fast-track them.

I wish the Bill every success. It is very timely. I look forward to discussing it again when we move on to Committee Stage.

I welcome the Minister to the House. I thank Senators Hoey and Sherlock and all of the Labour Party Senators for proposing this important Bill. I am encouraged that Senators from both Fianna Fáil and Fine Gael have broadly welcomed it. Seeing it through to implementation is a different test, however, and only time will tell what will happen in that regard.

We know there are immense burdens on the Minister. I do not doubt his credentials in terms of his absolute commitment. It is a very difficult time for anyone to take on the role of Minister for Health. I will not quote all the suggested titles for that Ministry but we know it is a difficult one. I believe it is the hardest portfolio at this juncture. Covid has impacted on all of our professional and family lives, and on commerce and everything else in this country. We do not really know what is coming down the tracks. There are challenges coming our way daily. It is not an easy, and I acknowledge that and the Minister's important work.

I also acknowledge the enormous emotional and psychological difficulties, pressures and burdens that fall on healthcare workers. Senator Conway referred to porters, cleaners and those who prepare food. The entire community of health workers is under enormous pressure. Students nurses are also under enormous pressure. I will not go into great detail because Senator Hoey directly quoted some of the people she has engaged with. I acknowledge the work she has done in that regard and her professional, in-depth drilling down into the issues. She did that very well, as she always does. She spoke to people in person. There is no better way to demonstrate the issues than to have personal testimony from people who are on the front line. Let us face it; this is the battle line. Those who are on the front line of the health service are saving the lives of citizens. They are holding the hands of loved ones, which is something that we should be doing but we cannot get into the hospitals because of the Covid restrictions. They stay with these people and afford them dignity until they breathe their last in this world. What a sad situation. Many nurses, fully trained and student nurses, go far beyond the call of duty.

There are also trained and trainee midwives. We know about the enormous difficulties people experience when they go in for what should be a joyous celebration of birth, new life and new people. Sometimes there are complications around that, and it is another harrowing experience not only for the expectant mother but also for the nurses and care workers. We are all on the same page. I do not see why there is a difficulty. Next week, we will be talking about another group of people who are underpaid. It is important that we recognise that people should be rewarded for their hard efforts.

I thank the INMO for the responsible attitude it has shown in difficult and challenging times. In many ways, the INMO has been very moderate. I know the organisation is sometimes criticised by its members because of its reasonableness and modern approach. We owe a deep gratitude to student nurses and all who train in hospitals. They should be recognised for their hard work and special bedside training. Up to ten years ago, there was traditional training and formation in place for nurses. I know nurses now have both a practical and academic basis for their training and they also do course work. Time and again, these trainees are on the front line experiencing trauma and working long hours way beyond the call of duty and expectation.

However, they have not complained. They have stepped in and they have stepped up to the plate and supported their colleagues.

It is important that we send a clear message on this issue. I know there are difficulties and constraints in the context of finance and remuneration, but these student nurses are of critical importance at this juncture when there are so many challenges around the health service. Members of Fianna Fáil and Fine Gael have spoken in broad acceptance and support of the terms of the Bill. I have no doubt that other Senators will do likewise when they have an opportunity to speak. I thank the Labour Party for putting this issue on the agenda. I have no doubt that its Senators will not leave it at that but, rather, will pursue it. I thank them for that.

I wish to acknowledge the work of the Minister. It is easy to be critical of a person who is in authority and leading from the front as the Minister is doing. He does not have an easy task. He was not in his role at this time last year. It is not easy, but he is on the front line of healthcare, as were previous Ministers, and has taken many knocks and bangs. He faces challenges every day. I do not doubt his commitment but it is important that he, as the leader of the health services in terms of policy, and the practitioners are in unison and support each other rather than battling against each other. It is that strength and solidarity that will bring about greater confidence in the health service.

The Minister is very welcome. It is great to have him in the House to discuss such an important issue. I thank Senator Hoey for bringing this issue to the floor of the House, as she has done many times. On behalf of the Green Party, I am delighted to support the Bill and all of the work she has done on this issue.

A crucial matter in this context is that the INMO has stated that nurses are the ones most deeply impacted by Covid, not just in terms of what they are seeing on the floors of hospitals, but also in terms of suffering as a result of contracting Covid-19. That is really important because when we think of an education system, we have to think of it in terms of empathy. In any form of education, empathy is key to what we teach young people. In order to teach empathy, one must show empathy. That may be where things have fallen down in the past.

As Senator Clifford-Lee noted, a critical point is that it is mainly women who are engaged in these caring roles in midwifery and nursing. These roles are taken for granted. Being able to discuss them freely on the floor of the Seanad is very important. However, we have to go beyond repeatedly discussing this issue; we need to show our support in a concrete way. It is not just about showing our recognition, it is also about who can afford to go into these kinds of careers. If it is not made affordable, it will be more and more difficult to get people into the profession.

This issue is not just about this generation. It is also about honouring the service people provide and thereby ensuring that future generations will take up this honourable profession. I certainly believe that all of the commitments in the programme for Government depend on that, as does Sláintecare. It depends on putting in place supports for the human resources and not just the infrastructural supports about which we often speak.

The Minister is to be commended for seeking a review on the clinical placement allowances but, as many Senators have stated, it does not go far enough and it is not fully implemented, so there is work to do in that regard. He is also to be commended for indicating that he believes it should be backdated. That is an important part. Those who have been engaged throughout the pandemic should be paid for their work.

I also refer to what Senator Sherlock said about this issue coming down to what is considered to be work. That is critical, because we have seen during this pandemic that the work of student nurses is not just about shadowing people. From my own circle and from my constituents, I know that people are in hospital to give birth or for some other reason, and they do not have anyone else there with them. Therefore, a great deal of work is going on beyond what nurses and midwives usually undertake, and that also has a knock-on effect on student nurses who are working during this time.

It is also important that we protect the clinical placement part of the education of student nurses. One criticism that has been made in this regard is that people will have to do catch-up in this area. I am interested in hearing how it is planned to address this issue. We must ensure that everybody is getting all their placement time, because we do not want to have that legacy again in our health service but also purely because the young people involved must feel the education they receive is the same as that received by previous generations. I thank the Minister for his time and I look forward to hearing his response. I again thank Senator Hoey and the Labour Party for introducing this legislation.

I am sharing time with Senator Warfield.

Is that agreed? Agreed.

The Minister is very welcome to the House. I congratulate my colleagues in the Labour Party on introducing this excellent, simple and straightforward Bill. This issue really should not be occupying our time because it should have been sorted out long before now. It is about fair, reasonable and sustainable rates of pay and allowances. This issue was first raised with the Minister for Health, Deputy Donnelly, by Sinn Féin on the floor of the Dáil in July 2020. A Sinn Féin motion before the Dáil last month calling for payment of student nurses was passed. Despite other political action by the Opposition as well, this action still has to be fought for. This is an issue which should not divide us. This House should be united on this matter, and, indeed, it appears today that we are united. I urge the Minister to act on this united message.

I state that because, unfortunately, it is clear to date that Fianna Fáil, Fine Gael and the Green Party have not yet recognised the role of student nurses and the value they provide. An allowance of €100 per week for first, second and third year student nurses and midwives has quite rightly been regarded as a slap in the face and far from adequate. It is not fair and reasonable. My union, SIPTU, has stated it fully supports the demand for the recognition of the role undertaken by all students within the health system during this pandemic and "the proposal that it should amount to a payment of €100 a week falls well short of what is needed".

Let us compare and contrast this €100 with the decision made in the halls of power in this State last month to give the incoming head of the Department of Health a pay rise of €81,000. I refer not to a salary of €81,000 but to a pay rise of that amount, which brings the salary of the individual concerned close to €300,000 a year. As I recall, the Minister for Public Expenditure and Reform, Deputy Michael McGrath, justified this on the basis of ensuring quality. If that ensures quality, he is obviously not in any way interested in quality for front-line essential workers. It is quite scandalous and it tells us much more about where this Government places value, which is at the very top of society, when we have heroes working on the front line not getting any pay. It is a scandalous situation.

The INMO has stated that student nurses "are thanked for their work so far but the thanks ring hollow when their reasonable demands for fair remuneration go unanswered". Student nurses have the miraculous ability to survive on good intentions. I wonder could the new head of the Department of Health survive on these platitudes and such praise. It would save the State a fortune if he did. Student nurses are required to complete 35 hours of work a week over three to four days. The day starts at 7:30 a.m. for handover, where students get patients out of bed and take their vital signs. The rest of the day includes making beds, dressing patients, washing them and assisting them in going to the toilet.

In December, I read the story of Áine Murphy, a third year general nursing student at the University of Limerick. Since September, she has been working as an unpaid nurse on placement in University Hospital Limerick. Ms Murphy has been quoted as saying:

We are out on the front line. We are there every morning at the crack of dawn making sure your loved one is okay. We are risking ourselves with the possibility of getting COVID-19. Some of us have had to move away from home for work and don’t go home or see our elderly relatives for fear that we may have it and pass it on.

How we treat those in healthcare really reflects the type of society we have and the place we have for professions that help and heal those most in need. Our health service was not in a good place before this pandemic. I could see it with the daily trolley figures in the University Hospital, Limerick, which often had the highest numbers in the State.

The Government needs to give a clear and direct message to student nurses and midwives that we want them to stay here working in the Irish healthcare system, not emigrating, that we value and respect the work they do on a daily basis and that there is a future here in a well-funded, modern public healthcare system.

I commend Senator Hoey on bringing forward this legislation and reading the testimonies of people on the front line into the record.

What is needed is a permanent solution with fair allowances to be put in place for student nurses and midwives. That should have been done yesterday, it should be done today and it should definitely be done before the next academic year 2021-22. I understand the Minister can do this at the stroke of a pen. The buck should not be passed to higher education institutions, the Nursing and Midwifery Board of Ireland or anyone else. The Department should engage with the Irish Nurses and Midwives Organisation and other unions representing these students to put in place a reasonable and fair system of allowances A fair system should also be put in place to address the needs of radiographers and others.

There is no more dangerous job on the front line than nursing. One-sixth of Covid-19 cases were in the healthcare profession and healthcare worker community. Healthcare workers' lives have been put on the line, as previous speakers noted. We should also consider the message that would be sent to people contemplating a career in nursing if they knew they would be treated with fairness and respect. There should be no more excuses, hiding behind reports or talk. These students deserve action now and I call on the Minister and the Government to support Senator Hoey's Bill.

I welcome the Minister to the House. I express my wholehearted support for this Bill and commend Senator Annie Hoey and the Labour Party on their dedication and commitment to honouring the student nurses who have so bravely worked on the front line from the beginning of this pandemic without any promise of pay. It is hard to believe we do not have legislation already in place to ensure student nurses and midwives are paid when they are working. This is a simple but essential Bill.

Student nurses and midwives have been thrown in at the deep end. They have worked tirelessly, as part of the front-line workforce, since the beginning of the pandemic. They have faced all of the fears and risks that any other member of the front-line services has faced, and continue to do so, without a guarantee of payment. We must ensure, through this legislation, that student nurses are no longer exploited. Student nurses have been used as full-time staff with no say in where they are placed and are worked at maximum effort but have received nothing in return. They have been exposed to the serious risk of contracting the virus in order to work on the front line. It is shameful that it has taken us this long, nearly a year after this started, to ensure that student nurses and midwives receive, at a minimum, the same rate as healthcare assistants. They certainly deserve that.

There are 4,500 student nurses working more than 36 hours a week. Since the beginning of 2021, we have seen the worst of the pandemic. I can only imagine how stressful that must be and the toll it is having on student nurses, particularly on their mental health. I have no doubt it is frightening. It is important to note that it is not only during this pandemic that student nurses have played a vital role in the healthcare system. For years, student nurses and midwives have worked numerous hours without pay. It is upsetting that it takes a global health emergency to realise that this is simply not right.

Anyway, it is high time we paid our student nurses and midwives and had this enshrined in law. I believe any refusal to do so at this stage would be simply shameful and wrong. Now more than ever, I find myself reflecting on the bravery of the front-line staff and how selfless and brilliant they all are. We are really lucky to have a dedicated front-line staff. I know from my work on the committee, which Senator Hoey is on as well, that the challenges faced by front-line workers are at an all-time high, as I am sure the Minister is well aware. Two weeks ago the health committee heard from witnesses working on the front line who presented some of the problems they are facing as a result of their work. Their mental health in particular is really suffering and their energy is really low. Many are contracting the virus and after a year of battle, the general consensus is that they are completely and utterly exhausted. It is paramount, therefore, that we honour their work and the fight they continue to fight in order that we can enjoy our health.

I also wish to take this opportunity to commend the work of the Irish Nurses and Midwives Organisation, which last November launched an online petition that gained 20,000 signatures within two days and now has over 75,000 signatures. The petition was a clear example of the public solidarity when it comes to supporting student nurses and midwives. These student nurses and midwives are the future of our healthcare system and are at the beginning of their vocation. I just cannot imagine the emotional burden and strain each of them must feel stepping into this new arena during these unprecedented times. Some of them are living with elderly family members, all of whom are at risk of contracting Covid. We simply cannot allow these health workers to go on without any pay. It is just unacceptable.

I wish to highlight the case of Áine, who is a fourth-year student nurse. It is amazing that she says, "not to sound cheesy about it", it is a really great honour to serve our country during this time. However, she has many friends who have contracted Covid. That is not an uncommon story. She says so many of them are very much at risk and are working in an environment that is unsafe. It is therefore more important now than ever to reward financially these workers for the valiant work they are doing to keep each of us safe by putting their health on the line. Again, I work with Senator Hoey on the health committee and the mental health committee and I know how passionate she is on this issue. I have to commend her on the phenomenal work she has done. She has done a fantastic online campaign on this as well, so credit where credit is due. I hope we can ensure that the work of all student nurses and midwives is both valued and paid.

I thank the Minister for coming to the House. I wish to take this opportunity to thank him for all the hard work he has done on Covid. He should congratulate himself and his staff in the Department of Health on the vaccine roll-out plan. People wrongly compare us with New Zealand regarding zero Covid, but when our vaccine roll-out is compared with New Zealand's, they will start on Saturday with only 60,000 doses, so we need to look at ourselves and say "Well done". As supplies come in, we seem to be administering the vaccines and we have to keep that point to the fore.

We are not here to discuss that today. I am here to commend Senator Hoey on her Private Member's Bill. She clearly is the Senator for the students, as our Leader pointed out, and she is doing a fantastic job. I spent a lot of time in 2019 in hospital and got to know many nurses and midwives. I was taken aback by the midwives especially. Midwifery is now a four-year course, and some of the students are in their final year and in their very early 20s and they have so much knowledge and professionalism. The standard of care coming down the tracks is just unreal. It would be so unfortunate and just awful to lose these amazing people, and it was mostly women I dealt with. We know there is a recruitment and retention issue in the Department and within our health system, and it would just be careless to lose these amazing women.

I got to meet many of them during non-Covid times. The majority of times they were meeting me in an educational setting where they were with other nurses and midwives in a training environment. However, as Senator Hoey and other Members have pointed out, once Covid hit and we had a huge wave, these student nurses were placed in a precarious situation. They were put on the front line, working in dangerous Covid wards. Many of them contracted Covid. It is only fair that they be compensated for being put in those situations where they have a greater chance of contracting the virus. It is unfair that we are not taking that seriously. The points on this have been well made across the House. Just on a basic fairness level, we all know that not only our student nurses but also doctors and cleaning staff, indeed anyone working in a front-line environment, are facing huge challenges. The Covid situation is not receding. Only two days ago St. James' Hospital issued an advance warning of mass screenings as it is having so many outbreaks due to people who are asymptomatic or presymptomatic. Covid is therefore still a very live issue and is still very much affecting our front-line workers. It has not gone away. The tide does not seem to be turning.

I thank our front-line workers and fully support the motion today on pay for student nurses, especially given the Covid environment. I hope the Minister can do something to compensate these amazing students, who are women in the main, albeit that there are some male midwives and nurses. Women do seem, particularly in relation to Covid, to be disproportionately affected. I will leave it at that.

I welcome the Minister to the Chamber and acknowledge the incredible work he has been doing over the past months tackling the virus. Although the numbers today are high, with 771 in hospital and 151 in ICU, they are dropping and that is positive. Today, the positivity rate is below 5%, I think for the first time since Christmas. That is very significant and welcome. On the vaccine roll-out, almost 300,000 people have been vaccinated. We are always compared to the UK and this is understandable as we are so close. However, it is important to note we have more people per capita vaccinated twice than the UK does, and a person is not fully covered until he or she has been vaccinated twice.

We are here today to debate student nurses. I acknowledge and welcome the Bill being brought forward by Senator Hoey. It is important that the work student nurses do at the moment is recognised. In fairness to the Senator, she has been very vocal on this issue since her election to the Seanad. It is worth noting however that in all the contributions it has not been acknowledged that student nurses have been paid while Deputy Donnelly has been Minister, up until the end of August. When we are campaigning for something it is important to acknowledge that there was recognition, at the start of the pandemic, that should nurses should be paid. Most people would acknowledge that what student nurses are doing at the moment is work and not placement. Admittedly, there is a technicality in that since September, clinical placements have been put back in position but anyone who has any experience of the health service at the moment would know that the work student nurses are doing is work and not placement. That needs to be recognised. A number of Senators, including Senator Sherlock, have touched on how there has been a big difference with placement in the last year and it needs to be recognised.

If we are to pay student nurses, it needs to be backdated to when their status changed in August because it cannot be said that nurses were working from the start of the pandemic until August but were not working from August until now, during the second and third waves. The third wave has been the most difficult.

Anyone who watched the "RTÉ Investigates" programme from Tallaght hospital last week saw the incredible work that all nurses do. What touched me in that programme was that nurses obviously do their professional work but for the past year, they also seem to be replacing the role of family members for patients. Student nurses are the ones who seem to do that first and foremost. It is incredibly challenging to be a source of comfort to people through very difficult times, for example a mother going through labour without her partner, which is hugely difficult at the moment, especially if she is getting bad news. Mothers are without their partner unless they are in the delivery room. Nurses are also supporting people who are in intensive care units with Covid-19 and cannot meet any family members. The work that student nurses do in that regard needs to be recognised. Most people here seem to be in agreement that nurses, particularly student nurses, go above and beyond.

We also need to recognise that, as Senator Hoey touched on, all nurses, including student nurses, have not been vaccinated. I am aware of a couple of cases in Tipperary where public health nurses are administering vaccines to people over the age of 85 but are not vaccinated themselves. They were sent from Clonmel to Galway to get vaccinated while it was snowing, which was impossible. Those public health nurses are being told that their GPs cannot vaccinate them. Everyone is qualified to vaccinate the over-85s who are coming in but, for some reason, GPs cannot vaccinate their own public health nurses. That seems unfair. I have spoken to a number of public health nurses who are in that situation and feel let down by it. Could the Minister give some direction on that matter? Surely a GP should be able to give his or her public health nurse a vaccination and the nurses should not have to go searching themselves to try to get vaccinated because it is not viable for them to go to Galway or Dublin, or travel long distances to get the vaccination.

I thank the Minister for coming here. I welcome the Bill and wish it well.

Fáilte roimh an Aire. I welcome the Minister and thank him for all he, the Government and many other people are doing to keep us safe at this time. I know this is a very difficult time. It was Mary Harney who said that the worst day in government was better than the best day in opposition. I presume that still holds true in the Covid-19 era. It is a tough time for many people but there is, of course, some consolation, as Senator Ahearn just said, in the gradual dropping of the numbers. Sadly, the numbers are dropping slowly at the moment but at least they are going in the right direction.

I support the principle of this Bill. However, I want to add a word of caution about what I think the text of the Bill actually does. I completely support the idea that student nurses who were placed in hospitals during March, April and May of 2020 and again in the past eight weeks or so had a terrible baptism of fire which no student nurse before them was asked to face. Without a doubt, they picked up the huge amount of slack caused by the onslaught of cases of Covid-19 during those months. As a gesture of our thanks to them, they should certainly be entitled, and should have been entitled, to a generous gratuity of some description in recognition of their service to the sick at such a difficult time. As Senator Ahearn stated, they have also provided a service to the families of the sick. Having borrowed €14 billion to spend on all the consequences of Covid, it seems like the least that we could do. However, I would add a word of caution about the Bill. There are many people, across many sectors, who are in trainee positions for short periods, doing on-the-job training for no pay. That is considered to be a quid pro quo of sorts.

In other words, the vocational training they receive is considered their pay, or a sort of benefit-in-kind. It is not cost-free for the employer since resources are used to train people, supervise them and so on. This is the case in hospitals and the stress on the system led to the cancellation of placements last month as hospitals could not provide more senior nursing staff to supervise people in training.

The Bill would designate all time worked by student nurses as working time for the purposes of the Organisation of Working Time Act 1997. Unless any other arrangements are made, they would be entitled to the same wages as healthcare assistants. Are we setting a precedent here that will be difficult to follow? Are there other sectors with a culture of unpaid placements, provided on the understanding that vocational training is given, where there might now be demands for pay? I support payments of some kind for student nurses but we need to be careful about enshrining new rights in law because of the possible knock-on effects. This may not be the way to go, although the intention is good.

I cannot understand the curious political detachment on the part of the Government regarding this issue. It is illustrated by the fact that, at the same time Ministers were resisting calls to pay even a pittance to students working for free in the health service, they were signing off on an €81,000 pay hike for the Secretary General of the Department of Health. The current Secretary General of another Department has effectively been installed in that position. How can that be justified? On what objective basis was such a huge pay hike agreed at this time? What does it say about the Government's priorities? Many people would think that €200,000 a year should be enough for any patriot.

I thank Senator Hoey and her party for once again being the voice of the working class in this country. Fair play to the Labour Party. It always puts the workers first. I also pay tribute to Phil Ní Sheaghdha and the executive committee of the INMO. Having been the president of a union myself, I can only imagine the pressure that has been on the executive of the INMO to take some sort of action to defend its members and its future members, namely, the students. They need our full support and backing. Fair play to them. I recognise what they are doing.

One thing has become clear to me during this pandemic, which is that the lowest paid in our society have been thrown under the bus to keep this country running. I am talking about the supermarket workers, the truck drivers, the Defence Forces, the trainee gardaí and the student nurses. I was in hospital for surgery in January and I can tell the Minister about my first-hand experience of the work done by those men and women, from the moment one enters the hospital, to protect patients. This is important for people who are non-Covid patients and who need to go into hospital today. The work the nurses do to keep patients safe as they pass through the system is unbelievable. Then one meets these young people. I ask the Minister to think of an 18- or 19-year-old student being expected to explain to somebody with severe dementia what is going on, being expected to play the part of a family member, being expected to comfort people when a death takes place and in some cases having to relay the news that a loved one has passed away. We are here talking about a Bill to pay them.

I commend Senator Hoey on what she has done but, ultimately, we all know that this Bill will have its second reading and that is all it will have. We are never going to see this Bill actually pass into law, despite all the nice words that are being said here. The Minister has it within his gift to do something and he should do it this evening. It is obscene that we are paying a man an additional €81,000 on top of a salary of approximately €200,000 when there are people who cannot afford to feed their families. Nurses cannot go home to their families for fear of bringing an infection with them and we are sitting here debating a Bill which should never have gotten this far because that to which it relates should have been done automatically. I do not share the fears of my colleague, Senator Mullen, about this creating a precedent that we will have to live with for the future. If one does the job, he or she must get paid for it.

Like others, I thank Senator Hoey for bringing this Bill forward and allowing us to debate this issue. I also thank the Minister for coming to the House.

One of the bigger questions we need to ask is why student nurses ended up in our healthcare system, essentially having to do the work of nurses and midwives. As students, they should not be expected to do this work. The challenge has been that we have had an underfunded and under-resourced health system for quite some time. One of the things that was overlooked in the budget was that the Minister was able to secure an extra €4 billion for the health service, the largest increase in the health budget in the history of the State, which will allow us to transform our health system. I hope we will never see a situation again - obviously, none of us wants to see a pandemic - that student nurses and midwives have to step into the role of nursing staff and that we will have a sufficient number of clinical and front-line staff within our healthcare system. The Minister is to be congratulated on that because he addressed the underlying problem as to why student nurses had to be step in and that deserves recognition.

I agree with the comments made by my colleague, Senator Ahearn, around the clinical placement issue and some of the challenges in that regard later in the year and that is something I hope the Minister will address. I was very struck by Senator Sherlock's definition of work, with which I certainly agree and which I am very clear about. If somebody works, then he or she should be paid for that work. In this context, during the course of the pandemic, student nurses and midwives worked. That was acknowledged in that many of them were directly employed as healthcare assistants but there were other instances where they were clearly engaged in work and it is arguable that it was not recognised.

The challenge, however, is the situation that will arise when we move beyond this pandemic, and we all hope that we will be out of it as soon as possible. Where is the line drawn between work and education? This is going to be a challenge for the legislation and it will need to be clarified.

During my student political days - Senator Hoey referred to her own - the big debate that was going on was the move from the vocational model of nursing education to this professional, academic, four-year degree model. It was a controversial decision at the time but was the right one. It means that we have probably the best model of nursing education in the world. It is something of which we should be very proud and the quality of our education is part of the reason our nurses are sought internationally. We should not go back to the vocational model.

On the point made on the exploitation of students, that has to be condemned in the strongest possible way. I hope students who felt that they had been exploited in any way, or put into situations in which they felt uncomfortable, reported that to the director of nursing and to the directors of the programmes in each of the universities where the nursing programmes are run. The exploitation of students is unacceptable and it should not have happened in any of the hospitals or in any of the universities in which there are students. I am quite certain the Minister would share that view.

It is very important we put on the record of this House our thanks to all of those student nurses and midwives for stepping up to the plate. They deserve to be rewarded and recognised for the work they have done. We need, however, to look at the longer term issue as to where the line falls between what is work and what is education and training and I am conscious of the issues raised by Senator Mullen.

In a broader context, I hope the fact there is such significant additional investment in the health service will mean far more employment opportunities for those student nurses and midwives when they graduate and, most importantly, a reduction in waiting lists and an improved quality of service for patients in the system. In addition, I hope that not only will we have the best education system for our student nurses but that we will have the best public health system in the world which will be able to serve all of our people.

It is often said, somewhat unfairly given the Minister has a very difficult job, that just because he cannot do everything, in some way he is being mean and that he does not understand. I know the Minister personally to be someone of deep compassion, who is passionate about wanting to get the job done. Our challenge in this House is not only that we address this issue but also that we acknowledge the additional investment and ensure that student nurses and midwives are never put into that challenging situation again.

I support Senator Hoey's motion to recognise the contribution of student nurses and midwives, who have been at the coalface over the last 12 months. It is important to note it is a key priority of Government to protect and support the continued education of all students, including student nurses and midwives. A key part of that education, in order to meet the standards and requirements of the regulator, is the completion of the supernumerary placements which place them on the front line in a learning capacity for up to 50% of the year. However, over the last year, student nurses have had to go above and beyond a learning capacity.

I raised this issue in November and I remember Senator Hoey was quite surprised that a Government Member spoke up on this. However, I feel that, in the meantime, the Government has reacted in a small way to this issue. The review by Professor Collins recommended a pandemic placement payment of €100 for each week spent on placement from last September, which was accepted by the Minister. However, I believe this payment should be backdated to the start of the pandemic in March. I also ask for an update on the talks with the unions in regard to other recommendations in the report.

It is important to acknowledge the other supports, such as the pandemic unemployment payment, SUSI and enhanced illness benefit, and also to note that other healthcare students are not paid before they qualify, be it medical students, physiotherapists or radiographers. Maybe it is time to start a conversation for all in the medical field. We want to keep them in their professions and in this country. It is important that we highlight their plight and support them in the future. We owe them a great debt of gratitude.

I acknowledge the work of the Minister, Deputy Donnelly, since his appointment, and the work of all of our health service staff on behalf of the citizens of this country. I support Senator Hoey and compliment her on the motion and all the work she has done on this in recent years.

Fáiltím roimh an díospóireacht seo. Gabhaim buíochas leis an Seanadóir Hoey as ucht na hoibre atá déanta aici. Cuirim fáilte roimh an Aire, an Teachta Donnelly.

I am a member of the Joint Committee on Health, which heard recently from Phil Ní Sheaghdha, general secretary of the Irish Nurses and Midwives Organisation, on the topic of the protection and support of front-line healthcare workers. We know the enormous work that nurses and midwives do year-round but particularly in the last year, which has been a very difficult one for so many sectors of society but particularly for front-line staff. We have to acknowledge that. We owe them more than a round of applause. We owe them our gratitude and additional supports, and I hope we can see to that being provided.

As others have said, the world faces a shortage of nurses and midwives and we, as a country, rely much on other countries to provide our nursing staff. This is a challenge we have to grasp. We have to make the profession more attractive so more people here will wish to study and stay in the sector once they graduate. The Irish registered nurse and midwife is a huge asset to the HSE, and we should acknowledge and be proud of the professionalism, the education and the practice that exists in this country. We have educational and clinical infrastructure for undergraduate nurses and midwives which is top class. It is why our nurses are so highly thought of internationally and in such high demand abroad, and we have to acknowledge that as well.

I acknowledge the decision of the Government, of which I was a part, in March of last year to pay student nurses. This temporary hiring of nurses and midwifery students as healthcare assistants as part of the first Covid wave concluded on 31 August.

Some of the commentary over recent months seems to ignore that as if this debate started on 1 September, ignoring the previous Government decision as if it had not occurred. It was the right decision at that time and I still believe it is the right decision now, and certainly as we experience another wave.

I welcome the review into nursing and midwifery that is taking place. It is due to report with recommendations this year also. Obviously, that will generate its own debate on the future of this very important topic. It is important that we show that nursing is a valuable and worthy career. It is a caring profession in which Ireland has a proud track record. We can all relate to people we know who are in the nursing profession or we have family who work in the nursing profession. We can all understand, from cradle to grave, the valuable role that nurses play. We can all expect interaction with the nursing and the caring professions when they look after our own families as they get older and ourselves as we get older. It is a very important profession and cohort of people. We all understand and acknowledge that.

While the Minister is here, I wish to raise the matter of the emergency department in Galway. I have raised this issue with the Minister, Deputy Donnelly, previously at the health committee and in a Seanad Commencement debate taken by the Minister's colleague, the Minister of State, Deputy Niall Collins. I understand there is a high-level meeting on 2 March with the CEO of Saolta University Health Care Group, Mr. Tony Canavan, and the HSE estates department, to try to progress the matter of the emergency department, which been debated ad nauseam for a number of years. Everybody accepts that the work is needed. Advance works have been done but we need to get to the next stage to ensure the Saolta University Health Care Group submits its planning application for that emergency department. I hope the Minister can assist in that.

I commend Senator Hoey and the Labour Party on this Bill. I hope the Minister will support it.

I ask the House for permission to share time with Senator Mark Wall, with four minutes and two minutes.

Is that agreed? Agreed.

I welcome the Minister, Deputy Donnelly, to the House. I thank the Minister for coming in to personally take the Bill. I commend my colleague, Senator Annie Hoey, on her great and passionate commitment to bringing the Bill before us and to ensuring the work of student nurses is recognised in this tangible way. This very simple and straightforward Bill seeks to ensure adequate payment and remuneration for work being done by student nurses. As other colleagues across the House have said, all of us must acknowledge and recognise the immense work and sacrifice from our front-line healthcare workers and from student nurses, in particular, who have done such Trojan work throughout this pandemic and over the past months. They have been disadvantaged in a way we do not see any other cohort being disadvantaged. On the one hand they are students in training and on the other hand they are being asked to do very hard and dangerous work. I also commend the Irish Nurses and Midwives Organisation on providing us with such a clear briefing on this. The INMO has pointed out to us the level of disadvantage faced by student nurses, and that despite broad public and political support for their case, which is evidenced today in this House, student nurses' and midwives' work still goes unpaid from first year to third year, with lower levels of pay for fourth-year interns since January 2021 than in March 2020. The INMO points out that first-year to third-year students also lack the protection of a contract of employment, so they are disadvantaged in a number of ways.

I must briefly express to the Minister the words of nurses themselves who have made known to me their own experience and perspectives on this debate. They say that the argument for not paying first-year to third-year student nurses is that placement is a learning experience to engage in observation and to be taught by a preceptor. Their experience is that because there is not enough staff they are doing the work of healthcare assistants full time without sufficient teaching because the "preceptors are far too busy with their own work to teach us". They say they end up doing the work of a healthcare assistant, and they often tend to take on this work for their entire shift with little tutoring and no pay. This is very bad for morale. I am told that it is common practice to pull students from a ward to another ward away from their preceptor and away from any reasonable teaching opportunity. A rule is in place against pulling a student nurse to another ward without his or her preceptor in hospitals, but given the staffing crisis it has simply not been practical to enforce this. Student nurses regularly spend entire shifts carrying out the sort of monitoring work, as others have described so eloquently, where they must observe a delirious or confused patient or someone who is at severe risk, with a whole day of placement missed on each occasion for the student nurse.

They say that friends who are training with the National Health Service are not used as bodies as they are, to use their own words. Clearly this has an immense effect on the health and finances of student nurses, many of whom need to take on other work to sustain themselves and many of whom have to pay rent because they are so afraid of transmitting the virus to a vulnerable family member that they cannot live at home even where this would otherwise be practical. In addition, they have to keep on top of college work and study. I know of nurses who are struggling with sleep and are worrying about patients, their own health and the risk they pose to their families and friends. As others have eloquently put it, we need to move on this. We need to recognise the work that student nurses are doing. I urge colleagues to support this Bill and I hope the Government will do so as well. I will now hand over to my colleague, Senator Wall.

I apologise to Senator Wall but it seems that, by order of the House rather than my doing, it was necessary to submit names in advance.

We did. Senator Sherlock who spoke previously did so.

We will take it now so. The Senators did submit Senator Wall's name.

Yes, we submitted it.

The officials say that it was not received.

I am afraid that I will not get to come in.

It is not about that. Senator Wall may continue anyway.

I welcome the Minister to the House. I thank my friend and colleague, Senator Hoey, for introducing this Bill. It was the Leader who christened Senator Hoey the Senator for students. It is a very appropriate title given the continuing work she does on behalf of all students. As somebody whose wife is a nurse and midwife and whose sister is a nurse, I am acutely aware of what is involved in this great profession. The dedication of those who choose nursing and midwifery as a career can never, and should never, be questioned. The issue is now how we, as a State, view the work currently being carried out by our student nurses and midwives.

The Government has conceded that it should pay student nurses and midwives but the pandemic placement grant of €100 per week is nothing short of an insult in light what these students are doing on behalf of the State, day in and day out, at this time. We have now reached the unwelcome milestone of more than 4,000 deaths from this disease in this country. Unfortunately, many families have not been able to say goodbye to their loved ones as they passed away from this dreadful disease in our hospitals. Many of the students to whom I spoke were there during those final hours, holding the hands of those same loved ones. These same students have filled in for and replaced their senior colleagues whenever requested without questioning why. Using the excuse that these students are in an educational setting while doing this work is totally unacceptable. Not paying them for this type of work is nothing short of exploitation and the Government continues to stand over it while accepting that these students should be paid.

We all want to build a health system that is fit for purpose. Some of us would like to build a public health system. Whatever one's view is, one thing is for certain; we need students to qualify as nurses and midwives. It is time that we recognise the tremendous effort of all of these students and time that they were paid for the work they are undoubtedly doing. Our front-line workers have performed heroically over this last year, doing what they do every other day but now dressed in full-length personal protection equipment to protect our loved ones, our families and our neighbours who have succumbed to this virus. They do this because it is their job, the profession they have chosen and the work in which they all have so much pride. The experience of our student nurses and midwives are accumulating at this time will surely stand to them as they begin and continue in their great profession. We should be ensuring that they stay in this profession and that they will become part of a public healthcare system of which we can all be proud. The time for applause is over. It is beyond time to pay our student nurses and midwives.

The Senator could have kept talking. I welcome the Minister and commend Senator Hoey on her work in respect of this issue. I welcome the Bill being brought forward by the Labour Party. We have heard today that the exploitation of our student nurses and midwives is absolutely scandalous. They are filling vital roles in a healthcare system that has been deprived of resources and chronically understaffed for years. During the pandemic, more than 4,000 students have been working on the front line. The work they are undertaking is incredibly dangerous. It is no exaggeration to say that they are literally risking their lives to protect every one of us. Not only are they not paid to do so, but they are asked to pay €3,000 to €7,500 for the privilege. It is an insult and it comes as no surprise that 71% of student nurses are considering leaving the country. A close friend of mine whose daughter is a student nurse was distraught during the first wave as she watched her daughter come home exhausted every evening, crying her eyes out at the despair she was witnessing in the hospitals.

Last month, the Dáil passed a Sinn Féin motion calling on the Government to publish the Collins report on pandemic pay for student nurses and midwives. We know that the scale of the pressure on the health service has utterly changed since the beginning of the year and the fact that there has been no movement on this matter is shocking. Students are constantly met with a wall of delays and excuses.

As others have stated, we should judge a person by his or her actions over his or her words. From the Government's actions in recent months, it is very clear where its priorities lie. The fact that the Government has not acted to pay student nurses but has acted to increase the pay of Members of the Oireachtas and to pay obscene salary increases to Ministers, as well as to the senior management of the Department, has not gone unnoticed by the public. It tells people everything they need to know about what the Government really thinks of working people.

This is an issue that should not divide us. It is an issue on which this House should be united. We have heard from Members on all sides about the wonderful work student nurses and midwives are doing and that of course they should be paid but as I stated, actions speak louder than words. We need to do what is right. The Minister must right the wrong here and pay student nurses and midwives reasonable and fair rates of pay and allowances.

I very much welcome the opportunity to address the Seanad on the Private Members' Bill, and the interest of colleagues in the health service and the nursing and midwifery professions. I thank the Labour Party Senators for tabling the Bill which initiated this evening's debate. I recognise in particular the ongoing, important work of Senator Hoey and her colleagues on issues pertaining to students.

Like many Members of the House, I take the opportunity to acknowledge the real commitment of all nursing and midwifery students to healthcare and to their education. I also thank all nurses and midwives and all healthcare workers for their dedication and commitment as we continue to deal with the Covid-19 pandemic. As we all know, it has been a very tough year right across the country. It has been a very tough year in particular for all those in healthcare, be they students or qualified staff - doctors, nurses, hospital porters, cleaners, receptionists or managers. Like many colleagues here, I have spoken directly with a lot of healthcare workers. What they have experienced is really tough. They are working long hours. They have been under huge pressure. They have seen awful situations within the hospitals. The recent "Prime Time Investigates" report from Tallaght University Hospital really brought home both the level of pressure that our healthcare workers have been under and the extraordinary commitment they have and just how fortunate we all are to have them. They continue to step up week after week to make sure the healthcare system in this country continues.

Student nurses and midwives are in educational placements and while they are on the supernumerary clinical placements, they are in addition to the rostered staff. That has been agreed between the colleges and the HSE. The education is carried out under supervision on the front line in accordance with the relevant EU directive, as part of a team across a wide variety of care settings. The supervision is provided by qualified, experienced nurses and midwives.

If they wish to do so, students may undertake paid work in healthcare settings while adhering to the public health advice, while maintaining their nursing and midwifery programme, which many do. Students obtain a high level of competency over the training programme and by the internship year this is at a level where they can work under what is called distant supervision. Up until then, they are building that competency and in line with education programmes, paid work is not counted towards regulated clinical learning hours and experience.

That is an important part of this issue. In order to qualify, very specific hours are required in terms of learning and competencies. It is highly structured. According to the directives laid down at European level, paid hours do not count toward that.

I note that the Bill refers to the setting of specific pay levels by the HSE for particular work; in this case, for healthcare assistants. Although I understand the desire to prescribe such pay in the Bill, it is important to note that pay determination is a matter for the HSE under section 22 of the Health Act. It is not a political act; it is a matter for the HSE under the 2004 Act. Such determination is given effect with the approval of the Minister for Health and the consent of the Minister for Public Expenditure and Reform. In that context, it is not a matter for the Oireachtas to deal with a specific pay issue such as this other than by way of amending legislation to the Health Act to determine pay.

That said, as I stated earlier, the Government is not opposing the Bill as it generally refers to pay for work. The Government fully supports the paid work internship programme, for example, that is in place for fourth year student nurses and midwives. It also fully supports the continued protection of the nursery and midwifery supernumerary clinical placements programme. Changing the supernumerary status of those placements, which is essentially what we are debating, to that of an employee would remove the educational protections that are so important to the learning experience. Those protections mean the students are unencumbered by an employment contract. In other words, what they are there to do is to learn, which is the most important thing.

That is not to dismiss what has been a very difficult year in which students and, indeed, all those involved the healthcare system, have stepped up. As colleagues will be aware, nursing and midwifery has been a graduate profession in Ireland since 2004. Research has demonstrated that positive patient outcomes, including lower mortality rates and fewer medication errors, are linked to having a nursing and midwifery workforce that is educated to degree level. It is a very important component of the healthcare system for nurses and midwives themselves, but also very much for patients. It is important to focus on the benefits of the undergraduate nursing and midwifery programmes, which, as colleagues noted, are second to none. As the chief nurse told me one evening when we were discussing the details of these placements, the degree training in nursing and midwifery in this country is the envy of the professions globally. We are recognised as having one of the best educational programmes anywhere in the world for nurses and midwives. It is one of the reasons they are so highly sought after when they graduate. They are actively pursued by other countries because they are so well trained. The reason they are well trained is partly down to the hard work they put in during the programme, but it also stems from the four-year programme which was modelled on medical doctor training when it was introduced in 2004. The final year internship programme is very unusual. It is a valuable part of the programme.

We may agree or disagree on various matters, but I assure colleagues that I spent a lot of time on this issue in recent months. I spent a lot of time with the chief nurse and departmental officials. I spent time listening to senior nurses and the higher education institutes. Each of those conversations started and ended with a passion from those people for education for the students. We can debate issues around pay for work and so forth, but I can tell the House with absolute certainty that I am confident that among the people whom we charge to make sure these students get the best education possible within the HSE - the preceptors, the nursing supervisors, the qualified senior nurses who work with the students, the professors, assistant professors and other staff in the colleges and higher education institutes, the officials in the Department of Health, the chief nurse and the NMBI team - there is an overwhelming commitment to ensure the students are safe, cared for and listened to and that they get the best possible education to make them the best nurses and midwives they can be.

It is important to reflect that, although we can obviously disagree on many of the issues raised today. I have seen that commitment at the core of everything in my interactions since becoming the Minister for Health.

Student nurses and midwives undertake an honours degree level programme over four years. Unlike in the UK and in other international degree programmes, our graduate programme includes a contractual internship with a salary for the final 36 weeks. The programme supports the optimal learning environment, where students actively take part in patient care and learn through supervision. Over the four years of the programme, the payment to the students is approximately €17,400. Additional expenses can also be claimed in some cases for travel and accommodation.

I am sure that every Member of this House will agree that our nurses and midwives are internationally sought after. As some colleagues said, we want to recruit more and we have put significant investment in place for the coming year both to scale up the nursing and midwifery workforces and, critically, to do so according to the agreed safe staffing levels. That is really important. We need the HSE and public healthcare in Ireland to be the place where our graduates want to work. That is important. The graduate programme has created exciting career opportunities. It has extended practice and has allowed for advanced practice routes, which were not possible previously and which are being seized upon by our qualified workforce.

There are many opportunities for graduate nurses and midwives by way of further education, for example. The policy for the development of a graduate to advanced nursing and midwifery practice provides a framework for graduates to draw upon their undergraduate programme. Additional funding of €2.2 million has been recently provided for the advanced nurse practitioner and advanced midwife practitioner roles. The numbers employed in these grades continue to increase, which is important. Today's graduate nursing and midwifery students can apply for the enhanced nurse midwife role after one year and 16 weeks of suitable experience, and that role has a starting salary of a little over €37,000. There are also various allowances and pay premiums in certain roles.

The expert review on nursing and midwifery is also a really exciting development. It is expected to report to me with recommendations in the coming months and it is going to be an important milestone in the evolution of the professions in Ireland. It is exciting work. This work on the future of nursing and midwifery is being undertaken in the context of significant planned reform within our health service. Student placements in our hospitals are a vital part of the clinical learning programmes. Clinical placements make up 50% of those programmes. As students rather than employees, supernumerary clinical student placements ensure that learning takes place on the front line, while being supervised. This enables students to develop the practical knowledge, clinical skills and professional behaviours required for competence to qualify and be eligible to join the professional register, which of course is what we all want them to be able to do.

The Government wants to protect the status of participants in these programmes as students and to protect the graduate programme, which has so many benefits. The supernumerary clinical placements afford students the opportunity to learn in the optimal clinical learning environment. That is the view of the Higher Education Authority, the preceptors, the directors of nursing and of Professor Collins. We will also have another review of those placements later.

The placements were disrupted several times during Covid-19, as colleagues have stated. In April 2020, all clinical placements were cancelled nationally to free up for full-time patient care the qualified nurses and midwives who would normally have been supervising students during their placements. An impression may have been given that the nurses while on placement were then simply paid as healthcare assistants and that there was a simple transition. Clarification of this point is important. That is not what happened.

All student places were cancelled. The hospitals then offered HCA roles, essentially, and approximately one in three students applied for those. The student places did not transition into HCA roles at all; they stopped. Much work was then done to make sure that learning time was made up. As I said earlier, the time in paid employment cannot and does not count towards their qualifications.

Significant recruitment across the system last year of more than 6,000 staff, which included approximately 1,700 nurses and midwives, enabled the placements to resume for this academic year, which obviously was very important. Then, of course, we had the third wave, of which Senators are aware. The HSE contacted the Department and asked again that the student placements be suspended for first, second and third years. Again, that was done because it freed up several hundred qualified nurses, and in some cases, senior nurses who would normally be supervising the students, to go where the HSE needed them for full-time patient care. That lasted approximately three weeks. As the pressure has eased somewhat, although they are obviously still under huge pressure, the HSE was able to put the placement infrastructure back in place. A phased return of those placements is now happening.

I want to acknowledge the efforts to maintain placements. There is, however, no doubt that the education of healthcare students during a pandemic is challenging, as evidenced today by the very powerful, personal and important testimonies that have been read out by many Senators. We need to listen to the students very carefully. It has been a tough year. Neither I nor anybody else is going to try to dismiss that. It has been tough and we need to recognise this.

I will clarify that the student nurses were vaccinated. I double-checked that they were vaccinated as part of cohort 2. If the Senator, or indeed, any colleagues have examples where that has not happened, they should feel free to contact me directly and I will raise it with the HSE immediately because they are most definitely included in cohort 2.

To further assist student nurses and midwives on clinical placements, I appointed Professor Tom Collins to carry out an independent review of the clinical placement allowance specifically during Covid-19, a more stressful time of which we are all aware. Professor Collins reported back to me on 31 December and made several recommendations. The one of focus is his recommendation to implement a pandemic placement grant, which is the non-taxable €100 per week for each supernumerary placement week during the pandemic. He provided an option for me to backdate that to the start of September. Therefore, the recommendation is that the 12 weeks of placement essentially would be subject to a non-taxable payment of €1,200. I would very much like to pay this and implement Professor Collins's recommendation. We have had good conversations with the representative bodies and will continue to have those. If we can get to a point where there is agreement with Professor Collins's report as a balanced response to the placements during Covid-19, we can implement his recommendations straightaway.

I have also asked for a long-term review of the placements and allowances to be carried out. I believe this is very important. This will go some way to addressing some of the issues that have been raised here by colleagues around students being able to afford to be students. My view is that financial barriers should never prevent someone from being a student. We are all aware that they do at times. There is no question about it. Graduate training for student nurses and midwives should not be down to, for example, how much family income might be available.

That is one of the points that is going to be examined in the long-term review. The work has commenced and I have asked that I receive a report in June. That will give us some time to work with the students themselves, the representative bodies, the educators and all the stakeholders to determine whether we can reach agreement and implement the plan from the start of the academic year this coming September.

I do not underestimate the difficulties that student nurses and midwives have had over the past year. Without question, it continues to be a difficult time. The Department of Health and I, in conjunction with the HSE, higher education institutes, the Nursing and Midwifery Board of Ireland, our clinical partners and representative organisations, will continue to focus on supporting our students, keeping them safe and ensuring they have the best possible education that they can have.

I thank everyone for their contributions. I thank the Minister for being here. I have recovered a little from my nervous jog up the stairs and I am a little calmer now that we are on the other side of my first go at this.

It seems that all in the room are in agreement that student nurses and midwives should be paid while they are working. It is clear from the testimonies of the students I read into the record today that student nurses are working from their first year all the way up to their final year. We are having a slight dispute over this and there are technicalities associated with what is defined as work, but the student nurses and midwives are working. There is no question about that.

Comments made by some people, although not made here today, to the effect that what student nurses are doing is not real work have been deeply hurtful, unfounded and really uncalled for. I have to hand the comment of a nurse who said:

To see the Government tell us we are not doing real work is a huge kick in the teeth. I have never been so hurt and upset by a comment they have no place making. I truly wish they could spend a day in my shoes and see what they have to say for themselves then.

The key point is that none of us in this room has spent a day in nurses' shoes. Perhaps some have but I am just unaware of their background. We are not on the front line and we are not nurses. I hope the testimonies give an insight into the reality students are facing on the ground.

Let me address some of the issues that have been raised. Regarding work, I alluded to the fact that student nurses and midwives have actually been working for a period longer than that of the pandemic and will continue to work after the pandemic is over, whatever that looks like. Therefore, while we have a need to deal with the additional workload undertaken over the past 12 months, I am still very firm in my belief that we need to recognise that student nurses and midwives from first year onwards have been working and will continue to do so. Therefore, I still believe this legislation is appropriate.

I want to respond to the statement that paying those who are working or training while students might set a precedent. I assume that it will strike no one as a surprise that as a former head of a union and student activist, I do indeed believe all people should be paid for work and that the line between work and training is thin, to say the least. A journalist asked me whether I believe everyone who is working while training should be paid and I said they should. There was a deathly silence. I will continue to be very firm in my belief. For example, I support SIPTU's call for radiographers to be paid and other calls coming up the line to pay students who are working. We should not build the public sector on the back of unpaid labour.

It was stated that we need to keep nurses and midwives here and that we have a shortage. It is common sense, therefore, that we should be treating our student nurses and midwives better. We should be paying them and treating them with respect and valuing the contribution they make from first year up. To treat people poorly at the start of their careers simply gives them an incentive to leave as soon as they can and go somewhere they will be paid well, respected and have a good quality of life. It is, therefore, a bad business decision not to pay student nurses and midwives. The evidence exists to back this up. We have high rates of emigration and a nursing shortage. We have overseas campaigns to recruit nurses from abroad. Even from a basic business perspective, we have got to get this right because student nurses, whether we agree with them or not, want to be paid and feel the need to be paid. Since they are not being paid, they are making plans to leave this country.

In 2014, when I was the president of the Union of Students in Ireland, we carried out a survey of student nurses and learned that 93% of them said they were considering emigrating. That number is bananas. If we were to propose in a business model to treat the student nurses as we are treating them, and do so in the knowledge that about 93% would think about leaving at the other side, we would not get away with it. We need to be very clear about that.

We have the best education system in the world but are we getting the benefit of having such a system if these student nurses and midwives are emigrating?

There is no question about the commitment to teaching and learning. The Minister has agreed to the payment of a weekly stipend of €100, so it seems that we may be splitting hairs over what we call it. That may be for legal or technical reasons. I do not know because I am still relatively new to this. We need to find a way forward and there needs to be financial remuneration for the work that those involved are doing. That is probably the simplest way to look at it. They are doing work and there needs to be some sort of financial remuneration for them. I am happy to sit down with the Minister in order to figure out a way to facilitate the introduction of that remuneration, whether through this legislation or by some other means.

Telling students that we are refusing to pay them in order to protect their learning will not cut the mustard with the student nurses or midwives. Where there is a will there is a way. The Minister is a clever man so I am sure he can figure out a solution. Between now and this Bill being sent into the ether, I implore him to sit down with the trade unions and find a way forward. I thank all the student nurses and midwives who are helping to hold our system together and, in particular, I thank those who have been taking good care of a special friend of mine in Beaumont Hospital for the past week.

We wish Senator Hoey's friend a speedy recovery. I thank the Minister and all my colleagues for their successful participation.

Question put and agreed to.

When is it proposed to take Committee Stage?

Is that agreed? Agreed.

Committee Stage ordered for Tuesday, 23 February 2021.
The Seanad adjourned at 5.12 p.m. until 10.30 a.m. on Monday, 22 February 2021.