I welcome the Minister to the House.
Welfare and Safety of Workers in the Public Health Service: Motion
I move:
That Seanad Éireann –
recognises that:
- there has been an ongoing increase in assaults on healthcare workers;
- HSE statistics show that there were 5,593 reported assaults against nursing and midwifery staff between January 2021 and October 2022, which is an under-reporting of the overall amount as it does not include all incidents in section 38 bodies covering the large voluntary hospitals, psychiatry and a broad range of community services where the incidents of assault are also much higher;
- data recorded under the HSE’s Serious Physical Assault Scheme (SPAS) in 2019 shows that 61% of all cases involved nurses being assaulted, and that HSE support staff employees are the second highest category of employees likely to suffer assaults resulting in physical injury and absenteeism from work, constituting 36% of all cases provided in the SAP HR data;
notes that:
- there is unequal treatment of healthcare workers in the supports provided by their employer after an assault, which depending on their grade, even if two staff are assaulted in the same incident and suffer the same injuries;
- following an assault, healthcare workers can avail of the SPAS with support staff granted three months of special paid leave; medical staff, health professional; and clerical administration granted six months; and nurses granted six months with two further extensions of three months each available;
- HSE data shows that after three months, 41% of support staff who have been assaulted in the workplace are still unfit to return to work and then have to transition to sick leave, making application for an injury grant or possibly having no pay if deemed unfit to return to the workplace;
- 41% of the total instances recorded under the SPAS in 2021, resulted in further absences beyond exhaustion of the SPAS entitlements, predominantly onto ordinary sick leave;
- a support worker, such as a healthcare assistant, who is assaulted in the same incident, by the same person, in which a nurse is assaulted, would get up to three months of benefit, whereas the nursing colleague would get benefit for up to one year;
agrees that:
- hospital overcrowding and poor staffing levels are creating a highly pressurised and unsafe work environment for healthcare workers;
- the physical and mental health of all employees working in hospitals and community settings must be a priority for the HSE and other health employers;
- there is a need for the HSA to strengthen its responsibility in respect of workers' health and safety, as well as the connection between poor staffing, overcrowded hospitals and increased assaults;
- there is a critical recruitment and retention problem within the Irish healthcare system and that the continued lack of a multi-annual funded workforce plan, incorporating robust recruitment and retention strategies, contributes to problems already evident due to the baseline staff shortages;
calls on the Government to:
- ensure that the Framework on Safe Nurse Staffing and Skill Mix is appropriately funded, operationalised and expanded across health and social services;
- publish and resource an urgent workforce retention plan from the Department of Health for all grades and as part of that plan, seek ring-fenced funding for continuous professional development for all grades, and to ensure that fund is equitably distributed;
- conduct a review of all relevant protocols to ensure procedures, staffing levels and training are appropriate to minimise the risk of injury from an assault to a healthcare worker, service user, patient or visitor to a healthcare facility;
- develop an educational public awareness campaign which highlights some of the examples of assault on healthcare workers, that should highlight the impact of these assaults on healthcare workers themselves and their families;
- immediately commit to policies designed to support healthcare workers should they suffer an assault in the workplace, based on equality of access and identified need, and not on grade or defined by an outdated system of officer and non-officer.
I second the motion.
I welcome the Minister to the House and thank him for coming in. Our motion is on the safety and welfare of workers in the public health service. It is coming out of a presentation that we had at the health committee.
There was a time when our health workers were thought of as smiling, happy people who were there to help us in our time of need. Now, we associate the public health service, unfortunately, with chronic understaffing, an overworked staff and a feeling, certainly based on what we heard at the health committee, of an unsafe environment for workers. With this shift in perception, there has also been an ongoing increase in assaults, be they verbal or physical, on workers in the public health service, which is why equal supports for all health workers must be made a reality.
The reality is that workers are regularly assaulted in the public health service and we must do better to ensure they are protected. There were 5,593 reported assaults against nursing and midwifery staff in the period between January 2021 and October 2022. I think we all know this is an under-reporting of assaults on staff in our public health service because these statistics only relate to what the HSE collates. They do not cover the section 38 organisations, which are the large voluntary hospitals, psychiatry or a lot of community services where we know incidents of assault also happen.
Ms Sylvia Chambers, who is a nurse in an emergency department in a large Dublin hospital, said:
I am qualified 18 years and I have never experienced aggression like we have in the past few years. On a daily basis there are numerous incidents where we are verbally attacked. I have been spat at, verbally abused and threatened that when I leave work that evening I will be stabbed as I get into my car. I have had grown men of 6 ft 4 in. towering over me or throwing objects at me. This happens on a daily basis. I do not feel safe going to work. My colleagues do not feel safe ... At night time, from 2 a.m. onwards, we only have two doctors. Sometimes we could have up to 60 or 70 patients waiting at that time with two doctors. It is not feasible for two doctors to see all those patients. Parents become very aggressive and tired. The nurse, who is normally the first person they see, receives the backlash ... Staff are leaving due to this because they are stressed. In the last 18 months we have had 30 nurses resign from our emergency department alone. We are on our knees when it comes to staffing levels.
I have a quote from a receptionist. We put out a survey to get some feedback from the workers in our public health service for ourselves. This is from a receptionist working at a hospital front desk. The receptionist has experienced verbal abuse, shouting, banging on the glass panes, screaming and slapping on the counter to intimidate her. She said:
Even though we are behind panes of glass and there is security there, I dread going into work. I get shouted at regularly and it is much more than just understandable frustration. It is abuse and it is awful.
I also have a statement from a health care assistant, who said:
I was left alone with no support staff in a residential unit. A patient cornered me, grabbed my arm [and] I had to block the door with my foot for my safety. There was no one else in the unit at the time so I had to wait as I was afraid he would grab me again. There was no one there to tend to the other patients while I was trapped in the room waiting for the patient to calm down ... My partner wants me to find another job as they are worried for my safety in there. They are also worried that I would be held accountable if something goes wrong but I am often left overnight on my own so any number of things could go wrong that are out of my control. It is a huge stress for us.
At the core of this is the understaffing and overcrowding of our hospitals and health services. Delays in admission from the emergency department are associated with increased mortality for patients. It is estimated that up to 400 people could die each year as a result of emergency department overcrowding. Studies have shown that emergency department overcrowding is associated with delays in receiving pain relief, medication errors and greater lengths of hospital stay. Sometimes patients even leave the emergency departments without having been seen because they simply cannot deal with the situation that they are in.
This morning, HIQA published a report on three hospitals in Cork, Kerry and Tallaght. It highlighted colossal overcrowding, significant staffing issues and huge risks to patient safety. My Labour Party colleague, Deputy Duncan Smith, stated:
The danger that the mismanagement of the health service poses to patients and workers alike is deeply shocking yet not at all surprising. We have seen the numbers of patients on [trolleys] increase tenfold over the past number of months and the recent harrowing testimony of workers speaks to the crisis in the health service.
Furthermore, the Irish Nurses and Midwives Organisation, INMO, stated:
Of the ten HIQA reports carried out in hospitals in the last eleven months, not one hospital has been found fully compliant when it comes to staffing.
We know that our hospitals are overcrowded and have long waiting times to be seen at emergency departments and the sensational narrative is about the difficulty for patients. The narrative that is less explored is the effect that this has on staff working in hospitals and healthcare services. Staff are overworked, exhausted and experience abuse on a regular basis and are then expected to carry on as normal. An emergency department nurse exasperatedly stated:
If I am verbally abused, you have to compose yourself and go on to the next person. I have to go on to the next child; I have to compose myself. Sometimes I am fighting back tears because the comments are so personal.
Some 94% of doctors reported having experienced some form of depression, anxiety, exhaustion or emotional stress, while 81% of doctors are at risk of burnout. Some 62.3% of doctors have had their working week extended beyond their normal contractual hours by 11 hours or more. A non-consultant hospital doctor noted:
Along with nursing staff we are sometimes the first people who come into contact with patients who are distressed and become verbally or physically violent. It is difficult to describe what it is like to experience something like that at 2 a.m. and then have to turn around and go ... see the next patient and other patients who are on a doctor's books that night ... It is not just physical and verbal abuse; it is very specific abuse. As I was saying, it can be gender-based or racial abuse. I have had colleagues experience racial abuse and then, exactly the same as me, turn around and treat the next patient or go back and treat the same patient.
It is also a terribly sad reality that healthcare workers and staff working in the health service often do not report incidents of assault or abuse, either because they are too busy or they do not see reporting the incident as doing anything or going anywhere. An emergency department nurse stated:
I could be verbally abused four or five times in a night, but I will not put in an incident report form because I am too busy. (I have 24 admitted patients that I have to provide care to, and I cannot to sit down at the desk and write incident reports, much as I would like to. I want all of that documented but I do not have the time because I have to prioritise patient care.)
Nurses have recently been refusing to fill in the incident reports as they feel it is a waste of their time. They complete a report and it goes into an abyss. A doctor working in a public hospital noted:
When I talk to some of my colleagues in the coffee room, people do not feel comfortable talking about it. When they say, “Something bad happened to me”, I will ask have they logged it ... and they will say, “No, I cannot do that.”
There are few data available on prosecutions against those who assault workers in the health service. We do not have figures from the Garda on prosecutions for assaults on workers in the public health service, but anecdotally we know the number of prosecutions is very low. There is the double-edged blade of having to care for someone, and then having to prosecute them following an assault, but this is the reality for many workers in social care. The National Ambulance Service stated today at the Joint Committee on Health that it has approximately 22 incidents of assault per month. Paramedics who provide first response healthcare at emergencies are regularly assaulted. I would like to read from the testimony that was sent to us from a worker in the National Ambulance Service:
I have been physically assaulted on numerous occasions. Once l hounded the Gardaí over 12 months to prosecute a patient who assaulted me, eventually it went to court and the defendant/patient got 3 months. He tried to physically assault his heavily pregnant girlfriend in the rear of an ambulance and l got in the way to help her. I regularly used to get abuse from drunk or intoxicated patients and-or their friends often in front of CCTV and-security and gardaí. I would make Garda statements and submit NIMS forms but nothing would come of it.
It is a shocking indictment of the care we show for workers in our healthcare system that some workers will receive better supports than others, based on their grade or profession. Following an assault, healthcare workers can avail of the serious physical assault scheme. Support staff are granted up to three months of special paid leave, whereas medical staff, health professional staff, and clerical and administrative staff can be granted up six months. Nurses can be granted up to six months and can avail of two further three-month extensions. This is an archaic system, which favours some staff over others, depending on their classification as officer or non-officer. It is an entirely unfair system, especially as some staff may be given different amounts of leave if they were both assaulted in the same incident. I know SIPTU and Fórsa have been vocal on this. They both presented on this before the Joint Committee on Health, and have also spoken before the committee previously. SIPTU has today called for support for this motion and said in its statement:
At the Joint Oireachtas Health Committee, we highlighted the fact that healthcare workers employed as support staff within the public health service only receive 25% of the benefits that their colleagues in other grades [get] in the event of an assault at work. At the hearing, SIPTU [representatives] highlighted that, after their nursing colleagues, support grade staff endure the second-highest level of assaults in the workplace, according to HSE data. We also raised the fact that, according to the HSE data, 41% of support staff assaulted at work are still unfit to return after three months by which time they have exhausted their entitlements under the HSE serious physical assault scheme.
What is this motion calling for? This motion is calling for a number of measures from the Government that will help to alleviate the pressure on workers in the public health service. We want the Government to ensure that the framework on safe nurse staffing and skill mix is appropriately funded, operationalised and expanded across health and social services. Inadequate nurse staffing has been regularly highlighted. Even today, HIQA’s reports into University Hospital Kerry and Tallaght University Hospital paint a bleak picture of the realities of unsafe nurse staffing. In the case of both hospitals, unsafe nurse staffing levels mean that the medical assessment units have had to close or operate at a reduced capacity. Funding and operationalising the safe nurse staffing and skills mix framework is a necessary first step we can take.
We also want the Government to publish and resource an urgent workforce retention plan for the Department of Health for all grades. As part of that plan, it should seek ring-fenced funding for continuous professional development for all grades and ensure the fund is equitably distributed. We have a major issue with staff retention in our public health service. The publication of a workforce retention plan will allow us to begin resolving staffing issues in our hospitals.
We want the Government to conduct a review of all relevant protocols to ensure procedures, staffing levels and training are appropriate to minimise the risk of injury from an assault to a healthcare worker, service user, patient or visitor to a healthcare facility. Reviewing procedures, staffing and training means that we can stop the conditions that allow these assaults to happen in the first place.
We want the Government to develop an education and public awareness campaign that highlights some of the examples of assaults on healthcare workers, and highlights the impact of these assaults on healthcare workers and their families. Unless they were watching the Joint Committee on Health recently, the public might not even be aware of abuse and assaults of workers in the health service and the real-life effects this has on the people working there.
Finally, but importantly, we want the Government to commit immediately to policies designed to support healthcare workers if they suffer an assault in the workplace. This support should be based on equality of access and identified need, and not on grade. It should not be defined by an outdated system of officer and non-officer. It is a shocking and archaic reality that some workers will get more time off than others following an assault, even if both workers were harmed in the same assault, because of their grade or type of profession.
I welcome the Minister to the House. I thank Senator Hoey for her work in preparing this important motion. I also thank her for her work at the Joint Committee on Health and in relation to health on behalf of the Labour Party, including her work in support of student nurses and other campaigns, over the past two years. I listened to some, and read more, of the testimony at the recent Joint Committee on Health meeting. Hearing that direct evidence was worrying and indeed frightening. HSE statistics show there were 5,593 reported assaults against nursing and midwifery staff between January 2021 and October 2022. That is totally unacceptable, and it is the reason we should be debating this important motion tonight. As that figure does not include incidents in section 38 bodies, the true figure is much higher.
As others have mentioned, the joint committee heard from a witness who said, "In the last 18 months we have had 30 nurses resign from our emergency department alone." This shows what those we depend on most are having to face while caring for us all. The witness followed that comment by saying "we are on our knees when it comes to staffing levels." Like many Members of this House, I have and have had family members in the healthcare profession. I have friends who continue to work there. There can be no doubt that their safety and mental health is being tested much more regularly than in previous times. The lack of beds and the unavailability of overworked staff at certain times seems to give some people a licence to be abusive. In some cases, that becomes physical abuse. Our motion states that "the physical and mental health of all employees working in hospitals and community settings must be a priority for the HSE and other health employers". Most importantly, the motion speaks of the "need for the HSA to strengthen its responsibility in respect of workers' health and safety. It also refers to "the connection between poor staffing [and] overcrowded hospitals", which seems to give some people a licence to carry on this abuse.
When one speaks to those on the front line, as we did in the Labour Party in preparation for this debate, one hears all too often that people have been punched, slapped and called every name under the sun, and none of them nice. People have witnessed their colleagues being called such names too. They have seen them being punched and spat at. All they can do is wipe themselves down and continue, and go again and again. Unfortunately, as the health committee heard, many healthcare workers cannot wipe themselves down and get on with it anymore. Who could blame them? We need action and our front-line healthcare workers need support. The days of the nurse, doctor, care assistant or any healthcare professional being a lifetime position have unfortunately long disappeared. Unless we address these major incidents and this unacceptable abuse, we will find that those we need most in our hour of need will simply not be there. I look forward to the Minister's response. Actions speak louder than words, and action is needed. We cannot continue with what is happening.
Senator Conway has six minutes.
I welcome the Minister. I commend Senators Hoey and Wall on putting forward this important motion. I work with Senator Hoey on the Joint Committee on Health. She is a valued member of our committee who brings common sense and cop-on to her contributions. I enjoy working with her and value her contributions. That extends into this House and to this motion. I am glad the Government is not amending or opposing this motion in any way, because we need to shine a light on what is happening, particularly in accident and emergency departments. I have spoken to people who work in the emergency department in Limerick. Three of them are people to whom I would be very close. I know another two or three people who work in the emergency department. Some of the stories they tell are shocking, particularly about people who turn up on a Saturday night and at weekends. The behaviour they describe is unacceptable and needs to stop.
A number of people have responsibility in this regard. The HSE management has a responsibility to ensure that security, particularly at flashpoints like accident and emergency departments, is adequate and able to respond. Second, we need an education campaign to inform people that this behaviour is just not right.
Sometimes you just need to spell it out to people and tell them it is just not right. People who are there to help should not be abused. It is simple common sense to us here because we come from that frame of mind but that needs to percolate down into society.
A health education programme in schools is something that should be looked at. Just because someone is under pressure or feels threatened, does not mean he or she should respond in an aggressive way. This morning - and Senator Hoey will appreciate this - the ambulance service was before the Joint Committee on Health. We had the National Ambulance Service and the Dublin Fire Brigade ambulance service in the committee rooms and I asked them about abuse and assaults. There are 22 people in the National Ambulance Service today who are out on sick leave simply because of physical and verbal abuse they have received in their work of responding to calls in the ambulance and fire services. That it totally unacceptable. It works out in a 12-month period as 6% of people working as crews in the ambulance service being out sick, and of that, approximately 20% off because of verbal and physical abuse. That this type of thing happens does not bear thinking about.
What can we do? We are in the business of coming up with solutions. This motion is important because it shines a light on the situation. In my view, the solutions are around education and creating a module at transition year level or incorporated into the civic affairs curriculum. We need some class of an education programme on people working on the front line who are there to help in a time of crisis; whether it is the Garda, National Ambulance Service or the Irish Coast Guard etc. We need to look at whether there should be a law or some sort of legislative approach and if somebody is physically abusive to a person on the front line, there would be a mandatory minimum sentence for that person. I know it sounds punitive but what is happening on a daily basis is just totally unacceptable.
It was heartbreaking to listen to the National Ambulance Service personnel say that there is not a day in the 365 days of the year, when at least one member of its teams is not verbally abused. It was heartening to hear that the level of physical abuse had actually decreased in the last 12 months but it is still an issue.
In terms of emergency departments, of course where there are challenges with resources and reduced personnel, that is going to lead in its own way to people becoming frustrated and angry. That is something I know the Minister is dealing with and I hope he does so expediently. I am aware my six minutes are up.
I commend our colleagues in the Labour Party for shining a light on something that really and truly is unacceptable and on which a light should have been shone a long time ago.
The next speaker is Senator Black followed by Senator Gavan. They each have six minutes.
I welcome the Minister to the Chamber. I thank the Labour Party group for tabling this really important and timely motion which I wholeheartedly support. I sit on the Joint Committee on Health and the Joint Sub-Committee on Mental Health with Senator Hoey and was present during the recent shocking health committee meeting where trade union officials representing healthcare workers detailed the horrific level of violence to which the workers are subjected. I am sure the Minister is aware of it himself. It had a profound impact on us all. I spoke in the Chamber the day after the meeting and requested a debate on this topic. I am grateful, thanks to Senator Hoey and the group, that we can now have this debate.
Healthcare workers already contend with difficult conditions to provide the care we all rely on. They deal with inadequate pay, understaffing and overcrowding, and all of this takes a huge toll on the well-being of these workers. We have a responsibility to ensure that healthcare workers, who commit their careers to caring for us, are properly cared for themselves. It is really truly unconscionable that they are not receiving the bare minimum that a worker is entitled to expect which is a safe and secure workplace. The continued crisis in staffing means that all healthcare workers are stretched thinly. We know that. They are often isolated without coworkers present who can help if a situation escalates into violence. Security in healthcare settings always seems to be at a minimum. During that recent meeting of the health committee, one witness spoke about a locality where several health centres shared an outsourced security service meaning that at any given time they had no on-site security presence. It is truly hard to comprehend. Workers are being left to fend for themselves. It is not fair and I do not think it is good enough.
According the data from the Health and Safety Authority, HSE staff members made 4,796 reports of workplace physical, verbal or sexual assaults in 2021. These are absolutely staggering figures. The same data show that there are only 446 inspections and this is clearly insufficient. The Irish Nurses and Midwives Organisation noted in its briefing document, which was sent to the health committee members, that this is not only a workers' rights issue, but actually a women's rights issue. Some 63% of assaults in the health services are perpetrated against nurses and midwives. These professions are 95% female. The failure to protect healthcare workers from violence constitutes a failure to adhere to our obligations under the Istanbul Convention, which sets out member state responsibility to prevent domestic violence and violence against women.
I am glad the motion highlights the absurd situation where healthcare workers who are the victims of violence are afforded different levels of leave under the HSE's serious physical assault scheme depending on whether they are classed as an officer or not. Based on this totally arbitrary distinction, medical and clerical staff get six months while support staff, such as healthcare assistants, only get three months. If a doctor and a healthcare assistant get assaulted in the same incident, they are afforded different levels of support based on their job titles, rather than the nature and severity of their injuries. It is a glaring injustice which reflects the same lack of respect shown to these support workers as the delayed payment of the Covid-19 service payment to contract cleaners and security guards. These workers are treated as an afterthought even though they play an essential role in the smooth and orderly operation of a hospital.
I am sure we are all familiar with the recruitment and retention crisis in our healthcare system. I know it is a constant dialogue. Sometimes it feels as if it is the only thing we talk about in the health committee because it is at the root of so many of the issues we face. The issue of violence against healthcare workers is a vivid example of the vicious cycle of understaffing. Workers are more vulnerable to violence because of understaffing, minimal security and overcrowding. The failure to protect these vulnerable workers then becomes a powerful push factor which results in people leaving because the feel undervalued and unsafe. We need to break the cycle if we are ever going to resolve the perpetual dysfunction in our healthcare system.
Ensuring medical settings have adequate security is the bare minimum. There should be security guards on-site at all times ready to intervene. If recruitment is an issue, addressing low pay for security guards and taking them off the list of ineligible occupations for an employment permit, are potential pathways forward. The employers of healthcare workers owe them a duty of care to provide them with a safe and secure working environment. In addition to that, we as a society owe healthcare workers immense respect and gratitude. It is our collective responsibility to provide these workers with the protection and support they need at this time. I really hope this House adopts this sensible, and what I would call, humane motion. We clapped for healthcare workers during the pandemic and now it is time to stand up for them. I thank Senator Hoey and the Labour Party again for bringing forward this motion.
In the seven years I have been in the Seanad, this is the first time I have seen a Private Members' motion from the Opposition being addressed with no Government Senator present in the Chamber. For the first full 15 minutes, there was no one in the Chamber. Then Senator Conway came in, just at the very end of the presentation, and half an hour in to this debate, there is still no Fianna Fáil Senator present.
We are being told that the welfare and safety of workers in the public health service is an important issue, "extremely important", according to Senator Conway, and yet of the 40 Government Senators, we had one who arrived after 15 minutes and we had a second one, Senator Kyne. No one from Fianna Fáil has bothered their backside to even come into the Chamber. I appreciate it is not a regular thing but I have to point this out because it is hugely disrespectful both to my colleagues in the Labour Party and to this Chamber.
On a point of order, I was in the anteroom and I heard everything Senator Hoey said.
Some Senators are at meetings.
I was in the anteroom.
Can we stick to the motion?
Absolutely. I had to make that point.
I welcome the Minister, Deputy Stephen Donnelly. I am pleased that this issue is being raised. As a former union official, I know first hand how appalling the challenges are for workers in the health service. The statistics are shocking. There have been 5,593 assaults on nurses within a 20-month period. Frankly, I do not think the public are aware of the extent of the problem and the Joint Committee on Health was crucial in terms of trying to highlight the matter.
Of course, we are talking about a context of under-staffing and overcrowded wards and emergency departments. As the Minister will be aware, another report today highlighted the fact we have massive problems in terms of under-staffing across the hospital network at the minute.
I am glad the Minister is here because, obviously, I am going to talk about University Hospital Limerick, UHL. As he Minister will be aware, because I have written to him and the Deputy Leader has written to him, he needs to correct the record in relation to UHL. Three weeks ago, the Minister declared in this Chamber at the end of his speech that there were on average just six patients on trolleys in UHL. That is factually incorrect and so far out of the mainstream.
Should I respond?
That is factually incorrect and I would like the Minister to correct the record.
Does Senator Gavan want the Minister to?
I will happily give the Minister the floor to correct the record.
I will not be correcting the record. The data I have is the HSE figures, the 8 a.m. TrolleyGAR figures, which showed the averages there. I read the Senator's letter this morning. Senator Gavan is factually incorrect. The Senator is out of order asking me to correct the record.
I am not.
The information I have directly from the HSE is the 8 a.m. figures and they were the averages at that time.
I was happy to give the floor to the Minister.
I find that frankly incredible given that the Irish Nurses and Midwives Organisation, INMO, trolley watch figures were in the 70s for each day of the week in question. Not being funny, the dogs in the street and any of the staff in UHL would tell the Minister that he is factually incorrect. It worries me that the Minister is getting information that is incorrect.
Rather than finding things incredible and not having the information-----
Sorry, Minister.
It is incredible.
-----why do you not go and get the information and inform yourself?
I got the information.
No, you did not. Have you seen the HSE TrolleyGAR figures?
Sorry-----
Did you see the front page of the Limerick Post last week?
Did you see the TrolleyGAR figures?
You made front-page news, Minister.
Did you see the TrolleyGAR figures?
You made front-page news, Minister.
Yes or no, Senator.
Sorry, Minister.
Have you seen the TrolleyGAR figures, yes or no? It is a simple question.
Oh my God.
Yes or no.
I have seen the INMO figures. Those are the figures I believe.
Senator Gavan, order.
You have not seen the figures I quoted.
The INMO are liars, is that it?
Maybe before writing to me-----
Is that what you are saying?
-----and asking me to correct the record, why do you not look at the source that I used?
Your source is incorrect.
Could the Minister resume his seat? Could Senator Gavan conclude? There is a little time.
I will. When people in Limerick see what you said, you just wait for the outcome. You have no credibility.
The people of Limerick would be delighted to know that you do your homework before asking people to correct the record.
Homework. Oh my God.
Sorry, Minister. Can we allow the Senator continue without interruption?
The Minister for Health is on the record here as saying he believes only six people were on trolleys in the week of 1 February.
Per day, the average 8 a.m. TrolleyGAR figure was exactly that.
Per day, that is absolutely shocking. I will get back to the point.
Maybe you should do your homework.
You do not even know what you are talking about, Minister. I have to be direct with you.
Sorry, order.
Sometimes you have to call it as it is.
Sorry, I am chairing.
It is disrespectful, Acting Chairperson.
Sorry, I am chairing and I am speaking. The Senator to continue without interruption. The Minister will have 15 minutes to respond. Let us try to do it in an orderly fashion.
Focusing again on this important motion, it is important that we see action from the Government. We need to see the framework underpinned by legislation and expanded across all health and social services. That is what the INMO has called for.
I am also concerned that support staff - SIPTU is clear on this in its presentation - only get 25% of the financial supports afforded to allied health professionals. That is a real problem for the support staff - the healthcare assistants, HCAs, and the porters. Indeed, I know people first hand who have quit working in UHL to take positions, for example, as a bus driver, because they simply could not cope with the level of misery, including these issues of assaults and threats on an almost daily basis. It is an issue that has to be tackled clearly.
Of course, we also need to remember the security staff. The security staff are being outsourced and they have no recourse if they are assaulted. My call there is clear. We should in-source all security staff at all hospitals.
I thank Senator Hoey and the Labour Party team for putting down this motion. Apologies, I was not here earlier. There is certainly no disrespect intended. It is safe to say the Fine Gael team on the Joint Committee on Health are active in terms of turning up, as are others as well.
We had a good discussion on this important topic with the unions at the recent meeting of the Joint Committee on Health. The figures were stark. Indeed, the figures are worse than that because they are under-reported in relation to the level of assaults. That is the worrying aspect.
An interesting point raised in the debate was on how to encourage people to report incidents of assault, whether it be physical or verbal assault. There was a concern that people felt there was no point because if they do so, they do not get anywhere. That is worrying because assault of any nature is wrong.
There was an understanding that people get frustrated. We know there are waiting lists and people wait in certain instances for too long in hospitals. Whatever the reason for the delays, the frustration and the stress, nobody has the right to take that out on staff of any kind. People can express annoyance, but to assault staff for any reason is wrong and they should be called out on that. There is no excuse.
The testimony we heard at the committee would not encourage people to go into that profession, which we need. We need people across all sectors. We need people in all our caring professions. Certainly, we need to root out this problem. The issue of security staff was raised in relation to visibility of staff in emergency department, in that they would be seen and would be able to intervene in those cases as well.
Another issue raised was following up on the reports that came in. We were advised that the Health and Safety Authority, HSA, has a role but is not following up as it does not have the resources to do so. This is an issue for outside of the Department but it is something the Government needs to look at. The HSA must take the same approach to the health workplace as it does to other workplaces but it is not doing that. It tells us it requires additional funding for a separate division to deal with the health service. If it does, it is important it gets that because, as I said, there is a vulnerable and visible cohort which deals with the public at all times and it is right and proper that the HSA be resourced to protect those staff and follow-up on complaints. That, in itself, will encourage the proper reporting of assaults and, I would hope, would spur all into increased action.
One of the cases mentioned related to midwives. I expressed disbelief at how it was possible for people to attack midwives. Ms Phil Ní Sheaghdha put on the record that it can be partners or visitors and that the Covid restrictions on visitors and partner attendance, which, as quite rightly pointed out, were not the fault of the midwives who were following the policy these Houses and the Government laid down, were a real issue and a pressure point.
Unfortunately, the midwife was the visible face of that policy, albeit not the author of it. Again, irrespective of that, there is no excuse for verbal or physical assaults on a midwife or any front-line staff member.
We know that in other areas like the disability sector, staff are dealing with some serious issues. In some cases, patients are physically strong individuals who can sometimes strike out unintentionally. It is something that happens on occasion and it is a severe risk hazard for individuals. We must be conscious of that as well and ensure there are proper staffing levels and appropriate staff to patient ratios in the disability sector.
All in all, more needs to be done. While it is clear that the Government has increased the budgets over the last number of years, there is still a demand for additional staff. The HSE tells us that recruitment is difficult. Indeed, I attended a meeting today about community care in my own area, where I heard that there are 13 empty beds in Áras Mhic Dara in An Ceathrú Rua because of a lack of staff. The HSE cannot get staff. It is trying to recruit internationally but it cannot get staff. Staffing is a major problem across all sectors of the health service. We have to broaden the reach and widen the search for qualified staff. Indeed, it is a worldwide problem. We also have to look at the capacity in our universities and training institutions to ensure that we have sufficient staff here. We must encourage more people to stay in this country and those who are abroad to return home, if they can.
I apologise for missing the start of this debate on what is a very serious issue. The Joint Oireachtas Committee on Health recently heard from a number of different unions representing health workers including the INMO, Fórsa and the Irish Medical Organisation, IMO. It was really shocking to hear what some healthcare workers are putting up with. The shortage of healthcare staff is a global problem but that does not mean they should be facing such harassment in the workplace. What was clear from that meeting is that there is a culture within healthcare settings of not reporting attacks because staff feel that management will not deal with them adequately. That is a really important point and one that can be tackled. While it is completely unacceptable, there are numerous reasons for people feeling under pressure in their workplaces and we can do a lot. I thank the Labour Party for initiating this debate, which is a really important one.
I also thank the Labour Party Senators for tabling this motion. It is a serious issue. I speak on behalf of the Roscommon and Galway area and in particular, Portiuncula University Hospital which is in my own home town. Huge numbers of patients are presenting at the emergency department at the moment. The hospital is also seeing a lot more people presenting with addiction problems related to both alcohol and drugs. Such patients are presenting at the emergency department. What I would like to see the HSE addressing is the issue of different categories of staff. We have porters in our hospitals but they cannot be expected to take on a security role as well. The HSE must make sure that our hospitals have the right staff to monitor addiction-related behaviour that has increased exponentially in some areas in the past year. It is not acceptable that healthcare staff, who now number close to 140,000, up from just over 110,000 three years ago, would have to work in already confined spaces and deal with people in traumatic situations. I really cannot imagine it. It frustrates me and I appreciate the fact that this motion has been brought before the House.
As the motion notes, the HSE needs to make staff available to support healthcare workers, monitor patient behaviour and tackle this problem. I welcome the fact that there has been a considerable increase in staff numbers. There is a recognition on the part of the Department of Health and the Government that we must have the staff to deal with the pressure we have seen over the last two years. The challenge is that we are seeing a different type of pressure now, outside of Covid, particularly in these behavioural-type events that are happening in our hospitals. No one wants to see it. It would be great if we did not need to have proper security. I ask the Minister to speak to the role of porters and security staff in hospitals. Is there general HSE guidance around that?
The other issue I wish to raise may not be under the remit of the Department of Health. Gardaí are required to attend to incidents in our towns and cities across Ireland. In our cities we have generous numbers of Garda members, although more are always needed, but in small towns that is not the case. We must look at the fact that incidents that are happening in hospitals are having an impact on gardaí who are being called out to attend to them.
This is not an easy issue in the context of everything that the Minister has tackled in the last two years. The supports that he has put around regional hospitals are very much appreciated. What he has done in the community healthcare organisation, CHO, area as well, around supports for Westdoc, is also welcome. The Minister has sought to ensure that community supports are in place as well. The area where this is an issue is in our hospitals, particularly in towns. Staff may never have faced this before but in the last year or two, it seems that there has been a lot more incidents. On the CHO side, is there any consideration of addiction centres? There is one in Galway that the Minister opened recently. Addiction centres are needed, particularly for alcohol. In Ballinasloe, we have a day hospital. The addiction centre deals with patients who have a primary diagnosis on the mental health side before it deals with the alcohol side. I am wondering if there is capacity for pilots around centres in addiction studies. That would be very much appreciated, as it might alleviate some of the pressures that we are seeing presenting in the last year. Again, this is just what we are hearing from staff on the ground.
I thank the Minister for coming to the Chamber. I also thank my colleague, Senator Annie Hoey, for drafting this motion and tabling it this evening. On the Minister's watch, there are workers in the Irish health service going to work in fear, stressed about what is going to happen in the course of their work. It is on his watch that we heard testimonies from healthcare workers about being shoved, grabbed, slapped, and kicked and all of the other testimonies that Senators Hoey and Wall talked about earlier today, as well as those heard at the Oireachtas Joint Committee on Health a fortnight ago. Day in, day out, our healthcare workers are having to bear the brunt for the failures of the Irish health system.
We all know that violence is never acceptable, no matter what the circumstances. That said, we need to look at why people are venting and physically attacking healthcare workers. There is no doubt about that. We need to consider the waiting lists and the under-resourcing of the Irish health service. We also need to hear clear answers tonight on how the Minister is going to protect health workers in the here and now. The waiting lists are not going to change any time soon under the Minister's watch. The lack of bed capacity is not going to change any time soon and recruitment will not transform overnight. We need to hear clear answers from the Minister tonight as to what steps he is going to take to ensure that our hospitals and other healthcare settings are safer places for healthcare workers.
First, we need to hear what the Minister is going to say to the HSA. There were almost 6,000 assaults in two years but just 69 inspections. When one takes out the Covid inspections, there were only 69 inspections of healthcare settings.
Where is the respect for healthcare workers in that? A blind eye is being cast to what is being seen almost as a rite of passage. I was struck by the testimonies that Senator Hoey put together. One of those people said that when they talked about whether to complain, another colleague said it is a rite of passage in the health sector to be abused in the course of your work. That is intolerable and unacceptable.
What is the Minister going to do about the bizarre and unequal treatment of medical and nursing staff when compared to the treatment of allied health professionals and all others who work in hospitals? To be frank, it is a classic case of the "Upstairs, Downstairs" mentality in the Irish health system. Those allied health professionals, porters, receptionists and other workers are vital parts of the Irish health system. We can listen to the tea and sympathy all we want but we need to hear that if they are assaulted, they are going to get the same entitlement as a nurse or doctor. We have to cut out this disrespect, which is what it is, in respect of the different jobs that exist within the Irish health sector. Is the Minister going to implement a staffing plan? The Irish Nurses and Midwives Organisation, INMO, has talked for a long time about an overall framework for staffing and recruitment to be published on an annual basis to ensure safe working conditions. We have heard the figures in respect of over-capacity and the lack of safe working conditions. If we do not hear clear answers from the Minister, we will be looking to bring forward legislation which means that where there are breaches, laws will be broken and there must be some kind of comeback or recourse for workers. At the moment, they are toothless. They cannot fight back in places of work that are over capacity and under-resourced.
I have no doubt we will hear more tea and sympathy this evening. We need clear action and a timeframe for it. We welcome that the Government has not sought to amend our motion. We will all walk out of here and think we are great because we are supporting healthcare workers while we reflect on the shocking things that go on in Irish hospitals. Workers watching this evening want to hear more than that. They want to hear a programme for action that will be implemented in the coming weeks.
This is a difficult motion in many respects. I have great sympathy for the issues that are raised in it. They are serious issues and at a time when recruitment in our health service is such a massive issue for the Department of Health and for hospitals throughout the country, they are vital.
I heard what Senator Sherlock said about the two-tier system, and I agree with her, but I see two different tiers. On the one hand, I see front-line workers and on the other hand, I see management and administration. One of the difficulties we face is that the administration, who are back from the front line and do not face many of the problems that have been discussed in the course of this debate, are the ones who are the upper tier and are somehow given a greater value than the front-line workers, be they porters, nurses, doctors, laboratory staff or whoever else, who are actually delivering services to people. Those are the people who actually do what the health service has to do. To my mind, they are the most vital cog in the wheel that keeps us all safe and alive. The difficulty I have is that as I look at the health service, which is a behemoth, it seems as if greater value is placed on management and administration. Those people, in a strange way, are not difficult to recruit in the same way that front-line staff are. They are not suffering the same difficulties as front-line staff.
As the justice spokesperson for Fine Gael, I am particularly concerned about the situation healthcare workers are facing in patient-facing roles where they are at risk, assaulted and abused. I agree with measures that we can put in place to stymy that in whatever way possible. I am not sure that specific offences will do that. It is an enforcement issue rather than a law issue. It is an order issue rather than a law issue. It is about having people in the hospital or any other healthcare setting who can deal with those patients. Some people who are committing those offences do so because of difficulties they have that are beyond their control. I have sympathy for those people but we cannot allow a situation where the behaviour goes unchecked. Others are behaving in a way that is simply unacceptable and has no legitimate excuse. In either case, the reality is that our front-line healthcare workers are not properly protected or insulated from the dangers that come with being front-line healthcare workers. That is an issue. As long as it remains an issue, we are going to have difficulty recruiting people and encouraging them to come and work in that environment. That is one issue. To an extent, I agree with Senator Sherlock and in another way, I see the situation slightly differently.
I also wish to raise the attractiveness or otherwise of working in the health service. A couple of issues arise. I live and work in Dublin. I have friends who are nurses, medical staff and doctors who work in hospitals in Dublin. They are paid at the same rates as their colleagues in hospitals outside Dublin but the costs for them are massively higher because of the higher cost of living, particularly the higher cost of accommodation, in Dublin. It seems to me that nothing is being done in that space. Back in the day, there would have been nursing homes, accommodation options and other ways to help people who were working in the health service to make ends meet or to facilitate them somehow. Many of the people I am talking about are not from Dublin but come to the city for work and go home when they are not at work. I see the Department and the HSE as administratively the same thing, even though I know legally they are not. Between them, could they come up with a suite of measures to make it easier for people to come to work in the health service? We need to make the health service more attractive. Leaving aside the first issue I discussed, we must address the simple economics. It is not an attractive enough job, as we know. I know people who have returned from Australia and other countries to work here but they find it difficult. It is a choice they make not because it is an attractive job but because they want to come back here for other supports and to be close to family. Perhaps they have young children they wish to raise in Ireland or whatever the case may be. It is certainly not the pay and conditions in the health service that are bringing them home from Australia, America or anywhere else. Until we address that, the reality is that we are going to have difficulty in making it attractive and bringing those people back. I have suggested two approaches. Whatever we can do in respect of either of those issues should improve the situation.
I thank everybody for their contributions. I will call the Minister in a moment, before we return to Senator Hoey, as the Labour Party proposed this motion. Among others, I have been talking about all front-line workers in recent weeks, including gardaí, nursing staff and teachers. For a number of years, we have let things drag on. I do not think there is one person, on whichever side of the House, who is not worried at the moment. We are all worried. I know it is also of concern to the Minister, who I thank for being here. I call on him to respond.
I will ask for the direction of the Acting Chairperson on the following point. A vote is being called and, unfortunately, pairs are not being granted. I want to respond comprehensively. I have a proposition but I do not know if it is in order. Senator Gavan raised a point of order that I am very happy to address now. Perhaps the House could suspend after that and I will give a comprehensive response thereafter.
Everyone would like to get the response. Is that proposition agreed? Agreed.
Senator Gavan wrote to me. He has, in quite a melodramatic fashion, practically accused me of misleading the Seanad. The Senator is referring to figures I gave at a debate in this House on 1 February, when I said the number of patients on trolleys at 8 a.m. that morning was eight. Obviously, as Minister for Health, I am quoting the HSE 8 a.m. TrolleyGAR figures. I said that the average, thanks to the extraordinary work of the team at University Hospital Limerick, had fallen to approximately six. I was pretty sure I was correct. I have just checked, unlike Senator Gavan, who clearly did not check anything before making any of the accusations he made.
Yes, I did.
Let the Minister respond.
If the Senator had bothered checking what I was able to check on my phone while sitting here, he would have been able to see publicly available information that is published on a daily basis by the HSE. Let me repeat that the HSE 8 a.m. TrolleyGAR figure for 1 February was eight and the average for week five of this year was six. Those are the official figures from the HSE.
Those figures are wrong.
They are not wrong.
They are 100% wrong.
As you may or may not know-----
Please speak through the Chair.
Ask the INMO.
Through the Chair-----
Ask the INMO.
Senator Gavan, I am not going to tolerate this interruption.
It is incorrect.
The Senator made an accusation. Anybody is entitled to answer, so please allow the Minister to answer. Minister, please respond.
I note the Senator has made false accusations -----
No, it is not.
----- and then when presented with verifiable facts, has chosen to simply shout down the person who is pointing him to the facts. As the Senator may or may not be aware, the HSE and the INMO publish different figures. The figures the HSE publishes are the patients on trolleys in emergency departments at 8 a.m. That is what is counted. That is what is reported. That is what I spoke to. The Senator may not accept what the HSE is saying. He may believe they are liars. He may believe that they are trying to mislead people.
I do not accept the figures.
I ask that the Minister would not -----
The figures that I have quoted are verifiable.
Sorry, Cathaoirleach-----
Minister. Sorry -----
I would ask the Senator -----
Cathaoirleach-----.
Minister, I am chairing. Sit down, Senator.
If the Senator has any interest in the truth -----
On a point of order-----
No, I will not give a point of order. Minister -----
-----he would withdraw the accusations made -----
Minister, please.
I will never withdraw that.
I would prefer if the Minister did not use the word "liar" about anybody. I would prefer if he did not use it. I do not think he should have used it but I am not allowing this debate to go any further.
A charge was made.
We will suspend as the Minister has to go and vote. He has offered to come back and give a full response to the debate with the agreement of the House.
I propose that we suspend the House until the conclusion of the division in the Dáil.
Is that agreed? Agreed.
Cuireadh an Seanad ar fionraí ar 7.51 p.m. agus cuireadh tús leis arís ar 8.14 p.m.
Sitting suspended at 7.51 p.m. and resumed at 8.14 p.m.
I thank the Senators for raising the important issue of the welfare and safety of the staff of our health service. When it comes to the safety of our staff, it is vital that this House sends out a strong and united message. For this reason the Government will not oppose the motion. Matters were raised in the motion and in the debate this evening which I do not agree with, but it is important that a strong message is sent out about our healthcare workers.
While I have no doubt whatsoever of the good intentions of the proposers of the motion, it was a missed opportunity that the motion does not condemn attacks on our healthcare workers. I will do so now. There is no excuse, ever, to attack a healthcare worker. Every day tens of thousands of health and social care workers endeavour to deliver the best possible care to thousands of patients. It is completely unacceptable - it is intolerable - that any of our fantastic staff in the healthcare world should endure any form of abuse, attack or bullying while doing their jobs. We know things can be difficult for patients and their families. They may be very sick, dealing with heart-wrenching news about diagnoses or struggling to get the care they need. Our healthcare services are getting better but many services have a way to go when it comes to rapid access. Our healthcare workers are human. They get tired, make mistakes and they too get frustrated trying to provide their patients with the best possible services, but they are totally dedicated to providing the best possible services to their patients. We are blessed in Ireland with highly trained, dedicated healthcare professionals and it is never acceptable for them to be assaulted. As I said in the Dáil earlier this month, it is particularly invidious that some of the attacks are racist in nature. Everyone is welcome in Ireland's healthcare service, regardless of race, creed or ethnicity.
Hear, hear.
In our service, more than two in every five nurses and doctors were not trained in Ireland and without them we could not provide the essential care people need. To all our healthcare workers, I say thank you for everything you do day after day for patients and their families. To all who have come here from another country, I say you are welcome, you are valued and we will stand with you to resist any form of abuse, assault or attack. I say to people who are perpetrating these attacks on our healthcare workers, you need to stop. The person you are attacking or abusing is the person you are relying on to treat you or a loved one when you or they need that care most.
Ensuring the safety of our health and social care workers is a priority, for me, the Government and for the HSE. While even one assault on our staff is too many, it is important to note in tonight's debate that the HSE has reported that incidents of assaults across the health service have reduced by more than a fifth since 2018. The HSE constantly endeavours to mitigate risks to its staff from violence and aggression. Training in respect of this - rightly called for in the motion - is in place and it is particularly welcome that the HSE is prioritising a review of policies in this regard to ensure they are fit for purpose and as effective as possible. Four teams of specialist health and safety advisers are in place to support managers and staff in respect of occupational safety and health. In addition, other supports are in place, such as the employee assistance programme and the occupational health team which provide assistance and support to any staff member who is impacted by an assault. The HSE’s national health and safety office is working to develop a violence and aggression training strategy and to roll out a work positive tool to assist staff.
Under-staffing and a crisis in recruitment were referred to in the motion and in this evening's debate. I will speak about that directly. This Government has been committed to the large-scale expansion of the health and social care workforce since the beginning of the pandemic. Today, there are 18,000 more healthcare professionals in our health service than there were when Covid-19 arrived here at the beginning of 2020. This includes 4,400 additional nurses and midwives; 3,000 more health and social care professionals; 1,800 more doctors and dentists; and many more healthcare assistants, home helps and other staff. It is simply incorrect to say that we have a recruitment and retention crisis. Can we do more? Of course we can. Are there parts of the system where things are particularly difficult? There are. I meet staff who work in emergency departments and other parts of the system who are under sustained intense pressure.
There are particular parts of the system, therefore, that we need to staff up more and to provide with more supports.
It is also important, however, to acknowledge what is happening. There are 18,000 more staff. This year will be the fourth in a row of record recruitment into the HSE. We must acknowledge this. Health and social care workforce planning is also rightly referenced in the motion. We are looking to ensure there is an appropriate pipeline of qualified healthcare professionals. We know we need to keep increasing the workforce, which is why I have said we need to double the number of college places for healthcare professionals in the coming years. As Senators will be aware, we are making inroads in this area.
Additionally, the HSE has been engaging in the programme of work to attract essential talent to meet the needs of the health service now and in future. In recent years, the HSE has worked in partnership with service areas to enhance recruitment capability and retention. Again, there is a way to go. The HSE needs to get quicker in terms of retention and hiring consultants. Improvements need to be made in the panel system, concerning health and social care professionals and others. A range of initiatives is currently available to graduates. These include the opportunity to work in and across speciality locations, professional development and mentorship programmes, additional career pathways, such as the significant increase in advanced nurse practitioner roles and advanced midwifery practitioner roles, and the introduction of an enhanced nurse contract. We are now looking at rolling out advanced practice in health and social care professionals as well.
The motion correctly refers to safe staffing and calls on the Government to implement the safe staffing framework and we are doing that. We have put significant public funding into the framework for nurse staffing and skill mixes. More than €30 million in new development and hiring funding has been allocated since 2020. An extra 470 whole-time-equivalent registered nurses and healthcare assistant positions have been created in phase 1, which is focused on general and specialist medical and surgical care settings. Some 62% of these positions have been filled and recruitment is ongoing for the remaining posts. Recruitment of a further 101 registered nurses for phase 2, focused on accident and emergency departments, is also under way. A quarter of these staff are now in post, with recruitment for the rest fully funded and under way. Phase 3 of the safe staffing framework includes three distinct care settings. Development has commenced in long-term residential care settings for older persons and will commence this year in community care settings, followed then by step-down rehabilitation settings.
Reforming our health and social care services is critical for the services we are delivering today and the care needs of the next generation. Our ambition is universal healthcare. What this means for people is that when they need healthcare, they will be able to access it quickly, it will be of consistently high quality and it will be free or affordable. This is one of the most important unfinished projects of our Republic and it is now within our grasp. A significant programme of ongoing reform is under way and is making progress. My aim is to make our health service one of the most attractive places around the world for healthcare professionals to work in. We commenced negotiations on a new contract with consultant bodies in April 2021. I expressed confidence then that we would deliver a remuneration package that would rival healthcare systems around the world, and I am glad to say that we have, by any measure, delivered such a contract. We will introduce it shortly.
The implementation of RHAs is also well under way. Transition to these population-based health services is taking place through this year. The population profiles of the six regions are being used to guide and inform the strategic workforce planning and the capital projects. The development of integrated care pathways, based on delivering the best outcomes for patients, means greater integration between care settings at national, regional and local levels. The pathways are agreed between GPs, primary community care providers, community specialist teams and hospital-based specialists who can provide better links across these care settings. These also ensure that resources are used to provide the best care for patients and that services are provided to patients more rapidly. A total of 2,400 healthcare workers have been recruited to the enhanced community care programme. This is a big change in our approach to care. It allows for more care to be delivered at or near home. Some 94 community health networks, 21 specialist teams for older people and 21 specialist teams for chronic disease management have now been established across the country.
This Government has invested more in our health service than any of its predecessors. The health budget allocation is now at an historical high of €23 billion. Almost 1,000 additional acute beds have been delivered since 2020, while we have increased our number of critical care beds by 26%. Our greatest investment is in the people who deliver care and in ensuring they can do so in a timely, safe and effective way. I again take this opportunity to recognise the remarkable work of the staff in our health service, including those who have been there for many years and those more recently recruited under the initiatives I mentioned.
My Government colleagues and I commend these staff on their dedication, professionalism and commitment to delivering health services to patients. We will continue to invest in our workforce. We will continue to grow it and we will continue to provide additional opportunities for learning and advancement in our workforce. I, this Government and the HSE take very seriously any threats to the safety of everyone working right across our health service. Many of the asks in this motion are being met, in terms of the reviews I spoke of, safe staffing levels and ongoing recruitment and retention across our healthcare services. I again thank the proposers of the motion for this opportunity to discuss what is an extremely important aspect of ensuring our healthcare staff are looked after and protected and that we continue to invest at significant levels in our workforce.
I thank the Minister very much for that comprehensive reply. I compliment Senator Hoey and her colleagues for bringing forward this important motion. I also thank all the Senators who contributed to this debate. We all fully support it. I call Senator Hoey to sum up.
I thank everyone for their contributions. This is an emotive issue. There is no way around this. It is trite to say things like "everybody loves nurses" and so on. We talk about these issues in the House all the time, but we must value our healthcare workers. I do not doubt the bona fides of the Senators reflecting on experiences in hospitals in their own areas. It is not just hospitals we are talking about, but also staff working in section 38 organisations, the voluntary hospitals, psychiatric units and residential units.
I mentioned a woman working in a residential unit who has been left many nights on her own there. We cannot have a situation where section 38 workers are left on their own in residential units. The place where this woman was working on her own is out in the country. The facility has vulnerable people she cannot get to because she has been left working on her own. I am pretty certain she is going to leave her job and the service in the next couple of weeks. This is not good enough.
Unfortunately, this is happening under the Minister's watch. We must condemn the fact that this is happening. We must condemn the fact that we have got ourselves into a situation and a state where this kind of behaviour has been deemed acceptable. I must also take issue with the Minister when he said it was incorrect to say we have a recruitment and retention crisis, when only last Friday INMO executive council agreed to ballot the union's members on industrial action. Many in the INMO, IMO, SIPTU and Fórsa would probably take umbrage with the Minister saying there is not a recruitment and retention crisis when they are saying they feel unsafe in their workplaces because there are not enough staff. I am struggling to marry these two aspects together. HE outlined enormous recruitment numbers, but are we accounting for the numbers exiting the healthcare service?
I must stand up and speak on behalf of the unions on this issue, because of what they, their members and the people who filled out our survey told us. I have pages and pages of testimony, as I am wont to do, from people who feel unsafe in their workplaces. All of them mention feeling unsafe because there are not enough staff. They are all talking to me about this. The question simply asked whether people had experienced any behaviour that made them feel unsafe in their workplace and if there was anything else they would like to add in this regard. It was not a leading question, and all of them got back to me to say they felt unsafe because there were not enough staff to be able to do anything about the situation. I, therefore, take umbrage at the Minister's description. It is something I am sure people listening would feel does not reflect their situation.
That may be a challenge for the Minister to look at, if people are saying in the service that they feel unsafe with the staffing numbers but that the Minister is saying that he has record numbers of staff coming in. Those two are still not adding up. I do not know what is happening if we have record numbers of staff coming in for four years in a row, yet I have staff, former staff and people who are currently working in many of these places coming to me saying that there are just not enough staff. This is an appalling indictment of our health service where we have a nurse attacked on a night, and the most time she can take off is to go to the bathroom, to wipe herself down, to clean and to give herself a splash of water over her face because there is simply not enough staff for her to walk off the ward. It is a terrible indictment of our health service when this happens where I have a staff member who is saying that they were attacked so badly that they do not think that they will ever go back to work again. Another section 38 worker's upper arms were so badly hurt they could not even lift up their grandchild. That is a terrible indictment. These people are saying that they want to go back to work and feel so guilty that their colleagues are being left to deal with this on their own.
The Minister has outlined some of the things that are happening and there is no question but that this is an immensely difficult period. We have come through Covid-19 and there is a lot of talk about what it is like to work in the public health service. I do not envy the Minister's position to have to try to pull people into this service but the burden is on me to stand up to say that the reality of what we are hearing on the ground is not matching what he is saying with respect to his numbers. I am not saying that the numbers are not happening; it is about the situation on the ground with the people who have spoken to us who are not feeling the benefit of these numbers and they feel it is unsafe. When we have unions who are talking about taking industrial action and going on strike; we have to listen to that seriously.
I will quickly end by thanking the people who put the their faith in the Labour Party and in us by telling us the stories. I have not even been able to read out some of the stories because some people just rang me and wanted to get something off their chest. They were difficult stories to listen to. I very much hope that when the Minister leaves, and I have listened to all of the things that is going to do, that what is very important is that we need to put together plans of action for those nurses, security workers, psychiatric nurses, porters, canteen workers and ancillary staff, which will help them this week. Plans of action and comfort needs to be given to them so that they will be able to go into a safe workplace and that the Government, the Minister, the HSE and all of those actors will work together to ensure that they have a safe workplace. We do not want to end up in a situation where we have industrial action being led by unions because of unsafe staffing levels. That is what is ultimately at the root of what we are discussing today. I hope that we do not find ourselves in that situation because it would be a very poor indictment of this Government if we have nurses and staff walking off their jobs because of unsafe safe staffing levels. We will be out on the picket line with them. I thank the Cathaoirleach Gníomhach.
Question put and agreed to.
When is it proposed to sit again?
Tomorrow at 9.30 a.m.
Cuireadh an Seanad ar athló ar 8.33 p.m. go dtí 9.30 a.m., Déardaoin, an 23 Feabhra 2023.
The Seanad adjourned at 8.33 p.m. until 9.30 a.m. on Thursday, 23 February 2023.