Vol. 309 No. 8
An amendment has been tabled by the Minister for Health to the motion in the names of Deputy Boland and other Deputies. To that amendment a further amendment has been tabled by Deputy Joan Burke to add after the word "Enquiry" the following:
"into the remuneration and conditions of employment of the profession".
I move:
That Dáil Éireann calls on the Government to establish a Commission of Enquiry into the remuneration and conditions of employment of the nursing profession in relation to other categories of employment in both the public and private sector, bearing in mind (1) the educational requirements on entry (2) the period and degree of training (3) the responsibility (4) the professional proficiency (5) the dedication and nature of service, required of members of that profession.
It is true to say that the Minister for Health is living dangerously with the nurses. The result of that dangerous living has not been a good relationship between the members of that profession and the Government of the day. A large measure of the fault for that must lie with the Minister because of the attitude he has adopted and the approach he has taken to the nursing profession and their representative body since he took office.
Since he became Minister, the Minister has engaged in the politics of brinkmanship with the nursing profession in the various claims they have made. His attitude can only result in forcing them more regularly into considering what they are so obviously reluctant to do, that is, to resort to militant action. If we look at the recent history of the Minister's relationship with the nursing profession, we find that, although the nurses sought equal pay and an arbitration award over a protracted period, they could get no agreement with the Department on a submission to the arbitrator. The Minister held out steadfastly and employed every delaying tactic available and, when the nursing profession made it quite clear that they had reached the limit of their patience and were no longer prepared to accept the public relations campaign engaged in by the Minister, last June, two or three days before they had threatened to take to the streets in protest, mirabile dictu, the Minister was suddenly able to agree on the basis on which they should go to arbitration.
If that is not a bad enough indication of a bad attitude and a bad relationship between the Minister and the profession, we then discover that, before the date of the annual general meeting of the INO no decision has been made on the arbitration award and understandably the nurses were upset and becoming increasingly vocal in their criticisms and complaints. Again, mirable dictu, just two days before the AGM of the INO, suddenly the Minister was able to announce that he was accepting the arbitration award. At that meeting the members decided to call for a commission of inquiry into their levels of pay and their conditions of service relative to other categories in the public and private sectors. The Minister rejected that concept out of hand in a rather condescending letter to the INO. He refused to accept that request. Once again the nurses organised and arranged a mass public protest march to this House. This party considered their case and decided it was valid and worthy of support. We also believe it has the support of the general public.
I should like to quote from the editorials in two of the daily newspapers following immediately on the AGM of the INO which seem to us to indicate that the general public, through the responsible media, were in favour of the case made for the setting up of a commission of inquiry. In an editorial in The Irish Times on 25 September reference is made to the fact that the nurses had taken the unusual and unprecedented step of allowing themselves the right to strike action. The editorial states it is highly unlikely that they will use this new industrial muscle precipitately or irresponsibly, but they have given the nation notice that they are no longer the submissive handmaidens of every Tom, Dick and Harry to exploit them, and about time too. It is also stated in the editorial there can be no doubt that the nurses' commitment to ethical and professional considerations has allowed them to be exploited by a community prepared to pay them only lip service for their devotion.
The editorial in The Irish Press of 27 September referring to wage negotiations states that whatever the final outcome of the negotiations between the nurses' representatives and the authorities, it is certainly time for a sympathetic look to be taken at improvements in training, job opportunities, duties, working conditions and wages of one of the most long-suffering, hard-working and vital professions we have. It goes on to say that the nurses are better organised now, that they are intent on improving their lot, and that they are prepared to fight for a better deal and they certainly deserve one.
That is an indication of the degree of public sympathy for the reasonable claim by the nurses for the setting up of a commission of inquiry, a commission similar to those set up for other branches of the public service, such as the commission set up by the Government for the Garda for the second time. The Minister's reply to the nurses was that he could not see that an inquiry of the nature demanded was necessary and he suggested they should continue to work for the well-being of their members through the medium of the established and well-tried procedures available. That was the Minister's letter of 31 October.
The tone of that paragraph is the tone of an academic looking down on a bunch of unreasonable school children. It runs right through his letter and it seems to me to be an extraordinary attitude for a Minister to adopt towards a responsible body. Faced with this Private Members' motion in this House tonight and tomorrow night, and with the massive public protest march scheduled for tomorrow afternoon, the Minister suddenly produced action as he did in June and before the AGM of the INO. He met the INO yesterday and, according to press reports, he told them he has changed his mind and is prepared to set up a commission of inquiry. If that is the case, it is to be welcomed. I am glad the INO were successful. I am glad our party were associated with it through the pressure we brought to bear and our support for the nurses' worthwhile proposal.
I suggest this is not the way for a Minister to do business. The Minister is changing his mind pretty frequently now. Not long ago we watched him on television saying he might decide to change his mind and go back to the people in Roscommon and tell them he did not really mean what he said some time ago. The Minister will always be remembered for the fact that during his tenure in office the nurses decided to remove from their constitution the no-strike clause which was contained in it. It is unfortunate that things should have come to such a pass that they decided upon that action.
We understand a commission of in-quiry is to be established. We expect the House will be told clearly this evening what the terms of reference of that commission will be. Nothing said so far makes us any the wiser in that regard. I deliberately read into the record the wording of our motion in which we mentioned specifically the terms of reference of the commission and the factors to be taken into account in any recommendations it might make. For reasons best known to himself the Minister has chosen to submit an amendment the effect of which will be to delete all reference to the terms of reference of the commission and the various factors we believe should be taken into account in fairness and in equity in arriving at a reasonable assessment of the status of the nursing profession and the level of pay to which they are entitled.
The Minister's amendment suggests that the House takes note of the recent decision to set up a commission of inquiry. There is no indication as to what they will investigate or recommend or as to what will be their terms of reference. In his statement to the House it is vital that the Minister set out clearly the terms of reference of the commission and that in particular he sets out that the commission will be empowered specifically and will be expected to recommend on the levels of pay and on the related conditions of service of nurses. Also, it is vital that the commission state what are those pay levels and conditions, regardless of whether they be in line with comparable rates either inside or outside the public service or inside or outside the health service.
It is very important, too, that the Minister tell the House during this debate whether he has acceded to the request of the INO that this commission be set up before the first of next month and that they be instructed to make their report within six months of that date. I trust that the Minister has decided, in keeping with his change of heart, to accede to those reasonable requests.
In stating that a commission of inquiry are being set up the Minister should say also whether it is the intention of the Government to take any action on the findings of that commission and also within what length of time after the publication of the findings the Government intend stating whether they are accepting them. I appreciate it is unusual to suggest that a Government, while appearing in good faith to set up a commission of inquiry, might not give the sort of undertaking I am requesting but I have in mind the fact that in order to salve their conscience and to vindicate their stance in Opposition, the Government did not seem to have qualms of conscience about setting up the Ó Briain Commission in relation to the Garda although a large skelp of the recommendations of that commission—as much as three-quarters—was merely shelved by the Government. We were told that the recommendations were to be noted but that no action would be taken on them. Is there a likelihood that the commission we are talking of this evening, which is being set up so reluctantly by the Minister under threat of public protest in the street, and because of this motion which amounts to a motion of censure, will be set up without there being any intention on the part of the Government to accept their findings? That is why I take the unusual step of suggesting that the Minister tell us during his contribution whether the Government intend accepting the findings of the commission and also the length of time that may elapse before the Government announce their decision.
It is important also that we distinguish between the work of this commission and the work presumably being undertaken by the working party on nurses who have been in session for three years and whom I understand are due to report their findings to the Minister in stages from the beginning of next year. We must distinguish between the areas that party are examining and the areas which the commission should examine. It would seem pointless to set up a commission who would duplicate the work being undertaken already by the working party. In such circumstances we would have a commission without much merit. That is not what the INO want. It is not what we are calling for. We are calling for a commission of inquiry specifically to investigate the pay and conditions of employment of the nurses.
Up to now the profession generally has been equated for purposes of wages and salaries structure with the clerical officer grade in the public service. Not much elaboration is required for the House to realise that that analogy was not there and did not take into account such special working conditions as the unsocial hours worked by nurses and the level of training and dedication required of members of that profession. In saying that I am not attempting in any way to denigrate clerical officers in the public service. Generally speaking these clerical officers work a 40-hour week and during the ordinary working day from Monday to Friday. Like nurses, they are required to have leaving certificate at entry but they are not required as are nurses who, very often are required to have several honours in their leaving certificate, to embark on a three-year training course. Neither are they required to work the unsocial hours on any day of the year as nurses are expected to work.
It is interesting to compare the different levels of pay, both for nurses and for clerical officers with whom they are compared for this purpose. Including the recent arbitration award, about which the Minister will undoubtedly pat himself on the back in due course, a student nurse is paid £47 per week at the commencement of her employment. This increases to £49.54 in her final year. On becoming a qualified staff nurse the weekly pay is £62.41. A clerical officer starting at leaving certificate level and without any training is paid £55 per week, increasing on an incremental scale to £86 per week. After nine years' increments a staff nurse's salary increases to £79.90 per week.
That is not a great deal for what is expected of her, for the sort of service that she is expected to give and which she gives so willingly. Neither is it good remuneration when compared with other grades in the hospital service. For example, a hospital storekeeper starts at £77 per week and this increases to £106 aften ten years while an assistant storekeeper starts at £69 per week and receives £82 per week after ten years' service. Irrespective of the good work that those other people are doing, they do not require the long and special training course that nurses must embark on. If the comparisons are rather odious, what is the position of the ward sister whose pay increases from £79.70 as a staff nurse to a maximum of £89.46? Another example is a matron who starts at £95 per week and receives £114 maximum. These figures are not good when such factors as unsocial hours are taken into account.
There are a number of strange anomalies through the nursing service which should be examined by this commission. Although nurses are supposed to be analogous to the clerical officer grade for purposes of remuneration, their working week does not include meal times whereas meal times are included in the clerical officer's 40-hour week. There is the fact that very often a nurse on duty would be expected to work broken shift hours. She might be expected to work from 8 o'clock in the morning until 2 o'clock in the afternoon, with four hours off duty, returning from 6 o'clock until 10 o'clock in the evening. In effect therefore we are talking about somebody whose entire day from 8 o'clock in the morning until 10 o'clock in the evening has been taken up in connection with her duties. No special benefit is afforded people in that position.
Nurses are upset, and rightly so, that no special allowance is given them in respect of additional qualifications. There is the extraordinary position that nurses engaged in post-graduate courses, if they leave the hospital they trained in and where they have been working in order to go to another hospital to attend specialist courses, instead of being seconded from their original hospital are assumed to be taking up employment at the level of a temporary nurse at the hospital where they are undergoing their special post-graduate training course. Consequently they are paid at the minimum of the scale on the basis that they are temporary officers, although they have the entire training of a staff-nurse and sometimes some years experience at staff-nurse level. Yet they are made revert to the minimum of the scale on the basis that they are operating only as a temporary.
Then there is the situation that has obtained for years in the nursing profession, one that cannot be allowed continue, in which there are relatively few promotional opportunities open to nurses and in which, at certain levels in the service, promotion from one grade to another can mean an actual loss in pay. For instance, somebody working as a ward sister, working on a rota basis, sometimes at night, sometimes during the day, is paid time-and-a-quarter in relation to their work at night. If that person applies for the post of night superintendent, when she would be working permanently at night, that should represent promotion. In fact, a night superintendent or anyone else working permanently at night is paid only at the rate of time-and-one-sixteenth. The person who ostensibly gets promotion loses about 10 per cent in real terms for the first year of occupancy of their supposedly higher position. That hardly sounds like equity.
There is the extraordinary situation also which would not be tolerated in many other professions, or indeed in industry in this country, in which a nurse who works on Saturdays is paid the princely sum of £1 extra, one single pound sterling, one miserable extra £1. Indeed, as I am reminded, that is £1 gross before the Minister's colleague and friend, Deputy Colley, and the Revenue Commissioners get their hands on it.
It is worth mentioning also that nurses on call—for example, a nurse working in an operating theatre and on call—is allowed from Monday to Friday inclusive only £3.24 per night and an additional £3.24 per case on the basis of being called out. If a nurse has sufficient dedication, as so many of them have, to go on and undertake special courses or obtain special qualifications in very many cases she is paid not one penny extra for the special qualifications she obtains. The most common example that can be given in that field relates to the qualification in midwifery for which there is no additional payment unless she happens to be working entirely at midwifery—in other words, unless she happens to be working in a maternity hospital.
When the Minister is replying later this evening can he cite any other profession in which people would be expected to study for additional qualifications and then, having obtained them, their employer did not pay them one additional penny? I do not know of any. Perhaps the Minister can explain and justify it, because certainly I cannot. In relation also to certain other qualifications, most of which have emerged since the special qualifications were set some years ago, nurses who had studied and now hold such special qualifications, who are working whole-time in fields allied to those special qualifications, still do not obtain any additional payment. I refer to nurses with a diploma in ear, nose and throat who, although working fulltime on ENT, do not obtain any special allowance for the fact that they hold that special diploma. Likewise nurses holding an ophthalmic diploma although working fulltime in that field do not obtain any additional payment or recognition whatsoever.
It should be mentioned also that nurse tutors—that vital area of the training of nurses—are paid at a very low level. It could well be argued that nurse tutors are of a comparable grade to people working in the other teaching areas at third level. After all, students who enter the nursing profession are required to hold their leaving certificate, often with a certain number of honours. In that regard nurse tutors are training people who have gone through second-level education; therefore they are training them de facto at third-level. Yet their salary rates bear very little relationship, if any, to that being paid to teachers in third-level colleges. In fact, nurse tutor salaries do not compare well with the level of salaries being paid to teachers at second-level. When we examine this teaching area one can see quite clearly the validity of the case I have been making about special qualifications. Any teacher who takes on an extra, special qualification is automatically allowed additional payments per year by the Department of Education in respect of that special qualification. For example, teachers in the vocational field are allowed special additional moneys if they have a university degree, if they have their H.Dip. and their Ceard Teastas. Yet there are nurses working fulltime, unsocial hours, with a dedication not apparent or readily identifiable in many other branches of the public or private sector.
It is to the detriment of this country that the same level of skill, service and dedication consistently displayed by people working in the nursing profession is no longer displayed by those working in other branches of industry and the public service. It would be a shame if the attitude of Governments, whatever Government it might happen to be, was such as to shake that dedication and sour the contribution and level of service nurses are prepared to give. As newspaper editorials have pointed out, it is time our society recognised the special role of the nurse, the special contribution she has to make, that we recognise that special role in the only way Governments have on behalf of the public: through hard cash in their pockets, through promotional opportunities, through recognition of the fact that those who wish to study and obtain additional professional qualifications be rewarded. That sort of attitude is not being displayed at present.
The Commission of Inquiry might well be asked to examine the position in which very many people in the nursing profession find themselves, especially those working in hospitals in rural areas where very many nurses are engaged on a basis which can be described only as a permanent/temporary one. They have never been made permanent and apparently there is no intention of making them permanent. The advantage of that to their employers, the Department, is that as temporary nurses they will continue to be paid at the minimum of the scale. There are all sorts of disadvantageous conditions attached to nursing, in relation to uniforms, for instance, which should be examined by a commission of inquiry.
I will refer now to a certain branch of the profession which has been in dispute with the Minister, although not consistently reported in the newspapers, during the past two months. In this matter there is apparently no likelihood of an initiative or solution. I refer to the public health nurses. They are expected to work a five-day week and are paid special allowances for services they provide at weekends. They want their conditions changed so that they would work on any five days of the week but that they would be allowed to have two continuous free days. They want recognition in relation to Saturday and Sunday work in the level of payment made to them. Except in the greater Dublin area, public health nurses have been engaging in industrial action and have refused to provide service at weekends since the beginning of October. Action has not been taken by the Department to help to bring an end to that dispute.
The terms of the Minister's amendment suggest that the House should welcome the suggested improvements in the pay, conditions and status of the nursing profession. I presume the Minister refers to the improvements since he took office, and I presume he will tell us how that extravagant and unjustifiable claim can be justified. In the last few days I have been considering what has been happening to the nursing profession in the past year. There has not been any great improvement as far as their status is concerned. I agree some additional public health nurses have been employed and that some additional nurses have been in training. There are supposed to be three additional nursing posts in the Department of Health. This has been talked about for a long time. These posts will be of benefit only when they are filled, and as far as I know these posts have not been filled and I do not see any likelihood that they will be filled in the foreseeable future.
I suppose the Minister will tell us that he sanctioned an arbitration award of 15 per cent improvement in nurses' salaries. That is not correct. In common with the rest of the public, nurses have been seeking to have the equal pay award made available to them. I suggest they are the last branch of public service employees outstanding in so far as equal pay is concerned. The 15 per cent has been awarded in the form of a flat payment of £308 to each nurse to make up the difference in relation to the marriage gratuity, and a 5 per cent award which has been given to the analogous grade to which I referred earlier, the clerical officers. That means 15 per cent to junior nurses in training—indeed it is a little higher than 15 per cent—but for the senior nurses it means less than 15 per cent.
This has not improved the position of nurses, as the amendment of the Minister appears to indicate. It has merely belatedly removed the discrimination between men and women in the profession. I emphasise that it is very belated because the nurses are the last branch of the public service to have received equal treatment. The 5 per cent has been given to stop them falling further behind the clerical officer grade. They should not be tied to a grade who work from 9 a.m. to 5 p.m., Monday to Friday, a 40-hour week, including meal times. The special status of nurses should be taken into account. Their educational requirements, the amount of training they have to do, the special skills they must possess and their unsocial hours, should all be taken into account in computing a wage which would be realistic from the point of view of 1980's society.
For too long nurses were prepared to serve the general public because they believed they had a vocation to give themselves unstintingly without just reward. One change has come about in our society: people have been insisting on obtaining a just reward in return for their services, and I do not believe there is any branch of the public service with whom the general public would have more sympathy than the nurses, or any branch of the public service who would receive more support from the public.
It is deplorable that nurses should have been driven at their annual meeting to contemplate strike action. It is pathetic that nurses should have been driven to march en masse on this House tomorrow, and it is a sorry state of affairs that this party should have to continue with this motion despite the fact that the Minister has announced that he is to set up a commission of inquiry. We are reluctant to accept that the Minister's proposed commission of inquiry will be on the same basis as the terms outlined in our motion. Our reluctance has been reinforced by the wording of the Minister's amendment, the effect of which is to strike from the record the terms of reference suggested in relation to the remuneration and conditions of employment of nurses vis-à-vis other branches of the public and private sectors. The commission should be asked to examine levels of pay along the lines of our motion, and I cannot understand why the Minister, if acting in good faith, should table an amendment to strike from the record our suggested terms of reference unless it is his intention to appoint a commission which may not produce the kind of recommendations which the nurses expect and which we endorse.
It is up to the Minister to say whether he is prepared to do the big thing and agree to the terms of reference outlined in our motion and asked for by the INO. It is incumbent on me to say that the general attitude of the Minister to the nursing profession has not endeared him to its members. Many of them do not believe that the Minister is acting in good faith because of the way he handled the demands for a commission, because of his steadfast refusal to agree to a commission until he backed down at the last moment when faced with a public protest and with this motion in the House. It is indicative of the amount of faith the nurses have in the Minister that although the announcement of a commission was made last night they will still arrive at the gates of this House tomorrow afternoon. When they do, this party will be with them.
I move amendment No. 1:
To delete all words after "Dáil Éireann" and substitute the following:
"approves the measures taken by the Government to date to improve the pay, conditions and status of the nursing profession and welcomes the recent decision to establish a Commission of Inquiry".
Tomorrow afternoon will bring what perhaps is an unprecedented demonstration to the gates of Leinster House, when for the first time representatives of the general nursing profession will take to the streets to highlight their demands for improved pay and conditions. Tomorrow's demonstration and those which have occurred in Cork, Tullamore, Bundoran, Castlebar, Kilkenny and Kells, represent a watershed in the battle for proper recognition of the status of the nursing profession in Ireland.
Until now the nursing profession sought recognition by adopting a "softly, softly" approach. Quietly and patiently they endured the role of the charitable volunteer in our health services, the role of the dedicated employee whose commitment to service and to people somehow evolved into a reason for tolerating inferior educational programmes, few opportunities for career advancement, poor working conditions and grossly inequitable salaries. As a doctor who has worked for a number of years in hospitals I have seen the nurses' dedication to duty and their commitment to people; but I fear that dedication and commitment has been exploited because the Department of Health have become accustomed to the provision, as far as nursing is concerned, of patient care on the cheap. That is exactly what the nurses have been providing. No longer are they willing to have their vocation used as a convenient means of perpetuating poor conditions of employment. Rather late in the day they realise that they have been downtrodden and treated very shabbily by successive Governments. They are fed up with the Florence Nightingale charade where demands for decent pay and working conditions and a real say in patient care have been seen as unseemly or unproper demands coming from a profession founded on dedicated and ideal service. The point should be made that the ultimate beneficiaries of these demands will not be solely the 14,000 nurses providing the general and psychiatric care: there will also be the patients themselves. Much will be achieved by improving pay and conditions of nurses. They will not be the only people to benefit when we politicians finally grasp the nettle and deal with their demands.
Nurses perhaps more than anyone else have been in the forefront in highlighting conditions under which patients have been cared for in hospitals. They have condemned chronic overcrowding, lack of facilities and general disregard for the physiological and psychological needs of patients in hospital. A few days ago I saw where nurses in Newcastle psychiatric hospital exposed the miserable failure of the health board and local management to provide proper care for patients. In highlighting this I felt they were performing a very important public duty. This is just another recent example of nurses championing the rights of patients. Many of the demands we are discussing this evening are linked to the quality of patient care.
The motion in the name of the Fine Gael Party and the Minister's decision to grant the special inquiry into pay and conditions gives us an opportunity to discuss the outline of the new deal for the Irish nurses which will also benefit patient care.
The special inquiry which the Minister has agreed to is sadly needed, given the historical lag in pay and conditions which has existed between the nursing profession and the other public services. I think there are two reasons for this lag. First, nursing has primarily been a woman's profession and, whatever about equal pay and increased opportunities for women, we have been very slow to change the stereotyped and discriminatory notion that a woman's profession is automatically linked to a lower rate of pay. That is the mentality that still lies behind the low pay structure for nurses. It is a mentality we must continue to fight and overcome. The second reason is that there are so many applicants for nursing training each year. It is a classic case of low wages in the case of readily available labour which is also a notion we must resist in our society now. A better idea of what consideration should lie behind nurses' pay can be found in a resolution on nurses' remuneration passed by the International Labour Organisation, of which Ireland is a member, which says:
Remuneration for nursing personnel should be fixed at levels commensurate with their socio-economic needs, their qualifications, their responsibilities, their duties and experience. It should also take into account the constraints and hazards inherent in the profession.
A brief look at the pay structure of the nursing profession compared with that in the public and private sectors will be sufficient to demonstrate that nurses' pay in Ireland in no way meets the criteria set down by the International Labour Organisation. One can compare the starting pay for a student nurse with leaving certificate at £47.18 with that of somebody joining the Army at 17½ or 18—I have just seen the advertisement on television—at £58.50. I think the Minister will agree there is a great disparity.
As a student nurse she is not wholly a student; she is employed in very important work. Much of the work undertaken by student nurses is not commensurate with the particular type of duties she has decided to undertake. Much of it infringes on her actual training and educational work. This must be accepted because I have seen it too often and for too long in hospitals, nurses expected to do work not in keeping with their training or obligations, and I have often felt it should not have been tolerated.
They must pay for their maintenance out of £47.18. The Minister will agree that is absolutely unrealistic especially when compared with other employments in the health service and the public service. Even in the case of the nurse with many years experience, pay has lagged far behind that in other forms of employment in the public service. There is definitely a case of injustice against the nursing profession. Anything we could do, other than setting up a special commission of inquiry to examine pay and related conditions, would be futile.
The special inquiry must not resemble the committee set up in 1975. In August of that year the Department set up a working party on the whole range of issues involved in nursing and, as far as I can understand, its final report is expected some time in 1979. It would be wrong if this evening we were to allow any ambiguity in the terms of reference of this commission of inquiry into nurses' pay and related conditions. I should like the Minister to lay down clearly and explicitly exactly what the commission of inquiry will do because I have great fears about the Department of Health and their commissions of inquiry. I often feel these are delaying and stalling tactics by the Department to leave the matter in abeyance and that in fact they are used as a political ploy by Governments—I do not blame any one Government—to put the matter on the shelf. The committee set up four years ago was a scandal which we must not allow to continue when it can take so long to consider such basic issues.
Having made the right decision about a special inquiry I hope the Minister will set the deadline at six months. I should like to know exactly what will happen when the report of the commission is made known because we have had a few commissions of inquiry—the Conroy Commission on the Garda and the Devlin one—and I often feel such commissions involve no financial commitments and are a useful ploy of Government. When the report of this commission is published, can we have an indication from the Minister as to when its recommendations if accepted will be implemented? As I see it they will not be implemented in the 1979 budget year. If the report is made in June 1979 at the latest the nurses cannot expect implementation of its recommendations before 1980, because they are not being provided for in the budget. How does the Minister feel about this very important aspect?
The Minister has changed his mind; he deserves credit for that. Changing one's mind is difficult in politics. The question of pay and conditions for nurses did not suddenly drop down from the sky in 1978 and it would be politically dishonest to imply that it did. The problems have existed over a long period and a number of Governments were involved, but this does not excuse the present Government from their responsibility to act. We should not allow the issues to become clouded by a political slagging match over who did what and when, or who got what Government to do such and such. The problem is not new but we should approach it realistically. Nurses have had a raw deal over the years. We should debate the issues this evening and put forward useful, constructive suggestions as to how they might be best confronted. It would be wrong simply to look upon this matter as certain increases that would be required. The only thing to do in a situation like this is to wipe the slate clean.
We should evaluate a nurse in terms of education and training, of the hours she works and the abnormal work she is called upon to do. There is a great barrier between nurses and doctors in conditions and pay, and there is very little in the degree of responsibility between a nurse and a doctor. The other night I was examining what the consultants are seeking in the new common contracts, and there is talk about £27 an hour for consultants. In regard to patient care it is ironic that we can talk about such figures and yet treat nurses so shabbily in terms of rates of pay. Compared with even ten years ago, nurses nowadays have very grave responsibility in the care of patients. In hospitals they are involved in very highly technological work in cardiac units where their responsibility would be perhaps greater than that of a doctor who can just look in casually and issue directions which a nurse must carry out. She has responsibility over life and death. It is ludicrous that an unskilled labourer can get more pay than a nurse. Every one of us may be involved in this question of patient care, and only when we are at the receiving end of it do we realise how important the nurse is and how responsible is her position in the health service. Nurses were very silent on the question of responsibility in the health service. The injection work they do nowadays is highly complex and responsible and fraught with great danger. The nurse is dealing in a highly technological world of medicine nowadays, and we have not made any attempt to assess her value in the health service.
For instance, we have disregarded the nursing profession in the question of the health boards. Doctors have obtained for themselves a very important place on the health boards far out of proportion to their numerical strength, and the nurses, who are four times as numerous, have not won their rightful place in the operation of the health service, especially with regard to membership of the health boards. They were treated very shabbily. I have often criticised the medical authorities for allowing this and for their silence in the face of this injustice to nurses who are their colleagues in the health service. They did not do enough to support the demands of nurses.
We have an obligation here tonight and we should all agree on this. I would appreciate if the Minister would spell out exactly what he wants done to satisfy this profession. It would be a tragedy and a disaster if the nurses were forced to take strike action, and we all know the consequences of such strike action. We should not become involved in political wrangling over who is responsible. The Minister should accept the fact that one political party have decided they can do this. We will get a lot of work done in Government if we have a strong opposition pressing for this through motions in Private Members' time. It would benefit the Government and the country to have an active opposition to do this.
The Minister should accept the motion from the Opposition without trying either to distort it or to ensure that the Opposition do not get credit for Private Members' motions such as this. Such an attitude in politics would be wrong and regressive. I would like the Minister to admit that nurses have had a raw deal, that they have not been compensated as they should be, that they do not get the hours, conditions and terms of employment that they should, and that he will see to it that they get them. He should spell out specifically the terms of the motion and he should see to it that the Commission of Inquiry carry out exactly what we as legislators want for the nurses. The Minister will be a big man and a statesman if he will stand up and say "Yes I will get the full terms of this commission of inquiry spelled out in detail."
Before Deputy Brady comes in, may the Chair throw out a suggestion? It cannot enforce anything on this. There are three speakers whom I am anxious to call. Deputy G. Brady would be the next, then Deputy Mrs. Burke to move her amendment and Deputy Blaney. Would they be satisfied with about 20 minutes each? That would bring in the Minister tomorrow night and Deputy Boland to reply. This matter is covered by rule and I cannot change it. Are the three speakers agreeable?
Other Deputies may want to speak. I do.
It is the first time the Independent Deputy has offered in a motion of this kind and I want to bring him in. If Deputy Brady, Deputy Blaney and Deputy Mrs. Burke are agreeable to 20 minutes——
Fifteen minutes would be sufficient for me.
I would be agreeable.
That would leave five minutes. Deputy Blaney never confined himself to 15 minutes in his life.
If there are five minutes left we will give them to Deputy Desmond.
We are wondering who are leading on the other end, without privilege or precedent.
If I get agreement from Deputy Brady and Deputy Blaney that they will speak for 15 minutes each——
Twenty minutes.
Sorry, 20 minutes each. Deputy Mrs. Burke will have her time. Is that agreeable to the two?
Yes.
Yes.
There is no argument whatsoever about the value of the nursing community. The dedication of their long and very often unsocial hours of service and their loyalty to patients are undisputed. Having listened to the previous two speakers, what saddens me is a definite attempt to make a political football out of this issue. I resist this very strongly from the word go. We have a Minister for Health who has a firm commitment to every aspect of the medical profession. If one examines the record of his involvement in every sphere since he took office one finds the record speaks for itself.
Full well we all know and recognise that nurses are not clock watchers. Of their own choice they provide a full and thorough service to the community. They are a link, if one may put it that way, between the patient and the doctor. And what a very valuable link that is.
Now the Minister is well aware that if there is a disruption in that role, any break in that link, the medical service will immediately start to disintegrate or crumble. It has not started to crumble because the Minister is very quick to receive deputations or representations on any aspect of the medical services.
The Minister has always had excellent relations with the nursing profession. Long may that continue. Less than two months ago the telegram arrived from Bundoran and the Minister has now agreed to this commission of inquiry. It would not serve any useful purpose to narrow the inquiry under the five headings set out in the motion. When one considers all the ramifications and all the issues involved it becomes abundantly clear they could not possibly be tabulated under just five headings.
Through my family I have been associated with various aspects of the medical profession. I am well aware of the grievances nurses have, in many cases justifiable grievances of which the Minister also is aware. In June last there was an award of a 15 per cent increase to nurses. One Deputy put the case in regard to that 15 per cent award incorrectly. Roughly half was paid in June, approximately 3½ per cent more will be paid in January and another 3½ per cent in June next. By next June, therefore, the maximum salary of a staff nurse will be of the order of £4,400. In addition, there will be approximately another 12 or 13 per cent earned for double time, unsocial hours of working, and so on. This will represent a further £600 or so.
I do not believe that is enough. Nobody believes it is enough. What can be done about it? Throwing out figures for the sake of making an emotive and sensational case will not get anyone anywhere. The nursing profession, which has been engaged in negotiations over the years, will see the falsity of that approach. What the profession really wants is a direct say in the destiny of its own career and the formulation of standards and conditions governing the profession. In other words, nurses want to know where they are going. They want active participation in the higher echelons of power within the Department of Health. This has already been granted to the profession. Within a few weeks positions will be advertised inviting nurses to participate actively in the Department of Health so that they will know exactly where their profession is heading. This is of paramount importance. Lack of active vocal participation has been a bone of contention for many years and I am delighted the aim of the profession will be realised in the very near future.
Incidentally, I cannot let this opportunity pass without referring to the scheduled march tomorrow. I do not see it as a protest march. I see it as a march organised as part of a general information campaign and every Member of the Dáil should make himself or herself available to the members of the nursing profession because we all have to be educated about their needs, their grievances and so on.
Tomorrow night the Minister will meet the representatives of the profession. There is no disinclination on the part of the Minister to meet militant marchers. He is totally aware of the situation and wholly sympathetic towards the profession. There is just no point in trying to put over the argument that the Minister is standing aloof. He is highly sensitive to what is going on in negotiations.
One speaker referred to the working party set up by the previous Government in 1975. This working party seems to be very slow in producing any findings. The Minister and his Department have repeatedly encouraged this working party to come forward with their findings as quickly as possible.
Naturally there are areas of contention as there are areas of contention in any profession. There is the question of overcrowding in hospitals. There is the demand for recognition of post-graduate courses. The Minister is considering the question of awards for extra diplomas in post-graduate training.
This debate is not just about conditions and pay. It is about everything relating to the well-being of the nursing profession. It is not concerned specifically, in my opinion, with just one or two aspects of the profession. As we all know, there is conciliation and arbitration machinery available for the purpose of negotiating salaries, hours of work and so on. Last June a measure of agreement was reached on the 15 per cent increase to which I referred earlier. But there are grievances apart from salary and the Minister is very anxious to discuss these grievances with the representatives of the nursing profession.
For my part, I am totally in favour of upgrading the profession. The role played by the nurse has increased over the past number of years. Like all professions that of the nurse is evolving all the time. It is within the Department of Health the real decision-making takes place and when the profession has got proper representation within the Department that will be a major step forward in improving the lot of the profession.
Deputy O'Connell referred to participation on health boards. I think that would be somewhat removed from the actual decision-making. I believe it is much more important that members of the profession should actually work within the Department because there they can relate in a much better way to the profession as a whole.
The Deputy is at cross-purposes with the Minister's thinking. The Minister wants the health boards to take the decisions.
Deputy O'Connell can have his interpretation. I have a different one. I do not agree with this approach of using such a serious issue like a political football around the House.
About 16,000 general nurses and 6,000 psychiatric nurses are employed in the health services. They work an average of 40 hours per week, but they have appalling extra night duty, extra work on bank holidays and work coming up to Christmas. Apart from the difficulties of their work nurses derive tremendous satisfaction from their duty or their vocation. We must have a respect for their dedication. Tomorrow evening the Minister will spell out clearly his future intentions in relation to the evolution and development of the nursing profession. Expressing fears within the terms of this motion is meaningless. The nursing profession is much wider than just these few points.
The Minister should give consideration to the question of a reward for service, for so many years work and so on. There should also be a reward for post-graduate education. I know these issues are being actively examined at the moment and I feel the Minister will refer to them tomorrow night.
In relation to salary structures, Deputy Boland spoke about hard cash which is very important. I spoke to nurses recently who said that we hold our own when making a comparison with the nursing profession in England. The salary structures here are on a par or are even greater than in England. For many years due to the non-availability of work but mainly due to the salary structure Irish nurses were forced to go to England. The situation has changed and I welcome that change. I would be glad if nurses were paid more, but their salaries must be realistically negotiated. We cannot give out large sums of money which cannot be substantiated through any health budget. That would be mischievous and misleading. It might be the popular thing to say "pay nurses £10,000 or £12,000 a year," but it is just not possible. The Minister will not adopt that approach but will constantly monitor the nursing profession, will keep in touch with their requirements and will have a sympathetic attitude to their working conditions.
Perhaps some of the problem arose in the early years because the nursing profession evolved slowly and nurses were prepared to work appallingly long hours for little pay.
The Deputy has three minutes left.
Such was the social order of the day, but now times have changed. The Minister wishes to encourage negotiations to take place in relation to upgrading the profession and making sure that the nurses get a fair deal. I will be batting for them as I am sure will many Members of this House, but it is by a critical examination founded on fact that their case must be heard.
The 15 minutes is gone.
The Chair said I had three minutes left.
We agreed on 20 minutes eventually, Deputy. We will give Deputy Blaney 20 minutes as well, 10 tonight and 10 tomorrow.
It was 15 minutes each way.
We agreed on 20 minutes, eventually.
Sorry, I misunderstood the whole thing.
I will finish in one minute. The amendment should have the support of the House because it is very much more far-reaching and it will enable us to lobby the Minister from every possible angle rather than confine him to a narrow field as the motion does.
I join with Deputy O'Connell in congratulating the Minister. Do not misunderstand me when I say that; I do not congratulate him for changing his mind because he did not change his mind. The Minister succeeded in the last few weeks in changing the minds of his colleagues in Government so that he could be in a position to put down his amendment and to announce yesterday at his most recent meeting with the Nurses Organisation, that a committee of inquiry or a commission was being set up. What I dislike about commissions is that—and as a member of a government for many years this has been my experience, as I am sure it has been the experience of other Members—if one wants to do nothing about something, one sets up a commission. In the library in this House there is a large bookcase full of commission reports; nobody knows what is in them, and certainly they have never been acted upon. I advised the nurses in my constituency, because of my abhorrence of commissions, that they had made a mistake in looking for a commission.
The Minister did not change his mind, the Minister wanted to do something about the situation in which nurses now find themselves. Over generations no charter has ever been set out for the nursing profession. The profession is manned by people with a vocation who were perhaps educated to the view that it was wrong in their profession, important as it is, to ever contemplate industrial action such as has been used and abused by many others in our community to feather their own nests. It may be regarded as an advance that the nursing organisation in recent months decided to delete the "no strike" clause from their organisation articles. In another way it is a tragedy that it had to come to the point where the "no strike" clause had to be removed. Without any question the organisation of nurses over the years has been anything but methodical or professional. It is only now that they, like some other bodies who were getting nowhere in the past with those they negotiated with because they did not have the clout, have the professional approach and have got for themselves a professional secretariat. I hope that the secretary is the driving force behind correlating their demands, bringing them to a head and getting something done about them.
The pay structures are well known and can be readily ascertained but some of the highlights mentioned by Deputy Boland are worth thinking about. The pay of a nurse in the first year after she qualifies is equal to that of a trainee psychiatric nurse. It is also true that health board clerical staff are on the same scale or, to put it another way, fully trained nurses are on the same scale as clerical staff. It is also true that the incremental movement of nurses' salaries is not what it should be and ranges broadly from £57 to £75 per week. That is as far as it can go. When a nurse moves to a sister's post the recognition is that on appointment a sister starts at the maximum of a staff nurses' pay. It is unusual for a nurse to reach sister status without first having reached, and exceeded, staff nurse pay.
The whole system in regard to pay in the immediate vicinity of the trained nurse in her early years, and at the top of the scale, and that of the sisters in charge does not recognise their responsibilities or experience gained over the years in the form of pay. There was no noise when the doctors got a 25 per cent increase and I saw a headline in a newspaper last week to the effect that they had refused £730 per week. There was mention tonight that they were looking for £27 per hour.
Those figures are a bit erratic.
And so is the Minister's attitude to the nurses.
Maybe they are but one thing which is not contained in any of those figures is what they earn outside their salaries and that is far greater, in the case of any worthwhile consultant, than what they would receive if they got £27 per hour. Even if the figures I quoted are too high there is enough being made on the side by them to far exceed my figures.
Can anybody say with sincerity, or with any hope of being believed, that a doctor is worth 12 nurses? That is the evaluation we have at present. In fact, if the truth was known the more successful doctors at the top of their scale are getting more than any 12 nurses. We also have a bad situation in relation to holidays. Nurses receive 23 working days holidays, plus days in lieu of bank holidays but clerical officers in health boards receive half-days and Church holy days also. They are nearly as good as the continentals. It is probable that we are taking after the EEC in this regard but if we are we should not forget the nurses and give them the half-days and church holy days in addition to what they have. We have heard about a 40-hour week for them but that is a 40-hour week plus the half-hours they are allowed for meals, where they are allowed any time for meals. It should be remembered that night nursing staff do not have any time allowed for meals but on the psychiatric nursing side time is allowed for meals and the night staff have their meals supplied free.
I am not advocating that we take that concession from the psychiatric night nursing staff but what I have indicated makes it clear that psychiatric nurses, much fewer in number but far more important where the clout and organisation are concerned, have won these things for themselves while the general nursing service have remained behind. We have heard talk about the responsibility that nurses carry and comparisons between that responsibility and that of doctors. Unlike the other speakers I cannot speak from experience in the medical profession but it is well known that nurses carry a responsibility equal to and in most cases far exceeding that of the medical staff whom they serve. If it was not for the nursing staff being exploited in many cases by the doctors—I say that deliberately—those doctors would not be as successful financially or otherwise as they are at present.
I also understand that the minimum qualification for going for nursing training here is not intermediate certificate standard, something which I did not realise until recently and that not only is it not intermediate certificate but leaving certificate is not sufficient unless certain subjects are passed to a certain degree. Only a small quota of those offering and seeking to get training are taken in. A lot of those unsuccessful applicants go to England to get trained and, fortunately, a lot of them return here and we get the benefit of the training they got in that country. It is totally wrong to talk about the regulation which indicates that the entrance point, educationally speaking, is intermediate certificate. Some leaving certificate subjects are compulsory, particularly maths. The nurses, literally and methaphorically, carry the can as far as the operation of our hospital service is concerned and nobody can deny that although some on whom it may reflect may attempt to do so.
