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.