Dáil Éireann díospóireacht -
Tuesday, 3 Apr 2007

Vol. 635 No. 1

Nurses’ Dispute: Statements.

Minister for Health and Children (Ms Harney)

The fundamental question we have to ask ourselves, as a Parliament, a Government and a society, is what does fairness demand in this situation?

First, and more important than anything else, is what fairness demands for patients. More than 1 million patients are seen in our hospitals each year. Fairness demands that we put patients first, avoiding at all costs inconvenience, distress, disturbance and delays for patients and their families. It is up to those who are strong and healthy in Government, administration, management and trade unions to do this. Fairness demands that disputes are fully explored and settled without distress to patients. There is no point arguing in theory over what type of industrial action affects patients and their families. The test is a simple one: what do patients and their families experience? What do they say? On that basis it is clear already. I deeply regret that the current industrial action is simply not fair to patients, even before any escalation.

Fairness demands that we should take account of 300,000 other public sector workers who have agreed to a fair and collective way to address their pay concerns through benchmarking and Towards 2016. We cannot allow one dispute effectively to dishonour that agreement with them. I believe they rightly expect the Government to hold the line. Fairness demands that we take account of 1.7 million private sector workers, for many of whom pay and conditions are also set or influenced through partnership and whose taxes pay for the salaries of the public sector. These workers include nurses in the private sector. For most of these workers, pay increases amounting to 32%, as per the INO-PNA claims, are unimaginable, and, if paid to others from their taxes, are unacceptable.

Fairness demands that we take account of all taxpayers who together will pay more than €14 billion for health services and investment this year and who rightly can ask for the reasons upwards of €1 billion more would be required from them to meet the demands in this dispute. Fairness also demands that we engage reasonably with the issues raised by the two nurses' organisations in this dispute, that we make available all the industrial relations machinery of the State to address their claims and that we engage in good faith in those processes. We have done all this and we stand ready to continue to do so. In short, fairness demands that a judgment is made taking into account the needs of all groups, starting with patients, and reaching a balance between all. It is not just about fairness to nurses; it is about fairness to all.

The public will rightly want to decide whether their Government is balancing all the needs of all people in its response to this dispute. To make up their mind, the public deserve to know some of the facts. The INO-PNA lodged eight cost increasing claims in December 2005. The dispute centres on two claims for a reduction in the working week from 39 to 35 hours and a pay increase of 10.6% for more than 43,000 nurses of all grades to address a pay anomaly in the intellectual disability sector, which affects 50 staff nurses. A four-hour reduction in the working hours of nurses would take 7.7 million nursing hours out of the public health system and would represent a pay increase of 11.4% on the hourly rate for nurses. The two claims translate into a claim for a 22% pay increase, which, when combined with the 10% available under Towards 2016, amounts to a 32% increase. The four-hour reduction in working hours per week amounts to 30 more days off a year.

A total of 70% of the workforce in the health sector is contracted to work a 39-hour week and nurses account for only half of that figure. Nursing support staff such as health care assistants, attendants and porters, as well as NCHDs and ambulance personnel, also work a 39-hour week. The two nurses organisations are seeking a Dublin weighting allowance. The estimated cost of granting an allowance of €3,800 to Dublin-based nurses would be in excess of €52 million per annum. All other public servants in Dublin would seek a similar allowance. If an allowance were granted to all public servants, the annual cost would be in excess of €252 million.

The claims were heard by the Labour Court in June 2006 and a recommendation issued on 9 November 2006. The court did not recommend concession of the major claims, nor the Dublin weighting allowance, but, instead, urged the unions to reconsider their position on benchmarking so as to have their pay claims dealt with though this process. On the claim for reduced hours the Labour Court stated concession of the claim at this time would have profound consequences for both health care delivery and costs unless effective countervailing measures could be put in place. The court recommended that the parties should jointly explore the possibility of initiating an appropriate process aimed at achieving major reorganisation of working arrangements and practices within the health service generally. Health service employers have confirmed their acceptance of the Labour Court recommendation and their willingness to hold discussions on the claim for reduced working hours as recommended by the court. The national implementation body was made available to the INO and PNA to take up these issues and engaged in good faith to chart a way forward without industrial action. Unfortunately, this outcome of this process, like that of the Labour Court, was not accepted by the INO and PNA.

Public sector nurses pay amounts to €2.2 billlion. The last national agreement, Sustaining Progress, gave cumulative pay increases to nurses of 13.16%, in addition to benchmarking increases of between 8% for staff nurses and 16% for directors of nursing. Nurses' pay has increased by between 75% and 103% across grades since 1997. The basic pay of a newly-qualified staff nurses, before premium shift pay, is €31,233, which compares to the average industrial wage of €31,360 last September. The average annual salary of a nurse in 2005 was €56,000. The number of nurses in whole time equivalent terms has increased by more than 11,100 since 1997 to 36,730 whole-time equivalents or 43,000 individual nurses in the public sector alone. The number of promotional posts in nursing is almost 9,500, an increase of almost 4,000. We have created over 1,900 new clinical nurse specialist and advanced nurse practitioner posts. As a strong supporter of expanding the role of nurses, I have given approval for nurse prescribing to start.

Like most people, the Government and I value and support the profession of nursing and the work of thousands of nurses. Many people rightly say that no price or payment can be put on compassionate care by a top class nurse. No price can be put on a top class teacher or the skill of doctors, no amount can be paid for the bravery of a garda facing criminals and no price can be put on the courage of air-sea rescue staff and many other public servants. Yet we must to settle on a payment and that is why we have to use sophisticated industrial relations methods in a way that is fair to all. I want to see nursing and nurses continue to be held in high esteem by our society. No one wants to see the standing of nurses diminished in the eyes of patients. It would be a tragic mistake if an industrial relations dispute were to have that result and, unfortunately, this dispute runs the serious risk of doing just that.

So what is the way out? There is one way out, one way forward, and it is the same way that hundreds of thousands of other public service workers have taken without special preconditions. It is a way that holds no threat, no dangers, no hidden pitfalls for nurses. It is easy to take, it is available and it is not a long and arduous path. It is the benchmarking route.

Less than nine months are left in this year for the benchmarking process to be completed. In that context, can this disruption to patients and their families be worth it? Surely it cannot.

I urge all involved to reconsider. The Government remains ready to deal with all these issues in a way that is fair to patients and their families, to public servants, workers, taxpayers and the public.

Dr. Twomey

Patient safety is a very important issue at the centre of this dispute. Everything must be done to resolve the dispute as quickly as possible to protect patients in the Irish health care system. They must be our foremost concern and we must ensure nobody dies or is put at risk on our wards, increasing the anxiety of families, because we have not done our best to resolve the dispute.

Like all political parties, Fine Gael has met the INO and the PNA, both of which bodies have been vocal in the course of the dispute. Their representatives told us they did not trust the current benchmarking process and the Minister must address that lack of trust. She must make clear to the House exactly what options are available to her to resolve the dispute. Is she saying the Government will do absolutely nothing, only wait for the benchmarking process to deal with the nurses' pay issues? Is she saying it has nothing to do with her and that she will stand back while that process takes place? That will create the impression that the Minister was stringing the nurses along by asking them to go to the national implementation board, particularly in the context of the letter the Taoiseach wrote to the nurses' organisations to the effect that he would look for an imaginative solution. If she now says she was never going to do anything but was always going to leave it to the benchmarking process, what is the imaginative industrial relations solution about which the Taoiseach spoke?

The Taoiseach appeared to say today, during Leaders' Questions, that of the main concerns of the nurses, the claim for a 35-hour week seems to have been sorted out, apart from the timeframe. Am I correct that the pay anomaly seems also to have been sorted out for the nurses involved? A pay increase of 10% under partnership seems to be available now and the Minister says the 10.6% increase, to which the nurses say they are entitled, is available if they are willing to take their chances with the benchmarking process. The Minister talks about holding the line as if she were controlling the public finances, but, as well as being careful about how we spend taxpayers' money, we are also responsible for patient care so we must exhaust every possibility to resolve the dispute. The concerns I have pointed to, however, do not seem to be as insurmountable as they have been portrayed up to this point.

When we met the nurses on 9 January, two months before the Taoiseach wrote his letter to them, they stated their willingness to change their rosters and work practices to counterbalance, to some degree, the costs involved in the changes they sought. How far did the Government take that discussion? I do not have the same amount of information as the Minister but I have heard from the national implementation body that the nurses felt they had almost achieved agreement on those changes. Significant changes will take place to nursing in the next decade. Nurses will be involved in prescribing and advanced nursing practitioners will come into being. Nurses will take up duties currently performed by doctors and will delegate some responsibilities to care assistants. There seem to have been significant discussions on those changes so if everything is going in the right direction, why are nurses going on strike?

I spoke to nurses on this issue and some of what they say does not bode well, perhaps explaining why the INO takes such a hardline stance. Nurses feel unacknowledged by the HSE and the Government and undervalued as people and as professionals. They feel incredibly frustrated in their dealings with Government and the HSE, which I can understand, and there seems to be a significant lack of trust, which might have its roots in the last benchmarking process. As the Minister said, frontline staff nurses received an award under benchmarking of 8% but administrative nurses received 16%. The Government made it clear in the last round of benchmarking that it valued administration more than it valued frontline nurses, who deliver the service every day to elderly patients and people in accident and emergency units. A lack of trust has developed because nurses feel a lack of appreciation, which is a serious issue and must be addressed.

We have no idea why some received 8% and others 16% in the last benchmarking process because, in its wisdom, the Government shredded all the background material. That lack of accountability and transparency has contributed to the lack of trust. The reason for that lack of trust can also be traced to the Minister's statement on the "News at One" yesterday. She implied that the dispute contributed to the fact that some elderly patients could not be moved to the Beaumont nursing home. If she had made a simple telephone call she would have found that the Beaumont nursing home, which had closed down three years ago but had recently been redecorated, did not have medical cover for elderly patients. More important, the nurses who would look after those patients were not in dispute with the Government because the HSE is in India looking for them. Unless nurses in India are on a work to rule with their colleagues in Ireland, that was a red herring. The nurses know that and it contributes to the lack of trust they have in the Minister. The Minister is playing mind games with nurses, with patients in the middle. She should get off her hobby horse and resolve the dispute.

The HSE has taken a very active part in the spin-doctoring in which the Minister loves to partake. It is great when the TV cameras are around to show its incidents room, manned with personnel, but if one was looking for staff in an emergency one would not be able to get hold of them. The HSE owns St. Joseph's Hospital in Raheny, which had plans to build a long-term care unit for the elderly, which the HSE said would be constructed by the end of 2006. However, not even a single shovelful of dirt has been dug from the site to construct that care facility. It was galling to watch the HSE shedding crocodile tears on the television news. The Minister should stop playing such public relations exercises with patients. This issue is serious and neither she nor the HSE can simply spin their way out of it. While I was surprised the HSE has participated in this exercise, it has begun to act like an arm of the Government, which is of concern to me.

The Government should begin to take patients' concerns seriously. The Taoiseach and the Minister should negotiate. They appear to have written letters and will probably meet the nurses' organisations in the corridors of Government Buildings to whisper into their ears that all will be well and that they will do the business. However, the Government should be protecting patients and, thus far, I have seen nothing in this regard that cannot be resolved to some degree.

It is not good enough for the Minister to try to wash her hands of this business and to state that only benchmarking will solve the problem. There must be a resolution to this dispute and, if not, the Minister should make it clear that she believes the Irish Nurses Organisation, INO, to be completely wrong in this regard and to be intransigent in respect of its grievances with her. This is a very serious matter and both the Taoiseach and the Minister should make up their minds. They should tell Members exactly what the Government is doing and whether it can solve this issue on patients' behalf. The Minister should stop the nonsense of belittling nursing or putting them down in some statements. While I accept that some of the pay costs involved are enormous, this matter is negotiable.

The Minister made some interesting statements, including the fact that nurses' pay has increased by between 75% and 103% across all grades since 1997. The same is true of the Minister's pay, which also doubled during that time and is far greater than the salary of €31,000 that basic grade nurses will receive this year. The mind games should stop and this issue should be resolved. Nurses are willing to make some concessions and are willing to change their work practices. New clinical nurse specialists and advanced nurse practitioners have entered the health services and have made fantastic changes to it. While I also believe that benchmarking is the route to take, the Minister must regain the nurses' trust in regard to these negotiations. If she cannot do so, she should tell the House the reason and what is happening in this regard.

At present, many patients are suffering because of what is taking place. I am under no illusions as I have worked in the health service and I am aware of the work carried out by nurses. If one loses goodwill from nursing, patients will suffer seriously. My concern is that some nurses may either become militant or despondent. They may simply give up because they feel frustrated, undervalued and unacknowledged by the Minister and completely lack trust in the manner in which she has been treating them. The Minister should have been following these concerns as they went through the Labour Court. On meeting the INO and the Psychiatric Nurses Association, PNA, in early January, Members were made aware of a problem and the Minister would have been in the same position.

As for the national implementation body's talks with the nurses, the Government was simply dragging them through a process and stringing them on, while getting closer to a general election, to ascertain whether it could get its way on this issue. I note that when concerns arose, the Government established a commission on nursing. I am unsure whether this pertained to a different matter or whether the Government's commitments in this regard are clear. However, it is incredibly important that such games stop, for both patients and the 40,000 nurses who work in the health service. Whoever is responsible for this problem should make the decisions and if the Minister really believes she is getting no help from the Irish Nurses Organisation or the Psychiatric Nurses Association, she should state what are the problems.

I know many nurses, having worked with hundreds, if not thousands, of them during my medical career. They are serious about patient care and do not take such action lightly. I am aware their anger and frustration may lose them public goodwill and may not help their cause. Moreover, being baited by the Minister and other members of the Government will not help some of those involved to keep their cool because they have been so angry with the Government for so long.

The Minister's job is to protect patients and she should tell the House exactly what is happening. As Members are only making statements, they have no idea as to how the Minister intends to respond to them. I have no method of replying in respect of any concerns she may raise. However, I wish to be made aware of what is happening and whether this issue is solvable. My only interest is in whether this matter is capable of resolution. If not, the Minister should explain clearly to the House why she does not believe it to be so and who she believes to be responsible.

The only issue that patients and potential patients of the health service want answered today is whether this issue can be resolved and, if so, who is responsible for so doing. If nurses lack trust and do not believe in the benchmark process as it is constituted at present, what commitments can the Minister or the Taoiseach give that do not disrupt social partnership but that will bring nurses back into the process? Must the terms and conditions of benchmarking be changed? How advanced are the talks regarding those work practices and changes mentioned by the Minister? Can such negotiations be resumed and can the Minister ensure that patients do not suffer during the next two months? A general election in the offing means that matters become extremely confusing and I do not wish to see patients suffer for the next eight or nine weeks because the Minister and Taoiseach are grandstanding, or, in the Minister's phrase, holding the line. I seek a resolution.

Ms McManus

I note that in the Minister's speech, she continually repeated the word "fair". This is a verbal device used by script writers. However, it is somewhat paradoxical when one considers that the Minister's political outlook is to promote inequality. The leader of her party has made it clear that he considers inequality to be good for us all. If Members consider the Minister's approach to the health service, they will have observed a deepening of the divide, promotion of privatisation and greater provision being made for those patients who can afford to pay. Meanwhile, public facilities such as the acute hospital sector are struggling to an increasing extent to stay within their budgets. The entire concept of fairness does not come easily or appropriately to the Minister's lips.

A short time ago, I raised an issue relating to elderly people. If one cannot look after the very elderly, who literally have been robbed by the State, I am unsure how one can claim to be fair. However, the Minister has presided over a system and has promoted a privatised option in respect of paying repayments to elderly people, which simply has not been working.

A new feature has arisen in the health service, namely, a serious escalation in the nurses' dispute, which has been simmering for some time. It arises in a context of a health service that has been shamefully mismanaged by the Government. This is the Government that promised to eliminate waiting lists within two years of its re-election. It promised 200,000 medical cards and to end the severe problems that persist in accident and emergency departments. None of the aforementioned promises were kept and a point has been reached at which the Government's commitments no longer have any credibility.

This loss of confidence in the Government on the part of patients and those who care for them creates uncertainty and disaffection at a time when certainty and commitment are most needed. The Government is reaching the end of its term and, remarkably, despite a significant increase in health funding, the list of key stakeholders in the health service with whom the Minister has failed either to begin or to conclude negotiations is lengthening on a daily basis. Hospital consultants, junior hospital doctors, chiropodists, dentists, pharmacists and general practitioners have all found their contract negotiations being attenuated or ended peremptorily by the HSE and the Department of Health of Children. However, the most serious dispute is with nurses, the biggest group of health workers by far. It is disturbing that the Minister for Health and Children has displayed a certain lethargy and, at times, an ignorance about the critical problems affecting these professionals.

At the start of this year I tabled the following motion in the Joint Committee on Health and Children:

That the Joint Committee on Health and Children notes, with concern, the emerging industrial unrest between the Health Service Executive and the nursing and midwifery unions, the Irish Nurses Organisation and Psychiatric Nurses Association.

It is clear to the committee members, from representations received, that the professions hold a deep sense of grievance with regard to their hours of work and relative pay position within the health service.

Nurses and midwives are among the most flexible of public servants who provide essential care to the community on a seven day, 24-hour basis. They are an essential part of our health service.

The joint committee believes they hold substantial grievances, are prepared to engage in significant reform towards improving patient services and are seeking accommodations in line with those provided for other public servants.

On that basis, we call on the Taoiseach, Minister for Finance, Minister for Health and Children and the Health Service Executive, and its employer organisations, to engage with the INO and PNA and to take all reasonable steps towards ensuring equitable conditions apply in the health service and, therefore, avoid a potentially damaging dispute in our already challenged health service system.

The motion was supported by all members of the committee across all parties, including the Minister's. However, the Government has not done what it was asked, and we now face a deepening crisis. Every effort must continue to be made to find a resolution to this dispute. None of us is under any illusion about how difficult is that task.

There is a well thought out industrial relations structure in place which has, generally, served us well, but it is not clear that this dispute can be resolved within the current mechanism. I pay tribute to the members of the national implementation body who have spent the last few weeks trying to move towards a conclusion. It is important to recognise that this dispute is not just about money but is also about a shorter working week. Nurses have shown that they are willing to be flexible and to approach this issue in new and innovative ways.

A feature of nursing that has not been acknowledged by the Government is that nursing is continually changing. I recall a previous occasion when nurses were in dispute with a Minister. The Minister at the time, Deputy Noonan, established the Commission on Nursing, which had the brief of considering the changing role of nursing and making recommendations for the future. That commission was worthwhile and dealt with many issues. In a way, this dispute is a follow-on from concerns that might not have been addressed at that time.

There might be merit in establishing another commission on nursing to consider the changes that are being, and will be, faced by nurses in the 21st century. Deputy Twomey itemised some of them, such as the role of nurse practitioners and the issue of prescribing. A commission could consider these issues in conjunction with the forum on health, which the Minister has agreed, at long last, to establish. I regret that the forum on health, which was proposed by the Irish Congress of Trade Unions a year ago, was not taken up energetically by the Minister. If it had, we might not be in the current mess.

The health service needs nurses. It cannot provide for patients without them. The standard of care they provide is of high quality, even though the conditions in which they work can often be stressful and inadequate. It is not fair on patients or nurses to have to continue dealing with conditions the Government has failed to address. Overcrowding in hospitals, the extent of MRSA infection and the fact there is an insufficient number of step-down beds, which leads to beds not being appropriately occupied, are unfair to patients and to the staff looking after them.

Nursing and midwifery manpower is a fundamental issue for the health service. Over 11,000 Irish trained nurses have left the State since 1998 and we are increasingly dependent on nurses coming to this country from overseas to fill the gap. Approximately 8,000 have done so in the last eight years. The number of qualified nurses taking up employment in sectors other than nursing is considerable. That is not an indication that nurses have it cushy. These realities must be acknowledged when finding solutions to this dispute. I greatly regret the ill-considered and aggressive criticisms of nurses that have appeared in some media.

The Labour Party would support the argument that change can only come about through partnership. We support and promote that principle. We understand that for many nurses the idea of partnership might have a hollow ring to it but partnership for change is ultimately the only way forward. The forum for health is about developing that partnership and, indeed, repairing much of the damage caused by this Government. When a system is in constant crisis, partnership is hard to retain and people tend to work in an isolated way. That has happened more frequently. The old ways of doing things certainly have not been replaced by better and more understanding about the importance of team work as a result of the pressures within the health service being so considerable.

It is interesting to consider what the INO has been saying about issues affecting its members. This dispute is being presented as if the nurses have, out of the blue, made unrealistic and unreasonable demands and the Government is standing firm. It is not that simple and should not be dealt with so simplistically. In December 2005, shortly after the current Minister took office, the INO made a thoughtful pre-budget submission. It described what had to be done to make the health system fair. It talked about the elimination of the practice of keeping patients on trolleys for long periods in accident and emergency departments, continuous overcrowding in many acute hospitals, repeated cancellation of elective admissions, inadequate or absence of service for the mentally ill, inadequate community based services to meet the needs of those on the margins and people who live alone, and excessive workloads on frontline staff. That was the picture of the health service in December 2005.

It is now April 2007. Has the situation improved and have the problems eased? They are probably worse than ever. No amount of massaging the figures by the HSE will convince people that matters have improved significantly. In December 2005, however, the INO was itemising its issues of concern. They included the anomaly between nurses and social care workers, the issue of the 35 hour week and the Dublin weighting issue. The latter has not taken a central role in this dispute but it is clearly important. The nursing shortages are most acute in the Dublin region, where nurses simply cannot afford to buy a house or afford to live. That problem has been endemic in the system for some time. Various means have been used to meet the needs of Dublin hospitals, including bringing nurses to this country from overseas, heavy use of agency nurses and so forth. I hope the Taoiseach might live up to the reputation he built as one who was able to solve difficult industrial disputes. I am not sure if this reputation is justified, but I certainly know that the perception exists that the Taoiseach has ways of sorting out difficult problems and finding consensus. If this is so, he should be challenged to get down and start finding the consensus and the way through here.

Nobody can afford to have a situation deteriorate in the way that is now opening up to us. More than any other group of people, patients need to feel secure and know they are being cared for. There is a presumption that nurses will care for patients and nurses have shown that they are responsible in that regard. They have not gone on an all-out strike, have given a considerable amount of notice and have been making the case about these issues for years. The level of frustration and low morale have now reached a point where nurses feel completely alienated by the lack of attention given to them and feel very strongly that they have not received fair treatment. The Minister spoke about fairness, but it is all about the evidence of fairness rather than just the words used.

Mr. Gormley

I wish to share time with Deputies Ó Caoláin, McHugh, Connolly and Joe Higgins.

The Minister gave a very well-constructed and clever speech in which she highlighted patient care and fairness. The clear implication was that, by embarking on industrial action, nurses were being unfair to patients and other professions, such as teachers. I will return to that point because I am a former teacher. The Minister's speech has not helped matters. The speech was provocative and divisive. The obstructionist, rejectionist, "come on if you're hard enough" approach will only further antagonise nurses.

The nurses entered negotiations with an open mind and wanted creativity. I will quote from the Taoiseach's letter to Liam Doran, general secretary of the INO. When one reads this letter, one really believes that the Taoiseach, who is renowned for his negotiating skills, wants to resolve this. In the letter, he says:

As you know, I have always maintained that progress could be made without the need for industrial action, which, I know, would be resorted to with great reluctance by the nursing profession. The care of patients has always been such a paramount value for the nursing profession as to win them the respect and admiration of the wider public.

He goes on to say:

For my part, I will ensure, with my colleague, Mary Harney T.D., the Minister for Health and Children, that the Government representatives in this intensive process will be as open and creative as possible in achieving outcomes to the benefit of nurses and patients alike.

We know that those negotiations were embarked upon and that the INO-PNA entered into them in good faith. In respect of the problem, we are talking about a two-humped camel. We can narrow it down to two issues, namely, pay and the working week. I genuinely believe that if we could, for example, deal with the working week, the other issue would fall into place fairly rapidly. It can be resolved.

Statements have been made about the national implementation body. The problem with the statement by the national implementation body is that when it attempts to address the 35-hour week, there are so many caveats and conditions surrounding it that it is unacceptable to the INO. What the INO wants is a very clear commitment, namely, a starting date. However, there is no starting date and if there is no starting date, it will not happen in its view. This is the difficulty.

I urge the Minister to go back and look at this in a very different way. The problem is that, as the Minister is aware, this will escalate and will have to be resolved at some stage. I do not want this to escalate. I believe, like the nurses, that patient care must be uppermost in everyone's mind. I do not want to see a situation emerge where nurses are being blamed for neglect of patients because one point the Minister rightly made was that nurses enjoy a high reputation with members of the public.

I take issue with the Minister on one particular point. She says that other professions do a fantastic job. That may be so, but I speak as a former teacher when I say that while teachers do a great job, it is not the same sort of job as that done by nurses. In addition, teachers are recompensed with very good holidays. Nurses do not get the same sort of holidays and are under constant stress in an overstretched hospital system. I do not know how anybody could stay sane in our current hospital system and try to deal with a situation where one finds trolley after trolley on which patients lie in great pain.

The Minister is, in some way, responsible for this situation because she has let the hospital system deteriorate to such a degree that nurses now find themselves under pressure. I ask the Minister to try to resolve this issue as quickly as possible.

Caoimhghín Ó Caoláin

I take this opportunity to extend my support and that of Sinn Féin, as expressed at our Ard-Fheis last month, for the demand of the nurses for a 35-hour week and the resolution of outstanding pay anomalies. It is a scandal that the INO and the PNA should have to undertake a work to rule. This Government and the health service employers stand indicted that they have failed to resolve the key issues — issues that have been the subject of negotiation not for a few weeks or a few months past but for six years.

In calling the work to rule, the INO and PNA expressed their "extreme disappointment and frustration at the failure of Health Service Employers to agree, despite previous statements that openness and creativity would be applied, a date for the introduction of a 35-hour week for nurse and midwives and the elimination of a pay anomaly which sees a qualified nurse paid less than an unqualified social care worker".

The climate in which this work to rule is taking place was worsened significantly by the statement of the Minister last week in the context of the separate Cork University Maternity Hospital dispute. She accused the nurses and midwives of delaying the opening of the hospital for money. The public knows that those nurses and midwives were not motivated by greed but by concern that the new maternity hospital would be properly staffed so that mothers and babies could receive the best care. I welcome the resolution of that dispute and the opening of the new hospital as of last Saturday but what lessons have been learned by the Minister, the Department and the HSE?

Nurses and midwives are clearly not prepared to tolerate any longer the understaffing and overworking which they face as front-line workers in a hospital system that is in perpetual crisis thanks to the bad policy and bad management of this Government and of the HSE. I have no doubt this work to rule would never have arisen in a system where real reform was under way and where patients and staff knew that resources were being used in the best way to deliver care equitably and efficiently to all who need it.

The mantra of benchmarking again trundled out in the Minister's contribution this evening has been much used and abused in this dispute. The attitude of the nurses was expressed when they announced the escalation of their protest action in March. They stated then: "As each day passes, the frustration of our members nationwide increases as they hear the one line retort of "go to benchmarking" from management grades who obtained a pay increase without having to go to benchmarking. The top three advisers of the HSE and the chief executive, Professor Brendan Drumm, between them were paid €1 million in just 15 months up to January this year. What benchmarking applied in their case?

For the sake of patients, their families, nurses and midwives, this dispute needs to be settled soon and justly. That is a very important point. The Minister should intervene immediately to ensure that the dispute is resolved speedily through the granting of the shorter working week and the resolution of the outstanding pay issues. The Taoiseach must join with the Minister in that exercise to ensure that the coalition partners of Fianna Fáil and the Progressive Democrats face up to their responsibilities in the dying days of this Administration. Nurses and midwives previously took action in support of patients and demanded action to address the crisis in our hospital services. The nurses and midwives deserve our support for their just demands and I wish them success in their efforts to ensure that justice in pay and working conditions is restored to them and that we have a service of which everyone can be proud.

Mr. McHugh

I am glad to have the opportunity to speak briefly on the nurses' industrial action. The Taoiseach and the Minister for Health and Children effectively indicated that they were digging in their heels on this issue. However, such a hardline approach will achieve nothing for patients, nurses or industrial relations in general. I request the Government to adopt a more conciliatory approach to this issue.

The nurses have eight demands and movement on some of those demands would break the deadlock. The demands of a 35-hour week and a pay claim to restore parity with other health care professionals are minimalist and I urge the Government to engage with the INO and the PNA to bring about a solution. The consequences for patients in the event of a prolonged dispute would be catastrophic. Negotiations begun but consequently broke down. I urge all parties to re-engage in the interests of everybody involved and everybody who will be affected by a prolonged dispute.

Mr. Connolly

I also take this opportunity to support the nurses' demands. There are seven or eight demands, but there are only three core demands, namely, the anomaly with other grades, the 35-hour week and the 10.5% pay lag behind equivalent grades.

This has the hallmarks of becoming a very dirty dispute. Officials from the HSE stated that they had contingency plans, but I believe the contingency plans were to create chaos. On the first day of this dispute, 14 elective operations were cancelled in Cavan General Hospital, which is about one day's work. That was either due to incompetence or deliberate chaos. I believe the HSE has a plan to turn the public against the nurses. The Government will not win against the nurses, but it might if it can create enough chaos.

Most nurses now have third level qualifications after four years of training. Many of these nurses have dual qualifications and some of them even have three or four qualifications, yet they are paid less than their colleagues. Their colleagues deserve what they earn, such as house parents who often earn 10% more than nurses, but nurses' salary should at least match that. When nurses are asked to move from the hospital into the community where they are needed, those nurses have to pay their own bills. They suffer a 20% loss in income by moving into a community setting because part of their wage is made up from night duty, weekend duty and so on. They must also pay their bills and energy costs, which are increasing all the time. These nurses are expected to lead the service. The Government must sit down with nurses and get involved.

Nurses are acting in very stressful situations in accident and emergency departments. The north east has 20% of the national bed count. Nurses expected to deal with this every day become demoralised because they cannot perform their task, yet the Government will not get serious and enter negotiations with them.

Mr. J. Higgins

The refusal of the Government to award nurses a decent wage increase and a reduced working week stands in absolute contrast to how this same Government facilitates extremely privileged groups to rip off the taxpayer left, right and centre. This same Government will not pay nurses for critical life-saving work, but it raised the fees of senior barristers at the planning tribunal from an already massive €1,700 per day to €2,500 per day. That has given them, at taxpayers' expense, as much money in three weeks as a critical care nurse earns in an entire year, yet the Government now proposes to take the moral ground with taxpayers' funds.

The Government allowed senior consultants rip off the health service to the amount of tens of millions of euro in the PPARS fiasco. It did not raise a finger in ten years to stop its friends, namely, speculators, developers and landlords, amass obscene riches at the expense of ordinary working people through land speculation, profiteering in housing and rack-renting. However, citizens who fall seriously ill will not want at their side a senior planning barrister nor a computer consultant, and they will certainly not want a speculator, a developer or a landlord. They will want a kind and qualified nurse, yet the Government takes a cudgel to hammer this group's demand for decent wages and a reduced working week, while allowing free rein to those for whom greed is the driving force.

I support nurses, the healers and the life savers, just as I detest parasite speculators and others who have enriched themselves enormously as a result of the policies of this Government. The Minister for Health and Children really does have a brass neck. She stated that fairness demands that we put patients first, avoiding at all costs inconvenience, distress, disturbance and delays for patients and their families. These are the problems which the Government and the HSE visit daily on hundreds of thousands of patients and their families in many accident and emergency rooms and in many hospitals throughout the country. It failed to honour a promise to deliver thousands of extra hospital beds that were drastically cut in the 1980s. It failed to fund properly the health service. The Government does not have any moral authority to lecture nurses. It should pay nurses and cut back on some of the goodies thrown to its privileged millionaire friends at the expense of the taxpayer.

Minister for Health and Children (Ms Harney)

I thank the Members who contributed to this debate. It was certainly very wide-ranging and went way beyond the issue of the dispute between the health service and the PNA and INO. Some nurses are represented by SIPTU and, as such, have signed on for the 10% pay increase through the social partnership agreement. They have put their faith in the benchmarking process. We went to extraordinary lengths to put in place what is generally regarded as a progressive and modern industrial relations machinery, comprising the Labour Relations Commission and the Labour Court. The latter has adjudicated on the eight claims and has made recommendations in respect of some of them.

In the time at my disposal, I cannot deal with all the issues Members have raised, but I will respond to some of them. The current pay claim represents a 32% pay increase for nurses, comprising 10% for the national agreement, 10.6% to deal with the anomaly and 11.4% to deal with the reduction in working hours. Members asked what the problem is in reducing hours and claimed it is not a question of pay. That is not the case. It is a question of 30 additional days off for nurses, representing 7.7 million days of nursing time lost. It is a question of a pay increase of 11.6%.

I have put the Government's position on record. If it is the case that we can reduce working hours, as some nurses' representatives have suggested, and that this can be done on a cost neutral basis through innovative change in rostering and work practices, I will be all for it. We made that position clear through the National Implementation Body. If it is the case that the same number of nurses, through changed rostering and work practices, can do in 35 hours what they currently do in 39 hours, there will not be an issue. However, I have not been shown how that can happen. Until that exercise is undertaken, we cannot begin the process of implementing a reduction in working time. I cannot say we can begin to reduce working hours from 1 January 2008 without an additional cost in terms of nurses' pay.

I said in my opening comments that the average pay for nurses in 2005 was €56,000, or some €25,000 more than the average industrial wage of €31,360. Most people accept this is reasonable and fair when compared with the salaries of many other public sector workers. I am a strong fan of paying people well and reducing the burden of tax on workers, including nurses, thus providing higher take home pay. However, I cannot accept Deputy McManus's suggestion that we could grant the Dublin weighting allowance to nurses without this having a spin-off effect for all public servants in the Dublin area, at a cost of €252 million. One cannot say it is more expensive for nurses to live in Dublin but not for gardaí, civil servants, teachers or prisoner officers. That is not acceptable.

The 10% pay increase is available over a 27 month period to all workers who sign up to the social partnership agreement. Last December, 3% of this increase was paid, and 2% falls due on 1 June. SIPTU has agreed to this and those nurses who belong to that union will receive the increase. The anomaly affects some 50 nurses. In 2003, a commitment was given to provide 50 promotional posts to deal with those nurses in that reporting situation. This was rejected by the INO and the PNA. It remains our position to seek to resolve that anomaly through benchmarking. However, the nurses' claim is that everybody should receive the 10.6% increase, not just those in that reporting situation.

Deputy Twomey asked me about trust. Almost 300,000 public servants have placed their trust in the benchmarking process. That process is concerned with benchmarking public sector pay against private sector norms. Deputy Twomey asked why directors of nursing receive more than staff nurses. The former have huge responsibilities. The director of nursing in the Mater Hospital, for example, is responsible for ensuring, through rostering and so on, that 1,000 nurses are available where and when they are required. I presume this is the reason the benchmarking exercise gave directors of nursing more than staff nurses. Such differentials arise in many other areas of the public sector. This was a matter not for me but for the benchmarking process.

I hope this issue will be resolved through dialogue and discussion. Our door remains open. Last weekend, the national implementation body met for several hours on Saturday and Sunday. Despite this effort and that of recent weeks, however, it was not possible to resolve the issues. The forum to which Deputies referred is not concerned with pay. It was suggested by the Irish Congress of Trade Unions. I was a strong fan of its establishment in view of the need to change the role of the different players in the health system. In particular, we must ensure people work together in a different way. The forum seeks to find innovative ways for health care professionals to work together at both community and hospital level. In particular, it is about empowering nurses to do more. I am an advocate for such change; it is the reason I provided for nurse prescribing.

We have 13 nursing schools, graduate entry to nursing and eight times more applications than places. In the last decade, nursing in Ireland has gone through a revolution. I want to see nurses empowered in the health care system. However, we cannot simply sign on for reduced hours unless we know the financial implications. We cannot agree to such a reduction if it means more nurses to do the same amount of work. If it can be done without additional costs, as we are told it can, we must be shown how that is so. That exercise has not been completed, however, and nobody has shown me how we can achieve a 35-hour week for nurses on a cost neutral basis. If we could be convinced on this point, there would be no difficulty between both sides.