Ceisteanna ó Cheannairí - Leaders' Questions

Thousands of patients are being impacted as we speak because of the nurses strike. In passing, I welcome the care that is continuing to be given to cancer patients and to patients on dialysis, and that an agreement was reached with the nursing organisation. However, 25,000 appointments have been cancelled and there is a lot of anxiety out there among patients, people with chronic illness and people awaiting elective surgery in regard to what will happen in the coming weeks.

As the Taoiseach knows, this strike will be followed by more intensive action, with consecutive days of strike action throughout February. It is my view there has been no proactive engagement from Government in regard to this dispute with the nursing representatives. The belated, 11th hour activity that we witnessed in the last number of days was far too little and far too late. The sense from officialdom was, "We are going to let this strike happen today and then see what happens after that." I do not think any genuine attempt was made to engage with a view to preventing today's strike.

The Government, in my view, is also in denial about the recruitment and retention issues within the health service, specifically in nursing. Agency nursing is costing €1.4 million a week. We are haemorrhaging nurses from our colleges to the United Kingdom and further afield. A young student was on Today with Sean O'Rourke this morning saying he will be offered six months accommodation in London and that he has three job offers, which is fairly typical. The UK hospitals come over to all of our college campuses on a regular basis. There will always be toing and froing, and I get that, but the imbalance today is extraordinary. We are talking about 80% to 90% of final year students not staying in the Irish system and going overseas - those are the estimates being made, so it is a serious issue. Meanwhile, we are spending hundreds of thousands on trying to recruit from non-EU countries to fill the gaps in our service. There is an imbalance that reveals something is unattractive to those who are qualifying as nurses which means they do not stay in Ireland. I have no doubt about this. Morale is low. Nurses are working in a very high-pressure environment and they are very worried about the quality of the care they are giving because of the shortage of staff, high acuity levels and all of that.

Yesterday, the Taoiseach said he wants to resolve this, that these disputes do ultimately get resolved and that Government is part of the industrial relations machinery. Can he indicate what initiative he plans to take to get this issue resolved and to prevent the anxiety many patients undoubtedly feel? Does he accept there is an excessive level of haemorrhaging of nurses from our colleges to overseas locations and what does the Government intend to do about that?

I thank the Deputy for raising this important matter. I am, of course, as is the Government, very aware that a strike by nurses and midwives belonging to the Irish Nurses and Midwives Organisation is taking place today across the country. I profoundly regret and am sorry for the disruption and inconvenience that has been caused to patients. Appointments and operations are often cancelled for one reason or another but for 2,000 operations and 12,000 appointments to be cancelled on one day is without precedent. We will do all we can in the weeks ahead to catch up on the lost work, just as we did when days of work were lost last year on account of the storms and bad weather. I am confident we can catch up on those lost appointments and lost operations over the spring period.

I want to recognise the fact nurses are providing cover in emergency departments, cancer care, maternity units and some other essential areas as well. I have no doubt, nor does anyone in the Government have any doubt, about the strength of feeling on the part of nurses and midwives about their pay and conditions. We have no doubt about their resolve and their willingness to strike again. I have no doubt the public is strongly behind them. We want to resolve this dispute but I believe it can only be resolved within particular parameters, which I outlined yesterday. Any solution has to be affordable to the taxpayer, has to be fair to other public servants and has to be fair and beneficial to patients as well. We are available to engage, as is the normal process, under the auspices of the Workplace Relations Commission or the Labour Court to resolve it.

What do I mean by being affordable to the taxpayer? As the Deputy knows, we ran a small budget surplus last year and hope to run a small budget surplus this year, but that is far from guaranteed, given the uncertainty around Brexit. We are not in a position to borrow hundreds of millions of euro to fund pay increases. I can justify borrowing hundreds of millions of euro for emergency measures to save jobs, if it comes to that in the next couple of weeks. I can justify borrowing that money for one-off capital projects that will be with us for 40 or 50 years, but I think borrowing money and funding pay increases with borrowed money is bad policy. It is the kind of thing that leads to pay cuts in a few years time and I never want us to get back into that position again.

When I say it has to be fair to all public servants, we need to bear in mind we have a pay deal with all public servants and there are also other claims being made that have to be examined. If we do a special deal with one group, it will not be possible to do a special deal with all groups, so any solution has to be done under the umbrella of the agreement and with the involvement of the Irish Congress of Trade Unions.

We also need to be fair to patients. Even in one of the richest countries in the world, and we are one of the richest countries in the world, health budgets are limited. I do not want to be put in a position where we have to divert money that is earmarked for new medicines, new technologies or new treatments to pay increases - I do not think that would be right. We also need the co-operation of unions in making the kind of reforms to the health service that we want to make.

There was no limit to the budget for the children's hospital. It is wrong to try to pit against nurses the idea that if we do a deal with nursing, or if this issue gets resolved, it will somehow be at the expense of medicines and patients, and so on. The Taoiseach gave a very impressive, detached commentary and a series of observations at the beginning of his response, full of empathy and understanding of how committed the nurses are to getting this issue resolved. However, he then went on in the latter part to give every single reason why he does not think this can be resolved or that he is in a position to resolve it. I got no sense of any initiative he is about to take.

Nobody is asking him to borrow money. He is the person who, without any provocation, said he had €3 billion over the next three to four years for income tax cuts - out of the blue, he said he could produce €3 billion just like that. He can promise what he likes to those where he deems it to be in his interest but for everybody else and when it comes to climate change or the health service, different rules apply.

Thank you, Deputy.

Brexit was never invoked at his Ard-Fheis last autumn. My point is that the Taoiseach said yesterday that this will be resolved and that all disputes end up being resolved. There are mechanisms available. We had a nursing commission in the past which dramatically transformed nursing relative to the prior position.

The time is up.

There are proposals around various pay mechanisms or increments that could be deployed to help bring this to a resolution but I get no sense there is any proactivity in that regard. The Taoiseach said yesterday the Government was a party to the industrial bodies and that this would be resolved, but I get no sense of how the Taoiseach intends to set in motion the resolution process for the dispute.

I am afraid I cannot help the Deputy with his senses. I outlined in my previous answer where I believe the parameters are for a solution to the dispute. I explained that very clearly.

In relation to tax, I have always said that any tax cuts have to be affordable. I would not borrow money to fund tax cuts and have not done so in the past two years.

The Taoiseach could use the €3 billion the Government had.

Where are we getting the €3 billion from?

Members should please allow the Taoiseach to reply.

What we propose is that if the economy continues to grow-----

The Taoiseach should not forget that nurses get up early in the morning.

What I propose if the economy continues to grow the way it has been growing in recent years, because there are more people working, people are earning more, the amount income tax we have taken has gone up by approximately €1.2 billion a year, if we can afford it, is to give about half of that back to 900,000 taxpayers.

The Taoiseach did not qualify that.

The vast majority of nurses and midwives would benefit from that as well-----

The Taoiseach saved the detail for the Fine Gael membership but I suppose it went over their heads.

-----but it would not just be one group who would benefit; nearly 900,000 taxpayers would.

The reason nurses and midwives are on picket lines today is the Taoiseach's failures. I refer to his inaction and absolute failure not just in regard to the pay issue but the recruitment and retention crisis associated with it. I stopped to stand on picket lines with nurses and midwives this morning on my way to work. I was at Temple Street, the Rotunda and the Mater hospitals. Nobody to whom I spoke this morning wanted to be on strike; in fact, it is the very last thing they want. They are upset and angry. They want to be at work and they are aware better than anyone else of the stresses and strains their hospitals are under. However, they are resolute. They feel they have been failed and let down, they have not been listened to and they have been backed into a corner and, therefore, they have taken the action of last resort, which is to strike.

They reject the Taoiseach's reaching for the Brexit excuse. In fact, that made them more angry. I suspect when they hear that the Minister for Health, Deputy Harris, is also running for cover behind Brexit, they will be even more deeply angered. As the Taoiseach noted, they have broad support from the public and there is a reason for that. People recognise the quality of care delivered by staff who are underpaid in unbelievably difficult circumstances, particularly in emergency departments but not only there. They are astonished that the Taoiseach, above all people, because he is a medical doctor, does not grasp or get this. They are annoyed that he is sitting on the sidelines. He is acting as a commentator, a dispassionate observer of events. He is in charge, he is the Head of Government, he is the employer, and he has a duty not to pass the buck on this issue and to intervene.

Nurses and midwives are not looking for a special deal. They are not looking for condescension and to be told to wrap up warm and well. They are not looking for sympathy. They are not looking for tears. They are not looking for praise. They are looking for a just and fair settlement. They believe that it can be achieved within the scope of the current pay agreement. That is their view. What they want the Taoiseach to do, as Head of Government, is to come off the sidelines and to engage.

I assume that he accepts that there is a recruitment and retention crisis in nursing. That is a fact. The figures on agency nursing tell us part of that story. I also assume that he accepts that nurses, who are incredibly well qualified, deserve to be well paid, and not insulted by being treated almost as second-class employees within the system. He has accepted that those workers are resolute in their position and that they will not back down.

The time is up.

I invite the Taoiseach, therefore, to take the next logical step, and commit to directly and personally intervene and engage. I ask that of him today as Head of Government.

I am not entirely sure there were any questions there or solutions, just commentary. We have a mechanism by which industrial relations disputes are resolved - and all industrial relations disputes are resolved - namely, the Workplace Relations Commission and the Labour Court. They are State bodies and that is the mechanism through which we will engage and, I have no doubt, in due course resolve this dispute.

I accept that recruitment and retention is a real issue for the nursing and midwifery profession but it is important to understand what that means and what it does not mean. The number of nurses working in the public health service has increased by more than 3,000 in the past five years since the recruitment embargo was lifted. The number of nurses working in the public health service in December 2018 compared with December 2017 is 860 higher. That does not include student nurses. The impression created by some that there are more nurses leaving the country than coming into the country is not correct. The impression created by some that there are more nurses leaving the public service than are entering it is also not correct. Those are the facts and I hope the Deputy will at least acknowledge them.

Are the pictures of our young nurses in Melbourne and Sydney and all around the globe asking the Taoiseach to give them a reason to come home fake news? If he will pardon the pun, are they doctored images? I do not believe that they are. People know that certain nursing staff go abroad for a year but then they come back but the reality now is that we are losing so many of our best and brightest and they are not coming back.

I refer to another fact. There is a strike on today. How is that for a fact? As the Taoiseach acknowledged, procedures have been cancelled. How is that for a fact? Should any of us or our loved ones get sick, every man, woman and child in this land want the best of care for them. All of us know that is only possible if one has the right staff and one will only have the right staff if they are treated with dignity and they are paid and rewarded at an appropriate level. How are those for facts?

What nurses and midwives want is very reasonable. I know all about the industrial relations mechanisms of the State. The Taoiseach does not have to keep repeating that to us as though we are morons. We are all well acquainted with and well versed in all of that. I do not accept that it is satisfactory or acceptable for him to passively sit on the sidelines while this strike is on.

I thank the Deputy. She is way over time now.

I speak on behalf of the nurses and midwives I spoke to this morning who asked me to tell the Taoiseach to engage. Deputy Varadkar is their Taoiseach and Head of Government. They are asking him to engage. If he is interested in sorting this dispute, that is what he will do, and he will do it speedily.

I do not think the Deputy is a moron.

I thank the Taoiseach.

I can assure the Deputy that I am not a moron either, but if she keeps asking me the same question, I will keep giving her the same answer. We have a mechanism under which we resolve industrial relations disputes, namely, the WRC and the Labour Court, which are State bodies and we are happy and willing to engage through that process.

We know what they are. I thank the Taoiseach.

This dispute can be resolved but, as I explained previously, it can only be resolved in a way that is affordable for taxpayers and in a way that is fair to all other public servants with whom we also have a pay deal, and in a way that is fair and beneficial to patients. If those are the parameters, there is a very strong basis for engagement.

It is important to set out again what the pay deal we have with the INMO and all the other unions says. It runs until 2020. On the Government side, we have a responsibility to honour pay rises of approximately 7% during that period, restore pay for anyone earning less than €80,000 a year, and pay annual increments and special pay rises to low paid staff and new entrants recruited after 2012 and 2013. We will honour that agreement.

The nurses are on strike.

On the other side, the unions agreed there would be no strikes and there would be no cost increasing claims.

But there is a strike.

I too sympathise with the nurses who are on strike today. I ask the Taoiseach to ensure that they get properly paid and remunerated for the work they do.

I again wish to raise the Road Traffic (Amendment) Act with the Taoiseach which has changed rural Ireland forever. The social fabric that was known to the people of rural Ireland has been blown to smithereens.

Before, during and since Christmas, many people found they could not come out, socialise, meet their friends and do the things they have traditionally done since the foundation of the State. Transport was promised. Rural Link was to get funding. Now we find it is still on a trial basis and is only funded until the end of March. The Minister for Transport, Tourism and Sport, Deputy Ross, the Minister of State, Deputy Griffin, and Deputy Heydon promised they would provide plenty of funding for transport, yet there has been no extension of services as promised. What we have are plenty of Garda checks. It is not the gardaí who are to blame, because direction is coming from on high. This is happening across every county and every Garda division. People are being checked going to and coming from Mass. Last week an elderly man was stopped coming home from Mass with his invalided wife. What is going on is absolutely ridiculous. People taking their children to school in the morning and women who never drank are being stopped. They are outraged at what is happening. The Government has turned the people against the Garda with its instructions and directions. That is what is happening.

I have to clarify one thing. Eight of us voted against the Bill because it was wrong. Some 75 Deputies voted for it and 74 abstained. I must correct Deputy Brassil, who said on Radio Kerry this morning that Fianna Fáil abstained. That is not true. Some 11 Fianna Fáil Deputies voted for the Bill. That is the truth. The rest abstained. Fianna Fáil abandoned the people who voted for it over the years. Part of the Bill hits drivers with provisional licences. Young people cannot drive unaccompanied. These youngsters need a car to go to school or college, to work at an apprenticeship or to go to sports training.

What about their insurance?

I never interrupted Deputy Brassil. That is the kind of blackguarding he is at. I represent the people of Kerry here. All Deputy Brassil is doing is interrupting me and that is not fair. There are parents and mothers out at 5 a.m. driving their sons and daughters to work or school. They are out again in the evening to bring them home and take them out to football training. They have to go out again at 9 p.m. to bring them home. They are out all day, from 5 a.m. to 9 p.m. That is what the Government has done to the people in rural Ireland. They must also wait nine months for a driving test.

I thank the Deputy. When we talk about road traffic legislation we should never forget why we have those laws. It is because of road safety. Thousands if not tens of thousands of Irish people in urban and rural Ireland have lost their lives on the road or become disabled for life as a result of road traffic collisions. Many of us have been affected by deaths on the road in our own families. People never forget the anniversary and always think about it at Christmas time and other times of year. When we talk about road traffic we should never forget the people who have died on our roads and the families that have been left behind. That is the whole point of having road traffic laws. It is why we have them. It is why they have been strengthened in recent years, and they have worked. Last year fewer people died on our roads than in any year since records began. It is in rural Ireland that the lives are being saved. That is historically where most road traffic deaths have happened.

I totally appreciate that the new rules have made it harder for many people to get out and about and to socialise if that involves drinking alcohol. That is why we have invested in Rural Link. I recall that Deputy Healy-Rae criticised that at the time. I am glad to see that he now wants it to continue and to be extended.

None of us criticised it.

In some cases, the uptake and the demand for these services has been very poor. We need to look at other solutions and we are doing that, particularly around rural taxis and hackney licences. We are trying to liberalise that system and make them more available, particularly at night-time and on weekends.

There are more Garda checks because there are more gardaí. We now have 14,000 gardaí again. How they are deployed and the work they do is entirely a matter for the Garda Commissioner. It is not done under political direction and it should not be done under political direction. Deputies should bear in mind what Garda checks are all about. They are not just about checking people to see if they are over the limit or have been taking drugs or alcohol before driving. It is not just about making sure they are taxed and insured. It is also about denying the freedom of the road to people who are committing crimes. There are a lot of people, as Deputy Healy-Rae knows very well, who are travelling around rural Ireland committing very serious crimes and burglaries. Gardaí say to us that when they run these checkpoints on the roads, they deny freedom of the road to people who commit those crimes. It is not just about drink-driving or catching people out. It is about catching people who are burglarising people's homes, farms and businesses.

The Taoiseach is hurting a lot of good people. We talk about deaths. Surely he knows about isolation and what it causes. We are losing a lot of people through suicide. That is a fact in Kerry and Cork, witnessed before, during and since Christmas. The Government promised to provide transport and promised plenty of funding for it. It has done nothing but hurt the people. The Government promised it would do something to speed up the driving test. Youngsters have been waiting anything from six to nine months to get a driving test. As a result, parents are out in the morning and at night-time to keep the family together and to keep the children going. The Government has done massive harm to people in rural Ireland. It has affected good people who never did any harm, never did anything wrong on the road and never caused a fatality. This is the result of what the Government has done. Its members have abandoned the people who traditionally voted for them over the years. All parties here have done that, in spite of how hard we fought to tell them that what they were doing was wrong. The Taoiseach says this was about saving lives. I will tell the House what it was about: it was about saving the Minister, Deputy Ross, keeping him on the Government's side-----

-----regardless of what he asked it for and preventing a general election. I will tell the House one thing. Members of the Government should take Deputy Ross to the doorsteps with them when they go canvassing in the local election or the general election. He will get an answer whoever he travels with. One thing is sure; he will not be travelling with me.

Maybe Deputy Healy-Rae will go to Deputy Ross's constituency.

People who abide by the laws passed by this Oireachtas have nothing at all to fear from the Garda. People who take alcohol or drugs and then drive are a threat to themselves and others. People who drink several drinks, get a few hours' sleep and then drive in the morning are impaired. They do cause accidents, they do kill people and they do cause injuries. That is a law that should be enforced and that is what the Garda is there to do.

On a separate matter, I absolutely acknowledge that there are unacceptable delays faced by people getting driving licences. It varies in different parts of the country but it is something we are working on. We want to get that waiting time down to a reasonable level as soon as we can.

I want to return to the issue of the nurses' strike. I find it very hard to understand the Taoiseach's thinking. What is his strategy, or does he have any strategy at all for resolving this issue? Sometimes I think it is more about being seen to be tough than playing his part as leader of this country in dealing with a very serious and pressing issue. The question must be asked whether the Taoiseach actually wants a solution. If so, what action, if any, is he taking to achieve one? The Government has been engaging in a campaign of consistently denying the seriousness of the shortage of nurses in the health service. It has also sought to misrepresent the case being made. At no stage did the Irish Nurses and Midwives Organisation, INMO, lodge a pay claim of 12%, or of any other percentage for that matter. Could the Taoiseach please stop saying that? The INMO has not lodged a pay claim so I call on him to stop misrepresenting the situation.

The nurses state that they want to engage with the Government on a number of key issues relating to the future of the health service. They want to engage in respect of the significant problems relating to recruitment and retention and the implications of these for the health service as it operates currently. They want to engage in respect of the fact that there is now only one applicant for every four vacancies in nursing. How do we address that? They want to engage in respect of the fact that the health service is spending over €100 million per year on agency nurses. There is no sense to that whatsoever. Not only are there major problems regarding the cost of that, there are also various issues in terms of a lack of consistency, a lack of stable teams in hospitals and so on. Agency nursing, apart from being expensive, is not a solution. The nurses also want to engage in respect of the fact that the HSE has an expensive unit which is supposed to recruit nurses from all over the world but which has not been very successful in its efforts. There have been a couple of expensive and long-running campaigns aimed at trying to bring Irish nurses back home. However, those nurses have not be available to return.

That there is an issue in the context of pay parity cannot be denied. There is also a point about graduate pay. The Taoiseach cannot defend the fact that there is a €7,000 gap in pay in circumstances where nurses are required to have the same academic qualifications as allied health professionals. Does he accept that this is a genuine issue which has not been resolved or addressed over many years and which must be contemplated in the context of any attempt to tackle the difficulty we face?

I thank the Deputy. I am really not sure who is misrepresenting the facts here. I heard the Deputy state that there is no cost-increasing claim.

There is no pay claim.

Pay parity is, by definition, a cost-increasing claim and it is one that is not accepted by other unions. They have indicated that in writing to their members and also to Government. It has never been the case that all of those who have four-year degrees are paid the same. Many people in various professions - accounting, teaching, etc. - have such degrees. It has never been the case that because one's degree takes three or four years to complete, one gets paid the same as everyone else who pursued a similar degree. To my recollection, that has never been the case.

The front-line-----

As stated earlier - I appreciate that I am repeating myself but the questions are the same so it is only reasonable that I be allowed do so - those of us on the Government benches have no doubt about the strength of feeling among nurses and midwives regarding their terms and conditions. We have no doubt at all about their resolve and their willingness to strike and strike again. We also have no doubt that the public will be very much behind them. We absolutely want to resolve this matter. We are willing to engage, as is the norm, through the WRC and the Labour Court, the State bodies that have been set up to resolve disputes of this nature. However, that can only be done within certain parameters. Any resolution has to be affordable for the taxpayer. I cannot justify borrowing money to fund pay increases. It has to be fair to other public servants, including those who are not on strike, those with whom we have a deal which has been adhered to and those who work in the health sector as well. It also has to be fair to patients.

The Taoiseach is quoting the public service stability agreement, PSSA, quite a lot. That agreement allows for additional measures to address problems with recruitment and retention. In fact, clause 4 specifically allows for Government action in respect of those two issues. The Government needs to engage. The General Secretary of congress, Patricia King, has been reported as stating that a resolution can be found within the PSSA. Ms King is probably the most experienced union leader in the country. She has more industrial relations experience than the entire Cabinet. Will the Taoiseach agree to set up a meeting with her as a matter of urgency in order to examine how this issue can be addressed, how we can break the current logjam and how we can get people to the table for talks, a matter to which the Minister for Employment Affairs and Social Protection has referred. We must have genuine engagement on this matter and the employers, who are represented by the Department of Public Expenditure and Reform, must come to the table with a proper attitude rather than the kind of dismissive and disingenuous attitude they have displayed up to now. This matter is in the Taoiseach's hands. He can address it and he can stop further strikes taking place. Will he make a significant intervention and meet Patricia King in order to examine strategies for resolving this issue?

I have met Patricia King and I have spoken to her about this issue. I would have no difficulty meeting or speaking to her again. That is the way we engage with the trade unions. The Minister for Public Expenditure and Reform, Deputy Donohoe, and I, as Head of Government, engage regularly with the Irish Congress of Trade Unions, ICTU, on issues such as this. Such engagement will continue.

We are discussing this particular issue-----

-----not "issues such as this". Will the Taoiseach meet Patricia King?

It is not my practice to organise meetings in the Chamber and I do not think the Deputy-----

It is the Taoiseach's responsibility-----

-----should be organising meetings for third parties-----

-----to take action to avert further strikes.