Nurses, Midwives and Paramedics Strikes: Motion [Private Members]

I move:

That Dáil Éireann: notes that:

— nurses and midwives have taken industrial action to end wage restraint, lack of pay parity and against the working conditions they are faced with;

— there is a crisis in recruitment and retention of nurses and midwives as a result of pay and conditions they are faced with;

— like all workers, nurses and midwives have seen a massive rise in the cost of living, such as childcare, rent and housing generally;

— there is considerable support and solidarity for nurses and midwives as a result of ordinary people’s direct experiences of the health service;

— paramedics have taken strike action seeking recognition of their union, the National Ambulance Service Representative Association (NASRA);

— there is enormous wealth in our society and yet our health service is being starved of resources, resulting in nurses and midwives being underpaid;

— €270 million was used to pay Anglo Irish Bank junior bondholders in December 2018;

— BAM Ireland, the construction company that is building the new children’s hospital, saw its turnover rise by 28 per cent in 2017 to €465 million, while its pre-tax profits for that year were €15.9 million; and

— Ireland’s richest 300 people have €79 billion in wealth;

believes that:

— there is a need to reverse austerity measures that have hit the health service;

— there is a need for a national health service that is free at the point of use and under the democratic control of working class people;

— a victory for nurses and midwives in this strike would be a victory for all workers and our health service;

— strike action by nurses and midwives has demonstrated the effectiveness of strike action in seeking just and necessary pay increases and improvements to working conditions;

— the recommendations from the Labour Court on 11th February, 2019, which are supported by Government, fall short of the demands of nurses and midwives in their dispute; and

— if this offer is rejected, the Irish Congress of Trade Unions must give full support for the nurses so that the struggle can be brought to a quick but satisfactory outcome; and

calls on the Government to recognise NASRA as the representative union of their members and to accede to the full pay demands of nurses and midwives.

The motion deals with the pay and conditions of nurses, midwives and paramedics. Many messages have been circulating online and on the picket lines from nurses and midwives about why they were brought to take the unprecedented step of national strike action. One woman who has been a nurse for five years wrote:

The education and respect that I got in the NHS when I emigrated was second to none. They constantly wanted progression for their nurses and even offered to pay for funding of college courses so we could up our skills. Unfortunately, I made the silly decision to move home, which to this day I deeply regret. I have been forced to move back with my parents, which was a difficult decision to make. I will never be able to afford a mortgage. I worked four long years in university to be where I am today. Why can't we have pay parity with other professionals we work alongside? Why can't the Government respect us?

That sums up many of the reasons and sentiments we have heard throughout the past couple of weeks.

The INMO in its 100 years of existence has only twice waged a national strike. It is quite an unbelievable circumstance and shows the urgency of the issue. It is anathema to nurses to have to leave behind the patients they know to go on a picket line. It shows how far they have been pushed and how low they have been allowed to go by this Government.

For weeks we listened to the Government saying there was no money for nurses. For weeks it even said there was no recruitment and retention crisis at all, and it was a figment of the INMO's imagination. It then said it was not due to pay and that pay would probably not make any more nurses want to stay in the country where their families and friends are. In just three days of industrial action, however - this should be registered by anyone watching this debate or interested in this issue - the INMO achieved more than the rest of the trade union leadership did for their members in years, in the sense that an offer is on the table, which is obviously an improvement on the current situation.

The question nurses will be asking is whether it is a fundamental change and what nurses deserve, or is it the Government continuing to abuse the goodwill of nurses. There is no question that the Government was absolutely desperate to avoid three more days of strike this week.

It witnessed the significant public sympathy there is for the nurses. It also saw the massive demonstration that took place on Saturday It is unusual to have 40,000 to 50,000 people marching to defend workers. It was primarily the INMO and members of the public who use the health service who mobilised. It was people who know what it is like to be on waiting lists, who know what it is like to wait in accident and emergency departments and who see where the Government is spending public money and that it encourages private healthcare.

As we speak, nurses and midwives are getting information about the pay offer and they will have time to consider it. We tabled this motion before the deal was offered but it is still a major issue. Nurses will ask whether the offer provides pay parity and pay restoration and if it will stop the brain drain of young, qualified nurses. They want to know whether the wards will be safer and whether the pay offer will pay the rent or buy a house. We have been getting some feedback from nurses on pay parity. Perhaps the Minister could clarify the position. On paper, it can appear that there is parity with other therapists and grades, which has been sought by nurses. However, pay for nurses is heavily dependent upon an allowance. As we saw during the recession, the first thing to be taken off workers were allowances. We saw it with teachers and other professionals. A bank manager does not count an allowance as part of a person's wage. In addition, allowances do not always apply to every group. There are questions about whether it will apply to community nurses, those in outpatient departments and others. Another key issue is that occupational therapists and physiotherapists, with whom nurses are seeking parity, usually progress to become senior occupational therapists or physiotherapists but there is no such progression, even in this offer, for nurses. They will still remain on the same pay scale.

The Minister should feel ashamed and embarrassed about staff nurses' pay. In 2008, the starting point for a staff nurse was €31,875 and the scale went up to €46,541. Following this deal, the starting point is still €29,346, which is lower than 2008, and now the highest one can go on the enhanced scale is €45,841. Despite winning better pay, it seems that nurses still do not have full pay restoration, which they should have, in the context of what was taken from them during the recession.

Another matter of concern is the productivity that will be demanded of nurses. The general response of nurses is to comment on the cheek of the Minister for Public Expenditure and Reform, Deputy Donohoe, to state that they must qualify to go on the scale when they have given all they can give. It shows the response of the Government to the idea of workers having a recovery. The Government boasts about the economy being in recovery and being one of the best performing in Europe. However, it is not happy for workers to get back what was taken away. We constantly hear in the media that there is no money or wealth available, that there is just a little pie for the health service and that if nurses and paramedics get an increase, then something else will have to go in the health service. We completely and utterly reject that concept. There is a large pie of untapped and untaxed resources in this economy. We have the €14.3 billion sitting untouched in the Apple account. We are informed that the cost of the Labour Court recommendations will be €35 million in a full year, but the Apple money would pay that 400 times over 400 years. What greater demonstration is there of the Government working hand in hand with Apple to protect that company's interests?

Meanwhile, in terms of the cost of living for workers, the average rent nationally is €1,347. In Dublin, it is €1,800. The average rent in Waterford has gone up 16%, in Galway by 13% and in Limerick by 17%. That is what any wage increase has to compete with. In terms of wages, the average weekly earnings for workers in the health sector were €796 in 2008 and today are €720. Workers will look at the example of what the nurses have been given and act accordingly.

There will be a debate on the national children's hospital. Let us contrast what has been spent on it and how the purse strings have been opened with the treatment of the nurses. On every single picket line when I got into a conversation with nurses the question of gender was invariably raised. Phil Ní Sheaghdha raised the point on the demonstration of whether they are so shoddily treated because they are women workers. I have no doubt we will see the Minister talk about the advancement of women on 8 March, International Women's Day, but this is the gender pay gap in action and how it works. That is what happens if one decimates the wages of female-dominated professions such as nursing, teaching and many others in the public sector. The Minister has to answer for that.

I wish to refer to paramedics because they are still in dispute with the Government. They have demanded to join a union of their choice, not of the Minister's choice. It is meant to be a right of workers to use whatever organisation or union it wishes to negotiate on their behalf, but it seems that the Government would rather pick unions they consider tame or under its influence or control. Ambulance workers, paramedics, nurses and midwives are in the Gallery. The Minister has just come into the House. Workers should be allowed to join a union of their choice. The HSE must be directed by the Minister to recognise NASRA as the union of choice to negotiate on behalf of those workers.

Nurses will assess in the coming days whether this deal goes as far as they wish. If they decide that it does not, on the basis that it does not provide for pay restoration and pay parity and it is not what they made the sacrifices for, and if they decide to vote "No" to the agreement, the entire trade union leadership and movement must get behind the nurses for their sake as workers but also for the sake of the health service. It must mobilise and support them completely, and not leave them standing on their own, to end austerity throughout the public sector and also to bring up the wages of all workers. It is time for a recovery after a decade of austerity.

I am not sure whether the Minister was at the march on Saturday but a few of us were and it was probably one of the best marches I have been on for a long time. The only comparison I can make with Saturday's march is the anti-water charges marches. There was a great atmosphere. I do not think any workers have the same respect among the public as nurses. The level of solidarity and support for them was second to none. There is an unbreakable bond between the nursing profession and the public and that was borne out by the public support over the three days of the strike.

I speak from first-hand experience, as I was a care assistant for 17 years before I was elected to this House and I worked with nurses in many hospitals and various other care settings. Nurses play an extremely important role in society. They are extremely professional and passionate about their job. That is what it comes down to: they do not do it for the money; they do it out of a sense of commitment to their fellow human beings and to try to help them as much as possible.

Nurses do not want platitudes. They want attitudes to change in the Government about pay and retention in their profession. Nurses were very reluctant to go on strike. They wanted to be on their wards caring for people but they were forced to take action because this is a safety issue.

This is a pay issue. It is an issue affecting our whole public health system. It goes to the heart and soul of their profession and what we are fighting for in public life. What does it say about society when nurses have to go on strike while the Government paid bondholders €270 million in November, gives tax exemptions to banks and puts bankers on a pedestal? Meanwhile nurses do not get a fair hearing. The substantive issue has not gone away. That is recruitment, retention, pay and conditions for nurses. If hospitals are not safe places for nursing staff, auxiliary staff or care assistants they will become dangerous for patients and patients will die.

We will wait and see what comes of the Labour Court recommendation. We will take our green light from nurses themselves. The indications are that this does not go far enough and does not address the substantive issue of retention and pay parity. Nurses do not ultimately want a pay rise. They want to be respected and paid like other allied professions. Nurses have crossed the Rubicon and there is no going back. For too long they have heard platitudes from successive Governments and they have stood down. As Deputy Coppinger said, it largely comes down to the fact that nursing is a female-dominated profession. They have crossed the Rubicon and it is time for the health professions as a whole and the public health system to stand side by side with the nursing profession because when they win, we all win.

I move amendment No. 2:

To delete all words after “Dáil Éireann:” and substitute the following:


— the industrial action already taken by nurses and midwives in recent weeks;

— the decision of the Labour Court to intervene in the dispute is in the public interest; and

— the acceptance by the Government of the Labour Court recommendation; and believes that:

— while respecting the requirement on nursing unions to ballot their members, the recommendation represents a fair and balanced solution to the dispute which is consistent with the Public Sector Stability Agreement; and

— an important opportunity exists to enhance the status and significance of nursing and midwifery through collaboration and dialogue, and through the implementation of Sláintecare.”

I thank Members for their contributions and I thank the Deputies tabling this motion for the opportunity to discuss the recent dispute between health service employers and the nursing unions, the INMO and the Psychiatric Nurses Association, PNA.

Following the recommendations issued by the Labour Court on Monday, the INMO and the PNA industrial action scheduled for three days of this week has been suspended. That has been very welcome news for patients throughout the country. Taking the point made by other Deputies, it is also welcome news for nurses and midwives, who want to be back in their workplace, not on a picket line. Since this suspension was announced, I can assure the House that the HSE immediately commenced work to address the cumulative impact this dispute had already caused and to get our health service back a degree of normality.

It is clear that the previous three days of industrial action, which involved a withdrawal of labour by nurses and midwives across the public health services, had already had a significant impact. The further planned escalation, if it had proceeded, was likely to severely challenge the ability to provide a safe service to the public. On that basis, the Government very much welcomes the decision by the nursing unions. I understand and accept the decision to take this action was not taken lightly by nurses and midwives, who would rather be at work. I agree on the point that this was an action not taken lightly.

I would also like to take this opportunity to thank the members of the Services, Industrial, Professional and Technical Union, SIPTU, who did not engage in industrial action throughout this period. It is important to point out that SIPTU nurses and midwives did not engage. When we talk about other unions it is important to acknowledge their decision and thank them for their ongoing services. The Government has accepted the recommendation of the Labour Court to resolve the industrial action with the nursing unions. That is important. An independent recommendation was given by the Labour Court, the highest industrial relations mechanism in the land, and the Government accepted that recommendation in full at its meeting on Tuesday. The Labour Court intervened in this dispute due to the exceptional circumstances and the grave and extensive implications of the dispute. I would like to thank the Labour Court for its intensive work between the parties, particularly over the weekend. I also thank my own officials, the HSE and officials in the Department of Public Expenditure and Reform for the hard work they put in to help us to arrive at a point where the Labour Court involvement and engagement proved fruitful for both sides by producing a recommendation. While I am very conscious that the recommendations remain to be accepted by the INMO, I would like to thank the union's leadership for its continued engagement with health service management throughout this dispute. That is very important to note. During this dispute the INMO was working to put contingency plans in place and I thank the leadership for that.

As referred to in the constructive Fianna Fáil amendment to the motion, an amendment which I welcome, the Government agrees that all sides to the dispute should be given time to consider the recommendations without interference. It is important we allow the unions to do what they do, have their deliberative process and consult with their members. I understand that the INMO is to consider the recommendations further at its executive meeting today. The INMO will also consider its ballot process. The Government does not intend to interfere with that process and I suggest that we in this House should not do so either. It is now a matter for nurses and midwives, the members of the unions, to give their views on these matters. I should also note that talks are continuing with the PNA and that the Labour Court has invited the parties to a hearing on Friday of this week.

However, the original motion, as presented by Solidarity-People Before Profit, seems to set out a very simplistic approach to dealing with a complex dispute. The recommendations issued on Monday by the Labour Court are grounded in the reality of what is achievable within the public service pay agreement. I heard from most parties in this House, although not from all groupings, that people wanted a solution to be found within the public service stability agreement. Indeed, many Members put it to the Government that it was possible to find a way forward within the context of that agreement. This was complex but that was the work that was under way. The recommendations also met the three principles this Government repeatedly stated it wanted to achieve in any solution to this dispute, namely, that a deal would be fair to taxpayers, fair to public servants as a whole and fair to nurses.

I welcome the recommendations as putting forward further realistic measures which should help improve staff retention and recruitment within the nursing and midwifery profession. It is also very important that the recommendations require staff to agree to improved productivity measures as part of the introduction of an enhanced nursing practice role. The recommendations include a range of changes and initiatives to deliver enhanced practice in nursing and midwifery. These include: contract changes; agreements to flexibility and assessment of rosters in the context of the framework on safe staffing; a review of staffing and skill mix in all areas, including ambulatory and outpatient areas; full co-operation with the implementation of integrated care organisations in our health service; and full co-operation by all sides with the implementation of the healthcare assistant review.

As part of the roll-out of these productivity measures, provision will be made for an enhanced nurse practice salary scale. Funding will be linked to savings from a reduction in agency staffing costs, using funds from the new entrant salary scale agreement and savings from increased productivity. The Labour Court also stated that these savings would need an independent verification mechanism under the auspices of the court. It even went so far as to state that if savings are not realised it will reconvene to examine this mechanism.

The recommendation also proposes a new location allowance for nurses working in medical and surgical areas. In the longer term, it is also proposed that an expert review of the nursing profession is to be undertaken, to be completed by 2020. Another positive development is the commitment to the national roll-out of the safe staffing and skill mix framework. As the Minister for Health, I very much welcome this and the acceptance of the recommendation by the Government. This will be implemented by the end of 2021 at an accelerated pace compared to what had previously been agreed. Additional advanced nurse practitioners are also to be recruited. If we are serious about Sláintecare, and I am, we will need more advanced nurse practitioners. The commitment under this recommendation to providing 700 across our health service will be a great help. In summary, this recommendation provides the foundation for significant and meaningful reform of the nursing and midwifery profession as we know it.

The motion also raised the separate issue of union recognition in the context of a separate dispute. The union in question, the National Ambulance Service Representative Association, NASRA, is affiliated with the PNA. This group is to engage in industrial action over three days starting on Friday. This is a further escalation of a one-day withdrawal of labour earlier this year. NASRA is a group which is currently not recognised by the HSE and, therefore, does not have negotiating rights for ambulance personnel. The PNA, which is a non-ICTU-affiliated union, has negotiating rights for nurses working in psychiatry and intellectual disability sectors. SIPTU, Fórsa and Unite represent the ambulance grades. It is regrettable that this industrial action is being taken. I have asked my Department to engage with the HSE to explore ways forward and see if we can progress a resolution to this dispute.

The proposers of the motion also describe the health service as being "starved of resources", despite record funding being provided to the HSE in 2019. We have many challenges in our health service and face many challenges in reforming it. There is a lot of ongoing work. However, the idea that it is starved of resources does not stand up to much scrutiny. Clearly, funding alone is not the answer. I note the reference in the motion to providing an equitable health service. I do not believe Solidarity-People Before Profit has signed up to Sláintecare. I think it is the only grouping in the Oireachtas not to have done so, although I am open to correction on that. The vision set out there will greatly assist us in achieving improved access to services based on a person's needs. Sláintecare is the bedrock. It is about delivering an equitable and universal health service. It is a document that all major political parties and most Independent Members of this House have signed up to.

To support the delivery of Sláintecare, the Government has put key structures in place to drive and implement reforms. These include a dedicated Sláintecare programme implementation office, led by an executive director, which is now established with an allocated budget for this year. The Sláintecare programme implementation office will publish action plans every year and progress reports twice a year.

In the meantime, for the first time, the HSE based and developed its national service plan for this year on the framework of the Sláintecare implementation strategy. The focus on Sláintecare in this process is an important element of the strategic transformation of our health service.

It is worth noting that the changes to the nursing profession contained in the Labour Court recommendations are transformative and in line with the agenda of Sláintecare. When trying to resolve an industrial relations dispute, to find it being resolved in a manner that is compliant with our health reform policy, Sláintecare, is very encouraging.

The cost of living is also something the proposers of the motion have also put forward. The Government has taken, and will continue to take, a number of measures to try to address issues relating to the cost of living.

By the end of 2019, the Government will have spent €6.6 billion in the past four years to accelerate the delivery of housing supports. In my Department, over successive budgets we have extended access to free GP care, reduced prescription charges, which will be reduced again at the end of next month, and reduced the threshold of the drugs payment scheme, which will be reduced again at the end of next month.

I would like to return to the Labour Court recommendation made on Monday in respect of the nurses' dispute. I firmly believe that these recommendations present an opportunity to enhance the status and the significance of nursing and midwifery through collaboration and dialogue and through the implementation of Sláintecare. There is a lot of work to be done by all the parties involved if the recommendation is accepted. A new nursing contract needs to be agreed and an agreed model of measurement and verification of savings needs to be developed. The expert review group on nursing, which many in this House called for, while many others called for a commission, will also need to be set up. However, the parties must now be given the time to consider the recommendation without the interference of Government and, I respectfully suggest, the Oireachtas. It is important that we allow nurses and midwives the space to consider what this recommendation means to them, to their colleagues and to the workplace and to give their adjudication on that.

As opposed to the proposers of the motion, the Government takes a longer-term, strategic view of the situation and we are working to ensure that the role of our nurses and midwives will be enhanced, strengthened and aligned with the future health needs of the population.

In respect of the other dispute, I hope engagement can happen to try to find a way forward to resolve it because we do not need any more industrial relations disputes in our health service.

I call Deputy Donnelly, who is sharing with his colleagues, Deputies Browne, Eugene Murphy and Cahill.

Deputy Stephen S. Donnelly

Yes, and potentially others if they arrive. I welcome the suspension of the industrial action following the recommendations of the Labour Court earlier this week. No nurse or midwife wanted to be out on strike. They wanted to be on the job doing what they know how to do best and what they are trained very well to do. However, a combination of issues, including pay discrepancies, staffing levels, working conditions and patient safety concerns, left them in a position where they felt they had no choice. They have been raising those concerns since 2013. They raised them directly at their national conference in Cork last year. They raised them through 2018 but they were not listened to or treated with respect. Their concerns were not acted on and so it took a national strike, the second such national strike in the 100-year history of the INMO, to get the Government's attention. Members of the PNA found themselves in the same position. It is welcome that they have also suspended industrial action following the Labour Court's recommendation.

As the INMO pointed out, the recommendation makes progress across all areas of concern to the nursing unions. These include safe staffing levels and addressing recruitment and retention problems. Importantly, both sides have also agreed that the resolution to this dispute must be found within the framework of the public service stability agreement.

Fianna Fáil welcomes proposals for enhanced practice in nursing and midwifery with the development of a new enhanced nurse practice salary scale. We welcome the guaranteed multi-annual funding to maintain safe staffing levels - it is critical that this happens; the increased education and training opportunities it is hoped will be seen; the expert review recommendation of the nursing profession to be undertaken in the medium term; and the addressing of other issues of concern to the union side as part of the resolution to this dispute.

At this point, we believe all sides to the dispute need to be given time to consider the recommendations without interference. For that reason, we will not support the motion, as it prejudges the outcome of those discussions. It seeks to influence those discussions, and those discussions should be left to the INMO and PNA members and to all other groups involved. It is not for the Dáil to tell them what to do; rather, it is for the Dáil to respect their right to consider the options before them.

The Deputy does not have a right-----

Deputy Stephen S. Donnelly

Fianna Fáil has tabled a countermotion to this effect, which I hope the House will support.

I welcome Monday's decision by the nursing unions to suspend their strike this week following the intervention of the Labour Court. The court's recommendations are aimed at resolving the dispute over pay and staff retention issues within the nursing profession and make progress on all areas of concern to the nursing unions, including in the key areas of safe staffing levels and addressing recruitment and retention problems.

The proposal states that a range of tangible and specific enhanced nursing practice measures constitutes the basis for a fundamental change in the role of staff nurses. To underpin the new arrangement, a new nursing contract focused on delivering improved outcomes should be finalised within three weeks. The court further recommended that an expert review of the nursing profession should be undertaken in the medium term. There is also agreement by both sides that the resolution to the dispute must be found within the framework of the public service stability agreement.

All sides in the dispute must be given time to consider the recommendations without interference. The members will rightly have the final say in a ballot.

Nurses did not want to be on strike. Nurses from Gorey, Enniscorthy, Wexford and New Ross reluctantly took to the picket lines in my county of Wexford. This was only the second time in their history that they did so. Nurses want to care for their patients and those who are sick.

The stress caused by the strike to the nurses and patients could have been avoided had there been meaningful engagement earlier by the Government. The cancellation of 75,000 appointments could have been avoided. The INMO and the PNA had been warning for some years about the stresses and strains the nursing profession was under and the risk to patient safety as a result of retention and recruitment issues but they were not listened to. Our nurses have many valid concerns aside from recruitment and retention, for example, the overcrowding in hospitals, which are running at 95% to 120% capacity, and the high level of assaults to which nurses are subject.

The nature of the nursing and midwifery professions has changed significantly in the past 20 years, with ever-increasing demands on them. I hope the Government is now beginning to recognise that, is starting to listen to nurses and understanding their needs, is beginning to demonstrate to our nurses that they are valued and respected, and giving them due recognition for their vocation. The suspension of the strike and the proposed agreement are welcome but it is now for the nurses themselves to decide.

I am delighted to say a few words on this motion. Nurses are genuine carers of all of us. When we end up in hospital or in a doctor's surgery, they are the ones who calm us. When we are anxious about our health, they are the ones who speak to us. I had a bad fall some years ago and as a result had many visits to hospital for surgery. I know the value of nurses and the way they look after people. They are the people who must be respected.

It has been made obvious time and again that nurses do not go on strike. History shows us they have not gone on strike. It is important we look after them and recognise the difficulties they are experiencing. That is why I welcome the intervention of the Labour Court. I hope the discussions that will take place will deal in a reasonable way with reasonable people because nurses are reasonable people. They make a major contribution to all our lives because at some stage everyone, through their family or whatever, will have an engagement with a nurse in terms of hospital or doctor surgery appointments.

It should be acknowledged that we have had many issues with the health service in recent years, particularly mental health issues. Many of the psychiatric nurses who deal with people with mental health issues are under an enormous strain. The pain those people experience worrying about others is not often recognised. Psychiatric nurses are concerned for people with mental health issues.

Let us hope the Labour Court sorts out the issue and that the nurses will be recognised because they have a grievance and it should be sorted out.

I welcome the progress made earlier in the week. I hope it brings about a resolution to the issues and the necessary progress. It is unfortunate that the nurses, for only the second time in 30 years, had to go out and picket to achieve their aims. It would have been far more favourable if they had been recognised without the need for a strike but that is the position.

I raised one or two issues in the previous debates that I want to ensure are continued and included in the negotiations. The first is the number of temporary contracts still in place, particularly for the members of the PNA.

I tabled a parliamentary question last month to be informed that 33% of contracts issued last year for psychiatric nurses were of a temporary nature. I posed a question on how we will resolve the issue of the long-term retention of staff if temporary contracts are going to be issued in a time of crisis. I do not have the figures for the nurses and midwives but I am informed that they are similar. The Government wants to reduce agency staff costs and if it is to do that, a positive measure would be to offer permanent as opposed to temporary contracts.

Another issue I want to raise is the safety of nurses in the workplace, in particular, psychiatric nurses. I also tabled a parliamentary question on this issue last month in respect of Kerry University Hospital to be informed that it was fully satisfied with all elements of security in the psychiatric ward. However, I was contacted subsequently by two nurses who were seriously injured, both of whom are now off work receiving treatment because of their injuries. There is a need for security staff, full-time if necessary, to protect our nurses in the workplace. This is a critical element to this dispute. It was not all about pay; it was also about terms and conditions.

I also want to mention the potential strike by the ambulance crew. I ask that even at this late stage, the HSE would intervene, recognise them and prevent this unnecessary action.

The nurses and midwives were forced to take their action because the Government refused to negotiate with them in any meaningful way. It was a last resort for the nurses. There has to be a lesson in it for the Government.

And Fianna Fáil.

As has been said, it is only the second time in their history that nurses have taken this course of action. I welcome the decision of the nursing unions to suspend their strike this week, following the intervention of the Labour Court. The court's recommendations make progress across all areas of concern to the nursing unions, including the key areas of safe staffing and addressing recruitment and retention problems. There is no doubt in my mind that the chaos within the HSE is making working conditions for those working at the coalface difficult. The stress and pressure that they are working under would not be accepted in any other industry. While we are grateful that a solution has been put forward in this case, there must be a root-and-branch change in the day-to-day working conditions in our hospitals and other medical facilities. To operate continuously in a crisis situation will not have the patient outcome that we all require. It is impossible for staff of all kinds within the system to work at their most productive when they are plugging leaks all day every day. When this particular crisis is over, therefore, the management style of the HSE must change. Instead of selling people on the ideas of the state-of-the-art, 21st-century medical system, they must begin at the bottom and make the health service user-friendly, efficient for patients and a safe and productive place in which to work.

I also concur with my colleague, Deputy Brassil, that every effort should be made to prevent ambulance personnel being forced to go out on strike as well. This would also cause great disruption to the health service and should be avoided. Their request of union recognition is fair and reasonable.

I will share time with Deputies Cullinane and Funchion. I listened with more than a wee smile on my face and a bit of amusement to Fianna Fáil telling us that nurses do not normally go on strike. In truth, the last time that Fianna Fáil was in government, it introduced the recruitment moratorium and there were nurses' strikes in Sligo University Hospital, University Hospital Limerick and Beaumont Hospital. A national strike is unusual and it should not have taken a national strike to bring the Government to the table but when the Government went to the table, a recommendation could be made from the Labour Court. It was not lost on nurses and midwives on the picket line that they were out for improvements in their pay to ensure that they could meaningfully address the recruitment and retention crisis and all the while, we have the lads here - and it is mostly lads - with the attitude of "what is €1 billion between friends?" and "let us keep the confidence-and-supply arrangement going". It is not lost on those nurses and midwives that money can be found for a catastrophic overspend on the hospital and it cannot be found for the vital personnel who will work in it. Doubts have been expressed by healthcare professionals and medics over whether there will be sufficient numbers to staff the hospital, should it be built. That is another concern.

The recommendation from the Labour Court is under consideration at the moment. I recall that when I worked as a trade union official I rarely, if ever, thanked politicians for interfering in the minutiae of industrial relations on the basis that there are processes and procedures and they are going through that at the moment. My understanding is that the executive of the INMO will consider it and it will go out to its membership for ballot. They, and only they, will decide on this. We hear that the Government has accepted it and that is fine but it is up to the nurses and midwives themselves to judge what has been recommended by the Labour Court and to apply a test on whether this meets their demands and whether this will meaningfully address the recruitment and retention crisis. They will cast their ballot on that basis alone. We will have to respect that, and we have to respect that process. I have heard Members eulogise nurses but they are the same people who were happy to cut their pay and so on. Nurses are not angels or saints and it is not a vocation. They are workers, they had an industrial dispute, they brought their employer to the table, and now they have a recommendation and they will consider that. We should allow that process to take place and allow those people to deliberate because that is their right. Anyone who was on the march on Saturday will say that there is great public support for them and that was not lost on the Government either. I do not believe that the Government went to the table willingly; I believe it was forced to the table, in part because of the support that was out there for nurses and midwives.

The Government is heading down the same road again with paramedics because that is also a group held in much esteem by the people. People do not want to see paramedics out on strike for a silly reason. Three unions are recognised within the health sector to represent paramedics. It is not as if it is a single union environment and it is not as if unions from outside and inside the ICTU do not have procedures and mechanisms in place to ensure that people are represented by the trade union of their choice. I have read a letter sent by Peter Hughes of the PNA in which he appeals to us to demand that the HSE, even at this late stage, engages through the Workplace Relations Commission, WRC. That letter is to the same people who were extolling the virtues of the third party processes. The Government should engage with these people and avoid the dispute.

It is unacceptable that the Minister for Health has left before he has listened to the Opposition respond to the Private Members' business debate. He made his own contribution, he listened to contributions from his partners in government in Fianna Fáil but he was not present to listen to the contributions made by the Opposition in Sinn Féin and other Opposition Deputies who will speak. If he listened to us last year when we moved a motion on the retention and recruitment crisis in nursing and in our health service, he would not have found himself in the position he found himself in over recent months, which is in direct conflict with nurses. We tabled a motion, which was supported by Fianna Fáil at the time and most of the Opposition, that identified all the problems that needed to be addressed and we said that while pay was front and centre, it was not the only issue. The Government ignored the motion, it would not support it and then it found itself in conflict with nurses. The Government brought that on itself.

There are solutions out there. The same is happening with the ambulance paramedics and with GPs where there is the potential for a conflict and industrial action with nurses. I agree that it is up to nursing unions and nurses themselves to work out their responses to the Labour Court recommendation. It is a matter for nurses but it is the Government's job to put in place solutions and to value people and to treat them with respect.

It is not treating nurses with respect when Ministers ignore their plight for years on end, are tone-deaf to the issues they raise and then come to the Chamber, as members of the Government and Fianna Fáil have done, and state that they respect nurses and that they are very good at what they do. There are hollow words and tea and sympathy, but the Government has not put in place any of the solutions that are necessary to support nurses. The Minister has not done enough.

I appeal to the Minister to listen to what the nurses' unions, the PNA and the GPs' representative groups are saying and to what the Opposition has been telling him for the past year, which is that he is making a mess of our health service. He is prioritising private healthcare and is not making the necessary investments in public health. He is tone-deaf to those on the front line who are bearing the brunt not just of Fine Gael's cuts but also those introduced by Fianna Fáil. Fianna Fáil cut and chopped our health service when it was in government. In fact, Fianna Fáil introduced the two-tier pay structure that lies at the core of the dispute, whereby people are on different pay scales. Fianna Fáil must take responsibility for that.

There have been enough hollow words and tea and sympathy. Nurses and other public sector workers need real support. Pay is part of that, but it is not the only issue.

First, I wish to pay tribute to the nurses, particularly those in my constituency of Carlow-Kilkenny, who have been on the picket line for the past few weeks. It is not an easy place to be. Anybody who has been involved in trade union activities will say that the last place any worker wants to be is out on strike.

To put it in context, in St. Luke's General Hospital in Kilkenny, which serves both counties, the level of overcrowding last year was the second highest on record, according to the INMO. That shows the type of conditions in which nurses and midwives are working. We all know this. It has been stated in many of the debates here. We all know how bad the health service is and how great a crisis there is. People regularly tell stories about there not being enough blankets and pillows, let alone beds, for patients, yet we expect nurses to work in that environment and those conditions every day. They do not get the pay they deserve.

I agree with my colleagues about Members coming to the House to say how fantastic the nurses are. They are. We all agree with that. We all have had personal experience or experience with family members and will say that the standard of care they deliver in difficult circumstances is unbelievable. However, it is not good enough just to say "Well done" and give them a pat on the back for doing great work. It is also not good enough that we wait until a crisis is reached before we acknowledge their work and the role they play.

I also agree with a previous speaker who referred to it being a predominantly female workforce. Time and again we see that it appears to be okay to treat the members of a workforce that is predominantly female as second-class workers. We also see it in the childcare and early years sector and in other areas where the workforce is predominantly women. I wish to point out to people who had an issue with the strike that, in fairness, nurses gave more than the legal requirement for notice. That is how much they put the safety and care of their patients front and centre. They gave three weeks' notice of the strike but one never hears anybody who criticises them acknowledge such issues.

This is quite simple. It is not rocket science or something fantastic. We must acknowledge the work they do with pay, decent terms and conditions and decent working conditions. We should not have people going to work in what are almost Third-World services. I do not like to use that term but the conditions in which we expect nurses, midwives and psychiatric nurses to work are absolutely ridiculous. It should not happen. We should treat them with the respect they deserve and the best way to do that is to put one's money where one's mouth is and give them the pay and conditions they deserve.

On that note, I support our proposed amendment to the motion.

We debated this last week so I will repeat what I said then. We are now in a different space where an agreement has been reached. I will not interject on that because it is up to the individual unions to vote on it over the next few weeks after having debated the proposals and reached decisions.

I wish to make a few points, however. What probably distinguishes this Government from previous Administrations is the fact that we should not have reached this point. The solution with regard to how we got here from where we were a few weeks ago, and before the nurses had to go on strike, was regularly outlined to the Minister for Health and the Minister for Public Expenditure and Reform. We always said that clauses three and four of the pay agreement could be used to deal with these issues. This was denied. However, when the solution was found, that was used as the excuse for how it could be kept within the pay agreement. Why bother? Why let it get to the stage where there was a strike? Why could this not have been intercepted? Tens of thousands of patients missed their appointments and that backlog will now have to be chased. Why could that not have been avoided? Was it that the Government had to have a show of strength? Did it have to be seen to face it down? It was unnecessary, to be polite. Was it ideologically driven? Was it the fact that it was a sign for other unions? What was it?

I and many other Members made the point that the potential savings from agency costs, income tax returns, recruitment costs, delivery of efficiencies and the resulting shorter bed stays would create savings that would neutralise much of the pay cost in the first instance. Including some other items that have been added on the employer side means that, essentially, this is not far from what the agreement will do. The agreement includes different pay recommendations that have to be debated. I will not discuss them because it would be inappropriate to do so while they are being debated among the unions. My point is that all of this was avoidable. It was unnecessary to reach this point, and the consequences and hardship for the public have been brought about because the Government just would not listen and debate.

It required a firmness on the part of the unions. I acknowledge the way in which the PNA and the INMO organised themselves. The withdrawal of labour is the final opportunity that trade unions have to force employers to recognise the issues before them, and those unions did that en masse. It was a pleasure to be with them last Saturday. If anything was needed to wake the Government up to the issue by which it was starkly confronted, it was the show of support from the volume of people who were in Dublin last Saturday.

There are other issues that are deeply worrying. We all know the tenure of this Government will not be long. However, the manner in which it purported to deal with this through the media was concerning. In industrial relations, where there is a serious dispute, potential strike or strike, there must be a manner whereby the dispute is discussed. It must be behind closed doors, without leaks and without innuendo. The way many of the communications were carried out, particularly before the agreement was reached, certainly left a great deal to be desired.

I have some final points. There is an opportunity as a result of this potential agreement. It is based on workforce planning. We have always known that the nurses were fighting for issues surrounding recruitment and retention. Part of that was better pay because of the need for safe staffing and to be able to attract people into the workforce.

There is a real issue in regard to the various plans, some of which the Minister of State, Deputy Byrne, who is present, was part of. I refer to Sláintecare, which I and my colleagues on the health committee spent 11 months putting together, the national maternity strategy, the mental health strategy and a range of other strategies, many of which are very good and which I fully endorse. However, the roll-out of primary care is pointless unless we learn from the Government being forced to come to the table to reach a form of agreement and we move on to the issue of long-term workforce planning in the health service. Frankly, all of these strategies are a waste of time unless they go hand in hand with workforce planning. Central to that, obviously, are all the various occupational roles and nursing is at its core because it is the oxygen for many services in acute and primary settings. The issue must be dealt with differently. There was much discussion of that at the health committee and more broadly in the run-up to the strike. We need a plan for the future across acute and non-acute services and all of the various sectors which will encompass educational needs, geographical requirements and interaction with GPs. The issue of the GP contract, on which GPs took to the streets last week, is intrinsically linked with this issue. In addition to addressing the points I raised on negotiations, communications, interactions with unions and respect, the area of workforce planning into the future must be dealt with in order to avoid continuous recruitment bottlenecks. New units at South Tipperary General Hospital and Limerick Regional Hospital, the two most overcrowded hospitals in Ireland, will not open on schedule because of recruitment difficulties. I ask the Minister of State to take that on board.

Deputy Joan Collins is sharing time with Deputy Pringle.

I welcome the motion as it symbolises a rising awareness among the public and a growing discontent at the state of industrial relations in this country. A positive result of the recent nurses’ strikes was the huge nationwide display of support for public sector workers and their struggle for better pay and conditions. We must give the nurses the space to decide whether they agree with the recommendations of the Labour Court.

I hope that some of that public display of support will transfer to support for another much-deserving group of workers who every day shoulder the burden in our national health service by providing necessary front-line medical supports. The issues involved will be far easier to deal with than the nurses' strike. I refer to ambulance crew members represented by the National Ambulance Service Representative Association, NASRA, who will take part in planned strike action this Friday by the ambulance personnel branch of the Psychiatric Nurses Association, PNA. The HSE does not currently recognise NASRA as representing emergency medical technicians although SIPTU, UNITE and Fórsa are officially recognised by the State agency. A large cohort of workers have signed up to the union, with more than 500 staff represented as part of the Psychiatric Nurses Association. Dozens of work-related disputes have been addressed by NASRA, but the HSE has repeatedly refused to negotiate with it on pay-related issues or to engage on the issue of payroll deductions of union subscriptions from NASRA members. There is a clear conflict of interest in circumstances where the only union recognised by the Government is the same union representing the workers' employers. This does not represent a healthy and diverse environment for industrial relations and compromises the pay and conditions of many workers in this situation. The refusal of the Government to become involved further undermines industrial relations in this country.

I wish to bring to the attention of the Minister the results of the most recent national ambulance staff survey, carried out in 2016, which reveals much about the Government’s refusal to recognise the union of choice for ambulance crew. It was found that many ambulance staff would not recommend their employer, felt undervalued and that their performance was not recognised, lacked feedback from line managers, rated quality of communication as poor and were dissatisfied with pay levels. Most strikingly, there was evidence of discrimination, bullying and harassment. Overall, some 53% of National Ambulance Service respondents were dissatisfied with their employer. This paints a clear picture of discontent within the workforce which has been allowed to fester beneath the surface thanks to many years of the State turning a blind eye. This has created an unfair power dynamic within the workforce whereby the HSE has been allowed to ignore invitations to work on a resolution at the WRC. In addition, the HSE has repeatedly refused to enter talks with the Psychiatric Nurses Association to use established dispute resolution mechanisms to avoid further escalated action. However, ambulance personnel represented by the PNA want the Government to know that this dispute will not go away. Support for NASRA continues to grow within the House and among the wider public. There needs to be a shift in the power dynamic. Workers should have the final say on who represents them, not the employer or the State. There is an easy solution to this strike. The invite to talks at the WRC remains open. All the Government must do is tell the HSE to respond in a positive manner, as it did with the nurses, and find a resolution with the PNA.

It is important to note that the Government, which only a week or so ago stated it would not discuss pay with the nursing trade unions, has been forced into a significant climbdown. The reality is that it had no other choice when it was facing the prospect of a three-day strike in a health service already in crisis and the tremendous militancy of nurses on the picket lines, as evidence by the massive demonstration last Saturday, which was organised in four days. The response was incredible. Up to 45,000 nurses and others took to the streets. I note that RTÉ downplayed the scale of the demonstration, stating that tens of thousands were in attendance when, surely, there were far more. There was widespread public support for the nurses.

The executive of the INMO believes it made progress in the Labour Court talks. However, there could be opposition among nurses to the proposals when they are balloted. The deal is somewhat complex - I am neither a nurse nor a midwife and do not understand life on the wards or in an accident and emergency department - but it seems the average pay increase will be in the region of €1,200 to €2,500 per year, which is far short of the nurses' equal pay claim of €7,000 per year. The deal contains a clause to revisit the issue next year and that may be sufficient to persuade nurses to accept it. I understand negotiations are ongoing.

Will the Labour Court recommendation meaningfully resolve the recruitment and retention crisis? It may be that many nurses, disappointed by the Government response to their situation, will decide enough is enough and move abroad. Will it be enough to encourage the nurses living abroad who stood in solidarity with the pickets to come home? Will it resolve the dire safety issues for patients and nurses in our hospitals? I do not know the answer to those questions. However, nurses and midwives will go through the recommendation with a fine-tooth comb and I will fully support whatever decision they make.

It is symptomatic of the mess in the health service that the Government raised such a hue and cry about the €35 million cost of these proposals while €114 million is paid to agency nurse and midwife staff and €53 million paid to agency psychiatric nursing staff. It is important to note that the PNA is still in negotiations pending the Labour Court reconvening on Friday.

The House should note that there will be a strike this Friday by up to 500 ambulance staff represented by the National Ambulance Service Representative Association, a branch of the PNA, which is taking action in pursuit of a claim for union recognition. The stance of the HSE, the Department and the Minister on that issue makes a mockery of a person's right to join and be represented by a union of his or her choice. The positions of SIPTU and Fórsa, which are blocking these workers' rights to be represented by NASRA, are deeply regrettable. I refer to a letter sent today by Mr. Peter Hughes, general secretary of the PNA, to all Deputies, in which he states, "The HSE ignored the clear indication from Minister for Health, Simon Harris in the Dáil that he wanted this issue dealt with by negotiation rather than confrontation." Again, there is confrontation. He explains, "The HSE ignored two invitations to the WRC to work to a resolution, and refused to enter talks with PNA to agree contingencies for providing essential ambulance cover during the strike."

He goes on to say:

I would therefore appeal to you as an Oireachtas member to demand that the HSE, even at this late stage, engage through the WRC to resolve this unnecessary dispute that has been forced on frontline ambulance personnel.

The Minister should accept the invitation of the WRC and instruct the HSE to enter these negotiations, as the PNA has agreed to do.

I, too, am speaking in support of this motion. While there has been some movement, it was pitiful to see the nurses, or angels of mercy, as I called them here last week, out on the picket line where they did not want to be.

This matter is not all about pay. It is also about dignity, respect and safe conditions in the workplace. It is about having a reasonable modicum of support staff so nurses do not go home from work every evening stressed out of their minds and totally disregarded by the petulant, juvenile actions of the Minister for Health. He has no respect for them. He threatened to dock their pay if they went on strike. At the same time, consultants got €80 million to design a hole in the ground. I have just come back from there. The Minister of State, Deputy Catherine Byrne, knows well where it is because it is in her constituency, or very near to it, in Dublin.

Our nurses need to be respected. They are the staff at the front line who meet us after any incident when we go to hospital or when somebody has a heart attack or some other problem. They take the patient from the ambulance into care. I include triage nurses in accident and emergency departments. Right through the wards the nurses cover a broad spectrum, from the cradle to the grave. They work in delivery rooms delivering the wonderful new creations, the new babies, and they are the last in attendance when one's eyes are closed when one dies. They do everything in between. I could not say enough about them. I could not say enough to support them.

I have to declare an interest because I am married to a nurse. She is not acting as a nurse now. She nurses me most of the time but she was a nurse in her career. I declare an interest in case someone says I am being biased. I am not.

We all know about the disrespect with which nurses are treated. The Minister of State, Deputy Catherine Byrne, knows because she has a family, including grandchildren. She will know about the dysfunction in the HSE and Department of Health. The nurses see the waste every day of the week. In the wards, there are ward managers, floor managers, bed managers, linen managers, hygiene managers and food managers but nobody managing. Despite this, the nurses are trying to run the hospitals and to keep everything in order. A consultant might breeze in and out, certainly, but the front-line staff are present all the time. We have way too many layers of management and no one managing. When there was a matron, the place was clean, well-managed and well organised, without five people going around with flipcharts writing down the same thing about the patient and asking the same questions.

I am pretty certain that if I asked the members of the Government what the weather was like last Thursday, most of them would not be able to tell me. I guarantee them that if one asked the nurses what the weather was like last Thursday, they could tell one exactly. It was a cold, wet day. It shows the character, strength and resilience of our nurses that they stood strong last Thursday despite the weather and fought for their rights and for patient safety. Last Thursday, I spoke to nurses picketing in Bandon, Dunmanway, Kinsale, Clonakilty, Schull, Skibbereen and Castletownbere, and at Bantry General Hospital. It was important for me to meet them face to face and show them I was committed to supporting them. The Government was not committed to doing so. Last week, the Government would do nothing for the nurses. When there was a protest last weekend, by God the Minister jumped off the table quickly and realised he had to do something for them. The whole country told the Government it is a disgrace that, up to now, the nurse and midwife professions have remained the lowest-paid graduate professions in the healthcare system.

It saddens me to read stories about how a young Meath nurse named Gabrielle Cooney McGuire left her job because she was burnt out and had her heart broken by the job she once loved. The mother of two said on social media, "I was the nurse who cried the whole way home after giving a patient the best care I could - but not the care he deserved." This lady sums up exactly what all the nurses have been fighting for. When one talks to any nurse, one of the first things she or he is concerned about is the patient. That is what I found on the line in west Cork last week. Outside each of the hospitals, it was the patients whom the nurses were worried about, not anybody else. The strike was not solely about pay. Even though pay restoration is important, the nurses want to be able to care for their patients in the best and safest way possible. All nurses deserve this.

It was reported this morning that the INMO will face an uphill struggle to convince its members to accept the Labour Court's pay recommendation. There is a risk that nurses could soon be returning to the picket line if this is the case. I will stand 100% behind them. Let us not forget that there is planned strike action by over 500 members of the ambulance personnel branch of the PNA. The strike is due to take place this Friday. These ambulance members already carried out a one-day strike in January and now have no choice but to strike again. The HSE has refused to afford these personnel the right to be represented by the trade union of their choice. The Government needs to engage with them because their requests are reasonable. If, however, it refuses to engage, there will be further strikes later in the month and also in March.

I am glad to get the opportunity to talk about our nurses, who do such a wonderful job. Everyone will talk about his or her own county but the nurses do an especially good job in my county, Kerry. I met the nurses last Tuesday. It was absolutely lashing in Killarney, Tralee, Kenmare, Caherciveen and Dingle, yet the nurses were determined. One could see the determination in their faces and demeanour. As Deputy Michael Collins stated, it was not just about them but also about the patients they take care of minute by minute every day.

We need to recognise that nurses have to be properly paid. Considering the amount of training they do and the amount of activity their rosters require of them every week, they certainly need to be paid properly. I know what they do because they gave great care to my father and other members of my family who were sick at various times, just as they gave it to everyone else in their wards.

It was horrible to hear of a young nurse crying because she did not have enough assistance to get an elderly man into his bed. She had to ask the man's wife to give her a hand. The wife could see her crying because she felt inadequate because she could not get enough help to deal with the man. The safety of our nurses is paramount.

There is certainly a staffing issue. Half the community hospital in Kenmare is not yet open because it cannot be staffed. In the hospitals that are open, we just do not have enough staff, including front-line nurses. This needs to be dealt with by the Government. We have been talking about it here for long enough. Deputies on all sides have been reminding the Government about it but it is not doing enough about it.

The safety of our nurses in the wards is important. Some nights ago, I met a nurse whose mother was also a nurse. Her three sisters are nurses. She is wearing a neck brace because she got hurt while working in the hospital. She will never again work. That cannot be allowed. I ask the Minister of State, Deputy Catherine Byrne, to take this to heart and do something about it. It is happening quite a lot in recent times and must be stopped. There must be security within the hospitals as well as outside so this will never happen again.

I call Deputy Bríd Smith.

Go raibh maith agat, a Cheann Comhairle.

The Deputy is more than welcome.

I am sorry for my interruption of Deputy Pringle earlier regarding the queue, or the pecking order.

It is amazing that it is less than a week since nurses and the leaders of the INMO and PNA, namely Phil Ní Sheaghdha and Peter Hughes, respectively, were in the Visitors Gallery to hear us discuss for two hours the nurses strike. We felt it was significant enough for this House to discuss its implications. After that, on the Saturday, we saw one of the most amazing demonstrations of workers' power on the streets of Dublin. I reckon that 50,000 to 60,000 turned up. I do not believe that is overstating the number. It very much reminded me of the Repeal the 8th movement. I was thinking about the role the Minister played in that and how, after we won the vote, less than a year ago, some people were shouting "I fancy Simon" and carrying placards about how wonderful Simon was.

Deputy Bríd Smith-----

No thanks. You were, Paul. I saw you.

Simon himself is now at the other end of the agenda and is probably one of the figures of disdain and disgust among the wonderful movement. There was a feeling of the Repeal the 8th movement on the march.

The march largely comprised young people. It was hugely feminine and it was international. It felt like the movement we had been through on the campaign to repeal the eighth amendment but nobody was carrying "I fancy Simon" signs.

I want to describe what goes on with the Government. This Government poses as liberal. The members of the Government have a liberal attitude in wanting to promote the just causes of same-sex marriage, the repeal of the eighth amendment, reproductive rights and same-sex family rights. However, when it comes to the neoliberal agenda, the Government is as vicious as Margaret Thatcher or any of the rest of them. The Government has set out to try to break the nurses because it wants to teach a lesson to all public sector workers.

I want to preface everything I say by saying it is for the nurses to decide if this recommendation is good enough for them. The issue here is for us to be able to state clearly that the public sector pay deal is not fit for purpose and blind adherence to it will guarantee that the core issues therein remain ignored. This will increasingly become a fact as we go through the next couple of years. It is not just for the workers concerned. It is not fit for purpose in terms of our public services and what we can expect to be provided from them.

The view has been put across by many commentators that it is an outrage that nurses would get anything outside of that pay deal and that it will bring ruination to the country if we pay them more than the miserly award in the deal. The rubbish and hypocrisy that comes from the usual suspects never ceases to amaze me. They go to great lengths to commission reports, the conclusions of which tell us that there is no case for giving the nurses a decent pay rise beyond the constraints of the public sector pay deal. They claim there are no outstanding issues and, a decade after the sacrifices that nurses and others made, there is no crisis in the hospitals. I suspect those shrill commentators and, indeed, many of the politicians on the other side of the House do not actually experience the pain, overcrowding and the seriousness of what the health service is grinding beneath and what those nurses work under. Most of those commentators and politicians have private health insurance which guards one from the chronic problems that nurses are trying to highlight.

The key question is not whether the nurses want to accept this recommendation. I do not believe it is good enough but it is up to them. The key question for politicians is whether this recommendation and the measures contained in it will deal with the chronic shortage of nurses and midwives in our hospitals. Will it recruit and retain nurses? We can say conclusively that it will not. If it does not keep nurses here, and we will see the proof in the pudding over the next period of time, then we really have to think about what sort of a Government we want.

The Minister and his cheerleaders say there is no crisis in the system and people are not endangered. I learned a lot listening to Ms Phil Ní Sheaghdha over the course of the strike. One thing she pointed out well, eloquently and scientifically was that we work under a seriously dangerous ratio of nurses to patients. The recommended international best standard is one nurse to every four patients. I would not hold California up as an exemplary social democracy but it has a law that states the ratio of nurses to patients should never fall below one nurse to every five patients. Our system has one nurse to every eight patients, at best, and one nurse to every 11 patients, at worst. The latter end of that scale tends to apply in the psychiatric services.

The Taoiseach, a former Minister for Health, and the current Minister for Health manage a system that oversaw the trolley crisis grow last year to 108,000-plus people on trolleys, in which nursing numbers fell by 6% last year which means there are 1,754 fewer staff nurses in Ireland today than a decade ago and where, in the psychiatric services in the past 13 years since A Vision for Change was born, 70% of all beds have been taken out with the promise that the shortfall would be replaced within the community but only 36% of what was lost of that service was replaced within the community. We now have a system which is in chronic crisis with very dangerous nurse-patient ratios. It seems that it is okay to endanger patients and, apparently, to overrun the national children's hospital by €500 million and to have a procurement process for CervicalCheck that results in the fiasco that we have witnessed. It is okay for all that to happen but God forbid that the Government interferes in a public sector pay deal that is not working for the public sector, the workers or the people in this country who rely on those services. It is ironic that the Government is prepared to stick with that pay deal and undermine our ability to recruit and retain the staff we need. The result is, for example, the shortage of beds in places such as Linn Dara in Cherry Orchard where, most of the year, half the beds are empty and those are beds for adolescent children with psychiatric problems.

We are happier to pay €100 million a year to agency nurses to bridge the gap in staffing than to deal with the issues. Beyond the health service, we are happy to pay almost €1 billion a year to keep people in homeless accommodation through a combination of supporting rack-renting landlords, hotels and bed and breakfasts. It never gets mentioned that we are wasting €1 billion a year in the homeless industry.

It will be a matter for the nurses and the shop stewards. We will know, in the next while, whether they accept this recommendation, but if it is not good enough for them, it should not be good enough for us. They will have our full and continued support whatever they decide both publicly and in our communities. There may be a howl of outrage from the usual suspects I mentioned earlier if the nurses reject the deal. They may see it as more guff and nonsense from some union leaders who should know better. The public, the ordinary people who receive the services from the nurses, know and understand that a bad deal for the nurses is a bad deal for all of us because it does not contribute one iota to improving the health service.

This motion also attempts to address another element of the crisis. I am shocked at how the Government is behaving with the Psychiatric Nurses Association and its paramedics and ambulance drivers. Deputy Paul Murphy and I raised this as a Topical Issue matter a little over a week ago and the Minister of State's colleague, Deputy Finian McGrath, in his printed statement, said that they concluded that the Government will not recognise the National Ambulance Service Representative Association, NASRA, union. Get out from behind the HSE. It is not only the HSE that is denying the ambulance drivers the opportunity to be in the union of their choice. The Cabinet and the Government are also sticking by that decision. It is most undemocratic, anti-constitutional and unbelievably right wing that the Government has taken that position and forced 500 paramedics and ambulance drivers back onto the streets tomorrow and beyond. It has been said that there are multiple unions representing paramedics and ambulance drivers, most of which do not have a membership of 500, which NASRA has. It deserves recognition. Shame on the Government if it holds out on refusing to give it to them because it is forcing another, deeper crisis on the health service.

I pay tribute to the almost 40,000 nurses for the battle they have fought in the past couple of weeks. It was summed up best by one nurse who spoke on "Morning Ireland" and said that this was their Rosa Parks moment and they were not going to get off the bus. They may settle for this or they may not but, whatever they do, the fight for parity and equality within nursing in this country is not over by a long shot.

I thank the Deputies on behalf of myself and the Minister, Deputy Harris, for tabling the motion on this important issue. It is good to have an opportunity to debate the concerns Deputies have around this dispute. The Government welcomes the recent development in the dispute in the recommendations from the Labour Court. Listening to some of the speakers, I noted how passionately they spoke about this serious issue. I do not believe there is one person in this House and building who does not have respect for the dedication of the men and women who are in our hospitals and dealing with sick people on a daily basis.

I am sorry that Deputy Mattie McGrath has left the Chamber because he mentioned that he visited the hole in the ground in St. James's Hospital where the new national children's hospital will be erected in the coming years.

This is a new beginning for sick children, as well as for their parents and families who have been forced to sleep on chairs when they are attending hospital. Many of them have spent months and even years comforting their children in this way. It will also be a new beginning for the nurses and staff who will work in the positive environment of the new national children’s hospital. Many public representatives on all sides of the House will be delighted to stand behind the ribbon when it is cut for the opening of the hospital. We must continue on our journey to build a children’s hospital to the best international standards.

I appreciate that nurses and midwives did not take the decision to engage in recent industrial action lightly . I know from meeting many of them that they prefer to be in work than on the picket line. I value the contribution they continue to make to the health service every day. The Government has always maintained that the existing State industrial relations mechanisms were there to help reach a resolution. It is happy that a solution has been found through those mechanisms.

This dispute caused significant disruption to our health services. The HSE is working through any backlog relating to appointments. Work has already begun in rescheduling appointments affected by this dispute. I thank the HSE and its staff for their execution and maintenance of contingency plans throughout this dispute. I also thank the members of the INMO and the PNA for their assistance in facilitating and enabling these plans. It is sincerely appreciated by the Government.

By intervening, the Labour Court recognised the grave and extensive implications of the dispute. I welcome the initiative shown by the Labour Court in helping to avoid further disruption to patients. Additional disruption this week would have further compounded the impact of the industrial action that took place last week and would have made the task to reschedule appointments in a timely manner more difficult. For that, the Government sincerely appreciates this intervention.

The Government and the two nursing unions signed up to a three-year public service pay agreement which commits to significant increases in pay by 2020. Nurses and midwives can expect to see their deserved share of these increases beginning this year. Through this agreement, financial emergency measures in the public interest, FEMPI, pay reductions for pay levels up to €50,000, which include a large proportion of the nursing and midwifery profession, will be fully unwound by the end of 2019. The issues of recruitment and retention in our health service are taken seriously. We fully accept the reality that the numbers of highly qualified nursing, midwifery and medical professionals leaving the country is an issue. This is why the Government engaged the Public Service Pay Commission to look at roles in the public sector where recruitment and retention had been identified as issues. Nursing and midwifery was among the first of the professions investigated by the independent commission.

In addition to the benefits nurses and midwives can expect to receive from the unwinding of pay restrictions under the public service stability agreement and the correction of salary scale issues for post-2011 new entrants, the Government has agreed to the commission’s recommendations of a 20% increase in local and qualification allowances for nurses, as well as accelerated promotion for staff nurses to the senior staff nurse level. This change would represent a further investment of €20 million in our nursing workforce. We are confident these measures can support nurses and midwives in their essential day-to-day work, along with paving the way for growth, progression, and development in their profession.

Monday’s Labour Court recommendation build on the findings of the Public Service Pay Commission. The recommendations are also grounded in the reality of what is achievable within the public service pay agreement. They also meet the three principles the Government wanted to achieve in any solution to this dispute, namely, a deal that is fair to taxpayers, fair to public servants and fair to nurses. While these recommendations remain to be accepted by the INMO, I am confident the recommendations offer an opportunity to fully address those concerns expressed by nurses and midwives. They offer a clear path to an enhanced nurse practice salary scale. The recommendations also specify productivity and service improvements which will be to the benefit of both nurses and patients.

The Government’s work to improve our health service for patients and employees does not end with the Labour Court recommendations, it continues. There will be more work to do to ensure those recommendations achieve what they set out to achieve for all sides. For nurses and midwives, the recommendations herald the beginning of a transformation process of the nursing profession. This will be continued in future public sector pay agreements. For our health service, those recommendations also signal a change in how our hospitals and community services are more effectively staffed. This is good news for patients.

Turning to the issue of recognition also raised in the motion, while individuals have a right to membership of any trade union, they do not have a right that such membership is facilitated or recognised by their employer. While it is regrettable the PNA has decided to take industrial action, it is not possible to negotiate with a union which is not recognised as having negotiating rights for ambulance grades.

That is tautology.

Allow the Minister of State to continue without interruption.

As the Minister has already stated, the health service is not starved of resources, contrary to what the motion claims. He referred to the record levels of funding allocated to the HSE this year. However, the health service is more than just numbers. The additional resources allocated are delivering improved services and outcomes for the public.

The positive impacts of these increased resources are being visibly felt, most notably referred to in the recently published Health in Ireland: Key Trends 2018. The report showed life expectancy in Ireland has increased on average three months per year over the past decade. Other developments reflecting the increased resources and policy changes to our health services by the Government include Ireland becoming one of the first countries in the European Union to provide access to Orkambi for children with cystic fibrosis aged six to 11 years old, along with Ireland’s membership of the BeNeLuxA initiative on pharmaceutical policy which aims to secure affordable and timely access to new medicines for Irish patients.

There have been reduced waiting times for procedures. Under the 2018 action plan, we saw real progress in driving down waiting lists, especially for high-volume procedures. The number of patients on such lists has fallen by 18% from its peak. We are also witnessing significant falls in waiting times. While Sláintecare is being implemented, we have already taken great strides to make the health service more equitable for all. The provision of free GP care to under sixes and those over 70, as well as the introduction of a diabetes cycle of care for adult GMS patients with type 2 diabetes are just some of the examples of improving access for all and those with acute long-term needs.

In terms of improving facilities for the general public, we are continuing to invest in primary care centres with another 12 such facilities due to open in 2019. This is in addition to the 126 already operational. The impact from these measures already taken by the Government is that improvements are being felt on the ground. The evidence from the recent national patient experience survey found encouragingly that over 80% of respondents reported that they had either a good or very good experience. This is further real evidence that the current service is delivering for the public, far from the simple vision suggested by the Opposition.

Coupled with the transformative agenda contained in Sláintecare, the outlook for our health service is positive. The Labour Court’s recommendations have already created a positive momentum in supporting the planned transformative changes which will serve our health service well into the 21st century. They are imaginative and grounded in the realities of which I already spoke. It is a fair and balanced solution to the dispute which is consistent with the public service stability agreement. The recommendations also present an opportunity to enhance the status and significance of nursing and midwifery through collaboration and dialogue, as well as through the implementation of Sláintecare.

Despite these difficult past few weeks, I want to strike an optimistic note on the outlook for our health services. When one examines the general improving health outcomes experienced by our people and the concrete steps taken by the Government to increase fair and equitable patient coverage, one can see demonstrable progress.

Adding that to the transformation agenda contained in Sláintecare and indeed to the measures recommended by the Labour Court, the outlook for our health service, its employees and our people is positive.

I thank the Minister of State.

The Minister of State has a minute into injury time.

The recommendation put forward by the Labour Court is a fair and balanced solution to a significant industrial dispute and is consistent with the PSSA. I thank all the Deputies and urge them to show their support for the Labour Court recommendation.

I call Deputy Barry who is sharing time with Deputy Paul Murphy.

Ambulance paramedics, advance paramedics and emergency medical technicians will strike on Friday and again on 28 February and 1 March. The striking workers are members of the National Ambulance Staff Representative Association, NASRA, a branch of the PNA. It is a strike for union recognition for workers to be allowed to be represented by the trade union of their choice. The Minister of State said the strike is regrettable. What is regrettable is that the Government refuses to even talk to this trade union. What is admirable is that these workers are taking a stand for their rights.

NASRA and the PNA are the union of choice for a very substantial bloc of ambulance workers. Some 1,800 people work in the national ambulance service. The Minister of State might tell us how many of these 1,800 are front-line staff with patient contact because approximately 600 of that number seem to want to be represented by NASRA. However, the Government and the HSE refuse to recognise this union. They continue to adopt a hard-line union-busting position. The Government and the HSE do not want to be put under pressure to deal with the underfunding of the ambulance service. The consequence is chronic overwork of ambulance staff. The national ambulance service is currently under-resourced to the point of approximately 600 staff and 300 ambulances at a minimum. Instead of confronting the issue, the Government prefers to overstretch ambulance staff, with pressure, threats and suspensions from national ambulance service management being used to whip the service into shape.

According to the 2016 national ambulance service staff survey carried out by Ipsos-MRBI on behalf of the service, 48% of staff members had experienced bullying or harassment in the organisation in the previous two years. Every worker in the service knows that a greatly disproportionate amount of that bullying and harassment came from management.

As an example of the methods used, two ambulance paramedics are currently out of work on suspension in Macroom, County Cork, because one of them cited a health and safety concern related to extra duties demanded at the end of a 12-hour shift. The formal disciplinary procedure only takes four to six weeks to process, but incredibly these workers have now been suspended for eight months. Is it an accident that both are members of NASRA and that one of them is the NASRA representative for the Cork and Kerry region? This management bullying culture in the ambulance service must end. The union chosen by hundreds of ambulance staff must be recognised and the service must get proper investment.

On 28 January members of SIPTU refused to pass pickets placed by their NASRA ambulance service colleagues. I have no doubt that they will do so again this Friday, again in defiance of appeals from their own union leadership. The stance of these rank-and-file SIPTU ambulance staff should set the template for the entire trade union movement in supporting this important fight for union recognition.

Some 71 years ago a leaflet was delivered to every home in the UK. It read:

Your new National Health Service begins on 5th July. What is it? How do you get it?

It will provide you with all medical, dental and nursing care. Everyone - rich or poor, man, woman or child - can use it or any part of it. There are no charges, except for a few special items. There are no insurance qualifications. But it is not a “charity”. You are all paying for it, mainly as tax payers, and it will relieve your money worries in time of illness.

That is the kind of health service this country needs - an Irish national health service. We need a national health service that is not for profit, free at the point of use, funded by a steeply progressive system of taxation, which fully included the super-wealthy and corporate interests, a health service that involves the total separation of church interests from State interests and one that provides a living wage and reasonable working conditions for its entire workforce.

A victory for the nurses and midwives is a victory for all who want a better health service. In reality the fight for workers' rights within the health service and the fight for an Irish national health service go hand in hand.

Saturday's march with 50,000 nurses, midwives, paramedics and their supporters in all sorts of different jobs and trade unions - a sea of INMO blue coming down O'Connell Street - was a striking demonstration of the power and solidarity of working-class people. Coming on top of three days of very effective strike action, it no doubt struck fear into the heart of the Government and brought it to the negotiating table over the weekend. The proposals on pay that the Government had ruled out quickly became possible.

The fear of workers being organised in effective unions is the reason the HSE, clearly under the instruction of the Government, refuses to recognise the union of choice of more than 500 paramedics, NASRA. There is a lesson there for all public sector workers and indeed all private sector workers. Getting organised and taking action can win concessions. However, it seems that the Government was not listening properly. Those who were striking and marching were demanding pay parity and an end to the recruitment and retention crisis. However, the Government is trying to get away with offering significantly less than that. It is no wonder there is significant discussion and disagreement from below with the Government's offer at this stage.

As we all know Fianna Fáil gutted the health service. It claims it is not for the Dáil to tell nurses what to do and we agree. Fianna Fáil's amendment to the motion precisely tells the nurses what to do, referring to the Labour Court recommendation in glowing terms. However, it is for the Dáil to tell the Government what it should do, which is what our motion does. Our motion finishes by calling on the Government to recognise NASRA and to pay the nurses' pay demands in full.

However, if the nurses and midwives reject the offer because it does not deliver the pay parity they were fighting for, we will support them as will the public, and we will be calling on other sections of the trade union movement to support them again. That power will be seen once more and can extract more concessions.

It is suggested that there is a problem with money in the health service. It is seen in the Labour Court recommendation where at a maximum cost of €35 million the nurses are meant to pay for their own small step towards pay parity through productivity. However, there is plenty of money in the health service. It is in what is a for-profit health industry. Denis O'Brien owns the Beacon Hospital whose profits rose by 27% to €8 million in 2017. The profits of the Blackrock Clinic, part owned by Larry Goodman, rose by 10% to more than €12 million in 2012. Pfizer Pharmaceuticals, a company with profits of over $12 billion globally in 2017, tried to decimate the pension rights of its workers in Cork. It is owned incidentally by Monsanto of Agent Orange infamy. It is a rogues' gallery of those who profit from illness and from the privatisation of our health services. The problem is not a lack of resources and money; the problem is with how they are organised increasingly on a for-profit and private basis. The same is true right across society.

There is plenty of money to pay the nurses. The question relates to who currently owns and controls it, and how that money is used. Let us consider the €270 million paid before Christmas to the junior Anglo Irish Bank bondholders, which is more than enough to pay the nurses claim in full. Let us consider the €14.3 billion in the Apple tax account where the Government is spending money so that Apple can get it back. Let us consider the €29 billion held by the richest three people.

The Government's response is that it has to make difficult choices and that it cannot just choose to pay the nurses but that illustrates the madness of its policies and systems from the point of view of the majority. We agree that choices need to be made but we do not agree that they are difficult choices. They are easy choices and from the point of view of working class people and society as a whole, it is very easy to say that we should pay nurses and not Anglo junior bondholders, that Pfizer should not be able to cut workers' pensions while making super profits and that private insurance companies should not be able to profit off the back of an underfunded health service. Making those easy choices means undertaking the difficult task of transforming our society, turning it on its head and taking on the power of the major companies that profit from illness and the underfunding of the health services and which own the major sources of wealth. It involves deciding that they should be in public ownership and building a socialist society where they are used for the benefit of the majority. A crucial part of such a society where resources are used for the benefit of the majority is building a properly funded national health service whose workers are respected in terms of union recognition, pay and working conditions.

Amendment put.

In accordance with Standing Order 70(2), the division is postponed until the weekly division time on Thursday, 14 February 2018.