Health Service Recruitment Freeze: Motion [Private Members]

Deputy David Cullinane

I move:

That Dáil Éireann:

notes:

— that the Government's mismanagement of the health budget has led to a disastrous embargo on recruitment into frontline posts; and

— the memorandums sent by the Chief Executive Officer of the Health Service Executive (HSE), which directed a severe escalation in the recruitment embargo across the health service, and which noted that the embargo "will create difficulties" in the face of "an enormous increase in demand";

further notes that the disastrous decision of this Government to underfund the health service has:

— resulted in the loss of more than 7,000 essential posts from the HSE workforce;

— caused the removal of vital frontline vacant posts which were needed for the winter ahead;

— caused the withdrawal of job offers from prospective health service workers;

— sent a message to Irish workers abroad not to come home;

— sent a message to workers frustrated with the health service in Ireland to emigrate;

— sent a message to foreign health services to come and take our healthcare workers; and

— seriously impacted the ability of the health service to deliver safe, quality care and expand provision to meet rising demand across almost all services, including mental health, older people, home care, community services, and acute hospitals;

condemns this Government for throwing in the towel on health and causing significant reputational damage to the health service through their disastrous recruitment embargo, as a result of the underfunding of the health service; and calls on the Government to:

— immediately end the recruitment embargo on essential HSE posts;

— urgently bring forward revised estimates for 2023, to properly fund the health service to year end; and

— reverse its disastrous decision to deliberately underfund the health service in 2024.

It is extraordinary that we are having a debate about a recruitment embargo on many key front-line posts in healthcare when we consider that almost 1 million people are on some form of health waiting list, the pressure many hospitals and emergency departments are under and that far too many people are not getting the right care in the right place at the right time. Despite advances that have been made in the enhanced community care programme, many of the teams that are needed are not fully staffed. Yet, we now have a recruitment freeze under which 7,000 posts have just vanished. The rug was pulled out from under many people who went through a lengthy recruitment process and were offered jobs, only to be told that because no contracts had been signed and the posts were not approved, the posts were gone. Nurses, doctors, healthcare assistants and allied healthcare professionals who emigrated to Australia, Canada, New Zealand, Britain and elsewhere have essentially been told to stay in those countries and not to come home to work in the public system. It is extraordinary, it beggars belief, that the Government has put in place this type of recruitment embargo. I put it to the Minister that the reputational damage this causes to the health service when we have such a real difficulty in recruiting and retaining staff, getting the numbers we need, is breathtaking.

I also put to the Minister that this is a chaotic way to fund the health service. It is unprecedented that the head of the HSE will have to essentially write a national service plan for next year with a built-in deficit. The Government announced today a Supplementary Estimate for healthcare of €1 billion, that is €500 million short of what the head of the HSE has said is the deficit for this year. The Minister knows the deficit will be €1.5 billion. Only €1 billion has been given so the difference now has to be carried over into next year, on top of the hole that is already there because the Government has not properly funded the health service. The mess that was created this year will be even worse next year. That is on the Minister.

The three requests in our motion today were reasonable. The first was that the Government end the recruitment embargo and that will not happen, certainly not anytime soon. The second was to bring forward revised Estimates to properly fund the health service for 2023; the Minister has brought forward a Supplementary Estimate that leaves the health service again short €500 million and lumps the deficit onto next year. The third was to reverse its disastrous decision to deliberately underfund the health service for next year. That certainly has not been done because, perhaps I am wrong, the €1 billion that was announced today will not be recurring expenditure that will go onto the base but yet, that all will have to be funded again next year. The Government has made a complete mockery of funding the health service. At the same time, as I said, 7,000 posts have been scrapped. Vital front-line posts are now gone, with the withdrawal of job offers from people who acted in good faith, and there are consequences for patients because what I am hearing right across the health services from chief officers to hospital managers is that they are making difficult choices.

There is confusion on the one hand as to what these memos actually mean. Many people are struggling to understand what to do. They are continuing to hold job interviews but with no sense of when those jobs can be offered and contracts signed. Some of them are saying they may have to ignore elements of the memo because they simply cannot do without the staff. The Minister's amendment to the motion talks about agency staff. One of the objectives was to cut down on agency staff and management consultancy. It is not possible to cut down on agency staff unless replacement staff are available to work in the public system. The head of the HSE talked about the conversion of agency staff into permanent public servants working for the HSE. That cannot happen now because of the recruitment embargo. There is a lot more in the Minister's amendment to the motion, which I will go through later.

We talk about the reductions in waiting lists. There has been a 1% reduction across all waiting lists. I am not sure whether the Minister is looking for a pat on the back for a 1% reduction but he certainly will not get it from me or from the nearly 1 million people who are on community waiting lists, diagnostic waiting lists and acute hospital waiting lists. On the other elements of the Minister's amendment, particularly the enhanced community piece and the care programme for older people, there is still no statutory home care scheme. Home care services will be affected by this recruitment embargo. If the Minister talks to any chief officer in community services, he or she will tell him that. The Minister and the Government have made a complete mess of funding the health service and a direct consequence of that is this recruitment embargo that will impact on patient care. Unfortunately, that is on the Minister and the Government.

I commend the motion to the House.

Deputy Pa Daly

It is interesting to note that the Government's line in response to this motion is that there is no recruitment freeze or embargo. According to the amendment to the Sinn Féin motion, recruitment is continuing for graduate nurses and doctors in training and that exemptions also apply in disability and a list of specified front-line and residential posts. However, senior people in University Hospital Kerry tell me they cannot recruit junior hospital doctors in non-training posts. They have sought clarification from the Department and are none the wiser because they have not received a reply. Despite the freeze being extended again - I note the HSE refuses to rule out further extensions - it now covers such a broad variety of positions that the effects are beginning to be seen in the hospital. Other people tell me that physiotherapy and occupational therapy services were already struggling and now are falling badly behind. For many who need physical rehabilitation this will likely mean irreversible damage or that they cannot be rehabilitated to an independent lifestyle. University Hospital Kerry was already short of 50 administrators before this freeze.

The scheduling of follow-up appointments is becoming increasingly difficult and waiting lists are lengthening across the board. Perhaps most worryingly of all, results from lab tests are not being processed and returned to GPs in a timely manner and there is no administration staff to follow up on tests of concern. Surgery, orthopaedics and rheumatology are also affected, according to people who I spoke to. Winter and the flu season is coming and there also have been some Covid outbreaks. The impact of the flu is already being seen in paediatrics and management positions cannot be filled until the regional health areas, RHAs, are commenced in the new year.

Outside of hospital settings, things do not look much better. The Government's stance is that the disability sector remains unaffected or it is exploiting the fact that some care roles inevitably have a higher turnover, meaning recruitment must continue, to claim that there is no embargo. I spoke to one worker in the sector, who told me that a contract offered was rescinded. Another healthcare worker was verbally offered a role, which was also rescinded. Investments that should have been made years ago and should have been enforced were left on the shelf and it is the sick and most vulnerable who will suffer.

Deputy Pauline Tully

The recruitment embargo put in place by the CEO of the HSE has been triggered directly by this Government's mismanagement of the health budget. Job offers have been retracted and recruitment has been frozen for thousands of essential front-line posts. More than 7,000 critical posts have been scrapped. As we head into an extremely difficult winter, the Government has decided to underfund the health service. Basically, this will mean there are no additional experienced nurses and healthcare assistants, in spite of hundreds of patients on trolleys and hundreds of thousands on waiting lists. There will be no additional psychologists for CAMHS, despite the fact the number of children on waiting lists has doubled under this Government's watch. There will be no additional home care workers, in spite of the fact that 5,000 older people are waiting for home support. There will be no additional therapists for specialist discharge teams, no additional radiographers or clerical staff for radiology departments, despite the fact there are a quarter of a million people on diagnostic waiting lists, and no additional porters, hygienists or cleaners to keep patients safe from infection. Further investment is required in enhanced community care reforms to deliver early intervention and integrated care for older people, chronic disease management and local rehabilitation services. All of these are urgently needed to take pressure off our hospitals and deliver the right care in the right place at the right time, but these will now not take place.

The recruitment freeze has caused extreme reputational damage to this health service. What about all the Irish nurses working abroad who want to come home? What about all the healthcare professions who are graduating this year and hoping to start their careers here at home in Ireland? What the Government has told him essentially is to leave and go to Australia, Canada, Britain and New Zealand. What the Government has told these and other countries is that they can come right ahead and take our essential workers. What a message to send at a time of great crisis in our health service. It is obvious, from the budget, that the Government is throwing in the towel on health. It has ensured that tens of thousands of patients and staff will be condemned to extreme risks in hospitals this winter. Fine Gael promised to end the scandal of patients on trolleys 16 years ago but under successive governments with Fine Gael at the helm, it has only got worse. The Government must reverse its disastrous decision to underfund the health service and lift the recruitment embargo. If it is incapable of doing this, it should stand aside for a government that will.

Deputy Pádraig Mac Lochlainn

The Minister will be in Letterkenny on Friday, and he will meet the representatives of the GPs and consultants who have expressed grave concern about the major acute hospital in the country. This is an important meeting. I urge the Minister to listen to what the representatives have to say and to understand that what lies at the heart of the crisis in our hospital is years of systematic underfunding. In a recent letter to the Minister from almost 30 consultants in Letterkenny University Hospital, it was estimated that the underinvestment right now amounts to €45 million. That is about 25% less than what the hospital should have. It also means that we do not have the number of consultants, junior doctors, nurses and beds right across the spectrum. It is absolutely unthinkable that with all of that said and the challenges the Minister is going to face on Friday, he would have a freeze on recruitment not just in Letterkenny University Hospital, but anywhere in the health services across Donegal. As the Minister well knows, if there is a recruitment freeze in community hospitals and community care, all of that has a knock-on impact in the crisis at the emergency department.

I urge the Minister to act on the issues that the representatives raise, to have a plan whereby the senior management of Letterkenny hospital and the Saolta hospital group meet the GP and consultant representatives, the TDs and the councillors in the HSE forum on a regular basis, giving us updates and actions. Fundamentally, the Minister needs to accept that it is an absolute and incontrovertible fact that there clearly has been systematic underfunding and neglect of the hospital compared with other hospitals and to turn that around and address issues raised here. The Government cannot defund the health service and have a recruitment freeze at a time of crisis but my God, it cannot do it in Donegal.

Deputy Mairéad Farrell

In life, two of the most important things are health and housing, and both areas seem to be in perpetual crisis here. Indeed, most of the Government's actions actually seem to be making matters worse for people. A recruitment freeze in the health service at a time when the system is bursting at the seams is just simply incomprehensible. You would think that it would be a cost-saving exercise, but is it? Many within the HSE want to move away from using agency staff but this requirement ban is doing the exact opposite. That is not to mention the young people who are being treated as afterthought by the Government.

The Government's idea of workforce planning seems to be getting graduates on an aeroplane to Australia as quickly as possible. I will tell the Minister the story of one young woman who contacted me. She is a speech and language therapist who was recently offered her dream job in a rehab hospital. Due to the demand she started the job in a temporary capacity, through an agency, while waiting for the contract. As this can take months in the HSE, she relocated to do so and then the job offer was withdrawn. As she had started through the agency before the freeze, she was allowed to continue to work, albeit with no job security. The HSE is now paying 30% more for her through the agency than if it had been able to honour the contract. As she said to me, nobody wins in this situation.

There are recent healthcare graduates who are wondering if this country does not actually want them. I was contacted by one woman about podiatry graduates in Galway, who were holding out for HSE jobs. They had done their interviews and were told that offers would become available because we are crying out for podiatrists in our more rural areas. They are now in limbo, scrambling to find private clinic jobs. As that woman said to me, the freeze will cause the brain drain of healthcare students. Ní dhéanann sé ciall ar bith nach bhfuil muid in ann daoine a earcú sa chóras leighis anseo, daoine óga atá cáilithe i réimse leathan ábhar agus atá ag iarraidh obair anseo in Éirinn, i nGaillimh agus i gceantair iargúlta ar fud na tíre ach nach bhfuil in ann mar gheall ar an mbac ar fhostú anseo, bac a chuir an tAire isteach. Caithfimid fís a bheith againn don tír seo agus breathnú ar an todhchaí, todhchaí na ndaoine óga sin atá díreach críochnaithe lena gcuid staidéar agus atá ag iarraidh fanacht agus a bheith lonnaithe anseo. Teastaíonn fostaíocht dóibh siúd.

Deputy Maurice Quinlivan

The recruitment ban puts the lives of patients at risk. That is as simply as I can put it. The embargo on recruitment makes the job of our dedicated healthcare professionals more difficult and more stressful, as if working in the emergency department at University Hospital Limerick, UHL, was not stressful enough. The embargo on recruitment prolongs the wait time for those on waiting lists and ensures that the numbers being treated on hospital trolleys and in our hospital corridors continue to rise. This is an absolute failure. This year to date at UHL, 19,153 people have already been treated on trolleys. We will exceed 20,000 this year, which is an utter disgrace. The people of Limerick and the mid-west have been utterly abandoned by this and previous governments. We have already surpassed last year's record figure of 18,012. I stress the word "people". Those lying on trolleys, devoid of privacy, are people. They are people who have been assessed and deemed in need of a bed at a hospital, yet no bed is available for them.

Winter is here, and without adequate staffing and with numbers at capacity, it will be a lethal winter for some of our patients. It is worth mentioning what Dr. Ian Higginson, of the Royal College of Emergency Medicine, said, namely, for every 82 patients who wait for more than six hours, there is one associated death. The CEO of the health service noted that the embargo on recruitment will create difficulties at a time of enormous increased demand. Yet, the Government opts to retain the recruitment embargo, opts to underfund the health service, and opts not to fill thousands of essential healthcare posts.

The lack of action has sent a clear message. It is a message of capitulation from the Government. It is the white flag being raised and the message to our healthcare professionals that says they are being abandoned.

The freeze and underfunding have a real impact on our hospitals. At UHL, there is a huge shortage of cleaning and catering attendants. Those who work as porters are having to do additional time all the time. The recruitment freeze has compounded this. UHL has now been six months without an attendant in the X-ray department. The person who was to fill the role retired and still has not been replaced. This not only impacts the X-ray department but has a knock-on effect on the delivery of the diagnostic services and inpatients of the hospital. What we need to do is immediately put an end to the recruitment embargo on essential posts and reverse the Minister's disastrous decision to underfund the health service for 2024.

Deputy Pearse Doherty

This debate is another example of why this country needs to get Fianna Fáil and Fine Gael out of government fast. The deliberate underfunding of the health service, which is exactly what these parties have done, makes no sense. It is bad for patients and staff and will cost us more in the long term. We know the consequences of that because the health professionals are telling us day in, day out. Delayed diagnoses and treatment means worse outcomes for patients. Let us call it what it is. It means people will die as a result of Government decisions to deliberately underfund our health service. The Minister does this with his eyes wide open, knowing that our health system is creaking and under massive pressure regarding resources and capacity, that our waiting lists have never been longer and that people are lying in corridors and on chairs and trolleys for hours on end and, in some cases, for days.

What do we have? We have a Minister who comes before us and tells us he is deliberately going to underfund the health service, as we have heard from the head of the HSE and the Secretary General of his Department. What does this mean for patients? It means more pain, more misery, and more delays. It means in my county of Donegal that Letterkenny University Hospital is facing into a further difficult time. Job offers have already been withdrawn and recruitment has been stopped for thousands of front-line service posts right across the State. In the first ten months of this year, 4,633 patients were admitted to Letterkenny University Hospital without access to a bed. That 400% increase in the past ten years means 4,500 people could not get a bed in Letterkenny hospital in the first ten months of the year. What does the Minister do? He deliberately underfunds the health service, forcing the HSE to introduce a recruitment embargo. What this means is that the two radiologists we have will have to continue just to put up with the way things are because there are five posts unfilled and now there is a recruitment embargo. The hospital has one endocrinologist for diabetes, the lowest number in the State. What happens? We have a recruitment embargo. We have lost our dermatology service in Letterkenny hospital with no chance of getting it back because the Minister has ensured there is a recruitment embargo. He has thrown in the towel on health. He has given up on the health service and on the people who rely on it. It is about time the people finally got their chance to give up on this Government and put it out of office.

Minister for Health (Deputy Stephen Donnelly)

I move amendment No. 1:

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

"notes that:

— the Government has allocated €22.5 billion to the health budget for 2024;

— the Department of Health's additional allocation in Budget 2024 is nearly €2 billion;

— this includes an increase of €808 million in core current funding, €1,032 million in non-core current funding and an additional €120 million in capital funding;

— as of September 2023, there were 143,075 staff working in our health service, and this is an increase of 5,330 Whole-time Equivalent (WTE) year-to-date in 2023;

— the current Government has overseen and funded an unprecedented growth in health service recruitment, with a net growth of 23,263 (+19 per cent) staff since the beginning of 2020, and this includes:

— a net increase of 6,808 (+18 per cent) nurses and midwives;

— a net increase of 3,388 (+20per cent) health and social care professionals;

— a net increase of 866 (+27 per cent) consultants; and

— a net increase of 1,806 (+27 per cent) non-consultant hospital doctors;

— 2020, 2021 and 2022 achieved the three largest increases in the workforce since the foundation of the Health Service Executive (HSE), and this expansion has continued in 2023 with approximately 6,010 new posts funded;

— higher than planned recruitment activity has taken place across the HSE in 2023, with the HSE set to exceed its funded target (6,010 net new posts) by year end;

— recruitment is continuing for consultant appointments, graduate nurses and doctors in training, and exemptions also apply in disability in a list of specified front line and residential posts;

— where contracts have already issued and been accepted, these will be honoured; and

— the Government has allocated funding to ensure an additional net workforce growth of approximately 2,268 posts in 2024;

further notes that:

— Ireland has one of the highest ratios of nurses per 1,000 population in the Organisation for Economic Co-operation and Development (OECD), based on the register of actively practising nurses, and Ireland has 12.7 practising nurses per 1,000 whereas the OECD average is 9.2, and this means Ireland has the 5th highest number of practising nurses anywhere in the OECD; and

— since its introduction in March 2023, more than 1,000 consultants have already taken up the new public-only consultant contract, and this contract, which facilitates extended consultant presence on duty, results in reduced emergency admissions, more rapid and appropriate decision-making, shorter lengths of stay, better patient flow and improved outcomes for patients;

acknowledges that record recruitment into the health service is delivering real benefits to patients, such as:

— 2022 marked the first annual reduction in hospital waiting lists since 2015, and waiting lists are set to fall again in 2023, despite a huge increase in referrals onto waiting lists;

— the number of patients waiting over the Sláintecare targets (10-12 weeks) has fallen by circa 150,000, or 24 per cent, since Covid-19 Pandemic peaks;

— the significant increase in staffing across the health service has facilitated the delivery of many new services, including the Enhanced Community Care Programme and the Integrated Care Programme for Older Persons, which supports older people to live well in their own homes and communities without the need to access acute hospital settings;

— the large increase in our clinical workforce has enabled the rollout of many of our important national strategies, including cancer, maternity, trauma and many others; and

— the improved care being delivered by our expanded health workforce is resulting in improved health outcomes, including improved cancer survivorship and fewer deaths after strokes and heart attacks; and

further acknowledges that:

— if the level of growth in 2023, beyond funded levels of workforce growth, is allowed to continue uncontrolled, it would have significant financial implications; and

— the recruitment pause is part of a suite of control measures, including an instruction to reduce expenditure on agency staff and management consultants across the HSE and Section 38 organisations.".

Last Friday, the head of our national screening service, Fiona Murphy, posted the following words:

Amazing to be part of this. I never thought when I started in healthcare a long time ago that it would be possible to eliminate a cancer, especially one that was increasing. Now we will see it in our lifetime. Remarkable.

Kim, a patient advocate, described how much it meant to her to be at the event, having had cervical cancer herself. She said: "To see the progress that’s being made in eliminating this cruel disease is really something.” On Friday morning last, clinicians and patient advocates met to launch our roadmap to eliminate cervical cancer. We are only the fourth country in the world to announce such an ambitious target. The launch is so significant and positive, yet I did not see a single comment from senior figures in Sinn Féin to mark this momentous day. In contrast, the Sinn Féin motion talks about throwing in the towel. We have just heard Deputy Doherty talk about throwing in the towel. Throwing in the towel is collapsing the Northern Ireland Assembly in the face of Brexit nearly seven years ago.

Deputy David Cullinane

The Minister is scraping the bottom of the barrel now.

Deputy Stephen Donnelly

How has that worked out for patients in Northern Ireland under Sinn Féin? Hospital waiting lists in the South used to be longer than they were in Northern Ireland but not anymore. In fact, the lists in the South are now half what they are in Northern Ireland. For people waiting in the South for over a year, the list is ten times shorter than it is in the North. That is what throwing in the towel means. It means walking away from the people of Northern Ireland when they needed leadership on the economy and public services such as healthcare. That is what throwing in the towel looks like and that is what it does.

Let us go back to last Friday. After we launched the plan for the elimination of cervical cancer, I visited the new outpatient building for the Rotunda maternity hospital. The building is just off O’Connell Street. It is a €45 million investment by the Government in a state-of-the-art women and infants healthcare facility. It will transform care for women and children for decades to come. Again, there was not a single word from Sinn Féin. Instead, Sinn Féin's motion describes things as disastrous. To read the motion and to listen to some of the contributions, you would be forgiven for thinking there was not a doctor or a nurse working in Ireland today, that they had all left the country and that nobody abroad wanted to come here. The truth, of course, is very different. The truth is that babies born today will reach adulthood in an Ireland where we expect to have eliminated cervical cancer because we have been hiring more doctors, nurses and health and social care professionals than ever before. We are in a position to achieve this ambitious target thanks to the incredible dedication of those working in our health service and the support of the patient groups. The truth is that we can provide new services for women and infants from new facilities because we have expanded the workforce. The truth is that the waiting lists fell last year for the first time since 2015, and they are on target to fall again this year, because of record levels of recruitment for three years in a row.

Since 2019, we have increased the number of doctors working in the HSE by more 2,500. The number of consultants in permanent posts has increased from 2,600 to 3,500. We have increased the number of nurses and midwives by nearly 7,000. We have increased the number of health and social care professionals by nearly 3,500. We have increased the number of non-clinical staff by more than 10,000.

Deputies have understandably spoken about their local hospitals in Letterkenny, Limerick, Kerry and other places. Those hospitals have never had the level of investment they have had over the past three years. They have never had increases in their workforces like they have had over the past three years.

Deputy Pearse Doherty

They have never had the levels of overcrowding.

Deputy Stephen Donnelly

Next year, we plan on increasing the workforce by several thousand more. There will be more nurses to roll out safe staffing, more clinicians to open more hospital beds, more intensive care beds and community beds, and more professional staff to speed up the pace at which we can build new beds, primary care centres and hospitals. There will be more digital professionals to help us roll out digital health services to patients. In fact, the HSE has been hiring at such a pace that it reached their full hiring targets early this year. Having filled the posts it is funded to fill, which is the third year of record recruitment in a row, at that point the HSE stopped hiring. That is how it works in every school, Garda station, local authority and business. You have money to hire a certain number of people and when you have hired that number you cannot hire any more. That is how it works. Yet, the motion before us describes this approach as disastrous.

Incredibly, the motion decries the mismanagement of the health budget, presumably a reference to the HSE spending more money than it was funded for because it treated a record number of patients.

Deputy David Cullinane

€1.3 billion is a lot-----

Deputy Stephen Donnelly

The motion decries the mismanagement of the health budget and then goes on to demand that the same HSE hires staff into a bunch of posts that it is not funded for. The Deputies cannot have it both ways. Which is it going to be?

Deputy Pearse Doherty

It is the Minister who mismanaged it.

Deputy Stephen Donnelly

Do they want proper financial management or do they want the HSE to just hire into thousands of posts for which it is not funded?

Deputy Pearse Doherty

We want the Minister to fund them.

Deputy Stephen Donnelly

When I speak with health ministers around the world, many of them tell me that their biggest challenge is an inability to hire doctors and nurses.

Deputy Pearse Doherty

The Minister should talk to somebody in Ireland.

Deputy Stephen Donnelly

In Ireland, by contrast, we are hiring at record levels and we have exceeded the already ambitious targets for this year. Where I agree with the Deputies is that there is absolutely no question but that many of the jobs in our healthcare service are very intense. They are tough, difficult jobs - working in emergency departments, intensive care wards and in complex surgery, to name but a few. There is also no question but that we must all strive every day to do better and better for patients and better and better for our fantastic healthcare professionals. That is why we set up the NCHD task force; that is why we hired a chief health and social care professional; that is why we are rolling out safe staffing through next year; that is why we are continuing to invest in advance practice; that is why we are investing in new primary care centres, bed blocks and hospitals; that is why we have been hiring at record rates for the past three years; and that is why we are expanding college places in healthcare.

It is true that he vast majority of healthcare professionals I speak with talk with passion about their work and their patients. They talk with pride about their hospitals or community organisations. It is also true that the vast majority of healthcare professionals who qualify in Ireland choose to stay and work in Ireland. Some do go abroad, as is normal, natural and healthy. It is also true that the majority of those who qualify here and choose to go abroad, in time choose to come back home and to work here.

Deputy Pearse Doherty

Not any more. There is an embargo.

Deputy Stephen Donnelly

We are very fortunate in Ireland to have such high-quality healthcare training and education. We are also very fortunate that so many internationally trained healthcare professionals choose to work in Ireland. They have been doing that for many years and they will continue to do that next year while we expand the healthcare workforce again by several thousand. This Government will continue grow our healthcare workforce. We will continue to invest in our healthcare workforce and we will continue to support in every way we can our fantastic healthcare professionals to be the very best professionals that they can be.

Deputy Pearse Doherty

That is so not true. The consultant who is working on his own is now left on his own because of the Minister.

Deputy David Cullinane

The Minister for Health was looking for more money.

An Leas-Cheann Comhairle

The Deputies are eating into their colleagues' time.

Deputy David Cullinane

He is obviously taking the soup.

Deputy Johnny Guirke

Having spoken to several healthcare professionals, I know the recruitment freeze is having a hugely negative effect on them. It is cornering them into an environment where burnouts in staff have become a frequent occurrence and the thought of emigrating to Australia, New Zealand, Canada and other places is not given a second thought. Organisations such as the Muiríosa Foundation, which provides care for individuals with disabilities, are also on the brink of service shutdown due to the recruitment embargo. The struggle to find and retain staff is real, and the embargo has only made the situation worse. The decision to withdraw job offers to qualified candidates has left many wondering about their futures in Ireland as trained healthcare professionals.

Too often, individuals with disabilities become casualties of the Government's inadequate health budgets. Without sufficient staffing levels and a steady influx of new healthcare professionals to fill vacant positions, many of these individuals are unable to live meaningful lives within their communities.

In my home county of Meath, the underfunding of health services by the current and previous Governments has had significant consequences. Navan Hospital serves as an example, with years of underfunding by successive Governments leading to the bypassing of its accident and emergency department. Hospitals and healthcare organisations should be adequately funded to recruit staff directly instead of using agency staff, which cost more money in the long run.

The impact of the embargo is being felt by both patients and staff. Urgent care is prioritised over routine care, resulting in increased waiting times and a strain on scheduled procedures. This could lead to the deterioration of patients' conditions.

The burden placed upon hospital management and consultants is immense. They are forced to make difficult decisions, choosing between urgent and routine care. Prioritising urgent care may seem like a logical choice, but we must remember that routine care is equally important. It is a delicate balance that should not be compromised due to staffing shortages. It also affects nurses, non-trainee doctors, health and social care professionals. It is not just doctors and nurses who are affected. There is also an embargo on administration staff. The work they do includes everything from answering the phone, organising patient clinics, ledger records, bloods, scheduled appointments, registering appointments, paying wages, purchasing supplies and paying for supplies. Then we have cleaners, patients and porters. This embargo will lead to more risk for patients and to longer waiting lists.

Deputy Rose Conway-Walsh

I cannot believe the response the Minister has given this. I really thought that he was going to come in here, listen to what was being said and commit to bring forward a Revised Estimate for health because he will have seen by now the disastrous decisions that were made in the budget, but he did not. Instead, he has come in here to paint a picture that is not the reality on the ground. The reason I know that is as late as yesterday our party health spokesperson, Deputy Cullinane, and I visited Mayo University Hospital to listen to the nurses and people working in the hospital, and to listen to management as well. I am really glad that the Minister talks to people all over the world but he needs to get down there and talk to people about the reality they face. That hospital alone is operating at 125% capacity. Does that not alarm the Minister? The capacity is at 125% with exhausted staff who have not even had time to recover since Covid-19 and all that was expected of them then and that is right across the system. It affects the people working in labs, the people working on the front line, in ED and everywhere else. They have not had time to recover, and we are asking them to continue on working in an environment where the capacity is at 125%. The Minister does not think it is a problem that 880,000 patients are waiting for treatment. Thousands of them are waiting in County Mayo alone for treatment. I am shocked at the reply the Minister has given.

Deputy Johnny Mythen

The recent announcement by the CEO of the HSE will have an immediate and very serious repercussions on public health services. Up to 7,000 front-line posts will be withdrawn from an already overstretched workforce, one facing the real possibility of not being able to provide necessary and vital care to communities across the entire country, including County Wexford.

It was obvious from budget 2024 that the health budget was way off the mark. The fallout from this on the Minister's Department and the Cabinet decision to underfund the health service in budget 2024. Sinn Féin forewarned the Government that the consequences of this undertaking would cause to vital services and patients alike. The list of services that will be affected by the decision is too great to name them all but I will mention a few.

There will be no educational psychologists for CAMHS where there are approximately 120 posts unfilled, even though the waiting list has doubled. What about elderly people who are in dire need of some support services? We already have 5,000 people on waiting lists, including more than 510 individuals from Wexford who are waiting for home care supports. Another 250,000 people are on waiting lists for diagnostic services. What about the hundreds of patients on trolleys? There were 562 today, plus the tens of thousands on waiting lists because there is a shortage of experienced nurses and healthcare assistants. Yet, the Minister is going ahead with an embargo on recruitment and retention.

His announcement of an extra €1 billion from the Cabinet this morning is very welcome and it may help this year but what about 2024? Will there be an embargo in place in 2024? The Government has made many promises that it is going to fix the health service yet how can he explain placing an embargo on 70,000 front-line posts that would help.

As a Wexford TD, it saddens me to see so many of our young health professionals from the county and beyond, forced to leave our shores for Australia, New Zealand, Canada, or Britain to find employment. I am sure their families felt heartbroken and let down as the said goodbye to them. We need to bring our highly trained health service staff back home to help deliver the health services the people of Wexford and lreland need and deserve. We ask that the embargo would be lifted and a restoration of the jobs that were promised in good faith.

Deputy Brian Stanley

The embargo on recruitment has been described by the INMO as a kick in the teeth. The Government's decision in the budget to underfund our health service means that 7,000 essential posts have been scrapped, placing a huge burden of work on struggling front-line staff.

In Laois-Offaly, there is chronic understaffing of posts in vital services and supports. A total of 42% of all CDNT posts are vacant in County Laois while in County Offaly the figure is 35%. In CHO 8, the area that covers the midlands and counties Louth and Meath, there are huge vacancies across the board, including 32% of speech and language therapy posts; 36% of occupational therapy posts; 41% of psychologist posts; and 55% of dietician posts. That is just a flavour of what is happening on the front line. Figures we received at the Committee for Public Accounts add further detail to the picture of what is going on in CHO 8. There are ten vacant posts in medical care; 30 in nursing and midwifery; 31 in health and social care; 15 in inpatient and client care; and 14 in community services. Yet, the same document outlines that there are 34 more management posts than are needed. That is 34 additional staff in management and administration, according to the HSE's own data. The decision to underfund front-line services is already creating difficulty and will continue to do so. Let there be no doubt that this will put the health of patients at risk.

Job offers to health service workers have been withdrawn. Advertisements for vacant posts have been removed from websites and the Department has sent a message to those healthcare workers working abroad to stay where they are and not to come home. In fact, healthcare workers are being trained here to leave to work in other systems. Our motion seeks the lifting of the recruitment embargo, a properly funded health service and an urgent Revised Estimate for 2024. The Minister himself actually looked for extra money. We both know that it is needed. Front-line services are falling down and the gaps in the service need to be filled.

Deputy Duncan Smith

This is a very good, simple, to-the-point motion that we wholeheartedly support because it goes to the heart of what is going on in the health service at the moment. The Minister's response was to begin talking about the aim to eliminate cervical cancer in Ireland. This is a very laudable aim, which we all support 100%. By God, what a legacy that would be for Vicky Phelan, just over a year on from her passing, if we were able to achieve it.

However, that is not what this motion is about. Even if it is, achieving that aim or any aim in our health service is going to be impossible while there is a recruitment freeze on front-line staff. I acknowledge non-training doctors and nurses are excluded from the freeze but doctors and nurses cannot operate effectively in a healthcare setting without healthcare assistants, porters and other front-line staff who are subject to this recruitment freeze. Our hospitals are at full capacity. The Minister will not solve or even make a dent in the trolley crisis if he cannot tackle delayed discharges. This means more home helps and home care workers are needed but they have also been targeted by this recruitment freeze.

In July this year, the Minister spoke at an event organised by the Irish Universities Association. He said that we will need to double the number of healthcare college places to meet the skills demand from the health sector over the coming years. This is a laudable long-term vision of what is needed. However, how can young people who want to enter the health service have any trust when the Minister says he wants to double the number of college places to meet the skills demand and four months later we have a recruitment freeze? How can people build a life and plan a career when, in the midst of huge budget surpluses and when the country has never been richer, recruitment freezes are announced and then extending them a couple of weeks later? It is crippling the trust of our young people who want to enter the health service. As it currently stands, almost 900,000 people are on waiting lists of some kind. That is just under one fifth of the ever-increasing, ever-ageing population. Our healthcare system is already understaffed with front-line worker numbers cut to the bone. Those waiting lists are not going to improve. They will disimprove and increase unless we get the staffing levels right.

Yesterday, the Irish Hospital Consultants Association, IHCA, raised concerns about the spike in the number of children on hospital waiting lists as flu season approaches. Waiting lists for child inpatient and day case treatment have increased significantly over the past year, with severe overcrowding expected in paediatric hospitals this winter. The figures are quite stark. Over the past year, child inpatient and day case waiting lists combined have increased by 26%, which is a much larger increase than that of adult inpatient and day case treatment. Children are being put into overcrowded and understaffed settings. It is outrageous and it is a complete failing of the health service, and the Government has to take responsibility, which it has failed to do. It is incredible that the legacy of budget 2024 will be of failing to fund the health service and two recruitment freezes in short order after the budget announcement.

The Minister mentioned budgeting and hiring the number of staff that is budgeted for. I have yet to see where all these staff have been hired that are doing nothing on the front line of our health service. I have yet to walk into a healthcare facility anywhere and see a load of healthcare assistants, nurses and porters doing nothing; they are not. These people are worked to the bone. The HSE managers are hiring the staff because they are needed to cope with an increasing and ageing population putting massive demands on our healthcare service.

It is so weak and insipid of the Minister to reply with this accounting comeback in the face of the healthcare crisis and especially on the back of our experience during Covid and how people embraced the health service. They were closer than they had ever been to front-line workers in supporting them and wanting to be there for them. This is being eroded by decisions the Minister and senior management in the HSE are making. The division between the Department of Health and the HSE and the public airing of positions and policies has to end. The ones who suffer are the sick and the vulnerable and those who require the health service, and those who are having cope are those on the front line.

A few days ago I was told of a CDNT where a new manager was about to be hired and onboarded has been subjected to the employment freeze. This has had massive knock-on consequences to the operation of that particular service. It will also have an impact on continuity, staff retention, recruitment, the establishment of family forums and everything else that needs to go into the running an effective CDNT.

I also spoke to speech and language therapists who voiced the fear that the recruitment freeze has compromised patient care and will have further negative impacts. It will lead to unsafe, poor quality health outcomes for patients. The clinicians who are committed to serve are being let down by this.

This again points to how the HSE is being run, staffed and managed in that there are not enough voices from the clinical side at the top of the organisation. More voices from the clinical side would be voices for the patients. Sadly, they have been absent from an awful lot of decision-making in the HSE. If there were more voices from the clinical side, I cannot see how we would end up with a recruitment freeze at this time. It is incredible that we are here debating for the sixth week in a row the issue of recruitment freezes in the health service. Whenever I or other members of the Opposition raise staffing levels we are told that they need to be put in context by the Minister. We are told that there are thousands more staff this year than last year. We are told that things are getting better instead of worse when we know that 7,000 essential posts have been scrapped since the implementation of the recruitment freeze. The number on waiting lists for home support has gone from 5,500 to 6,000 and there are 900,000 people on waiting lists. None of these key measurements are going in the right direction. No matter what the Minister says, every measure is going in the wrong direction. I am deeply concerned about the winter ahead. We need a greater uptake of the flu vaccine. Families who are not entitled to get it for free are making an economic decision and deciding that they cannot afford it. We need to get the RSV vaccine rolled out. We also need to see more uptake of the Covid vaccine to address the triple threat that will impact our winter trolley crisis. Will the Minister seriously examine a national adult immunisation programme that will take these three vaccines into account and consider shingles and other vaccines?

I know there is vaccine fatigue out there - I understand that on a human level - but nothing is better at keeping people out of hospital than having an effective vaccine. We need to look at the hurdles that exist, which are economic for many people, such as poor people who cannot afford to get a vaccine. It is something they will put on the long finger. It costs about €37 to get a flu vaccine. For a hard-pressed individual or family on a fixed income, that is something that will make them say they will just take their chances this winter, and they are the very people who will end up in our emergency departments.

We have a childhood immunisation programme and it is a good one. That is a good part of the health service. Some say the Opposition does not mention good things often enough but we do. We need a national adult immunisation scheme. Health technology assessments, HTAs, have been successful for a chickenpox vaccine for kids, so good work is being done but it needs to be brought together. My concern relates to the lack of funding in this budget for new medicines and that whole area. We are not seeing enough energy regarding vaccines and illness prevention. If that were brought in and people did not have barriers, and if we had enough staff and were lifting recruitment freezes in order that we could provide vaccines and keep people out of emergency departments, that would be a clever, smart way of impacting on the trolley crisis.

I brought forward a motion on home care two weeks ago and mentioned it earlier during this contribution. We need a proper plan for hiring, regulating and valuing our home care workers. They are so important to our health service and they do not get enough recognition. Unfortunately, what the Minister's Government has done on that is not enough. A living wage is good, but if they do not get travel expenses, mileage, regulation and value, we are at nothing.

Deputy Gino Kenny

I thank Sinn Féin for tabling the motion. We are all feeling a bit of shock at the recruitment embargo in the health service. Rather than going into a state of contraction in respect of recruitment and need, we should be expanding, and anybody would agree with that. The embargo is going to have a detrimental effect on our health services, and those fault lines between private and public, which were especially visible during Covid, will be exacerbated because of the historical inequalities in our health system.

As an example, in Dublin Mid-West, mothers are finding themselves in a ludicrous situation whereby, over recent years, there has not been access to public health nurses, especially in Lucan and Newcastle, both of which are expanding areas in the context of the services they need. Likewise, there are no public health nurses for small children. It rings alarm bells straightaway if a child does not have access to a developmental nurse for their healthcare. That has been going on for the past couple of years and, obviously, the embargo is going to prevent that from improving. That is extremely worrying. There is a huge deficit in the healthcare system, and now it needs a bailout.

It is not in great shape. I come from the point of view of saying we need to look at the positives of our healthcare system. There are a huge number of positives, but there are also a huge number of deficits. They are real; they are not made up by the Opposition, by any means. They are historical, whereby people who need access to healthcare cannot get it because they do not have private health insurance. It is ludicrous that 50% of the population rely on private health insurance. That is not a sustainable model for healthcare, not to mention universal healthcare, which Sláintecare is striving for. It is a good model, but we are a long distance from having a system for providing universal healthcare.

The recruitment embargo is deeply upsetting and troubling and will without doubt have a knock-on effect on professionals both in the health service and those who want to come into it. When they see that Ireland is not currently employing certain professions, that could have a knock-on effect and they will not come to our health service, which we need them to do. Ireland’s healthcare system, like that in most countries, is very multicultural. All medical professions virtually everywhere in the world - Ireland is no different - are very multicultural, with a huge number of nationalities and motivated people who want to do their best for their fellow human beings.

The embargo is a retrograde step for our overall healthcare system, which we want to be one with greater equality than inequality. It is a significant step backwards, and I hope it can be addressed soon.

Deputy Verona Murphy

I thank Sinn Féin for tabling this important motion. It allows us time to examine the Government's recruitment freeze in more detail, and perhaps the Government will set out a logical, detailed and coherent argument for its introduction. If not, we will support its removal.

The HSE is bloated. It costs the taxpayer too much via waste and the system is failing to deal with the major problems of waiting lists in the various health departments. Comparing the budget allocations for the Department of Health between 2016 and 2023, we see an increase in spending of almost 70%, from €13.6 billion in 2016 to more than €23 billion in 2023. This is a colossal increase. An increase of €10 billion in the space of seven years is simply eye-watering, yet despite all this money being thrown at the organisation, what do we have to show for it?

Waiting lists are getting longer and there is a crisis in virtually all sectors the health service, including the GP sector. The health service has not been underfunded - it is more than adequately funded - but the funding is clearly not being used to achieve the best outcomes. We are told a recruitment freeze, which has been extended to almost all areas of the HSE, is required to address the problem, but I have major concerns about the knock-on impact it will have on the functioning of our health service. I do not understand why it has been introduced or why the Government has not explained the rationale for it more clearly. The key question is what, in reality, a recruitment freeze will lead to. In what way does it address the problems of waiting lists and people being left in limbo for years awaiting medical treatment?

I regularly raise health-related issues with service provision, whereby people are left waiting for treatment and funded services are unable to operate. Between contributions in this Chamber and at the public accounts committee, I have brought up CAMHS-related matters about 50 times. On almost every one of these occasions, the crux of the issues raised could be linked back to one word, staffing. The vast majority of the time, the reason is a lack of staff in CAMHS, disability services, care settings and virtually every other setting.

Big capital investment projects in recent years have been shambolic. The national children's hospital is still not operational, despite construction having started seven years ago. When it is eventually completed, it is on course to be nearly three times as expensive per bed as the next most expensive hospital ever built in the history of mankind. How many people have been or will be held to account for this failure or removed from their positions?

In recent days, there was an announcement in the North for eight new MRI scanners in Belfast; meanwhile, Wexford General Hospital has been waiting five years for one.

When we see a health budget of €23 billion, one wonders why the people of Wexford had to fundraise €250,000 towards the cost of an MRI scanner that is still not in place years later. In addition there is no start yet on the new 97-bed unit in Wexford General Hospital. Planning applications are going in shortly and phase 1, the building of a car park, will begin first, but we have very scant information on when work on the 97-bed unit will begin or, more importantly, when it will be completed.

I do not believe the recruitment freeze has been justified or that it will help address the major problems that exist within our health service. There is no use in increasing health spending every year if all it means is the volume of waste is increased. I received a very disheartening email today from a young man who is suffering with seizures and believes he is quite ill. He is unable to obtain an appointment with a neurologist anywhere in the country, yet, at the same time, we are talking about a recruitment freeze in the health service. I ask the Minister to consider the motion and to consider reversing the freeze.

Deputy Matt Shanahan

I have sympathy to a point for the position Government finds itself in with runaway budgets and the difficulties of trying to rein in spending, but a recruitment freeze is a very blunt instrument to use. It cuts across all systems, including community, acute and primary care. It does not offer any help with trying to figure out who is actually doing a good job and who is not, or even more importantly, what areas are most in deficit with respect to staff, as opposed to those that are not. We have that imbalance throughout the health service and it is something we have not really tried to address. The recruitment ban is penalising all systems in healthcare at present and I cannot see how that can be placed anywhere as being within the interests of patients.

I will speak to our model 4 hospital in Waterford. I bring it up because, not surprisingly, I am deeply engaged with the issues at the hospital. We had a commitment to open the hospital up for seven-day cardiac cath lab access. Back in July the Minister visited the hospital and graciously came to meet staff on the ground and welcome the opening of the second cath lab, which I welcomed too. However, I pointed out at the time there was no budget to implement seven-day opening even though the Minister offered to the staff that it was his intention the hospital would move to seven-day opening at the end of the year. I told all and sundry there was no budget in place. How could that not have been known before the recruitment freeze came in? Given the freeze, we are in the position that if these people are to be recruited, a derogation will have to be sought. I hope that is what the Minister does, because it is one commitment Government has given that it cannot turn away from. We must get seven-day cardiac cath lab access for heart attack patients on the weekend.

Beyond that, as part of the end of Covid and the problems of the closure of Wexford hospital due to a fire, the Government opened an additional step-down facility up in Kilcreene hospital to provide orthopaedic and surgical step-down care. There were between 12 and 18 beds being operated and a business plan had been put in at some point to show 18 beds could be operated, and that was having a very marked impact on day cases and admissions at University Hospital Waterford, UHW. It was being done very efficiently by UHW staff on the ground in Kilkenny, but that has had to be stopped. That activity has ceased. Part of that, and nothing to do with the HSE freeze, is the money burned up from the UHW budget in dealing with the fire at the hospital. I understand there is a very substantial, multimillion euro bill awaited by the Ireland East Hospital Group to recompense the hospital in Waterford and the question is why it should stop services because it cannot get another part of the system to pay it..

The other point I have is about consultant posts. We have two emergency consultant posts and a radiology post that have been held up for months by the consultant applications advisory committee and just as they are approved we are told it has to go back to the South/Southwest Hospital Group. What are the chances it will give us funding? I would say there is not very much chance.

I am struggling to understand the benefits of this health recruitment freeze as there is nothing targeted in it. Let us consider the digitisation of the health service and the need to try to bring efficiency monitoring into what people are doing. Earlier, the Taoiseach was asked a question about the health freeze and he said there was not one as nurses could still be recruited. I am not sure whether the Minister can provide any clarity on that. The Taoiseach said it was still possible to recruit nurses but that is not the information I am getting. We cannot recruit anybody in Waterford and from talking to other people across the system, the impression is they cannot either. Returning to the issue of efficiency and digitisation, the Minister needs to start tackling the efficiency of hospitals, especially in the acute sector, and look at who is doing what well and who is not. Rather than bringing in this blanket ban on recruitment, he should start to look at the hospitals he said earlier in the year he was going to reward for the efficiency metrics they have gained rather than penalising hospitals across the board with the recruitment freeze.

I welcome the motion because it draws attention to the fact that the freeze is not going to work. It is not going to work for patients, it is not going to work in the system and it is not going to reduce the budget very much either. We wait to see what other plans the Minister might announce.

Deputy Róisín Shortall

I thank the Cathaoirleach Gníomhach for allowing me to contribute and I thank Sinn Féin for tabling this important motion. The Social Democrats will support it. It is frankly unforgivable this Government has allowed a situation to occur where a recruitment freeze is even on the table, never mind being implemented. It is not as if Government was not aware of the challenges facing the health service and the need for additional funding. After all, there have been repeated warnings, all of which have been ignored, it would seem. For example, the HSE national service plan was not published until March in 2022 and it was similar this year. This was due to a protected allocation process. That kind of delay would have been unthinkable previously. The statutory periods around the letter of determination, the submission of the service plan and the approval used to be adhered to and it seems they are being ignored completely now. It is now abundantly clear the process for allocating HSE funding has become extremely awkward and difficult due to inadequate funding. Attempts have also been made to conceal gaping holes in the budget, such as the €2 billion shortfall identified by a former HSE board member earlier this year.

This increasingly fraught process is a very disappointing development given Sláintecare was supposed to take the politics out of health by building consensus on the need for major reform. Instead, this Government has allowed it to become a political football all over again. In this context, there has never been a stronger argument for Government to lay out a five-year funding programme for Sláintecare. Only then will I believe it is genuinely committed to reforming our public health service.

What is most galling of all is this recruitment freeze is taking place against the backdrop of stubbornly high waiting lists. At any one time there are at least 1 million people on some sort of healthcare waiting list. Between April and June of this year there were almost 300,000 people on a waiting list for community services such as counselling or occupational therapy. When it comes to hospital care, the situation is, of course, even more stark. At the end of October, there were just over 826,000 people on some form of hospital waiting list. Of those, more than 106,000 were waiting for inpatient treatment, while almost 600,000 were waiting for outpatient treatment. To make matters worse, 70% of those waiting lists exceeded the Sláintecare targets for maximum waiting times six years after the report was first published. How can the Government ever expect to tackle these waiting lists without providing the necessary funding to increase capacity and activity levels?

Reform costs money and our health service is crying out for it but the Government is just not listening. The Government can try to put a positive spin on underfunding our health service but it is fooling no one. The Minister need not take my word for it; the INMO has said that this decision will send the health service into free fall while the IMO has warned of chaos in the system.

One would also have to wonder what this means for previously made commitments, for example, the commitment to implement the safe nurse staffing framework. In May, funding of €25 million was announced for an additional 854 posts to fully implement the framework. What now for those posts? The whole point of this framework was to take an evidence-based approach to determining safe staffing and skill mix in acute settings but it now seems this principle is to be abandoned, at least for this year.

Another concerning aspect of this decision is its impact on the implementation of Sharing the Vision. The strategy's national implementation and monitoring committee recently published two quarterly reports, which revealed continuing difficulty in meeting timelines. Its second quarter analysis noted “with concern that for the first time ... the problem category of cost and budget outweighs recruitment”. The report goes on to highlight the significant recruitment challenge that is resulting in underachievement in key aspects of the implementation of Sharing the Vision. It is clear that momentum is being lost in implementing this key strategy because of funding shortfalls. A recruitment freeze would effectively stall that progress.

With regard to home care, allowing this freeze to go ahead would completely undermine the Government's supposed commitment to implementing all 16 recommendations of the strategic workforce advisory group. What happens now to the four recommendations that relate directly to recruitment and training? Will they be put on ice at a time when almost 6,000 people have been approved for home care but when there are no carers available?

What now for regional health areas? Many of us were starting to believe that the Government was serious about restructuring the HSE, breaking up the centre and devolving powers held there, which is an absolutely critical component of Sláintecare, but this freeze has also cast some doubt over that. What does it mean for recruitment to key positions in these new regions, including the six regional executive officers? I would appreciate it if the Minister would clarify that point in his closing remarks. Is the timeline set out in the RHA implementation plan still going to be adhered to? The implementation of the six RHAs was supposed to begin next February with further reforms and devolved authority to be delivered the following year. It is now increasingly difficult to see how this much-needed reform can be delivered on time in the absence of increased staffing and funding. We already have HSE managers and administrators engaged in industrial action because of the freeze. Their work-to-rule action includes a boycott of all engagement with regional health areas.

The most concerning aspect of this whole debacle is its impact on patient care. In last month's budget, the Government was more than happy to throw money at people who did not need it, all the while failing to provide sufficient funding to meet patient need. Bridging the gap between supply and demand will not be achieved by austerity era measures. Recklessly repeating the mistakes of the past, mistakes we are still paying the price for today, is not the answer, nor is this Government's complete denial about the need to increase healthcare funding. Unless this Government takes its head out of the sand, health service overruns will be an annual feature of the HSE budget process. A recruitment freeze will not change that.

This Government needs to realise that our health service must expand, not stall. Progress was being made. We know that and I give credit for it but why are we not continuing that progress in reforming our health service? In fact, numbers need to increase by an additional 12,000 to 15,000 healthcare workers by 2035, according to ESRI estimates. That is the scale of the challenge. We cannot afford to lose a year. It is incredibly short-sighted, even for this Government, to allow this recruitment freeze to go ahead. Additional funding must be provided. I have given the Minister and all of the Ministers of State credit for starting a reform programme and getting momentum going. Things were really starting to move, particularly for healthcare staff but also increasingly for the patients who depend on our health service and for those of us who desperately want our public health service to be a success and equivalent to the public health services available in most other European countries. We were excited about that. We were starting to have real confidence that the Government was serious about implementing the Sláintecare reform programme. The serious errors that have been made right across this Government, although particularly at Cabinet, in restricting and basically freezing funding, resulting in a recruitment freeze, cast serious doubt over this Government's ability to address the whole issue of reform.

Deputy Mattie McGrath

I compliment Sinn Féin on putting down this very timely motion. It is interesting that the Minister, Deputy Donnelly, flees like snow off a ditch when the Rural Independent Group stands up for the first time. It is his responsibility to answer to this House and to listen to all sides. His leaving is a mark of what he thinks of other Deputies in this House.

This freeze is closing the door when the horse has bolted. The horse is long bolted. He has gone to Donegal or somewhere. There is spending chaos. Today, Cabinet had to approve €1 billion to plug a hole for this year. The Department wanted €1.5 billion. There is zero accountability. This is the lowest hanging fruit. Both of the Ministers of State should hang their heads in shame. This affects nurses, home helps and the lowest of the people. I do not mean "lowest" in any derogatory way. As I said earlier, they are most wonderful. I refer to na banaltraí iontacha and the staff who do tremendous work across our hospitals. There are plans rolled out throughout the year. We have heard what the INMO and IMO have said about the freeze. Last year, a commitment was given to junior doctors. They do Trojan work and keep the health service propped up. They were promised that a certain number would be recruited. Where does that lie now? It is in tatters. What good is making an agreement with people if unilateral decisions like this can be made?

The Government will not look at where the waste is. I refer to the scandalous waste at the top. What about the commitments to roll out boards and different kinds of initiatives? What about strategic working groups and advisory committees? All of these people should be brought in as was done in respect of Sláintecare. One of our colleagues, Dr. Harty, chaired that meeting and when he came in here to introduce its findings Fianna Fáil, Fine Gael, Sinn Féin and everybody else threw him under the bus.

Thousands are waiting for home helps. Elderly people, those trying to care for them and sick and vulnerable people are waiting for home helps. For the last two years, the policy has been to approve applications within days of them coming in, knowing that no one will be available to do the job. It is a disgusting three-card trick, conning the people. People are told they will be given help and that their applications will be approved, no problem, but there is no one to do the job. That is mean and low. These are the people who built this country, brought us into this world, worked hard and paid their taxes.

We are picking on the weakest sector in spite of the money the Secretary General, senior managers and the CEO are on and the obscene funding they are given. They face absolutely zero accountability for any of their actions. Do not get me wrong; an awful lot of good work goes on in the HSE but there are too many misadventures, tragic deaths and people being mistreated without any accountability.

I had a man in my office yesterday and he cannot even get his file or papers. He has made a freedom of information request and he cannot get them. It is shocking what is going on.

Is there any hope at all that somebody would do an audit of the property owned and rented by the HSE? We have hospitals that had 1,000 people in them, including St. Luke's Hospital in Clonmel, not that long ago - 30 years ago - and now it is full of offices. We have hospitals like that all over the country. We had St. Brigid's Hospital in Carrick-on-Suir closed. The Minister of State, Deputy Butler, closed it, even though it is only up the road from her and her constituents used it. What is inside it now? More clerical staff and fiddle-faddle or whatever is going on. There is a white elephant beside it empty that was built as a so-called primary care centre. It is a con and it is spin. The HSE has property everywhere and it has property rented everywhere. What is it all for? I do not know. How did the HSE manage when it did not have this property? How did it manage when it did not have the legions of secretaries and middle managers? There were good treatments and people in the HSE and there still are many good people in the HSE and the Department of Health. They are on the front line but they are being blackguarded by successive Governments and Ministers. I say that to na hAirí Stáit and they know that.

The Minister of State, Deputy Rabbitte, was reported to have stormed out of a meeting with some officials recently and I do not blame her for having done so. More of that needs to happen because the officials are not held to account. They are only pushing paper and appointing new layers of management. There is management and paper and no service for the people. It is a shame under the Irish Constitution. It is a crying shame for the people who fought to get freedom for this country that this kind of monstrosity could gobble up the system of the HSE. Two former Fianna Fáil taoisigh told me they would disband it. Bertie Ahern and Brian Cowen told me that when they were Taoiseach and it is still going on and getting bigger with fewer services being provided.

Deputy Danny Healy-Rae

I thank Sinn Féin for bringing this motion. This motion is so important because our sick people and people with disabilities have been hurt by this embargo on filling positions, employing more home help workers and even funding the fair deal scheme. I place no blame on the Ministers of State but I blame the Minister for Health and the Government for the way they have behaved. The Government has a legal obligation as an employer and it has let down the health service in a big way. We have had a situation for weeks where there is an embargo on recruiting staff. We also have this issue where the Fórsa trade union has commenced industrial action since Friday, 6 October. We are making representations on behalf of people for home help and the fair deal scheme and that is not good enough. Whatever their gripe or situation is has not been sorted out by the Government or the Minister for Health. That should be sorted out. People are entitled to healthcare but they do not get it. They come to us, whether it is me or other councillors or whoever, and they expect us to come back to them. We cannot come back to them when there is no one coming back to us. We have a list as long as my arm and it is not good enough.

We have a situation in certain areas in Kerry where home help workers are being told by their managers that they will not be paid for overtime. These home help workers are so good and conscientious that if one their comrades gets sick or has to go somewhere, be it to a family member or whatever, they fill the gap. However, they have been told by the managers that they will not be paid for overtime. That is not good enough. I will call out the managers who have done this if they do not change their ways because that is not fair. The home help workers are told that if they go to these people they will not be paid. That is not good enough.

I have at least a half a dozen people who have gone to the hospital by ambulance. Invariably they are sent home in taxis even though they are not fit to come home, and that is not good enough. One particular woman, along with the other five cases, wanted to go into a home, and the HSE would not qualify them for the fair deal. They will not get home help and they will not qualify for the fair deal so what are they supposed to do? I say to the Ministers of State that there is no need for a Committee on Assisted Dying because if this is what the health service is allowing to happen, they will die anyway. When they are 85 or 86 years of age, if they want to go into the nursing home they are entitled to the fair deal scheme. I would ask the Minister for Health the following question if he was here. What is wrong? This never happened before during my time. The fair deal arrangement was always approved if the person was sick enough and old enough and had no way of staying at home. This is ridiculous.

Deputy Mary Butler

I will look at that for the Deputy.

Deputy Danny Healy-Rae

I would appreciate that. I am not personalising anything but the Minister responsible need not walk out just because we were here. There is only one set of speakers after us and we deserve to be heard. He should listen to us the same as we had to listen to him. He made a speech at the start of the debate more or less saying there is nothing wrong with the health service. Well there is something wrong with it and that was proven when the health service was left €1 billion short, and maybe more. So many weeks after the budget it was decided to give the health service the money it needs and that it had suffered enough. People have died and have been suffering in the meantime. They cannot get home help. There is so much talk about how people will be helped to stay in their homes for as long as they are able and there is talk about how they will be assisted to do that. That is not happening in Kerry. The Government has to wake up to that. It is probably the same around the country but we certainly have a problem in Kerry and I have raised it since June 2022.

Deputy Joan Collins

I thank Sinn Féin for bringing this motion to the House. I am supporting it because my experience has been that there are serious issues in the health service. We are in this position because of a political choice by the Government to underfund our health services. We will now see plans to recruit an extra 7,000 needed staff scrapped. The recruitment freeze will continue into next year. That is what the Government’s decision to underfund the HSE by €1.4 billion looks like. The Government has reversed course. It realised it was wrong on the health budget only a little over a month after everyone else realised it was wrong. The Government added an extra €960 million for this year but it is still not enough. It is still an underfunding, especially with increased demand and inflation. There is still no word on reversing the recruitment freeze either.

According to the INMO, in September alone, we had more than 1,000 children on trolleys and a total of 87,321 people on trolleys from January to September. What will this look like in a month’s time as we face into our annual and worsening winter health crisis, with a recruitment freeze and a hundreds of millions missing from the HSE budget? What does this look like for people on the ground? I have a letter from the Coombe hospital's gynaecology section, in reply to a question I put from a constituent, saying that waiting lists are so long because of a lack of clinical nursing specialists. It goes on to say this is now compounded by a widespread recruitment freeze. That letter is from the communications manager in the Coombe hospital. She goes on to mention a recruitment freeze for all staff, with the exception of consultants and graduate nurses and midwives. That is the reality for people waiting on those lists.

I raised the issue last week of two women I have been representing. They have been waiting in pain for years for care due to a lack acute hospital beds for their aftercare, and in no small part because of the lack of staff. I have repeatedly raised the situation in the Old County Road primary healthcare centre, where for more than a year there have been no three or ten-month developmental checks due to the lack of nurses. I have also raised the issue of Curlew Road healthcare centre and Limekiln Lane healthcare centre, which are also not offering the three or ten-month developmental checks due to a lack of nurses. We know those developmental checks are massively important to any child's future health.

One of the women I have represented was due to have a hernia operation back in 2019. She was referred to the National Treatment Purchase Fund in early 2020 just before Covid. The private hospital to which she was referred would not perform the operation because the surgery was very complicated and as we know, the private healthcare sector is not interested in complicated cases but only in simple cases like knee operations, which is where the money is. The woman has been left languishing on the waiting list since then. I have submitted three parliamentary questions on her behalf in 2021, 2022 and 2023. Her stomach is so extended now that the operation is going to take five hours because her organs will have to be put back in place. The Government is saying that there is no crisis in bed availability but that is the reality for one woman. I also represented a young girl with scoliosis in 2018 who waited for four years for an operation on her back. Earlier this year the screws in her back became loose and the bones started coming away from the rod. She is in severe pain but has been told by Tallaght University Hospital that it cannot do the operation because it does not have an acute bed to link in with her surgery. That is the reality for people on the ground. I cannot understand how the Minister could come in and say what he said.

We had 1,278 people die last winter alone due to delays in care. That is a damning indictment of how our health system is being run. People are being let down time and time again because this Government and successive governments led by Fianna Fáil, Fine Gael, the Green Party and the Labour Party, have failed to reform our health service or fund it adequately in its current capacity.

What we have seen from the Government this year is less money, fewer staff and less services. There has been no real progress on Sláintecare and no hint of the resources and political will needed to transform our health service into a better public system. Health austerity, underfunding of staff and budget cuts are not reforms but a way of keeping our public system on life support in an attempt to pass the issue over to whoever gets the health portfolio next.

Deputy Marian Harkin

This motion from Sinn Féin highlights many of the critical issues facing our health service. The Government's amendment, on the other hand, outlines much of the work undertaken by the Government and indeed, there is some progress. However, it is from a very low base in that the number of inpatient acute beds per capita in Ireland was one of the lowest in Europe and just to start redressing that situation, we needed to employ significant numbers of staff to support those beds.

I note that the amendment quotes the number of nurses per head of population in this country as being positive, and it is, but I also note that it does not quote the number of specialists, consultants, physiotherapists or occupational therapists, as well as many other healthcare staff, per head of population. That is because we are well below the per capita rate of many developed countries. The bottom line for most people who need treatment is whether that treatment will be available in a timely manner. They will ask, will my surgery proceed within a reasonable length of time? Why are waiting lists so long? Why do I have to wait on a trolley for days on end before I can get a bed? Those are the realities that people face, as they themselves or their loved ones seek urgent and necessary care.

When I speak to people who need to attend Sligo University Hospital, they quite rightly tell me that they are concerned about going to the accident and emergency department. Just today, our local radio station, Ocean FM, reported that there were 61 people waiting for a bed in the emergency department. This is the second most overcrowded hospital in the country. Sligo University Hospital is a small hospital compared with many others so those numbers, pro rata, are worse than what we see elsewhere. I looked at the figures on trolley watch for the first six months of this year at Sligo University Hospital. A total of 3,926 people were waiting for a bed during that six-month period.

The Government amendment tells us of money spent and staff employed but the people in the north west have yet to see any real positive impact of Government policy. On top of this, we have the bombshell of the embargo on most front-line posts. This was announced because the HSE had already spent its budget. Talk about a crude instrument of rebalancing - just cut off new recruitment of most healthcare workers, close the door and pull down the shutters. There has been no analysis of areas in dire need or of different healthcare settings and what is required to deliver a decent, viable service. We have a situation where healthcare staff who have been interviewed and are awaiting a contract, who might be going through the Garda vetting process, CORU registration or occupational health screening, are having their job offers withdrawn. The rug is being pulled out from under them, just like that. Has anybody looked at the potential impact of this crude policy instrument? It is no wonder that the secretary of the INMO, Ms Phil Ní Sheaghdha, has said that this recruitment freeze represents a serious error on the part of the employer and the impact on the provision of care is going to be disastrous. Already Children's Health Ireland is warning about overcrowding at Temple Street, Crumlin and Tallaght.

I understand that the Government does not have a bottomless pit of money but if there is a problem, it must identify it and then figure out its causes. It must ask how we got to this point, not throw out the baby with the bathwater or throw the toys out of the pram. The Government must find a solution, a way that best protects our patients, healthcare staff and our healthcare system. It should not use a sledgehammer to crack a nut, a recruitment freeze that I and many others believe can do untold damage.

Deputy Violet-Anne Wynne

I have submitted around 1,200 written questions in the past 12 months. The vast majority of those were for the Department of Health, the vast majority of which were replied to citing a recruitment and retention crisis. The Government has blamed a recruitment and retention crisis for every one of the failings in health in particular and at the same time has refused to take any responsibility for it. The Government led us to believe that there were all of the healthcare jobs in the world but nobody was willing to take them. Now, suddenly, it turns out that people are willing to take these jobs but the Government will not put up the money to employ them. The Minister is trying to lay the blame on the shoulders of the CEO of the HSE.

A recruitment freeze in the HSE hurts absolutely everybody but not in a proportionate way. University Hospital Limerick already has one of the highest staff vacancy rates in the country, which is no shock. It is the only model 4 hospital in the country that is not supported by a model 3 hospital. Last week, we saw the trolley numbers break records, with 130 patients on trolleys in one day. The staff work in an environment that completely breaches clinical and patient care guidelines every day and now the Government is having a public fight with the heads of HSE that is going to result in a worsening of the situation and ultimately, in the death of my constituents. I do not use that language lightly but I make no apology for saying what needs to be said in this House.

The responsibility of the Government should be to do no harm but this recruitment freeze may be one of the most harmful things it has done to date. I ask, for the sake of my constituents, that the Minister meets the Minister for public expenditure and the head of the HSE to find and spend whatever money is needed to ensure the long-term sustainability of our health service and what is left of it in the mid-west region.

I listened to the Minister's statement earlier and it can be summed up in one word, which is "more". What he forgot to mention, in the same line of thought, is the whole picture. All of the "more" staff that he referred to are dealing with a population that is much more and an ageing population that is also much more. As there is a GP shortage in Clare and dentists cannot take on new patients, it was inevitable that time spent in hospital was going to increase, as we see more of our citizens lose access to vital primary care.

Minister of State at the Department of Health (Deputy Anne Rabbitte)

I am grateful for the opportunity to provide some clarity and reassurance to the House that disability service providers are exempt from the extended recruitment freeze. Unfortunately, when I was listening to the commentary earlier on, I did not feel that was quite understood and I thank the Minister of State, Deputy Butler, for giving me the opportunity to clarify this. The exemption includes section 38 and section 39 service providers, as well as HSE disability services.

I heard one of Deputy Cullinane's colleagues - I think it was Deputy Duncan Smith - saying a CDNT manager could not be recruited as the pause was in place. I want to know about such instances because I do not have an embargo. As Minister of State with responsibility for disability, I welcomed specific derogations for categories of staff employed across the HSE section 38 disability services from the HSE recruitment pause on 9 November 2023.

Since assuming responsibility for disability services in March this year, the Department of Children, Equality, Disability, Integration and Youth has committed to investing in the sector and improving outcomes for service users through the expansion, enhancement and reform of services, including the creation of additional services and posts and recruitment to these positions. I and the Minister, Deputy O'Gorman, and the Department have engaged extensively and consistently with the HSE since the announcement of the pause to ensure disability services are not unduly affected. The HSE confirmed the existence of an exemption for health and social care posts, as well as prioritisation and redeployment from within existing resources. In addition, the HSE has agreed to additional derogations in respect of specific categories within disability. These will include medical staff, domestic staff, drivers, service co-ordinators, area managers, family support workers, day service supervisors, care assistants, social care workers and personal assistants. I acknowledge the role played in this by Bernard Gloster as CEO and that of Ciarán Devane, chair of the board. I have spent the past three years saying that I do not have enough staff. We have deficits on all our CDNT teams. This will give me an opportunity to recruit in by not having a pause. I do not accept the carte blanche suggestion that the areas for which I am responsible will be treated like other areas of health in the context of the pause.

Minister of State at the Department of Health (Deputy Mary Butler)

I thank all those who spoke on the motion for their views. First, I reiterate what the Minister, Deputy Donnelly, said regarding the value we must place on all staff working in the health service. They are the people working tirelessly on a daily basis to provide care to those most in need, whether in their own home or in an acute or residential setting.

As highlighted by the Minister, recruitment across the HSE has been incredibly strong in 2023. The HSE workforce is at its highest level. To give some perspective on the level of growth seen in recent years, I can advise that 23,263 additional staff have been recruited since 2020. That is an increase of 19.5%. It is 6,808 nurses and midwives, 3,388 health and social care professionals, 2,633 doctors and dentists and 3,334 staff in patient and client care. In fact, the years 2020, 2021 and 2022 saw the biggest staff increases since the HSE was established and 2023 has continued on that trajectory. Each additional staff member hired has had an impact and contributed to an improvement in services throughout the country. The expansion of our workforce in recent years is a very positive thing for the public who use our services and for our staff working in them.

Ireland now has the highest life expectancy in the EU, as determined by the World Health Organization. We were also formally recognised as the first age-friendly country in the world in 2019. These are remarkable achievements and they are to be celebrated. We know Ireland has a rapidly ageing population. The Government’s priority is to support people to age in their own home and communities for as long as possible. To enable this, we continue to invest heavily in community-based services and deliver what I think of as the important triangle of supports, namely, day centres, meals on wheels and home care. Of our vital day centres, 323 have reopened following Covid. Earlier this year, I announced increased funding for day centres and to expand the meals on wheels network, which provided approximately 2.5 million meals to more than 54,000 people throughout the country last year. I also secured increased funding for these in budget 2024.

Improving access to dementia supports continues to be a key priority for me. Every day, there are at least 30 new cases of dementia, each of which has a direct effect on the families involved. I am proud to say we recently saw our 50th dementia-specific day care centre open following the pandemic, working with the Alzheimer Society of Ireland. Day care is an important support for many people with dementia and their families. Since 2021, vital funding is in place for in-home dementia day care for people who, for a variety of reasons, cannot attend a day care centre. Some 18% of all new home support hours are now ring-fenced for people with dementia.

As well as increased clinical services, we now have 29 dementia advisers throughout the country to provide crucial support around a diagnosis and to help people to continue to live well with dementia. In the budget this year, I also secured new funding for weekend activity clubs for people with young onset dementia. This is just a sample of what delivery on the ground looks like. Regardless of the temporary pause in recruitment, there is no service cut despite recent budget challenges. There is no intention to cut services.

However, it is important to state the health sector must operate within a budget each year and all services must be carried out within this allocation. This ensures that although the health service continues to function effectively, it must be managed in a measured and sustainable way in the context of spending. We must ensure we continue to operate an effectively managed health service into the future and that the funding provided is used in as appropriate and efficient manner as possible. All contracts offered will be honoured. People are still coming on board every day because these contracts have been going through the system. There is a cap but this is not a cut.

For context, I will outline examples across the HSE where recruitment targets have been exceeded. For example, the HSE has gone over its recruitment target for the management or administrative staff category by 343 staff this year. In the medical and dental staff category, 792 staff have been recruited but it was funded to 500. It has exceeded its target by 292 staff already this year. Acute services, for example, had a year-end recruitment target of 3,400 staff. By September 2023, it had hired 3,751 staff. This means it has exceeded its year-end target by at least 351 staff this year. It is clear from these numbers that, in reality, many areas of the HSE have been recruiting far more staff than they are funded for, and this simply cannot be allowed to continue uncontrolled. We are criticised for having a runaway budget but when the chief executive of the HSE tries to roll in the budget, we still get criticised. It is important to note, however, that if a contract was offered, accepted and issued, the individual who accepted the post will be in a position to take up the job. There are also a number of exemptions relating to disability front-line and residential posts, as the Minister of State, Deputy Rabbitte, outlined. These exemptions have been set out to the relevant chief officers. The measures are only in place until the end of 2023. The Government has made a further commitment to an additional net workforce growth of approximately 2,268 whole-time equivalents in 2024, which includes mental health.

It should be noted the Government has put significant funding into the health sector, with €22.5 billion having been allocated to the health budget for 2024. The additional allocation to the Department of Health in budget 2024 is nearly €2 billion. This includes an increase of €808 million in core current funding, slightly more than €1 billion in non-core current funding and an additional €120 million in capital funding.

The Government’s job is to ensure the significant investment in recruitment in the health sector in recent years is being consolidated and that staff are now being deployed appropriately to the most impactful areas of the health service to benefit patient needs.

Deputy Patricia Ryan

The Government's mismanagement of the health budget is no secret but mismanagement on a scale that forces the CEO of the HSE to escalate the embargo on recruitment, withdraw job offers and scrap more than 7,000 essential front-line posts is beyond belief. This is beyond disastrous when the HSE is already facing unprecedented staff shortages in all sectors, affecting its ability to provide the level of services required.

The health budget should, at least, maintain the existing level of services and provide for any new measures. That sounds okay, but what if the existing levels of service being maintained are bed shortages in hospitals, chronic staffing shortages, existing front-line doctors and nurses run ragged and people lying on trolleys in overcrowded emergency departments? I am speaking from experience. I was recently in St. James's Hospital. The staff in the hospital are excellent but the Ministers of State opposite should go to the emergency department there to see what it is like. It is haemorrhaging staff. They simply cannot work there because it is so bad. I have spoken to the staff at length on this issue.

Children are waiting for years for life-changing surgery. Hundreds of thousands are on long waiting lists for urgent treatments. Mental health services are in complete disarray. There are no staff to deliver home care packages for the elderly, no jobs for our graduate nurses and doctors, and no front-line porters or cleaners. With the Government’s budget, the HSE is not even running to stand still. The Government’s decisions have sent it running backwards. Service levels are not being maintained or even reached. They are being decimated. In my own constituency of Kildare South, their existing levels already fall far below what is desperately needed. There are not enough public health service nurses to reach vulnerable rural patients. Frail and sick older people desperately need home care packages that will not be delivered because there are no home care workers. Some 100 posts are now not being delivered in Naas General Hospital because of the embargo. Fine Gael and Fianna Fáil have had 13 years between them to fix this health service, and still we are facing into this catastrophe. Mo náire sibh go léir.

This Government’s continued failures have repeatedly put people's lives at risk. Enough is enough. The Government needs to lift the embargo and properly fund the health service. The level of service at the minute is so bad that people are actually going to die. We need to stand up here and say that.

I am going to finish with this. I recently asked a parliamentary question around cancer diagnoses and cancer treatment in patients. I was told that it had improved, that it is down to 57 weeks now, and that it is down 14 weeks on last year. Are we having a laugh here?

Deputy Louise O'Reilly

I remember the last moratorium, when Fianna Fáil was in government in 2009. It was a full public service recruitment moratorium. It was introduced in 2007 for the health service. The impact of that is still being felt today. The HSE did not recover from that and the evidence of that is all around us. The evidence of that is in the lengthy waiting lists in the health service and in the people who get left overnight on trolleys, on chairs, in corridors or wherever they can be put. That speaks to a staff shortage. That is the issue there. There is not enough capacity or staff.

I listened with interest to the Minister’s speech. As they say in the west of Ireland, he has a great welcome for himself. If I cut through the bits where he is throwing bouquets at himself, he refers to a target, and the setting of a target. It is not quite an achievement but the setting of a target, and it is absolutely laudable. I agree 100% that the elimination of cervical cancer is laudable. However, we need to get a bit of perspective. There are 650 women diagnosed with cervical cancer on an annual basis. That is about the same number as spend, on average, one night on a trolley. It is a laudable aim but perspective is also important.

The Minister says that he has no intention to cut services but Fianna Fáil said the same in 2007, 2008 and 2009 and services were cut to the bone. A recruitment moratorium, a pause, a freeze or whatever word the Government wants to put on it is a blunt instrument. It is no way to deliver decent healthcare. It is no way to treat those men and women who are working day in day out, night in night out to try to deliver a healthcare service. The Government has thrown in the towel on health, and the evidence of that is in its recruitment moratorium. Recruitment freezes do not work. They hurt patients. Recruitment freezes are what governments preside over when they have given up or thrown in the towel. The Government has underfunded the health service. It is compounding that with a recruitment freeze, and the people who will suffer are the patients and workers in our health service. Shame on the Government.

Deputy David Cullinane

Every single patient and healthcare worker in this State should watch back the Minister's response to our motion here today. What they will see in the Minister's response is that he spent most of his time attacking Sinn Féin. He points to the North which, obviously, Ministers do every time they are under pressure. What the Minister failed to point out is that in the last two elections in the North, Sinn Féin increased its vote to record levels, which should tell the Ministers across the Government where the people of the North stand with regard to Sinn Féin. Of course, it is all a smokescreen.

The Minister then went on to decry the fact that we described his recruitment embargo and the deliberate underfunding of the health service as disastrous. I do not know what words the Minister for Health wants Sinn Féin to use when it comes to a recruitment embargo and deliberate underfunding of the health service, or inadequate funding of the health service as it was described by the current head of the HSE. Do the Ministers of State believe that as an Opposition party, we should welcome the fact that we now have a recruitment pause and embargo in place in the health service? Do the Ministers of State see it as a good thing that the rug was pulled from under so many workers who were actually offered jobs? What is interesting about what the Minister of State, Deputy Butler said was that the second memo was very clear. It said all job offers which have been made, unless contracts were signed and unless the posts have been approved, are gone. If there has been a change, I would like to see that but that is not what is in the memo.

On disability services, we were getting feedback from chief officers in disability services and community health organisations, and they were unclear, so I contacted the head of the HSE. He acknowledged that CDNTs were not on the list that was published regarding disability. He had to issue a further list. There is confusion and chaos because of what has happened here. All of this is a crisis-driven response to a very deliberate underfunding of the health service.

I was in a number of hospitals over recent weeks in Kilkenny and Mayo, and I will be in Galway next week. I have met hospital management and I have also met staff. If they were listening to the Minister’s response, they would be very angry because they know that everybody in this House welcomes and celebrates the work that our front-line healthcare workers do. They do not like when Ministers try to hide behind their good work and their hard work. They will equally tell me that they are fatigued. They went through a very difficult time with Covid-19. When we came out of the Covid-19 pandemic, most of us got back to what we do - we can live different lives because of the improvements – but they are still living and working in very difficult circumstances with emergency departments that we know are still overstretched. Patients are on trolleys in record numbers, and there are really difficult challenges in our acute hospitals and also in primary care.

I spoke to the chief officer of community services in the south east, who used to be the manager of University Hospital Waterford, about the recruitment embargo. She said to me that it makes no sense because she now has services which are very stretched, including mental health and home support services. She is not able to replace staff, so there is no such thing as one in, one out. She has vacancies that she cannot fill. She talked about a whole range of areas in primary care services for physiotherapy and speech and language therapy, where there are vacant posts she cannot fill. There are posts in home care support services that she cannot fill, at a time when we need to make sure that older people are cared for in the community and in the home. She, like me, recognises the good work that was done with the enhanced community care model, as all chief officers do. This includes the integrated care programme for older persons and chronic disease management teams. However, a lot of them are not fully staffed. None of those positions can now be filled because of this recruitment embargo.

I want to say to the Minister, Deputy Donnelly, who is now gone, that his speech does not cut the mustard. He can attack Sinn Féin all he likes. In the real world, I hope that in the course of an election campaign he takes the same approach that he took here tonight because people will give him his answer very quickly. People want decent health services and investment in our health services. The very fact that we are debating here tonight a recruitment freeze and embargo in healthcare sends out a message. The message it sends to those who have left and emigrated and those who are going through our training colleges, and the message it sends to patients, when we have so many on trolleys and a million people on health waiting lists, is entirely the wrong message. If the Minister for Health does not see that, he is in the wrong job and he needs to go. We need a new Government and a Minister for Health that knows what to do with regard to fixing the problems in our health service.

Amendment put.

An Cathaoirleach Gníomhach (Deputy Pauline Tully)

In accordance with Standing Order 80(2), the division is postponed until the weekly division time tomorrow evening.

Dáil Éireann díospóireacht - Tuesday, 21 Nov 2023

Health Service Recruitment Freeze: Motion [Private Members]

Dáil Éireann díospóireacht -
Tuesday, 21 Nov 2023