Joint Committee on Health díospóireacht -
Wednesday, 8 Feb 2023

Welfare and Safety of Workers and Patients in Public Health Service: Discussion

Chairman

Everyone is very welcome. As so many groups are represented, it will probably be difficult to chair this meeting. I ask attendees to bear with me if I start pulling out my hair. I have informed members who specifically ask a question of union representatives that if the same question is then opened to everybody it will be quite difficult. The sessions are broken down into ten-minute slots, which includes time for questions and answers. I expect many members will want to get in. I ask everyone to try to work with me. If we can keep the responses fairly short, that would be very good. I am also conscious that some of the opening statements are a little long. I ask the representatives to try to stick to three minutes for their opening statements, as they were asked. If their statements are longer than that, we will read them into the record anyway.

Before we get to the main item on today's agenda, the minutes of meetings held on 31 January and 1 February have been circulated to members for consideration. Are they agreed? Agreed.

The purpose of today's meeting is consideration of the issue of the health and welfare of staff and patients in the public health service. The committee is joined by representatives of the Irish Nurses and Midwives Organisation, INMO, the Irish Medical Organisation, IMO, and the trade unions Fórsa and SIPTU. I welcome Ms Philomena Ni Sheaghdha, who will be replaced during the meeting by Mr. Albert Murphy as she has to leave early for another appointment; Ms Sylvia Chambers from the INMO; and Dr. Clive Kilgallen and Dr. Laura Finnegan from the IMO. We are also joined by Mr. Kevin Figgis and Mr. John McCamley from SIPTU and Ms Ashley Connolly and Ms Linda Kelly from Fórsa.

All those present in the committee room are asked to exercise personal responsibility to protect themselves and others from the risk of contracting Covid-19.

Witnesses are reminded of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable, or otherwise engage in speech that might be regarded as damaging to the good name of the person or entity. Therefore, if their statements are potentially defamatory in relation to an identifiable person or entity, they will be directed to discontinue their remarks. It is imperative that they comply with any such direction from me.

Members are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the Houses, or an official, either by name or in such a way as to make him or her identifiable. I again remind members of the constitutional requirement that they must be physically present within the confines of the Leinster House complex in order to participate in public meetings. I will not permit a member to participate where he or she is not adhering to this constitutional requirement and, therefore, any member who attempts to participate from outside the precincts will be asked to leave the meeting. In this regard, I ask any members taking part via MS Teams that prior to making their contributions to the meeting they confirm they are on the grounds of the Leinster House campus.

All the witnesses have submitted detailed opening statements, which have been circulated to members in advance and will be published on the committee's webpage as per normal. Given the number of witnesses, there is a need for effective and equitable management of the meeting time.

I ask each witness to confine their opening remarks to three minutes. The committee has also requested and received a written submission from the HSE. This, along with the submission from the Better Working Lives for All committee, has been circulated to members. I now call Ms Phil Ní Sheaghdha to make her statement on behalf of the Irish Nurses and Midwives Organisation.

Ms Phil Ní Sheaghdha

We are very happy to address the committee and thank it for the invitation. I will share my time with Ms Sylvia Chambers, who is a working nurse in an emergency department in one of the large Dublin hospitals. We have made a written submission and we would like to bring the committee's attention to two main points within that submission. First is the number of assaults. In the appendix we have detailed the latest statistics from the HSE, which set out the number of assaults against staff. Unfortunately, there were 5,593 reported assaults against nursing and midwifery staff in the period between January 2021 and October 2022. I emphasise that that is an under-reporting because these statistics only relate to what the HSE collates. They do not cover the section 38 organisations, which are the large voluntary hospitals, psychiatry or a lot of community services where we know the incidents of assault are much higher.

We are quite disappointed in the reaction we have received from the Health and Safety Authority. We have lobbied it extensively and met it on a number of occasions. We are seeking a greater role for it in the inspection and prosecution of health service employers when it comes to assaults. In our submission we set out the comparisons between its investigation and its work in construction and manufacturing, which is very good and has served the workers in those industries well. We believe the health service is not viewed by the Health and Safety Authority, or indeed by the Government, as an employment location. It is viewed largely for the job it does, that is, caring, but it is one of the largest employers in the State. The statutory body with responsibility for keeping workers safe must be strengthened and must have a stronger role in that regard, considering the number of assaults that are now being recorded.

Ms Chambers will set out what it is like for a nurse. Her testimony is typical of what we are hearing regularly from our members who work not just in emergency departments but increasingly on wards and in community areas right across from paediatrics to maternity to the general hospital services. We would ask the committee to look seriously at the provisions of the Health and Safety Authority and look at strengthening its responsibility in respect of workers' health and safety, as well as the connection between poor staffing, overcrowded hospitals and increased assaults. All of that evidence is in our submission and we are happy to give any further details that are required. There is no doubt but that poor staffing levels and overcrowded hospitals lead to situations that can be avoided. Public hospitals in this country are operating at a level of about 110% or 111% occupancy when the safety level is 82%. We are too slow with Sláintecare and we are still completely reliant on the public hospital. That, unfortunately, falls on the front-line workers to deal with.

Ms Sylvia Chambers

Good morning. I am qualified 18 years and I have never experienced aggression like we have in the past few years. On a daily basis there are numerous incidents where we are verbally attacked. I have been spat at, verbally abused and threatened that when I leave work that evening I will be stabbed as I get into my car. I have had grown men of 6 ft 4 in. towering over me or throwing objects at me. This happens on a daily basis. I do not feel safe going to work. My colleagues do not feel safe. This all comes down to security and overcrowding. The facility that parents are asked to wait in is not sufficient. At night time, from 2 a.m. onwards, we only have two doctors. Sometimes we could have up to 60 or 70 patients waiting at that time with two doctors. It is not feasible for two doctors to see all those patients. Parents become very aggressive and tired. The nurse, who is normally the first person they see, receives the backlash. It is just not appropriate. We cannot provide appropriate nursing care. Staff are leaving due to this because they are stressed. In the last 18 months we have had 30 nurses resign from our emergency department alone. We are on our knees when it comes to staffing levels. We have 24 overnight patients with two nurses providing care. If a nurse is verbally abused by a parent and has to provide repeated care episodes to that parent, it is extremely nerve-wracking. It is just not appropriate. We are at our wits' end. People are leaving because of this. Something has to be done. With the volume and acuity we experience in the emergency department, we are overwhelmed.

Parents cannot receive appointments with their GPs and that might have something to do with it. Numerous parents have said they would have had to wait a week for a GP appointment and therefore they are having phone consultations and then coming in extremely worried. That adds to their distress and in turn results in assaults and verbal attacks on nursing staff. I can only speak for the nursing staff I represent as I am the INMO representative in the emergency department. I have asked during exit interviews why people are leaving and it is because they are stressed and afraid in work and they cannot provide the appropriate care. We just want to go in and do our jobs. That is all we want. We do not mind being busy. We do not mind the acuity or the volume. In the emergency department a resuscitation, emergency or trauma might present and you have to provide care to those first. The people in the waiting area are waiting up to ten or 12 hours and they then become very aggressive. What do we do with this?

Dr. Clive Kilgallen

I thank the Chair and members of the committee for the invitation to discuss the welfare and safety of both staff and, most important, patients in our public health services. Patient safety and staff welfare are ongoing issues throughout the year and do not just happen during the winter, when everything gets much worse than it otherwise is. Our hospitals are full all year round and there is simply no excess capacity to deal with the increased demand, as we saw recently this winter and, indeed, all winters.

We know there are risks to patients from overcrowding and staff burnout. Delays in admission from the emergency department are associated with increased mortality for patients. It is estimated that up to 400 people could die each year as a result of emergency department overcrowding. That is an extrapolation based on figures from the UK. Studies have shown that emergency department overcrowding is associated with delays in receiving pain relief, medication errors, and greater lengths of hospital stay. Sometimes patients even leave the emergency department without having been seen because they simply cannot deal with the situation they are in. Hospital overcrowding contributes to the spread of healthcare-associated infections and adverse events due to the shortage of resources and elevated stress levels. Long waiting lists and delays in diagnosis and treatment inevitably mean patients are treated at a more advanced and complex stage of illness and overcrowding can lead to the further cancellation of non-urgent care.

Healthcare settings are inherently hazardous environments and as we have heard, staff face risks of violence, accidents, healthcare-associated infections and poor mental health outcomes from the stress. The HSE has failed to address the issues of chronic understaffing and capacity. We need to emphasise this. It is why we are here today. As part of our work, the IMO has surveyed our members in relation to their mental health and well-being. Our most recent survey, carried out last year, revealed that long-standing issues of staffing shortages, the backlog and the waiting lists have had an effect on the well-being of our doctors. Some 94% of doctors reported having experienced some form of depression, anxiety, exhaustion or emotional stress while 81% of doctors are at risk of burnout. Further, 62.3% of doctors have had their working week extended beyond their normal contractual hours by 11 hours or more.

Some 72% of doctors are not able to take their scheduled breaks during the working day, and 59.3% reported not being in a position to take two consecutive weeks off over the past year. Really, short-term solutions are not enough at this stage.

We recommend investing in bed capacity and ensuring that our hospitals operate at the safe occupancy levels of 85%; determining and resourcing appropriate and safe staffing levels based on population needs; creating a better working environment, which actually benefits doctors, nurses and patients themselves; ensuring clear policies and procedures are in place so all healthcare professionals feel able to take breaks and take time off when ill; and increasing the efficiency of our service by investing, an example of which would be e-health and electronic health records; risk assessments for both patient and staff welfare; and that all healthcare workers should have access to appropriately resourced, fully consultant-led occupational health services, including mental health supports. Many doctors are suffering and it is not only doctors; all healthcare staff are suffering. It is not just doctors who are suffering. A lot of the time, people feel fearful of bringing this forward to the hospital or whatever. We need to really address the stigma and encourage the use of support services and enhance those services.

Mr. Kevin Figgis

My name is Kevin Figgis and I am the divisional organiser in the SIPTU health division. I am accompanied this morning by my colleague, Mr. John McCamley, who is the national official within our union for our membership within health professions such as radiography, radiation therapy, phlebotomy, nursing and midwifery.

On behalf of the SIPTU health division, we welcome the invitation to meet with members today. Our division represents more than 41,000 members within both public and private health settings. Our membership includes the widest scope of grades within the health service including health professionals, healthcare assistants, nurses and midwives, support staff and the National Ambulance Service, NAS. Our union is a strong voice within the Irish Congress of Trade Unions, ICTU, staff panel of health unions and the health service union representatives on the national joint council.

We have provided a detailed submission to the committee today that seeks to highlight key issues for our members on the welfare and safety of healthcare workers within the public health system. We have demonstrated these issues in four sections, one of which is around the need for safe staffing levels for all grades and departments to ensure healthcare workers are best placed to provide for the needs of patients and service users in the evolving model of healthcare we have today. Safe staffing levels should be determined by the needs of the department and not solely on the budget that is allocated.

We have provided statistical data on the incidence of assaults in the workplace on our members and the unequal treatment of benefits that are afforded to support staff by their employer, even if they are assaulted in the same incident as other grades of staff. For the purpose of support after an assault in the workplace, support workers are classed as non-officers and are, therefore, distinguished at a lower rate of benefit than other grades deemed to be of officer status. The continued use of these types of policies is shameful on the Health Service Executive and Department of Health and they must cease.

We have outlined the activity our union has had in representing members through an investigation under the dignity at work policy. We have also provided a detailed report on the national review of the policy and the national investigations unit jointly undertaken by the Group of Unions and Health Service Executive.

Finally, we have outlined the deep concern of our union, and I know those of our fellow union colleagues, with the situation in which healthcare workers suffering from the effects of long Covid are left due to the cessation of the specific support scheme by the Department of Public Expenditure, National Development Plan Delivery and Reform. There was no consultation with the unions in advance of the cessation of the scheme. The HSE stated that it has no mandate to engage on a replacement scheme due to having no authority to do so, and the Department of Health has also refused to engage to date. The Group of Unions has referred this matter to the Workplace Relations Commission, WRC. To date, however, no offer has been made for conciliation.

Our union has chosen these topics for discussion within our submission as they broadly represent a significant percentage of the issues raised by our membership within the health service. It is essential we do all we can to ensure that healthcare workers feel valued for the important work they do looking after the sick and vulnerable in our society. We look forward to the engagement with members today and are happy to answer any questions.

Ms Ashley Connolly

I wish members of the committee a good morning. I will be sharing my time with my colleague, Ms Kelly. Fórsa represents more than 33,000 members in our health and welfare division. We confirm and support the submissions of our colleagues from the other health unions and our members share these experiences daily.

The issue of welfare and safety of workers and patients in the public health service is an issue that impacts all grades of staff and crosses all forms of employment in the health sector. It is not confined to any one employer or group. We welcome the committee’s foresight in examining this issue through a holistic lens.

"Leadership starts at the top" is a phrase we have all heard before. Let us examine what that leadership from the Department of Health looks like to our members delivering front-line services. It looks like ignoring fundamental issues of pay parity between healthcare staff in core public health services and the voluntary sector; unilaterally withdrawing protections for staff experiencing long Covid; failure to expand the serious assault scheme to encompass all staff; and arbitrary exclusions from the pandemic recognition payment.

There are many more examples, but time is short. The upshot is that leadership from the Department of Health at this present time means ignoring staff concerns tabled by the union side, or worse still, pretending to deal with them by tying us up in long, drawn-out processes with little or no chance of meaningful, effective outcomes.

The next two years will be significant in the Sláintecare agenda as the HSE restructures into regional health areas, RHAs. We urge the committee to view the upcoming RHA transition as a pivotal moment in challenging the current leadership message from the Department to ensure the RHAs are resourced appropriately and create a culture of meaningful leadership in each regional area.

We also urge the committee to question why the Department is not engaging on the issue of pay parity in the voluntary sector despite the Government's announcements before Christmas. We cannot seriously discuss the welfare and safety of staff if it does address fundamental issues of financial need in a cost-of-living crisis, and fails to address the recruitment and retention issues our members are experiencing across the public health service.

Ms Linda Kelly

There has also been a significant failure over multiple service plans to invest in clerical and administrative staff as well as health and social care professionals, HSCPs, pharmacy and other grades across employers in a strategic and planned manner to meet service needs. As a direct result, we see pressure points across the sector for which our members are regularly the first point of contact. They must ring families to cancel long-awaited appointments or deal with complaints about poor service delivery. It is a highly emotive situation for the lowest paid in our health service to deal with every single day.

Our HSCP and pharmacy members do not have the opportunity to develop and lead on innovative clinical practice because there are so many staff shortages and a lack of investment in continuing professional development, CPD, opportunities and career progression. We urge the committee to seek an urgent workforce retention plan from the Department of Health for all grades and as part of that plan, seek ring-fenced funding for CPD for all grades and ensure that fund is equitably distributed.

Our members continue to work in a system that demands everything from them but offers little in return. Staff must be heard and listened to on the issues affecting them and there must be a clear commitment to address the issues by those charged with leading the health sector.

Chairman

I thank the witnesses very much. I will move straight away to the members. We will start with Senator Kyne.

Senator Seán Kyne

I welcome all the guests this morning. They paint a very harrowing picture on behalf of their staff. I acknowledge the advocacy they have shown today on behalf of the members of staff they represent.

Ms Ní Sheaghdha mentioned in her opening statement attacks on midwives. Pardon my ignorance but by whom, exactly, or where, how and when are attacks on midwives? I am just trying to figure it out.

Ms Phil Ní Sheaghdha

Maternity hospitals record assaults against midwives. Those figures are part of the public record. It can be partners or visitors. Unfortunately, the whole Covid restrictions on visiting and partner attendance with birthing mothers was a real issue and a pressure point. Unfortunately, the midwife was the visible face of that policy albeit not the author of it.

As Ms Chambers set out in her opening remarks, there are many times when policies mean that people who attend hospital services have long wait times and perceive that they are being denied a service to which they are entitled.

A third of the workforce are nurses and midwives. Those are the ones they see and they lash out, rightly or wrongly. We believe the employer must know this as it is entirely predictable. It has to be prevented. It is not good enough for the employers or the political system to say that legislation has been strengthened, such as the Non-Fatal Offences Against the Person Act and other criminal justice legislation because that requires the individual who is assaulted to pursue the person who assaulted them, and to continue to provide care in some instances.

Our point is that these are workers in a workplace and they have to have the same status as a construction worker, retail worker or somebody on a farm. The Health and Safety Authority, HSA, must take the same approach to this workplace and it is not doing that. In our view, it is failing in its regulatory function and the employer is failing to provide the duty of care that it must provide to these essential front-line workers.

Senator Seán Kyne

Is Ms Ní Sheaghdha suggesting that the HSA has the powers but does not want to get involved in that, or that it needs additional powers through legislation?

Ms Phil Ní Sheaghdha

From our meetings with HSA officials, they are telling us that they require additional funding to have a separate division to deal with the health service. They will also give statistics and their annual report sets out that their inspections of the health service increased over the past two years. That is true but the majority of those inspections related to Covid outbreaks and, therefore, the number of inspections into assaults reduced, and only totalled 69 in the calendar year of 2022, which is lower than the previous year. Considering the number of assaults against nurses and midwives alone was in excess of 5,000, and all my colleagues here have set out the assaults against their members, that is incredible and is requiring of some scrutiny of the HSA’s viewpoint and the lens through which it views the health service.

Senator Seán Kyne

Ms Chambers mentioned parents or perhaps it was patients.

Ms Sylvia Chambers

It was parents.

Senator Seán Kyne

Obviously, parents are very concerned for the children. Ms Chambers believes the aggression and the assaults, or a proportion of that, is based on parents seeking quicker treatment for their children in emergency rooms.

Ms Sylvia Chambers

Absolutely. Parents are waiting ten and 12 hours, especially overnight, and it could be 4 o'clock in the morning, which is the time when instead of knocking on the door, a parent is kicking the door. They have to advocate for their child but our hands are tied. As I said, there are two doctors left between 2 a.m. and 8 a.m. At that point, there could be 60 to 70 patients in the department waiting to see a doctor, with two doctors trying to provide care for all of those patients. That is not feasible. When a knock comes on the door, it is the nurse who opens the door to that verbal aggression, and sometimes it can be physical.

It is not appropriate. I want to be able to go to work and to provide care. I am trained to do that and I take so much pride in my work, but I do not feel safe going to work. I could be verbally abused four or five times in that night but I will not put in an incident report form because I am too busy. I have 24 admitted patients that I have to provide care to, and I cannot to sit down at the desk and write incident reports, much as I would like to. I want all of that documented but I do not have the time because I have to prioritise patient care.

Senator Seán Kyne

From Ms Chambers’s experience with regard to patients and the people who accompany patients, how much could drink and drugs be responsible at weekends?

Ms Sylvia Chambers

That is minute. I am in the emergency department eight years and just twice have I experienced a parent under the influence.

Senator Seán Kyne

Not a parent, but in general - let us say, a patient.

Ms Sylvia Chambers

No, I do not experience that. Patients under 16 are not normally drinking or taking drugs.

Senator Seán Kyne

Okay, but in general, within the hospital system.

Ms Phil Ní Sheaghdha

In general terms, there is a percentage of alcohol and narcotic abuse but the bigger issue, certainly since 2017, is the longer waiting times and the frustration that comes with waiting for care. As some of my colleagues have said, patients leave emergency departments because they get so frustrated, but some stay and they get very aggressive towards the staff they meet. For patients who are admitted, we have had unfortunate examples and we can give many examples where alcohol and detox situations occur. However, when we have the correct staffing levels and the correct security, that is lessened. We do not have that. We still have a big problem with security companies and agency staff and with security being outsourced by various hospitals. We have to get back to the mentality that security is that hospital’s responsibility and the security staff must be a core part of the staff, and must be placed and available in the emergency department. Sometimes, people are looking for security personnel but they have responsibility for the whole campus, not just one department.

Our focus today is on trying to explain to the committee what it is like. Ms Chambers gave an example of 30 people leaving the department. We are talking predominantly about women who go to work. We have Ireland signing up to the Istanbul convention in respect of violence against women and every single day there are ten or 11 assaults against nurses. That is just for nurses. My colleagues will give the committee examples of the people they represent, but it is predominantly women. It is not good enough.

Senator Seán Kyne

I am sure there will be continued debates on staffing and we are all trying to work to achieve that. Irrespective of staffing, there is no excuse for an assault on any staff member within the health service or any other service. I accept that people are frustrated due to delays but there is zero excuse for taking that out on staff, and that should be a given. We have discussed workforce planning and I am sure it will continue to be very much a focus of Ms Ní Sheaghda’s advocacy. However, irrespective of any of that, assaults, whether physical or verbal, are not on. The testimony of the witnesses is important but it is not going to encourage people to come into the professions, and we want and need people in the professions to provide the support. There needs to be a crackdown on the aggression. Irrespective of whether people are waiting an hour or three hours, there needs to be a crackdown on aggression toward staff.

Dr. Clive Kilgallen

I want to amplify a point made by Ms Chambers, where she said she has had many bad experiences but she has not officially logged them. I have had the same experience in talking to my colleagues in the IMO. We did a survey and found a significant amount of verbal abuse and assault of doctors. Apart from the statistics, when I talk to some of my colleagues in the coffee room, people do not feel comfortable talking about it. When they say, “Something bad happened to me”, I will ask have they logged it in and they will say, “No, I cannot do that.” Therefore, I believe that all of these statistics we are listening to are under-reported. I am sure a trainee doctor would have exactly the same experience.

Chairman

We need to move on. As part of the discussion, we asked the HSE for a briefing note, which we have received. It is helpful and members may refer to it. We also asked the Garda for figures but given the way it collates the figures, it was not able to give us information relating to those in the medical profession. Again, we tried to get as much information to prepare the committee for the meeting. I call Deputy Cullinane.

Deputy David Cullinane

I welcome the witnesses. First, I want to say to Ms Chambers how sorry I am that she has experienced abuse and aggression. To hear of anybody who works in any profession being spat on or threatened verbally is unacceptable, and I know many of her colleagues have been assaulted as well.

The figures for 2022 are going to be similar to 2021. By the end of October, we were getting close to 5,000 instances. I imagine the number of assaults that were reported the previous year was exceeded and, as has been said, such incidents are under-reported. We need to take a zero-tolerance approach to abuse, aggression and assaults, verbal or physical. We have been here previously. We had a session similar to this last year. Many recommendations were made by the representative bodies regarding the HSA. Recommendations were made for the Department, the HSA and the HSE but they have not been implemented, which is a worry.

I wish to make a point about the highly pressurised work environment, which was a point made by all the representative bodies. I accept, of course, that hospital overcrowding, unsafe staffing levels and capacity issues are impacting patient care, which can create frustration. That point has been made and it is one of the reasons we are seeing high levels of assaults. We must say there is no excuse or justification for such a level of assaults. As political leaders, we must send out that message loud and clear from this session. There can be no excuse whatsoever.

I endorse the recommendations that have been proposed. We need to hear from the HSA. It is reasonable that there should be a separate division dealing with health. We have a similar setup in respect of agriculture and other areas. We should take such an approach in health. It makes sense.

I also endorse the call by the representative bodies for the safe staffing and skills mix framework to be put on a legislative basis because that means it has to be implemented. It would mean it is the law rather than as aspiration. That would also be helpful. Many sensible proposals have been made that need to be actioned.

I also raise an issue that was first raised with me on the "Lunchtime Live" programme on Newstalk. I have spoken to some of the witnesses about this issue. It relates to bullying and harassment. We are talking about a highly pressurised work environment and one of the most heavily assaulted front-line workforces in Europe if the relevant figures are right, which is completely unacceptable. We need to do all the things that have been advocated for to provide for additional security. Bullying and harassment are also serious issues. Perhaps I can start with the representatives of the INMO and ask about their experience of those issues and what more needs to be done. The focus on this issue started with an email from someone called "Kate", which is not her real name. She was a nurse who left the system. Since then, the floodgates have opened. Newstalk's "Lunchtime Live" received dozens if not hundreds of emails. I also received many emails after that programme aired. I will also ask that question of some of the other unions that are represented at the meeting. It is a serious issue. In any workplace, we need a zero-tolerance approach to bullying. If bullying and harassment are added to all the other issues in the highly pressurised environment of healthcare, a difficult situation is created. Ms Chambers said she does not feel safe going to work. We need to make our hospitals as good a place for people to work as possible. Some people have good experiences and we know that because they tell us. However, many have bad experiences. It is simply not good enough. I will start with the INMO because issues of bullying and harassment of nurses were not addressed in its opening statement. I will then move to the other witnesses.

Ms Phil Ní Sheaghdha

This issue has been a scourge in many occupations. All the research that has been conducted shows that it is an issue in hospitals, schools and the armed forces. All the unions representing healthcare workers have agreed a dignity at work policy from the code of practice. What is lacking is continuous and mandatory training for all those who are in management positions. That is one of the calls we have made regularly. It is fine. We do our jobs. We represent people who have been accused of bullying and we represent people who are making that allegation. Across all the unions, we take the issue seriously and do our jobs well. The best advice anybody can give somebody in a situation where they believe they are being bullied is to contact their trade union and they will be represented.

The bigger issue is that we are trying to move the focus away from investigation to preventative measures. The Deputy is correct that pressurised environments lead to all sorts of bad behaviour. None of it is correct. We believe there is a requirement for mandatory training on dignity at work. It is currently one of the few policies that is not mandatory. Manual handling training is mandatory.

Deputy David Cullinane

I wish to ensure I get to the other witnesses but one of the common themes that came through all of the correspondence I received, and this was also true of the correspondence received by Newstalk and other outlets that reported the story, was that many of the workers said that the system failed them. All the processes and the dignity at work policies that are in place simply did not work. Those workers did not get proper support.

Ms Phil Ní Sheaghdha

I listened to the programme in question and participated in it shortly after the Deputy did. Many of the calls that followed the comments I made were to the effect that many of the people affected did not contact their unions. It is the view of trade unions across the health service and beyond that if you contact your union, we will make sure that your issue is dealt with properly and in accordance with the policy we have negotiated. It is fair to say we do that regularly and take that role seriously, as advocates for people who find themselves in that position. The bigger issue - and this also applies to assaults - is that employers have a duty of care to keep their staff safe. They are not fulfilling their obligations in that regard.

Deputy David Cullinane

I have limited time remaining. Perhaps the representatives of the IMO could respond to the question.

Dr. Clive Kilgallen

I thank the Deputy. The IMO has started to address the issue. We conducted a gender-based survey of the experience of our members. There is bullying. Some 26% of our female respondents and 21% of our male respondents have had some experience of bullying in the past two years. Some 27% of women and 5% of men have experienced gender-based harassment. It is out there and women are more affected.

There needs to be a cultural change. There are difficulties on the ground because we are short of staff and face a lack of resources. We know about that. However, no matter the workplace, people have to respect each other and treat each other with absolute respect. Everybody working in the hospital environment and all grades of staff should be able to come to work and feel safe and respected. We need to be in that position. The IMO will address the issue in a meeting towards the end of this month. We will address gender-based issues. All genders are involved. We are also going to do some bystander training. That is where we are starting. There needs to be a cultural shift in the working environment whereby everybody feels respected.

Deputy David Cullinane

The HSA is key to all of these issues. It has a role to play in respect of how bullying and harassment is monitored and those issues are dealt with. It also has a role in respect of assaults and the general health and occupational well-being of front-line healthcare workers. That point has been well made. We need to hear directly from the HSA because it is a key player. We also need to hear directly from the Department and the HSE.

It is not good enough that we have hearings such as this every couple of months or once or twice a year. We hear the same stories over and over again and nothing changes. I am sure every committee member who speaks today will say a zero-tolerance approach needs to be taken to assaults, intimidation, bullying and whatever other issues that arise for those who work in our healthcare services, and yet these things are happening. We also need to agree once and for all that we are going to deal with overcrowding and unsafe staffing levels. Those are wider political issues. For the health, safety and well-being of front-line healthcare staff, we cannot continue to have these conversations but take no action.

I commend a submission we received from the better working lives for all committee. It made some sensible recommendations to improve legislation on bullying and harassment. The issue does not only occur in the healthcare sector. However, there was a particular focus on the healthcare sector and these are particular issues in the health service.

I feel strongly that we have a duty of care in that space in the context of those who work in the health service. We have a duty of care to patients, but also to those on the front line and those who work across the health services. The level of assaults, intimidation and harassment they have to go through in the course of their work is absolutely unacceptable. It should not be tolerated. A zero-tolerance approach must mean zero tolerance. We must have a follow-on session with the Health and Safety Authority, the Department of Health and the HSE. What we are hearing from Ms Chambers we have heard time and again. It is simply not good enough.

Chairman

I hope some actions will come out of today's meeting. A number of issues need to be highlighted. The committee will discuss appropriate actions at its private meeting after this one.

Senator Lorraine Clifford-Lee

I thank the witnesses for their opening statements. While they may have been brief, they were impactful and powerful. I appreciate the passion with which they were delivered. We all heard the message loud and clear to the effect that there is a real problem in our health settings. That is completely unacceptable. It is unacceptable that the members of a workforce that is female in the majority are going to work on a daily basis and facing assault. Some of the examples Ms Chambers gave are horrifying. She stated that a number of her colleagues have left emergency departments in recent months. Have they left nursing or have they moved to other areas of the health service?

Ms Sylvia Chambers

Some have left nursing and others have gone travelling or moved to different organisations. As the union representative for those who work in emergency departments, I always ask why people are leaving and have conversations with each staff member. It comes down to harassment, violence and aggression, and to the fact they cannot provide the nursing care they need to provide. We live in fear that a child will die on our watch because we could not get back to him or her. Sepsis is overwhelming, so a child could die if the appropriate care and treatment are not provided. When 24 patients are admitted and a further six patients are there, how can three nurses get back to all of them?

Senator Lorraine Clifford-Lee

Does Ms Chambers feel there is an acute problem in the emergency departments?

Ms Sylvia Chambers

It is across the board. There are no beds for those patients, so they are in emergency departments.

Senator Lorraine Clifford-Lee

The point I am trying to get to is whether Ms Chamber's colleagues find that the atmosphere in emergency departments is particularly aggressive and violent. Are those who are leaving moving to safer parts of the health service or is that level of violence across the board?

Ms Sylvia Chambers

Absolutely. Emergency nursing is tailored. These nurses are moving to GP services, where they feel safe. They are going out to the community, where they feel they are a little safer. Accident and emergency departments are volatile and nurses are moving away from them.

Senator Lorraine Clifford-Lee

We know of more than 5,000 assaults. There could be many multiples of that number. That is significant and horrifying. It would not get to that level in any other workplace. There seems to be an accepted level of violence because people are sick and stressed out. However, we need to send the message that this is not how people who work in healthcare settings should be treated. When an assault happens, what steps do or should people they take? Are there clear procedures? Do people know what to do if they are assaulted?

Ms Sylvia Chambers

We are so busy that at this point when an incident occurs, nurses try to gather themselves together and move on because there are so many sick children. There is a process to be followed. The incident should be reported upwards. I am the clinical nurse manager, CNM, 2 of the emergency department I work in. The incident would be reported to me on my shift. We complete incident report forms, it is then discussed at huddle, goes to the assistant director of nursing, ADON, and so on. However, nurses have recently been refusing to fill the incident reports as they feel it is a waste of their time. They complete a report and it goes into an abyss. There is never any feedback. These incidents are occurring and multiplying and they simply-----

Senator Lorraine Clifford-Lee

Is An Garda Síochána ever called?

Ms Sylvia Chambers

In the past six months, we have made a conscious effort to call the Garda. We are keeping track of that in our emergency department. In the past six months, the Garda has been called approximately 15 times.

Senator Lorraine Clifford-Lee

Is a signal from hospital leadership needed to someone like Ms Chambers who is in a senior position in the emergency department that she is required or leadership wants her to call the Garda in such situations? It that the type of leadership that is needed?

Ms Sylvia Chambers

Absolutely. A collective approach is needed. It cannot only be left to the emergency department CNM to manage aggression. Security has also been mentioned. Our security has a high turnover of staff. They are not familiar with HSE policy or what they need to do. We do not have one person dedicated solely to the emergency department. The security staff may be off dealing with something else in the hospital and we are then left without staff in the emergency department. We have to deal with that. I have often dealt with it myself when no security officer is available to me at that time. That is totally inappropriate.

Senator Lorraine Clifford-Lee

That is unacceptable. Ms Chambers gave the example of a parent becoming aggressive and kicking in a door. What happens to that parent? Is that parent removed from the hospital?

Ms Sylvia Chambers

Never. The parent is never removed from the hospital because one parent is allowed to be there. We may ask the parent to swap with the other parent. In that situation, parents always refuse. They are elated, they are trying to get their point across and they refuse to leave. They say that no one else is available to come in to sit with their child. That parent is left there and continues to repeat the behaviour.

Senator Lorraine Clifford-Lee

That leaves nurses in a difficult situation as they are dealing with a child and they cannot remove a guardian who has to give consent for medical treatment.

Ms Sylvia Chambers

We have to be so sensitive. The child is at the centre of our care. The parent could be shouting over the child. We have to protect the child at all costs. We try to de-escalate as best we can but sometimes we just have to ignore the parent's behaviour and let it go for the sake of the child.

Senator Lorraine Clifford-Lee

Are nursing staff given any training on de-escalation of aggressive situations or is it something they pick up by osmosis?

Ms Sylvia Chambers

It is something you pick up. I am being honest. There is management of actual or potential aggression, MAPA, training, but we cannot get to training sessions because we are so short-staffed. It is a vicious circle. My MAPA is out of date, as are many of the other aspects of my training. We are left to deal with it. We try to manage it as best we can. We ask security staff for assistance. Two members of staff are there long term and they are amazing but otherwise we feel abandoned, especially at night. Staff numbers are depleted at night so we are even more vulnerable then.

Senator Lorraine Clifford-Lee

I will ask a question of the INMO and the IMO. Both organisations mentioned that people are reluctant to log complaints. What could be done to encourage that culture to change?

Ms Sylvia Chambers

If we log a complaint, we should receive some kind of feedback. We all know things are going on behind the scenes, but there is a lack of communication back down stating that something was put in place or that a letter was sent to a parent describing their behaviour as inappropriate. Some feedback to staff would be beneficial and of course security is also needed.

Dr. Laura Finnegan

I endorse everything Ms Chambers said. I am a non-consultant hospital doctor, NCHD, or junior doctor. I work in similar environments to Ms Chambers and along with nursing staff we are sometimes the first people who come into contact with patients who are distressed and become verbally or physically violent. It is difficult to describe what it is like to experience something like that at 2 a.m. and then have to turn around and go to see the next patient and other patients who are on a doctor's books that night. We are just trying to get through the night, to get through to the morning. The CNMs are sometimes the first people junior doctors go to because there are not many senior staff around in the middle of the night. It is difficult to get feedback. When we experience something and perhaps try to report it and talk to people about it, it is not that our colleagues or seniors do not care about what happened to us but it is a difficult thing to address long term. It is difficult to get proper evaluation of the situation and feedback of what could have been done differently. The things Ms Chambers has listed are the things we need. We need better backup and to know we can rely on security and that the security staff are trained to deal with the situations we encounter. The interns, the doctors who are just coming out of college, are often the first doctors called on the ward if a patient becomes delirious or somewhat violent or abusive towards staff. They might be the first port of call.

They might not be able to contact security or security might be busy elsewhere, as Ms Chambers stated. It is an extremely stressful situation. It is obviously very emotive for us because we go into work and experience this on a daily basis. It is not just physical and verbal abuse; it is very specific abuse. As I was saying, it can be gender-based or racial abuse. I have had colleagues experience racial abuse and then, exactly the same as me, turn around and treat the next patient or go back and treat the same patient.

Senator Lorraine Clifford-Lee

I put the same question to the representatives from Fórsa.

Ms Linda Kelly

Just to affirm what people have said, staff on the ground do not feel there is any real value to the incident report. They do not feel any action is taken and it is a tick-the-box exercise from management that goes into a filing cabinet never to be looked at again. Because it is so common now, particularly the verbal aggression being experienced, people are desensitised to what is happening. It is taken as part of the work. If you want to work in this area, this is part of it and you are told to get on with it. If we are talking about a zero-tolerance approach, then employers need to take a significantly different approach to how they respond and react to assaults and verbal aggression in the workplace. It has to be meaningful. If they understood a bit more and listened to the lived experience of their staff, rather than trying to duck and weave away from the actual issues, it would be far more effective in terms of bringing about change.

Senator Lorraine Clifford-Lee

I had another question on bullying and harassment, but there may not be time for it. I am sure my colleagues will cover the issue in a comprehensive fashion.

Chairman

Let us see how the meeting goes. We might be able to bring the Senator back in at the end.

Deputy Róisín Shortall

I wish everyone good morning. Our guests are all very welcome, and I thank them for their presentations. There is a remarkable similarity in what they are all saying, namely, that the health sector work environment is very unhealthy and has resulted in many healthcare workers being in a state of bad health. The latter is the result of stress and the mental health issues that have already been outlined, and then there are the injuries resulting from assaults. This matter demands a response, and the witnesses have all been talking about it for a long time. We have talked about it here from time to time, but it strikes me that it is very much at crisis point and that a serious response on the part of the Government and the HSE is required.

Obviously, the lack of capacity and unsafe staffing levels are the key things that are having an impact. In practical terms, however, there is also a responsibility on the part of the HSE and hospital management to ensure that staff are protected. Reference was made to security within healthcare facilities. I would like to hear a bit more about that. It strikes me that the immediate practical responsibility should be to ensure adequate security. When patients or people accompanying them are out of line and abusive to staff, that needs to be dealt with. There needs to be a clear atmosphere created in healthcare facilities to the effect that it is not acceptable for people to be abusive or to physically assault others. I would like hear about the witnesses' experience of security in hospitals and other healthcare facilities. Reference was made to some of that security being provided on an agency basis. Will Dr. Finnegan elaborate on that? She referred to the importance of security either at her facility or in her experience. Is there adequate security? Are these permanent security staff or are they people from agencies who come and go?

Dr. Laura Finnegan

It varies. I have worked in maybe five or six different hospitals by this point in my career, having qualified five of six years ago, which is typical of NCHDs. Our experiences with security and these things vary. We have had very good experiences with security. We are in no way attacking those personnel who are trying to help us when we are on site at 2 a.m. That is not what we want to do.

Deputy Róisín Shortall

It is the adequacy I am asking about.

Dr. Laura Finnegan

Yes. Exactly. I will be honest and say that I have never really felt that there was adequate security in any public hospital in which I have worked or that if an incident occurred, security staff with the right level of training to be able to deal with situations in a appropriate manner would be available to us in the right amount of time Again, this is not a reflection on those individuals working in security. I am referring to the system as a whole and what needs to be done for them to be able to help us in those situations.

Deputy Róisín Shortall

Is it the general experience that security personnel would be agency staff who come and go or are they HSE or hospital staff?

Mr. John McCamley

It would be both. We represent quite a number of the security staff in each of the hospitals. They face their own difficulties in the context of staffing, resources and being left in very difficult situations. We represent members who are employed directly by the HSE and section 38 security staff who have come across incredibly difficult situations. Again, it is all about staffing and resources. That is just a general trend within each of the hospitals. Leaving aside security staff, we have other grades, such as porters or healthcare assistants, that have been left to deal with instances of aggression in emergency departments and in other locations. It is a general trend that has increased over the past number of years due to the number of presentations in emergency departments, waiting times and the cancellation of elective surgeries. All of that has led to a certain amount of aggression. It comes down to the crisis within the health service and the shortage of staff as well.

Deputy Róisín Shortall

Points have been made about the role of the HSE and the need for it to have a separate health sector division, and for that to be funded. Does anybody know where that proposal stands? Is it a live proposal? Is it being pursued?

Mr. Albert Murphy

I understand it is with the board of the Health and Safety Authority, HSA, for consideration of the work programme. We have not received a response to it as of yet.

Deputy Róisín Shortall

Presumably, it will only do it if it is funded by the State.

Mr. Albert Murphy

The point I made is that the vast bulk of the 500 inspections carried out by the HSA in 2021 were to do with Covid-19. Only 69 inspections were to do with assault. We know that-----

Deputy Róisín Shortall

How many?

Mr. Albert Murphy

Sixty nine.

Deputy Róisín Shortall

Is it the view of the INMO that this is a capacity issue, or is it down to a lack of priority?

Mr. Albert Murphy

If somebody is killed on a farm, that obviously grabs the headlines. If ten nurses or healthcare assistants are attacked every day, it is not being reported. The emphasis needs to be refocused on health where instances are as important and as tragic as others would be.

Deputy Róisín Shortall

That is a specific issue which the committee needs to pursue actively. Mr. Figgis made a point about staff. He provided the data on the incidence of assault. He referred to the unequal treatment of benefits affording to support workers by their employer even if they are assaulted in the same incident as other grades of staff. Will he explain that?

Mr. Kevin Figgis

I thank the Deputy for the question. The HSE data advises us that, after nursing staff, support staff are the second highest category of staff who are assaulted in the workplace. We obviously have data in our submission not only in relation to support staff but also on the National Ambulance Service where, ultimately, crews are going out and meeting whatever is happening on the streets. That is not happening in an emergency department or whatever, and we have a significant level of direct physical assault on paramedics, etc.

The situation relating to the benefit piece is that there is a tiered system. This originates from the old system whereby we used to have officers, non-officers, etc. Support staff were classed as non-officers. We had the same situation in respect of superannuation and sick leave polices that have been standardised over the years. This has not been standardised, however, and that remains the case. The HSE data tells us that after three months, 41% of support staff who have been assaulted in the workplace are still unfit to return to work. By that point, what they are entitled to under the scheme has run out. Under the scheme, support staff get three months and medical staff, health professionals and clerical administration get six months. Nurses also get six months, but they can apply for two further extensions of three months each, bringing the total up to a year.

This means that a support worker, such as a healthcare assistant, who is assaulted in the same incident, by the same person, in which a nurse is assaulted would get up to three months of benefit, whereas the nursing colleague would get benefit for up to a year.

Deputy Róisín Shortall

That is clearly very unfair. I thank Mr. Figgis for the explanation.

I turn to the issue of bullying. This is an additional pressure on staff, who sometimes deal with aggressive patients and people who are with them. There is all the stress associated with working in unsafe environments, with understaffing and so on. Then there is the issue of how staff are treated by management, whether management in a hospital or the HSE. In the short time remaining to me, I would like to hear the witnesses' views on the adequacy of the grievance procedure within the HSE at this time. People have contacted me who are going through that procedure to tell me how inadequate it is. I ask the witnesses, beginning with the representatives from Fórsa, to give their views on that briefly.

Ms Ashley Connolly

We recognise that our members work in a very problematic culture in which they feel undervalued, not recognised and not respected. We recently adopted a new dignity at work policy but, as outlined by my colleagues earlier, we need awareness campaigns, preventative measures and adequate training. There needs to be a stepping up of employers' duty of care. Our members have experienced the grievance procedure as quite a lengthy process, which is not acceptable. It is very clear in that policy what the timeframes are, but they are not adhered to. That in itself is an additional stress on somebody who is feeling vulnerable in the workplace and sometimes fearful going into it. It is a cultural problem and it is also led by the stresses within the workplace.

Deputy Róisín Shortall

I thank Ms Connolly. Will one of the IMO representatives answer the same question?

Dr. Clive Kilgallen

I agree that the grievance procedure needs to be made more available to people and we also need to ensure people understand it. Among my colleagues, I am not aware of anyone who has undergone a grievance procedure. They have to work through and sort out issues but I am not personally aware of anybody who has gone through the procedure. Interestingly, in the new contract that should be implemented shortly, a much more formalised process is set out. It is addressed that if there are difficulties with rostering or whatever, then a grievance procedure will be followed. This certainly is something we are looking into in the IMO.

My colleague, Dr. Finnegan, might indicate whether she has experience of the grievance process from a training point of view.

Dr. Laura Finnegan

I am not personally aware of anyone who has been through the entire process. Grievances are usually sorted out between those involved.

Deputy Róisín Shortall

Do the witnesses know whether there are data available on this? The SIPTU representatives might have something.

Mr. Kevin Figgis

We included in our submission some internal data. We have a SIPTU workers' rights unit that looks after our members on an individual basis through issues like grievances, etc. The health division takes up 37% of all the unit's activity across the entire union, with 35% of that activity relating to grievance handling. Colleagues who lead in that department tell me that one of the key issues they have is the difficulty in respect of timescales. These things take so long and have an overbearing impact on the workers.

Deputy Róisín Shortall

I thank Mr. Figgis. I ask for a brief response on this point from the INMO representatives.

Mr. Albert Murphy

The issue is to make the training mandatory for managers in order that they can deal with the policies.

Deputy Róisín Shortall

Is Mr. Murphy saying training on this should be mandatory for managers?

Mr. Albert Murphy

Yes, absolutely.

Deputy Róisín Shortall

There can be a policy on paper but that is not the full story. The HSE has told us about seven policies it has to deal with this area.

Mr. Albert Murphy

To go back to the point Deputy Cullinane made, the Health and Safety Authority, HSA, has to get on the pitch because the HSE cannot be trusted to police this. The HSA has a duty of care and it is looking elsewhere. There may be a resource issue but the HSA must be on the pitch.

Deputy Róisín Shortall

I thank the witnesses.

Chairman

It is bizarre that some people, because of their particular job title, would not get the same benefit as others do when they are the victim of an assault. That is bizarre in the 21st century and it something we will follow through on in our recommendations.

Deputy David Cullinane

It is clear the grievance processes are not working. This is a really important issue to take up with the Department and the HSE.

Chairman

The next speaker is Deputy Hourigan.

Deputy Neasa Hourigan

I thank the witnesses for their attendance. I am cognisant of the seriousness of the spectrum of issues we are discussing. I will use my time to focus on the issue of long Covid because it is an emerging issue. Like a lot of people, I am trying to get a good handle on it. It is one of those issues arising out of the Covid pandemic that we possibly will be dealing with long into the future.

Many of us were able to stay home during the pandemic but that was not an option for a lot of healthcare staff, who took a risk in going into work everyday and being repeatedly exposed to infection. As I understand it, there is a substantial cohort of workers, with whom the unions will have engaged, whose symptoms may not have improved after two or three years. People who come to me have spoken about symptoms like fatigue, joint pain, shortness of breath, insomnia, vertigo and others I will not list. There seems to be a disproportionate number of healthcare workers affected. I am aware of the State's role in this because those workers were repeatedly exposed to infection, often in circumstances in which they had inadequate personal protective equipment, PPE, and perhaps were not called for vaccination when they should have been. I am aware of a few cases, for example, in which managerial or administrative staff were called for vaccination before front-line workers.

I have put in a few parliamentary questions on this issue and my understanding is that many of the affected staff are currently on special leave with payment of their basic salary, but this scheme is due to end in June. The response to my latest question to the Department of Social Protection states:

Covid-19 does not constitute a prescribed disease or illness as set out in the Social Welfare Consolidation Act 2005 as it does not meet the criteria laid down in the Act... [which] states that a disease or injury shall be prescribed for the purposes of this section in relation to any insured persons, where the Minister is satisfied that-

(a) it ought to be treated, having regard to its causes and any other relevant considerations, as a risk of their occupations and not as a risk common to all persons, and

(b) it is such that, in the absence of special circumstances, the attribution of particular cases to the nature of the employment can be established...

When it comes to Covid-19 and front-line healthcare workers, I would have thought that could be established. However, the Department of Social Protection does not categorise them as having been more at risk of Covid-19 infection than an average person in the workplace who had the option of staying at home and isolating.

Many of the unions have been campaigning to introduce an occupational injury scheme for healthcare workers with severe long Covid. It is not necessarily an easy condition to diagnose, with there being a very long list of potential symptoms. However, such a scheme has been introduced in France, Italy, Germany, Denmark and Sweden. Provision in this regard has been recommended by the EU's Strategic Framework on Health and Safety at Work 2021-2027. I am interested in the opinion of all the witnesses on this issue. Placing people on standard sick pay will, in effect, be a pathway to early medical retirement for many of them, unless there is a major treatment breakthrough, which we hope there will be. We are talking about people in their 30s, 40s and 50s.

I have a number of questions on this issue, which I will put before asking the witnesses to respond within the five minutes allowed to me. It is hard to get numbers on this but I would like to get a sense or estimate, in the opinion of the represented groups, of how many healthcare workers might be affected.

I am hearing that some healthcare staff are feeling increasingly under pressure from occupational health departments to return to work on reduced hours and with adaptations to their roles, which will have an impact on their working life into the future. This is happening even though many of these people might feel they are still severely impaired by their symptoms, as may be the case with other conditions, and will struggle to do daily tasks or complete their work. How are the witnesses advising people who are being advised to go back to work on reduced hours? What are they advising in regard to the arrangements for special Covid leave with pay and in situations in which people trial a return to work and it does not work out for them?

Is it cut entirely or can the person go back on the payment? Is that something people are experiencing? What supports do people have in terms of dealing with that occupational health department when the more complex issues arise? What happens when an occupational health physician is recommending that the person should return to work but the person does not feel he or she can?

In the longer term, I am interested in hearing what the pay outcome will be for people who are experiencing long Covid. How are the unions going to approach this issue? Is there a possibility for collective settlement for different strands of healthcare workers?

Chairman

I do not know how all four unions will answer those questions.

Deputy Neasa Hourigan

I had to get them all in.

Chairman

I will kick off with Mr. Figgis from SIPTU. His submission referred to cessation from the Department of Public Expenditure, National Development Plan Delivery and Reform in regard to the scheme.

Mr. Kevin Figgis

I thank the Chair and the Deputy for her questions. The long Covid piece is a real challenge. People quickly forget, because we have been dealing with Covid for so long, that at the start of the pandemic we did not have the PPE, training, awareness, etc. A lot of the people we represent spoke about environments where, as we said in our submission, PPE was shared and reused. People were even told it was being prioritised for other grades and not their grade. It was not a good situation.

The unions have worked closely together on this. Last year we raised the decision of the Department of Public Expenditure, National Development Plan Delivery and Reform to remove the scheme in place for public servants. We asked for a scheme specifically for health workers. To my understanding, the HSE was referencing a figure of 200 healthcare workers having long Covid. We sought engagement and the Minister at the time said there would be no cliff edge in regard to 30 June. The committee may remember this.

The difficulty is that this is a decision made by the Department of Public Expenditure, National Development Plan Delivery and Reform. We then engaged with the HSE which is the employer and has no mandate to agree anything of outside of its control, which this probably is. We then had the Department of Health stating that it did not make the decision. We are caught in the middle of all of this. The group of unions collectively referred this matter to the Workplace Relations Commission, WRC, because we have had no engagement.

Ultimately, the Department of Public Expenditure, National Development Plan Delivery and Reform is an inch longer than an arm's length away and is out of reach. The Department of Health and the HSE have said they have no space or mandate to engage.

The challenge in regard to advising members is that we are obviously telling them this is an active issue for us and we are seeking to advance the matter in order to agree a scheme through the WRC. What is really important is the response from the Department of Public Expenditure, National Development Plan Delivery and Reform, which clearly outlines that our Government is out of touch with regard to what is going on in Europe, the EU Commission, etc., where long Covid is being recognised as an occupational disease as well as the fact there is a need to protect health workers. That is what we are trying to achieve in the review.

Deputy Neasa Hourigan

I know the Chair wants to move onto the next person, but to be clear, by my reading of that parliamentary question, if the Minister for Social Protection recognised it as an occupational disease we might be able to sidestep the Department of Public Expenditure, National Development Plan Delivery and Reform.

Mr. Kevin Figgis

Yes.

Mr. Albert Murphy

The issue regarding Covid is that 30% of those who got it got it in the workplace. There is a connection. People had to wait 12 days before they could claim the original special leave. There is a direct connection with employment. As Mr. Figgis said, we have tried since March 2021 to get into the WRC and resolve this issue. There are schemes in the health service, such as the blood-borne diseases scheme, that could form a basis for a Covid scheme under precedent. Quite frankly, bringing the Department of Social Protection in and asking whether it regards long Covid as an occupational disease for a benefit scheme is a red herring. It needs to put in place a scheme.

Regarding the overall picture, there are relatively few people who suffer from long Covid as a percentage of the workforce. The figure is less than 2%. This is not a Trojan horse. It is a recognised condition in Europe. The HSE has set up long Covid clinics. The people who went to work and put on the green jersey need to be looked after.

Chairman

I thank Mr. Murphy.

Ms Ashley Connolly

Reference was made to the scheme ending in June. Our members who are out are very worried about what that means for them financially, how they will pay their mortgage and bills and what impact it will have on their families. My colleagues in other health units and I have worked very closely on this matter, but we are meeting a brick wall. We ask for the support of the committee in pushing this. It needs to be addressed and cannot continue.

Dr. Clive Kilgallen

Many colleagues who got Covid were working on overcrowded wards. That is very likely where they got their Covid. I suspect they did not catch it anywhere else. I know more than one consultant who has long Covid. They are really ill and cannot work. They are shattered by it. It has changed their lives. These people must be supported. It is as simple as that. There is nothing more to say.

Chairman

I am conscious that assurances were given that there would be no cliff edge. Clearly that is what has happened. As a committee we will pursue the Department of Public Expenditure, National Development Plan Delivery and Reform in regard to this matter. It is to be hoped we will get some answers.

Deputy Gino Kenny

I thank the witnesses for their statements. Long Covid is an important issue in respect of the health service. The statements make for sombre and depressing reading.

It is incredible that there have been almost 6,000 assaults against nursing and midwifery staff in less than two years. That is unbelievable. I do not know what is happening to society if we are sanitising this level of abuse against people who going to work and trying to help us. Nurses, care staff and doctors are being subjected to abuse. I am guessing that in situations such as emergency departments things are quite volatile and people are sometimes there for days on end. People who would be very rational do certain irrational things, such as abusing staff. It is hard to believe. I am sure this is having a detrimental effect on Ms Chambers's profession. Morale among her colleagues must be on the floor if 30 of them have had to leave the profession because of abuse from people in that environment. The situation must have a terrible effect on the work environment.

Ms Sylvia Chambers

Absolutely. Morale is extremely low. We do a safety pause every morning. Funny and all as it might sound, we try to manifest a nice day. Within that, we hope nobody gives out us today. Things have gone to that stage. It does not bear thinking about. I am dedicated. As I said, I have been a nurse for 18 years. I do not want to leave the profession. I love the emergency department, but I am now considering alternatives and re-evaluating my career. I should not have to do that. I am a good nurse and I love what I do, but the environment we work in is not good. It is not fair on sick children.

Deputy Gino Kenny

Has the pandemic, which now spans two years, compounded some of the issues that have manifested, in particular in emergency departments?

Ms Sylvia Chambers

I do not know what the trigger is, but we have had conversations in the emergency department that after Covid the expectation has changed even for reception staff. If a parent is waiting for 12 hours, he or she may be aggressive, but even those checking in are aggressive to reception staff. That behaviour has increased since Covid. I do not know what the trigger is. I would not be able to pinpoint it, but since Covid we have seen a huge increase in aggression and passive aggressiveness.

Deputy Gino Kenny

As I said, the statement makes for sombre reading. People have to go to work and be subjected that behaviour.

Ms Sylvia Chambers

I am always conscious that we could have a child in resuscitation while I am called out to deal with an aggressive parent. Such parents are stopping me from providing life-saving care. It comes down to that. When I tell parents I am dealing with a really sick child, they tell me I am telling lies and everybody is drinking tea. That is absolutely not is what is happening.

Deputy Gino Kenny

Unions have said that due to staffing levels in particular areas, the environment is almost dangerous and is not conducive to a healthy environment for staff. If this is the case, it will trickle down to those people awaiting intervention in emergency departments. This situation is quite insidious.

My final question, which is on whistleblowers in the health service, is for all the union representatives. What has their experience been in respect of the treatment of whistleblowers who have contacted their respective unions? Whistleblowers play an important part in providing disclosures. The legislation on disclosures by whistleblowers could be much more stringent. What is the experience of the witnesses in respect of whistleblowers in their respective unions? How could they be protected better in the context of workplace disclosure?

Ms Linda Kelly

This ties in with the question Deputy Shortall had about grievances and the dignity at work policy. Since the Protected Disclosures Act came in, it has not bedded down in terms of real cultural change or understanding across the structures as to what it is, how people access it and what training is available. Does it even feature as part of induction when one joins the health service? I very much doubt it. This is something that needs to be looked at. What we are talking about is a toxic culture that needs to change and needs to be far more proactive about addressing these issues. They are all interlinked.

In order to keep the dedicated staff we have in their jobs and doing what they do best, the retention plan must address how they raise complaints and grievances. Staff should not have to get to the stage of protected disclosure. There should be an effective and local informal process long before that stage. As unions, that is something we always advocate for on behalf of our members. On the specific protected disclosures piece, it has not bedded down and I do not think there is a dedicated training aspect to it within the system either. It is not dissimilar to the grievance piece in that regard.

Dr. Clive Kilgallen

I agree with all that has been said. It must be part of the induction and must be supported. As a union, if any of our members comes to us, we absolutely support them. There is so much out there, where does one even start? Taking the risk registers that are in average hospitals, there are many major things in such registers for years and never change. That would be one thing. Does Dr. Finnegan wish to come in from a NCHD point of view?

Dr. Laura Finnegan

I completely agree. I do not think things like the dignity at work policy or how to bring up grievances were part of any induction I have done when starting in a new hospital. You are usually so busy that you fly through induction, pick up your badge and get the few basic details you can out of induction before going to your first clinic or whatever you are scheduled to do that morning. It is not just about the issues we are talking about today, such as the safety and welfare of all our staff and the knock-on effects on the safety and welfare of our patients; it is the whole situation. It is the capacity for beds, the understaffing, the undue stress we are under to get our jobs done every day. I feel very lucky to be a doctor. I absolutely love looking after my patients and adore my job. However, similarly to Ms Chambers, I know of many colleagues who have considered moving away from medicine altogether or going into different aspects of healthcare because they cannot live a meaningful life outside of work while managing the stresses they are under on a daily basis.

Mr. Kevin Figgis

Much like what we were talking about earlier regarding dignity at work and zero tolerance towards bullying and harassment, there equally needs to be a greater adoption of the protected disclosures protection and mechanism within the culture of the health service. Having spoken to people who have been involved in that process, they find it to be quite stressful. They find that perhaps they are being viewed as troublemakers. That should not be the type of outcome people experience for putting up their hand and saying they have seen something that is not right. A lot of change has to happen to make people feel more respected when coming forward and making a report. There is a long way to go in the health service to achieve that type of environment.

Mr. Albert Murphy

The HSE does not like anybody, particularly its staff, talking about it and it has policies on staff not communicating with the media. All of the other issues that are there come back to training issues and using the internal processes. Whistleblowing has a place as a last call and those whistleblowers should be supported. It is not a huge part of the health service. One would have to work hard to become a whistleblower in the HSE.

Deputy Gino Kenny

I think am running out of time.

Chairman

The Deputy has 20 seconds left. Does he have anything else to say?

Deputy Gino Kenny

No. If I ask a question, I will go on for another few minutes.

Deputy Bernard J. Durkan

I welcome our guests and their invaluable contributions, which come from the coalface and from people who have been working under stress for the past three years in appalling conditions and pressured situations all the time. We must do something about it quickly. On bullying in the workplace, it is simple. We do not have to build a structure. It needs to be followed. We have become accustomed in recent years to the practice of a report being published and someone looking at it five years later. There must be an instant response. Something must be done to deal with it.

There must also be a recognition that there are many contributory factors. Overcrowding in accident and emergency departments, such as those that I, the Chairman and other members of the committee have had occasion to attend over recent years, is certainly one that needs to be dealt with. A lot depends on the structures in the accident and emergency departments. Some hospitals have the staffing or the resources to deal with the situation quickly and in a way that calms the people waiting, so they are not asking if they will be sitting there today and tomorrow. When relatives have to ask what the hell is happening, if anything is happening at all and what is happening behind a window or door, it follows that pressure will be put on the staff because they are going to be wrongly blamed for it. The organisation should be blamed for setting it up in that fashion. There is a need to examine that in a way we have not done before in order to ensure we alleviate the pressure at admission stage in accident and emergency departments. This would allow people to understand what is happening and how long they are going to be there. Will it be three days, two days, one day or four days? Will it go on forever? The reaction is taken out on the staff.

We should also recognise everyone is less tolerant in the post-Covid situation. That is the way it is. Maybe it is directly as a result of Covid. If one enters a roundabout while driving, for instance, one will see the reaction of other drivers; everyone drives at the roundabout at speed hoping to chase everyone else off it. That was never the case nor is it a part of the rules of the road. That is just by way of an example. There is also an increased rejection of any kind of authority. It is a fact of life. Teachers, gardaí and various other operators say there is no respect for authority at all and this sentiment is growing. That has a serious and debilitating effect on those trying to provide services to the general public. It becomes one-way traffic with staff working under siege. Nobody should have to work under siege. We know this more than anyone else as we are often under siege ourselves. People in the health services, and in other public service roles, should not have to work under siege, with people standing over them saying, "I employ you. You do what I say now." That does not apply and that attitude must change.

We have to deal with that in our report to the HSE and in our interaction with the Department. There are three areas that we need to deal with.

My next point relates to long Covid. It has had an effect on everybody. All of us around the table here have had it. I have had it twice and some people have had it more often than that. It has a peculiar effect. It sticks with you in a way that nothing else does. It lingers on and so on and so forth. That has an effect not only on health service staff but on the patients as well. Everybody is at each other’s throat, for want of a better description, to get the services they want in the shortest possible time with a view to moving on.

I do not want specific answers. I am trying to address the issue from the points of view that are being presented to us. We have to make the moves after this. It is up to us to act as quickly as we can with the HSE and the Department of Health to address the issues that the witnesses have presented to us this morning and point out that it is hard to retain staff. We know one of the reasons and one of the contributing factors. Of course, it is hard to retain staff in those kinds of circumstances. Let us do something about it. At that level, at least we can do something.

My last point is on security. I cannot understand why security is so lax in sensitive areas. When entering the county council offices, there is security straightaway at the front door. People cannot get beyond that unless they are cleared. Any other business that I know of in the private or public sectors has security staff who deal immediately with any situation. They can interact with the person concerned, set them at ease and direct them to a particular area - all important and all liable to alleviate the stress and tension that the person might be under.

I ask that we call the HSE back within a short period – no more than five or six weeks – to see what has happened and whether a reasonable attempt was made to address the issues. It is not rocket science. It is the simple management of human beings that is necessary to deal with the issues they are raising under pressure. Remember, that is the important thing. This group of people has been under pressure at the coalface for a protracted period. There was not, and could not be, any let-up. The job that was being done had to be done and had to be done then – not later. One could not wait six months.

The presentations have been useful and we have all learned a lesson. I was aware of this beforehand, as were all committee members. It accentuates the necessity to deal with this when we get an upfront presentation from the coalface by people who are dealing with the situation every day.

I did not exceed my time.

Chairman

No, you did not.

The important point is that we asked the HSE for a report on the actions it is taking. They list different mechanisms and treatment to respond to aggressive behaviour to keep others safe. What is working and what is not? The list of actions they are taking is quite impressive. However, those actions are clearly not working. We need to follow up and find out from the witnesses what is working and what is not. I hope that as the meeting goes on, we will hear more of that.

Senator Annie Hoey

I thank the unions for the presentations. I was watching them on the screen.

There are two areas I want to focus on to give everyone enough time to answer. The first one is on the two-tier leave system that was alluded to in one submission. I have also read around that support staff are classified as non-officers under the HSE staffing structures and get paid leave for three months after an assault. Meanwhile, clerical and administrative officers, who are classified as officers, get full pay for up to six months. Nurses and midwives can avail of longer durations of paid leave than that. That results in a support worker who was subjected to a serious physical assault being left in a situation where they are getting only 25% of the leave of someone who could have been assaulted in the exact same scenario.

How did we end up in a position like this? Who decided it? This is an HSE policy and HSE officials are not here to respond to this. How did we end up in this situation where we have these differing grade levels? Is it because of the jobs they have? Is it an HSE policy? Is it the same policy in the private sector? I ask the witnesses to elaborate a little on that. I am sure many people listening in would be astonished to hear that we have a two- or perhaps three-tier system for who gets leave, despite the fact they could all be involved in the same incident.

Chairman

SIPTU might expand on that.

Mr. Kevin Figgis

I will. I thank the Senator for the question. This is just another example of these historical policies that have been in place within the HSE. They predate the HSE, so they would have been in place prior to the HSE even being a thing. We have seen some of them slowly being erased over time. For example, there used to be a different pension scheme and a different sick leave scheme for non-officers. The title for support staff is exactly that. They were classed as non-officers versus other categories of staff who were classed as officer staff. We have been vehemently opposed to this.

We previously raised this a number of years ago and the HSE's view at the time was that it was a cost increasing claim. It was going to review it as if the union was lodging a pay claim and that it was cost increasing. We raised it with the HSE again two years ago. The HSE advised us that it is not averse to this. It accepted the argument that having a policy that was unequal towards staff would not stand up, and also that there had been changes in policies, such as the pension scheme and sick leave scheme, as I said. At this moment, it is with the Department of Health. We understand that the Department of Health has received a full briefing from the HSE and it is for the Department to then engage with the Department of Public Expenditure and Reform.

It is important that the data the HSE provided us state that support staff are the second category who have been subject to highest level of physical attack within the service. These are people such as porters, catering assistants, household staff, security staff and paramedics who are simply trying to help people working in the health service. The last thing they expect is to be physically assaulted in trying to do that.

The Senator outlined a scenario where a number of staff can be involved in the same incident. To say that the policy of our national health service is that we will deal with those staff differently by tier and that after three months, a support worker will be told they have used up their leave and have to use their own sick leave, or may have to go off pay if they have no more sick leave, is simply unacceptable given the fact that other staff who may have been involved in the same incident will remain in benefit. It is a shameful policy and it does not belong in a modern health system.

Ms Ashley Connolly

It is a testament to the delays in engaging on any matter that is relevant to our members. We find there are multiple layers. We have the HSE, then we have to wait to see what the Department of Health’s position is and then it has to engage with the Department of Public Expenditure and Reform. We find ourselves in this cycle on every issue. All the unions are fully supportive of our colleagues in SIPTU in having this addressed. It has been on agenda after agenda and we are just meeting the same brick wall. It is becoming frustrating for our members and adds to belief that they are significantly undervalued, not respected and not recognised for the service that they provide on a daily basis.

Senator Annie Hoey

It seems farcical, if I could be so frank, that the system will continue to allow it and it is being held up by bureaucratic-----

Mr. Kevin Figgis

The big challenge is that they see it as a cost. Let us say there are different grades of staff who have all been physically attacked. They see it as a cost to look after and support a catering assistant, household member, porter, security officer or paramedic in the same way that they are absolutely willing and able to support other grades of staff involved in the same incident.

Senator Annie Hoey

Regarding the long-term consequences of the cost-saving measure of bringing someone back in early, what is the impact further along? It does not take a genius to figure out there is a longer-term cost.

Mr. Kevin Figgis

Support workers are the lowest-paid workers in the health service. For them to lose their benefit after three months can be devastating for their family, etc. Many are single-income homes. If they are deemed medically unfit to return to the workplace after something that happened in the workplace while they are doing their job, it is unacceptable that the employer turns its back while continuing to provide benefit to other grades.

Senator Annie Hoey

I will jump to my second question, which is still on the issue around assault in the workplace. From a nursing perspective, it has to be looked at through a feminist lens. Some 90% of the profession comprises women. It seems, at least, that, as Ms Ní Sheaghdha outlined, these are not seen as workplaces by the State; they are seen as places of care. Yet they are workplaces and, as Ms Ní Sheaghdha said, the HSE is one of the biggest employers in the country. If this was not in the health sector, this rate of assault would not be contemplated. It would simply never get to this stage. This cannot be looked at without putting a feminist lens on it or looking at it through a gendered lens and wonder if that is why this is being allowed to continue. As many plans and everything that are laid out to deal with it, it has not been dealt with efficiently by the powers that be up until this point. There is a nurse here and I want to thank her for coming in and sharing her testimony. She has elaborated on the impact the assaults are having on her and her colleagues. Does she go into work every day feeling safe? I cannot believe that in 2023 in a committee, we are asking the question, "Do you even feel safe going into work?" I cannot believe that we are at that. We should not be asking that question. Do her colleagues feel safe going to work? Is the risk or, at this point, reality of assault in the workplace pushing people out of the sector? We have all the reasons people are leaving the sector such as work, pay, and all those things, but is this one of the reasons people are leaving the sector and causing part of this staffing crisis we hear about all the time?

Ms Sylvia Chambers

Very much so. Like I said, we do a safety pause as part of each shift. We all go into work, we can see the screen and how many people are in the department and someone will always make a comment, "Tonight is going to be a really rough night, we are going to have loads of aggression tonight", because there is already a seven-hour or eight-hour wait and by 4 a.m. it will be up to 12 hours. That is especially the case for triage nurses. The triage nurse is the first person the parent and child see. They are out in the middle of the department. If there is a knock on the door, it is the triage nurse who opens the door. They receive the majority of that aggression. People are burnt out and stressed. They take it home. They re-evaluate and they think, "Did I say something? Did I say the wrong thing? Did I say the right thing?" People take that home with them. If I am verbally abused, I have to compose yourself and go on to the next person. I have to go on to the next child; I have to compose yourself. Sometimes I am fighting back tears because the comments are so personal. They can be very personal, about your appearance. I always get a comment on my big bun and my accent. It is personal and it is hard to separate yourself. When I am in the middle of it and it is 4 a.m., I am tired. I have been busy, doing the work of three nurses and running the emergency department. It is hard not to take it personally. The level of aggression would be one of the main reasons I would be looking to leave nursing.

Ms Linda Kelly

The gendered aspect needs further analysis. Most of our members are also women. Ms Chambers mentioned earlier the level of aggression that is now coming at clerical administrative staff. It would be remiss to only focus on emergency departments. It is a particular pinch point but we see it across all different areas of the health service. For our members working in social care, in particular, it is a big aspect, or if they are working on children's disability network teams, CDNTs. Physical assault is damaging physically and mentally for staff but verbal abuse can be just as insidious in terms of wearing down their professional identity. They can dread coming into work because they are so afraid of the insults they are going to get across the desk, over the phone, by email or on social media from people using their service. There is no escape from it. Whatever way they come to their job, whatever route they took to get there, people take pride in their professional identity. All of us experience that from our members. They made a decision to work in the health service and want to provide a good-quality service in whatever way they contribute. Their professional identity is called into question and abused on every shift or every day; it is certainly every week. That is demoralising for people. They do not see any support coming to scaffold them in that or buttress them. That is the problem from the employer. The employer viewpoint on it is, to be frank, "Put up with it. That is just the way it is. That is the health service, that is social care, that is disability, that is EDs, that is whatever". I do not think that should be acceptable.

Dr. Laura Finnegan

We work in a caring environment but it can be dehumanising for those of us who are trying to provide care when we experience these things. That is the feeling you get and that is what wears you down - the feeling that you are not human, you are just there, you are someone who is providing a service. Our physical and mental well-being is sometimes second to everything else.

Chairman

Is the answer, "It is happening across society so you should not be surprised that it is happening in your workplace"?

Mr. Albert Murphy

There are no consequences for the HSE. That is why we are saying that the Health and Safety Authority has to be on the pitch. If there are 5,000 assaults, nobody is held accountable. There are no inspections by the HSA. That is worth mentioning. It is a key factor. Another key factor is that last year there were nearly 80,000 people on trolleys. That is like Croke Park full on an All-Ireland final day. That is what we think is normal. It is happening year in, year out. Unless we get to grips with the overcrowding issue in emergency departments, this issue will not be resolved. The key part of the escalation policy is that there should be de-escalation. They all know what to do when the pressure is building up, but in terms of decanting the hospital and forcing management to deal with that, it is not being addressed and needs to be emphasised. Let us consider the winter we have just come through. In the first week of January, there were 900 people on trolleys. The health service has forgotten about that now. We will just get on with the next bit. There will be winter planning and it will come out in November. We were talking to the HSE in November saying, "You have to scale back the activity level." The response was, "We will manage the service. We know what we are doing". Then, the unions were called in before the end of the year, all of us, to say, "We have a crisis now, can you help us here lads?" It beggars belief that the winter plan comes out in November. It needs to be agreed and the workforce plan needs to be agreed with us early so we know what we are planning with.

Chairman

I am conscious, as the health committee, that we hop every week from one crisis to another in reflecting what is happening within the service. When the new head of the HSE comes before the committee, he is going to outline his views about how things are going to move forward and I am sure many of the members will have questions. I call Senator Black.

Senator Frances Black

I sincerely thank all of the witnesses before the committee for coming in. I also thank our front-line workers and those working at the coalface. What we are hearing is shocking. It is upsetting. What I am hearing is that front-line workers in healthcare and other healthcare workers are traumatised, burnt out, exhausted and at the end of their tether. I cannot imagine how they keep going and putting one foot in front of the other. I recall being with a family member in the emergency department and going up to a young nurse. It was about 2 a.m. I remember her looking at me and it was almost like she was traumatised; she could not hear me. The place was like a war zone. I was just asking her if I could get painkillers for the person I was in with. She genuinely could not hear me. She looked like she was completely shook. Her expression stuck with me. I wanted to put my arms around her and give her a big hug.

I apologise for having been late this morning. I was trying to listen online but I did not get to hear everything, so if I repeat some of the questions, please forgive me.

Fórsa's opening statement referred to a number of issues that Fórsa has tabled but that the Department of Health has ignored and drawn out. What mechanism, if implemented, would facilitate better working relations between trade unions and the Department, in the view of the representatives from Fórsa? What would their recommendations be? Could they say a little about that?

Ms Ashley Connolly

I thank the Senator for the question. I and my colleagues in the other health unions are engaged in the national joint council, where we meet senior management regularly. From Fórsa's perspective, these are long, drawn-out processes. They are not achieving outcomes speedily. I struggle to see them as a meaningful engagement, and that is my honest assessment. The first position, which was ignoring the fundamental issue of pay parity with our colleagues in the voluntary sector, just cannot be tolerated any longer. We have a two-tier system of people providing vital healthcare services, the services this State needs them to provide, but they are asked to take salaries thousands of euro less than those of our colleagues in the HSE. We have the unilateral withdrawal of the protections against long Covid, which we spoke to earlier. We became aware in June of last year that they were changing the scheme. We were notified after working hours that a new scheme was put in place. Our members' fear is what will happen in June, when that scheme is exhausted, and, therefore, whether they will be able to pay their mortgages. We cannot answer those questions because we are continually battling this bureaucratic environment where they have to go to the Department of Health, and the Department of Health has to go to the Department of Public Expenditure, National Development Plan Delivery and Reform, which assesses this from the point of view of cost, not of what is needed to deliver the services to front-line patients and staff. We are always in this spiral.

What we need is for them to engage meaningfully. We need regular engagement. We need outcomes from these discussions, not continued delays or waiting for another letter to be received three or four weeks later, after which we respond. To date - my colleagues will testify to this, I have no doubt - we have sent numerous letters on the issue relating to the pandemic recognition payment to the Department of Health. We are yet to have a single meeting with the Department to discuss that matter. Not one meeting has taken place. We could fill that table over there with the number of letters we have sent to the Department of Health. It is not acceptable. No wonder those working in front-line health services feel the way they do. No wonder they feel neglected. No wonder they feel ignored. We have to relay to them that we cannot get a response from the Department of Health. It is just not acceptable at any level.

I do not want to take all the time because I know that my colleagues have very valid points to add.

Mr. Kevin Figgis

In our dealings with the Department of Health over recent years we have voiced these concerns at the national joint council. Each of the unions that are members of the national joint council is represented by a national official, who is a representative of all the thousands of workers those unions represent. We then work collectively on behalf of the entirety of the health service, the workforce. The challenge is that whereas in previous years we dealt with the Department of Health, whereby we met with people of a similar grade or a similar authority, that is no longer the case. We have voiced these concerns through the national joint council. We have had special meetings about this because of senior people not turning up to national meetings with union representatives. I do not mean to disrespect the staff the Department does send, but it sends in people who say they do not know the answers to our questions so they will have to ask them and come back to us. We then spend six, seven or eight weeks writing to them asking if they have an answer to the question we asked them. Then they will respond with one line. It is purposely designed to drag and delay. It is dodge, drag, delay. That is the way our engagement is. We have said to the Department of Health that it is not acceptable. With reference to, for example, the section 39 workers, the committee will remember that the Minister on the floor of the Dáil last year committed that the Department would engage with the unions through the WRC to resolve the section 39 dispute. We wrote within 24 hours asking the WRC to assist us. The HSE wrote only last week to state that it was willing to engage on that. The Department, when we have asked the question, has said, "They may be the Minister's comments but that may not be the official position." We are therefore constantly caught up in this rigmarole that goes on. A lot has to change in the manner in which the Department engages with the likes of us. If we are sending in senior people who can negotiate, engage and make decisions, we expect we will meet a similar person on the other side, and that is just not happening.

Senator Frances Black

I hope this is not an inappropriate question, but why does Mr. Figgis think that engagement with representatives is not happening? What is going on?

Mr. Kevin Figgis

I think our collective view is that this is just part of the strategy. The strategy is just to delay things and to drag them out. When we left the Dáil last year after our discussion about the section 39 workers, we said to ourselves that it was a good day. We had the Minister, Deputy Donnelly, and the Minister of State, Deputy Rabbitte, come down to the committee room to respond to all the Opposition parties, which were all unified in support of the section 39 workers. We said to ourselves: "Here are two Government Ministers both saying that this has the support of the Government." We said we would write that letter and move this on to get those section 39 workers off the streets and back looking after very vulnerable people in our society. Yet it took three months for the HSE to respond and to confirm that it was willing to attend. It stated to us at the last meeting of the NJC, in front of the Department of Health, that it would not engage in a process where it had no mandate but that if it were given a mandate, it would gladly engage. This is the strategy. It is between the Department of Public Expenditure, National Development Plan Delivery and Reform, the Department of Health and the HSE, and the HSE for so many of these decisions is left with no authority yet its representatives are told, "If you go in, go in, but you can agree to nothing unless we give our approval, and we will not give that."

Finally, when we wrote the letter we asked for the HSE, the Department of Health and the Department of Public Expenditure, National Development Plan Delivery and Reform to be invited to those proceedings. The latter Department was the first to respond to say it would not attend, yet they are the people who hold the strings of everything else falling into place.

Senator Frances Black

As for the assault that happens and all the issues around the serious assault scheme, can Mr. Figgis say a little more about what safeguards are recommended to mitigate the likelihood of serious assaults in the first place? I know he might have spoken about that already, but it is a very important issue.

Mr. Kevin Figgis

We have spoken already this morning about the differentiation of the grades of staff within the scheme. That needs to change as a priority.

I think colleagues have also made reference to the general need to improve the issue of security within the health service. Security is at an absolute minimum. Some of these health locations are vast and the number of security personnel put in place just totally inadequate to deal with whatever will happen. People will be on rounds and so on. There is no doubting that that has to happen.

One of the key things that has to happen is a general awareness campaign for the public. The HSE, the Department of Health and our unions should co-operate in telling the stories of some healthcare workers. We should tell the public what happens. Healthcare workers are healthcare workers because they want to help people who are, to use the phrase often used, "some of the most vulnerable in society", whether they have an intellectual disability, are elderly or need help. It could be somebody whose life is in danger because of whatever illness or whatever is happening to him or her at the time. The fact of the matter is that the one thing a health worker should not have to suffer is an assault. We have provided statistics related to paramedics arriving in an ambulance, getting out to see what the scene is, with somebody possibly lying on the ground etc., and being assaulted in the course of trying to help that person. It is absolutely incredible. One of the key things is that there should be a public awareness campaign. To be honest, there should be shaming of those who do that. I think that that can best be done by letting them know in a public campaign that that type of behaviour is not acceptable. It affects not only the healthcare worker but also his or her family and children.

It has an effect when a person comes home and says he or she was assaulted last night. It is totally unacceptable that this should happen. We have represented people, as I know other unions have, where what has happened to them has absolutely devastated their lives, because nobody expects it.

Deputy Colm Burke

I thank all the witnesses for their presentations this morning. While they were making those presentations, I received a text from someone who works in a hospital in which a nurse was held on the ground in a headlock and physically choked. She was turning blue when a porter happened to come into the room and helped to get her out of a very difficult situation. What is frightening about that case, in which a nurse was held in a full headlock on the floor in a hospital premises, is that the person responsible was never prosecuted.

We are talking about more than 5,000 cases being reported in a very short time period. Of those, how many did the Garda prosecute? How many were brought forward for Garda prosecutions or were put on the record with the Garda authorities? Do we have any figures in respect of the numbers that were reported and the number of Garda prosecutions?

Chairman

Approximately one third are investigated according to the figures mentioned this morning.

Mr. Albert Murphy

One third of them are investigated by the Health and Safety Authority but the Garda does investigate. We are not aware of any prosecutions under the Non-Fatal Offences Against the Person Act that have taken place, however.

Deputy Colm Burke

In other words, out of 5,000 cases or even if we go back to previous years, we do not have any figures on the numbers prosecuted.

Mr. Albert Murphy

No. The only prosecution we are aware of was for an intellectual disability organisation but that was taken by the Health and Safety Authority for non-compliance with health and safety legislation. That is the only prosecution that has taken place in the last few years.

Deputy Colm Burke

What if an assault takes place in a hospital and someone is actually hurt? In this case, I am referring to a situation where a nurse was held in a headlock and there was no Garda prosecution. Surely, there is something wrong with the system. In fairness to that person, if she files a statement with the health authority or HSE, is the HSE as the employer not obliged to make sure there is a full Garda investigation?

Mr. Albert Murphy

That is the point. We are not sure that happens.

Deputy Colm Burke

Okay, then let us move it on another bit. Every two or three months, we have a joint policing committee meeting between the local authority, the Garda and local public representatives. Is it not now time for the unions together with the HSE and Garda to have joint meetings in a similar way?

Mr. Albert Murphy

We have called for a review of the security procedures in the HSE with regard to the emergency departments, in particular, but also the wider HSE employments.

Deputy Colm Burke

It could be taken to a national level. The unions together with the HSE and the Garda authorities need to sit around the table and see what processes can be put in place. Given that we have the same structure with local authorities, which was only set up in the last ten years, why can we not do the same to protect front-line workers in the HSE? Is it not about time we did something like that?

Mr. Albert Murphy

Absolutely. We will support that.

Deputy Colm Burke

Has the INMO made a request to the Department, the HSE or the Garda to consider putting in place a mechanism?

Mr. Albert Murphy

As I said, the INMO agreed recently with the HSE that a security review will be completed by the end of March and this will be part of that. As my colleague in SIPTU, Mr. Figgis, said, we would welcome a public campaign to say it is no longer acceptable, if it ever was acceptable, to assault healthcare workers. That message from the Dáil should be coming out loud and clear.

Deputy Colm Burke

I worry that when one-off meetings are held and organisations like those present today appear before the committee, we do not hear about it again for another 12 months. I suggest we set up a structure in the same way that we have done with local authorities, which has been extremely helpful in local communities. Likewise, with such a structure there would not necessarily need to be a meeting once every month but at least once every two or three months. The representatives of the workers, whether they are doctors, care assistants, porters or nursing staff, would sit down with the HSE management with Garda representatives also being present.

Mr. Albert Murphy

The emergency department task force is supposed to have been dealing with the overcrowding issue for years. It meets infrequently and the state of the emergency departments can be considered in that context. That is why we are saying, with respect, that the Health and Safety Authority should be tasked with enforcing the legislation that is in place. Of course, it would be good to meet the relevant stakeholders who deal with safety.

Deputy Colm Burke

We might ask the Health and Safety Authority to join those meetings as well in order that we cover all the angles. It is something for which we should all be looking. As a committee, perhaps we should also write to the Garda authorities on that issue as part of the outcome of this.

The second issue I wish to touch on-----

Dr. Laura Finnegan

I am sorry; I might just make a comment on that specifically. First, it is genuinely our employer's responsibility, and not that of the trade union, to put those through. It is not up to the INMO or the IMO to contact the Garda to sit down to put these measures in place. These things have been put in place in other countries. The NHS brought in an Act in 2018 that allows more protection for staff who are abused within healthcare settings. That includes things like mandatory sentencing and clear guidelines around the prosecution of these things.

The Deputy asked about things like arrest rates. We know from some figures that arrest rates are quite low. They are approximately one in 50 and then after that, conviction rates are approximately one in 200 in these kinds of settings. Our recommendations are that there should be clear guidelines around how these instances are dealt with and prosecuted going forward.

Deputy Pat Buckley

The problem is that guidelines are fine but if they are not constantly followed and if all the people involved, including those on the front line plus the management, Garda and Health and Safety Authority, are not communicating on a regular basis then the system falls behind.

Dr. Laura Finnegan

Absolutely, but if we have no Act or any legal obligation behind us, it is very difficult to move on with those talks and engage in a meaningful way to fix this.

Deputy Colm Burke

One way of dealing with this is to make sure all people are singing from one hymn sheet as regards how we deal with it and how we will reduce the level of both verbal and physical abuse of hospital staff.

Chairman

I will refer back to what I said earlier about what the big challenge is. We asked An Garda Síochána for figures but it does not collate them in that regard.

Deputy Colm Burke

Perhaps it is time we started to look for them to be collated to deal with this issue. These people are providing a level of care for the general public. They are doing their best to deliver a service in the best possible way and they are being hindered from doing so. As people said earlier, it is devastating for someone to go home from work having been assaulted the night or day before and then having to face going back into work within a short time period afterwards.

I will move on to another issue regarding the hours junior doctors are doing and the burnout that can happen. From the IMO's point of view, what is the up-to-date information with regard to hours junior doctors are doing and the stress levels that arise as a result of either the verbal abuse or sometimes even physical abuse? Have we different challenges in different areas of the country about the hours junior doctors are required to do, which is then causing a problem?

Dr. Laura Finnegan

The hours we work go hand in hand with the kinds of experiences we have in the hospital. If a person is working long hours, by definition, he or she is more likely to be exposed to situations, especially when people are working 24-hour and 72-hour shifts, in some circumstances, where a doctor might be on for a surgical specialty from Friday to Monday morning. We came to agreements before Christmas and we are hoping that what we have negotiated will come to be implemented in terms of the amount of hours we actually do.

Deputy Colm Burke

Are the agreed terms being implemented right across the board? Do we still have some facilities where doctors are required to work much longer hours than what has been agreed?

Dr. Laura Finnegan

Yes. We are all working very long hours. We are working over what we should be working per week. It is going to take time, however. We are hopeful that everything we spent last year negotiating for will come to pass and that we will have protected rest days and will not be working 12 or 19 days in a row or be doing things like 24-hour or 72-hour shifts. They are very difficult things to implement overnight when, as we mentioned many times today, we have a staffing crisis. It is very difficult to fill those extra shifts if we do not have the staff to fill them.

We need supports in respect of everything else in order to implement changes, such as reducing the number of hours we work in a week. It is all the things we are talking about today and all the resources we need available to us within a hospital.

Ms Ashley Connolly

To expand on that, it is throughout the wider health sector. Our members working in the disability services and social care constantly have to work additional shifts because there are not enough staff to provide the service that is needed. In respite care or residential settings, not enough staff are available and we are no longer retaining staff because they are burnt out and are looking to other areas. Some are moving into ICT or other administrative fields after spending years to train in a profession they love. They are so exhausted that they cannot keep working additional shifts week in, week out to provide a little bit of service when all they want to do is provide the best care possible. That is just not possible, however, unless we start tackling this.

I fully agree with the Deputy that we cannot just have these discussions every so often. We need clear recommendations in order that we can move these conversations along. Our members are tired of hearing the same stories and the false promises. What they want to see is real change. We believe the discussion on the RHAs will be pivotal to bringing about real change and now is the time to start cementing down what is required.

Senator Martin Conway

I thank our guests. The discussion has shone a light on an appalling issue. I propose that we hold another public meeting on this issue and invite in representatives of the HSA, the HSE and An Garda Síochána. I have no doubt the HSA will say this is a resources issue and that is probably correct, but it is given a budget and it is supposed to prioritise where that budget is most badly needed. I would be fairly confident that on building sites and farms, there is not the same level of assault and workplace incidents as that which occurs in our healthcare system. The HSA needs to explain, therefore, how it is apportioning its budget and how it is that it has not yet established a health unit within the authority to deal with this issue.

We also need to hear from An Garda Síochána as to why the level of prosecutions for attacks on healthcare workers is so low. I am sure that too is not reflected in other elements of society or other workplaces. I am concerned that we are talking about single figures, if even that, for the number of prosecutions. There were 4,500 reports in 2021, with almost 500 investigated, and I am sure the real figures are higher than that. Given that there were no prosecutions, at least that we know of, I think the Garda needs to explain its processes for dealing with this. An attack on a person, whether in the workplace or not, is a criminal matter, outside of the issue of workplace safety and the responsibilities employers have towards their staff. It is a criminal issue and work needs to be done in that regard.

Of the figures we have, are there regional breakdowns? I come from the mid-west. University Hospital Limerick is the most overcrowded hospital in the country, so logic would suggest there would be more assaults, attacks and incidents in that hospital than in any other. Perhaps our guests have some statistics on that or they may have been included in the paperwork they gave us. What are the views of the unions on the idea of there being a Garda presence in emergency departments, especially those where attacks are prevalent? Should a Garda presence, or perhaps a health unit within An Garda Síochána, be considered given the serious level of assaults and attacks, at among the highest per head of population in Europe?

Dr. Clive Kilgallen

The Senator asked about detailed figures. I do not have those detailed figures from the IMO. Perhaps they do not even exist. The first step we need to take is to get detailed figures on what, where, who, why, when and so on upfront. Before we can move forward, we need that detailed information.

Senator Martin Conway

Is there a breakdown even of the figures Dr. Kilgallen has to hand?

Dr. Clive Kilgallen

We do not have them by region.

Ms Linda Kelly

I wanted to come in on the point about criminal prosecutions, although this reflects anecdotal conversations I have had with members rather than formal figures. For our members in social care in particular, if they are assaulted by somebody accessing the service, they would have to prosecute the assailant in order for it to be a criminal offence. I do not know any social care worker who would go down that path, and I imagine Ms Chambers will affirm that point from a nursing and medical point of view. It is not in the nature of our healthcare staff to seek that sort of punitive arrangement even for the very people who have hurt them, unless in the most severe circumstance, and that is part of the problem. That is taken advantage of by employers in shirking their responsibilities and duty of care because they know it is easy to point the finger at staff and ask why, if they are so concerned about it, they do not go to the Garda. Employers know that very few healthcare staff will do that.

As Deputy Burke suggested, an involvement and engagement with the Garda, even to collate statistics and so on, would be welcome, but that can be only one aspect of the approach. People need to be safe in their employment and employers have a responsibility to make those workplaces safe. This goes back to the Senator’s point about there being a presence of An Garda Síochána, although I doubt the Garda has the resources for that. As Mr. Figgis said, security is at a minimum on our sites, with people having to walk around very large locations. What we need is an investment in the system and in making sure places are safe, not a response to a crisis whereby the Garda just attend a site for a few months as though that will calm everything. What people need is a consistent approach.

Mr. John McCamley

There needs to be a systemic change of culture regarding what happens if an assault takes place. The onus is on the staff member to report to the Garda that he or she has been assaulted, whereas in other sectors in which I have worked, the organisation involved would make that approach to the Garda. I have dealt with a lot of cases in the health service where the manager will maintain that the person has the opportunity to make a complaint at a Garda station. I do not think the onus should be on the staff member.

Equally, in respect of security on site, I am aware of a small hospital that shares an outsourced security service with other HSE facilities in the town. There is no on-site security, so the hospital has to ring for security to come, which means that the provision of security is dealt with by the staff, whether a nurse, a porter or a healthcare assistant, and that is incredibly dangerous. To cut costs, a decision is made whereby it is deemed okay to have security shared between three sites, with one security staff at night trying to cover three sites in a small town. That is a recipe for disaster, and it has definitely led to cases where staff have been assaulted. There needs to be far more investment in security. The outsourcing of security, in many facilities, has not worked. When there are directly employed security workers, that system tends to be staffed better because there will be direct engagement with the employer that is employing those security workers.

Senator Martin Conway

Is there even adequate CCTV in hospitals? A picture paints a thousand words. I agree that it should not all be up to the person who has been assaulted. Is the CCTV up to standard?

Mr. John McCamley

Anything that would deter someone from committing an assault would be good and positive, but what is needed is a proper, working security service within hospitals.

Proper training is also needed, as has been alluded to. A lot of staff, whether it be nurses, healthcare assistants or porters, do not get adequate training on how to de-escalate particular situations. Emergency departments have been mentioned. That is the pinnacle of these things, and it has a pinch point. However, out in the community we have lone workers, working in houses. We have mental health services. There are organisations that have people on their own in very isolated rural communities. They have no backup and there is no way of calling any help except ringing the Garda. That is it.

Senator Martin Conway

I am conscious of time. My final comment relates to what was proposed by Deputy Burke. The joint policing authorities in the local authorities were to create an engagement between the police, local authorities and communities in order that there would be more community involvement in and understanding of policing. That model would not necessarily work in this because one is talking about an employee and employer scenario. However, I think his proposal has merit. There could be some sort of forum that could meet twice per year. The Joint Committee on Health can do it every year, and we are happy to do so. It would be better if there were an open structure where the HSE, an Garda Síochána and unions would sit around and express their concerns and challenges and so on. I suggest to the Chair that as part of our report we should maybe look at some sort of proposed structure too.

Chairman

I am conscious that in my area there would have been a challenge in relation to the bus service. We have a bus forum that involves the Luas too. It is good for all of the different parties to be involved, such as people from the community, politicians, the Garda, the unions and management and so on. It is something that works, but it also helps focus those in the area regarding assaults or attacks on drivers. It is going on almost two decades now, but it is something that should be replicated. Similarly, this proposal has merits, but there is a challenge with regard to how figures are collated by the Garda. Maybe that is part of the problem, in that it is seen as just another workplace. I am conscious that gardaí are in and out of hospitals every day. They are dealing with issues of mental health, or bringing people in and so on. There is that rapport with the hospital. The last speaker asked a question about a possible rural and urban divide. I do not want to go into the idea that one hospital is worse than another, and naming that hospital. We are told, and we are all conscious that particularly at weekends if there is a lot of partying or whatever else, then some hospitals have difficulties. I am also conscious that there are feuds going on within communities. I think the hospitals and medical settings are a bit like schools. What happens in this community reflects what happens in the workplace. I am conscious that there have been feuds, some family feuds or criminal gang feuds. Those assaults must be terrifying for staff where the family of these members come in and assault people who in some cases have been shot or seriously injured. I am also conscious that there are medical settings where people do feel safe and secure. That is an important message to put out there.

There is another issue we have not touched on today and which I think we are all conscious of, namely racial abuse. The witnesses might also comment on that. Has a rise in the level of racial abuse been seen, particularly reflecting some things happening in society at the moment? We are not going to resolve this problem as a committee, but we might have another meeting on it and come up with some sort of improvement within the system. There are a number of issues raised today on which the committee can follow through. One that jumps out is the long Covid situation. We were promised that it was not going to be a cliff edge although that has clearly happened and there has been a lack of consultation.

There is a two-tier system regarding those who might possibly be assaulted and the level of care they receive. That is again something that can be looked at. The section 38 workers have been discussed in the past and the fact that it took three months for the HSE and the Department of Public Expenditure, National Development Plan Delivery and Reform to act. Maybe that can be raised at some stage at ministerial level, but the committee will also be looking for a written reply. I would be interested to see what they have to say about this racial abuse and attacks. It appears to us as politicians that it is much heightened and we need to do a lot more as a society to address it. We should not be relying on staff. It has to be a collective thing that we do as a society; if someone gets on a bus and engages in racial abuse they should be put off the bus. There should be a similar approach in any of our services including the health service. We must be more proactive in this area, as politicians, but also as community leaders. Would one of our witnesses like to comment on the racial abuse issue?

Dr. Laura Finnegan

I touched on it briefly when I spoke about the type of abuse we witness in emergency departments or hospitals. I have been there when colleagues have been abused in front of me, and it is a very difficult scenario. I have been qualified for five years. I cannot quantify exactly the difference, and how much worse it has gotten or the exact level of it. I do not have the figures in front of me. However, the Deputy is 100% right. We depend on a lot on non-Irish doctors to support our healthcare system. We would be absolutely lost without them. The fact that they go through that extra level of dehumanisation and degradation at work is despicable. On top of everything we talk about that we experience, they have to deal with that every day while they are just trying to do their job. They are trying to take care of patients and support our healthcare system. It is an awful situation.

Mr. Kevin Figgis

In wider society we have seen a great change in the multinational nature of people and that is obviously benefiting our people and culture. The healthcare workforce is no different. For a long time our health services have benefited from people coming to Ireland from other nations, and training here or workinghere. I do not think there is a grade within the health service now that is not populated by a multinational workforce. Unfortunately, it is another part of this category of abuse that we are referring to. There is no doubting it. We have had those issues reported to ourselves, where people have been racially abused etc. It is not acceptable and it could be another aspect of that public awareness campaign we are suggesting should take place. We need to try to personalise the healthcare worker to the general public, and personalise the fact that this is what we are trying to do to help them, but these are the issues standing in our way. Whether that assault is verbal or physical it is unacceptable. I think that could play a part in that.

Chairman

There was an anti-bullying helpline within the HSE, a 1800 number. I am informed by staff that it no longer exists. Were the witnesses consulted on that, or where has it gone? Has something replaced that? No. I call Deputy Shortall.

Deputy Róisín Shortall

On that last point about racial attacks and abuse, part of the awareness campaign has to be getting across to people how dependent we are on healthcare workers who come from abroad to keep the health service operating.

That is a point that is very often not appreciated. I would like to talk about some of the statistics. The point was made about the low arrest rates of perpetrators of assaults, one in 50 arrests, and one in 200 convictions. They are shocking figures. Where are those figures from? Are they in respect of doctors or are they across the board?

Dr. Clive Kilgallen

It is my understanding that this is across the board.

Deputy Róisín Shortall

Okay.

Dr. Laura Finnegan

It is in healthcare settings.

Deputy Róisín Shortall

They are absolutely appalling and in the release of the INMO figures we are talking about, at the end of the day maybe 28 people are being convicted if those ratios are applied, which is shocking, and it can be seen why staff are so fed up with what is going on and the lack of responsibility on the part of the employer. I do not know if anyone has seen the HSE's submission to the committee but it might be of interest. We asked it to make a written submission but reading that, one would get the impression that everything was fine and it talks about how proactive an approach the HSE takes to protecting and safeguarding the staff. That is available if the witnesses want to have a look at it because I am sure they would have responses to that.

The INMO figures are shocking in respect of 5,500 assaults reported over that period between 2021 and 2022. Are global figures for healthcare staff across the board available on an annual basis?

Mr. Albert Murphy

The figures quoted in our submission are from the HSE.

Deputy Róisín Shortall

Right.

Mr. Albert Murphy

They are the HSE's.

Deputy Róisín Shortall

Do they relate to nurses and midwives?

Mr. Albert Murphy

They relate to all healthcare workers, but they are broken down by category. Not included in those figures, as was pointed out earlier, are section 38s, the likes of the voluntary hospitals.

Dr. Clive Kilgallen

If the Deputy's question is from a global perspective I know the World Medical Organisation has done a piece of work on this and to answer, yes, the figures are high but as to the exact figures I cannot remember off the top of my head; they will be on the World Medical Organisation's website.

Deputy Róisín Shortall

Okay.

Ms Linda Kelly

One of the key actions that could come out of this hearing is that we need to establish a robust system for capturing the data because we can all agree that what is captured by the HSE is an under-representation of what is actually happening out there. It needs to look at how members of staff reported and I think the absence or exclusion of section 38s and community and voluntary sector organisations that are providing health services skews it as well. It should not be beyond anybody to get a robust system in place pretty rapidly whereby data can be captured, and there are versions of that in other areas that other groups in the country are doing as well around racial abuse.

Deputy Róisín Shortall

Dr. Kilgallen made the point about e-health earlier. It is right across the health board but what gets measured matters and we know that there is very little measuring of incidents or outcomes. Given the scale of this problem and how negatively impactful it is on staff, has this issue been raised with the HSE board at all? Do the witnesses know if the HSE board is aware of the scale of this problem?

Mr. Albert Murphy

From the INMO perspective we have raised the assaults recently with the HSE. We have also raised the issue the Cathaoirleach referred to regarding racial abuse. The message would be that the Irish health system could not function without our overseas colleagues and it is the one shining light in the Irish health system that we have managed to attract overseas staff. Unfortunately, some members are contacting us to say they experience racial abuse on their way to work, and also in the workplace. We asked the HSE to examine that issue and to set up an integration office, which was there previously, that welcomed and supported overseas nurses to integrate into the community and into the workplace. Unfortunately there is anecdotal evidence that outside of the hospitals, staff on their way into work are being subject to racial abuse. That is emerging and it is one thing we need to get on top of fairly quickly.

Deputy Róisín Shortall

The question of legislation to make it a specific offence to assault a healthcare worker was raised. That is something we need to pursue separately, arising from this meeting. Do the witnesses know from their colleagues in the national health service, NHS, the extent to which legislation in the UK has made a difference?

Dr. Laura Finnegan

I do not have the figures of how much better things like arrests, prosecutions, or staff generally feeling safer are but I guess the feeling would be that any level of protection behind them gives them that extra feeling of safety when going into work. We find as staff working in these areas that it is very difficult to think about prosecuting someone we may be taking care of. That is very emotive. On one hand one it caring for someone and on the other hand one has been the target of assault. It has been mentioned a couple of times that things like that, such as having that legal protection, takes the onus back off the person who has experienced the assault. It puts it back to being the responsibility of one's employer and the State and takes the responsibility or guilt away from the person who experiences the assault.

Deputy Róisín Shortall

Absolutely, and we need to be very clear about that. The responsibility lies at the door of the employer, the HSE, individual hospitals and also the section 39s. I want to go back to the inadequate role the HSE is playing at the moment. Ideally employers should be prosecuted for failing to provide safe working conditions for staff. Do I take from the response given earlier that there have not been any prosecutions at all in respect of the Health and Safety Authority, HSA, taking a prosecution against the HSE or other employer organisations?

Mr. Albert Murphy

As far as the INMO is aware there was one prosecution by the HSA in relation to a healthcare provider. It was for a failure to comply with health and safety regulations and not for assaults as such. We are not aware of any other prosecution. It is already a criminal offence to assault a healthcare worker but we are not aware of prosecutions.

Deputy Róisín Shortall

I take it from what the witnesses are saying that that is the nub of the thing, getting the HSE to first of all have the capacity to oversee what is happening in the health sector with this special unit and, then, for it to be proactive in taking cases.

Mr. Kevin Figgis

The HSE needs to take a much more positive step in how it engages on this type of data publicly. When one looks at Covid-19, for example, the health surveillance unit published weekly reports. They published weekly reports of incidents relating directly to healthcare workers directly themselves. We will ultimately get this data but only because we wrote and asked for it. As an employer, and again as part of that awareness piece, it needs to educate the public that this is the number of incidents we have had and the type of incidents that have taken place. When one looks at the different categories - for example, in our submission from the National Ambulance Service - aside from direct physical assaults, there was intimidation, threats, physical and sexual harassment and sexual assaults. It is quite incredible to think that people are suffering under these categories. I think the HSE has to be much more proactive in how it publishes this information to inform the public this is going on. If it just collects the data but doed not release it then the public is not aware. That is a major part of the problem.

Deputy Róisín Shortall

From reading the submission from the HSE one does not get the impression that there is a serious problem here at all and that is obviously a cultural issue.

Ms Ashley Connolly

I wanted to add that in collating the data it is very important that we start the process of measuring the real information. It is also very important to anybody who finds themselves the subject of an assault, whether it is physical or verbal, that there is a follow-up within the workplace with that individual so they feel that support and that is not happening either. Hence, a lot of people just do not bother with the paperwork anymore because they just wonder what is the point. It sits in a drawer and what gets done? People need to be actively encouraged to participate in the gathering in the data but also feel they are supported on a daily basis-----

Deputy Róisín Shortall

Good point.

Ms Ashley Connolly

-----when they raise these issues or they will not raise them.

Deputy Róisín Shortall

This committee has been doing a lot of work recently on workforce planning, or the lack of it.

Obviously, the whole question of the conditions for existing staff is a major factor in this and the whole aspect of workforce retention, as has been said, is also important. I am not aware of any work that is going on in that regard. We will, therefore, very much take this point on board. I thank all the witnesses.

Chairman

Deputy Durkan wishes to come in.

Deputy Bernard J. Durkan

I have a short observation. I was just thinking, regarding respect for people providing services and respect for authority, etc., that we did have a blasphemy Act in this country which was struck off the Statute Book. I could not understand why at the time. I asked the question many times then and in many locations if I was the odd one out. That Act was there for a purpose, but it was abolished. Now, we must reintroduce a similar Act. The first one covered religious hatred and religious incitement. It meant something to somebody because of their religion, their colour or whatever the case may be. We now have the Criminal Justice (Incitement to Violence or Hatred and Hate Offences) Bill 2022; we are bringing the same thing back in again.

What we need to remember, though, is that when I inquired about why we were doing this in the first place the answer was freedom of expression. This theory has grown to the extent now that everybody thinks they have the right to freely express their view on somebody else. They do not and we do not and we should not, because what we may want to express may be an insult to somebody else. God knows that we in this country should have enough experience of dealing with religious bigotry and so on and so forth across this island. We should certainly have a reminder of what that is about. The proposed new Act will hopefully address some of the issues we have been talking about in a different way, particularly where threats are made regularly.

These could be on a religious basis or on the basis of age, and I am conscious of this myself even. Ageism is illegal but there are some people who practise it all the time. Sexism is illegal but some people practise it all the time. This is a means of putting the other person in a lower position and the perpetrator in a dominant position. We live and learn. I ask people to remember that as we go forward we must confront some of these things being presented nowadays in a way they were not confronted before. This does not mean to say that we are going to fight in the streets but we must introduce the legislation to protect the people who are doing a job. Otherwise, the possibility of holding onto staff will be affected. There are enough reasons already why we have difficulty holding onto staff without adding another one or two. Fear is one aspect that we should not have to put up with at all in the workplace. I thank the Chair.

Chairman

We have reached the end of this session. Many issues have been raised by the witnesses. Hopefully, we will be able to advance some of them. We were not aware that there was no discussion regarding the pandemic payment rate with Fórsa, but this is something that this committee can follow through on with the relevant authorities or Minister. We will also look at various other issues, particularly the Health and Safety Authority and its disappointing role in this context.

I am conscious that a large number of people are working in the health service and, on behalf of the committee, I thank all of them for their hard work and especially during the stressful times we have lived in during the past two years. It is not enough to be clapping people for the work they have done. There need to be supports in this regard. I am appalled by the idea of one set of workers being treated differently from another, especially regarding long Covid-19 and one group getting additional support over another. This is not acceptable in the world we live in. It is similarly unacceptable in any service that one set of workers, because they are a particular set of workers, have not got a pay increase in the past ten years. Many issues have been raised during this session and we will try to follow through on them. We will submit questions and when relevant people are before the committee, the members can ask the questions at that time. We will also, though, follow up as a committee on many of the issues the witnesses have raised and hopefully get some sort of answers.

I thank the members of the Better Working Lives for All committee. Many of its representatives are in the Gallery today. I think it was really useful as part of our discussions that it sent in its document. I again thank the organisation for that. I hope they found this meeting useful. It is probably frustrating that they are in the Gallery and not at the table here, but it is very difficult to try to manage the number of groups coming in at the same time. I like to think that we would at some stage return to this topic in future, look at the format again and perhaps bring in different people, as has been suggested. I thank everyone very much.

The joint committee adjourned at 12.25 p.m. until 9.30 a.m. on Wednesday, 15 February 2023.