Thursday, 7 February 2019

Ceisteanna (5)

Róisín Shortall


5. Deputy Róisín Shortall asked the Minister for Public Expenditure and Reform the reason the submission made by the HSE to the Public Service Pay Commission was edited by his Department to remove a section (details supplied); and if he will make a statement on the matter. [6159/19]

Amharc ar fhreagra

Oral answers (7 contributions) (Ceist ar Public)

This question relates to the background to the nurses' dispute and what transpired in respect of the Public Service Pay Commission. It has been brought to my attention that a very important sentence in the HSE's submission intended for the commission was edited by the Department of Public Expenditure and Reform. It reads: "The overall picture of the nursing and midwifery workforce is one of a constant challenge to effectively recruit and retain to meet ever increasing service demands". Is that the case and, if so, why did it happen?

First, I wish to clarify that the HSE submission was not to the Public Service Pay Commission but instead came to the Department of Public Expenditure and Reform through the Department of Health to assist with preparation of a joint employer submission.

I also wish to clarify that, when requested by the pay commission, my Department made the HSE internal submission available to it in June 2018 and it was considered in the preparation of its report, published in September 2018. I understand that both the HSE and the joint employer submissions are available on the website of the pay commission.

It is longstanding practice that the Department of Public Expenditure and Reform, and before it the Department of Finance, represents the public service as employer.

The Department has the responsibility for co-ordinating, articulating and submitting the employer case in such matters on behalf of the Government as employer. This is absolutely essential to ensure consistency and coherence in approach.

The employer submission compiled by this Department is based on data and inputs from a broad range of sources, including material submitted to the Department by both the Department of Health and the HSE.

It should be said that the joint employer submission to the pay commission reflects evidence presented by the HSE, particularly the increase year on year in absolute numbers of nurses and midwives, over and above the level required to simply replace leavers and retirees. Since December 2013, the public service has now recruited an additional 3,876 nurses.

The pay commission is completely independent and comprises seven individuals with a vast experience of human resources and industrial relations in the private and public sectors and in the trade union movement.

Additional information not given on the floor of the House.

It forensically examined all the evidence from the employer side and from the staff side.

Its considered conclusion is that there are no generalised recruitment and retention difficulties in respect of nursing and midwifery. The report states that the commission was not persuaded, based on the evidence available, that pay arrangements were in themselves a significant impediment to recruitment and that current pay rates do not appear to be unduly affecting the number of nurses, midwives and doctors applying to work abroad.

In respect of nurses and midwives it considered that the national levels of nursing and midwifery turnover rates do not indicate a generalised retention crisis and that the available evidence suggests that none of the turnover rates reported are significantly out of line with those experienced in private sector employment generally.

Instead it recommended a targeted package to incentivise nurses and midwives to work in certain areas, a recommendation which the Government has accepted and which remains on the table alongside the other pay benefits of the public service stability agreement and the significant measures agreed with ICTU on new entrant salary scales.

The difficulty is that the constant line from the Minister, his Department and the Government is that there is no evidence of any difficulty in recruiting and retaining nurses. That is the line that is being put out, and it is entirely unhelpful to the current situation. It flies in the face of the evidence before our eyes. The HSE has said that difficulties in recruitment and retention pose a major challenge to its ability to meet the demand for health services. The HSE knows; it is dealing with this problem on a daily basis. It tries to find cover for its services, whether at hospital level or community level. It has made a clear statement that this is a constant challenge. In light of that, and in light of the fact that we are spending €2 million per week on agency nurses, why does the HSE have to travel all around the world, paying very substantial recruitment costs and still not managing to get enough nurses, why is the Minister in denial?

If the Deputy reads the conclusion of the submission to which the Deputy is referring, it says:

Equipping the public health service with the required nursing and midwifery workforce is undoubtedly a substantial challenge.

The text to which the Deputy refers, which went to the Public Service Pay Commission on behalf of the employer, acknowledged the challenges we face. It went on to state the challenges here "collectively...represent some of the greatest challenges faced by our health services nursery and midwifery workforce." It did acknowledge that there were challenges in this area. It made the point, however, that these challenges are not generalised in nature and are concentrated in particular hospitals and particular disciplines. It placed that in the context of our being successful in recruiting more nurses and midwives. We have turnover levels that are comparable with the rest of our public service.

If that is the case, why is it that procedures are cancelled because of a shortage of theatre nurses? Why is it that our child health programmes and our vaccination programmes are hopelessly inadequate in terms of coverage as a result of the lack of public health nurses? This is the evidence before the Minister's eyes, yet the Government continues to create the impression that there is no problem in this area. We all know there is a problem. Anyone who has any interaction with the health service knows there is a serious problem there as a result of those challenges. The longer this goes on and the longer a situation is allowed to continue where we are losing significant numbers of nurses, the heavier the burden becomes on those who remain, the more stressful the job becomes and the more incentive there is for those people to move on also.

This morning the Minister said he was genuine about engagement with the nurses. Will he ensure that people get around the table as soon as possible and that they do so in a constructive manner? Will he remove any preconditions in order that there can be open and frank discussions?

I repeat that across the entirety of this document, there are repeated references to specific difficulties that occur. I want to see another round of genuine and constructive engagement to try to deal with this issue. The only condition I have - I maintain it is vital - is that any engagement happens inside the context of the existing agreement. That agreement says that strike action should not take place and that cost-increasing claims should not be made. It is clear that those elements of this agreement are already being challenged. As I said during our two-hour debate on this issue earlier, the consequences of this going wrong in a very disorderly way, if we cannot maintain a wage agreement in our society for our public servants, will create even greater difficulties in the future as we try to maintain and improve services.

It will cost €300 million to sort out.