Public Health Service Staffing: Motion (Resumed) [Private Members]
The following motion was moved by Deputy Duncan Smith on Wednesday, 23 October 2024:
That Dáil Éireann:
acknowledges that:
— understaffing in the public health service is impacting the ability of staff to provide safe care and this will put patients at risk and damage efforts to retain existing staff;
— the health recruitment moratorium has continued through new recruitment caps, and positions are being left vacant in acute hospitals and community care; and
— thousands of frontline health positions that were suppressed during the recruitment moratorium were "decommissioned" by the Pay and Numbers Strategy in July 2024, and, in effect, abolished;
notes that:
— hospitals are already seeing record overcrowding before the winter surge, and more than 700,000 people were on hospital waiting lists at the end of September;
— nearly €650 million, or 3 per cent, of the entire health budget was spent on agency staff in 2023, and further substantial sums go to overtime costs and external management consultants;
— positions that become vacant due to retirement, a person leaving the health service, or maternity leave, are not being ringfenced for backfilling; and
— Health Service Executive (HSE) Health Regions are allocated a total number of positions to fill, with no clear plan for which positions will be prioritised;
further notes that:
— the derogations that had existed for areas like emergency department nurses and midwives have been removed and, instead of six months, it is now taking up to a year to fill nursing and midwifery roles;
— the Irish Nurses and Midwives Organisation says many nursing posts in cancer, palliative, paediatric, and rehab care are being left vacant;
— a survey of 4,000 members of Fórsa's Health and Welfare Division showed 88 per cent of respondents said there was a vacancy in their department, and 73 per cent said it had a very negative impact on staff;
— the failure to recruit enough therapists into children's disability network teams is compounding waiting lists for assessment of needs and therapies;
— SIPTU has highlighted that 30 per cent more radiation therapists are needed, and that the staffing crisis is causing delays in cancer treatment; and
— staff deficits also exist in the National Ambulance Service, radiography, support services, the Health Care Support Assistant workforce and other critical areas;
supports the decision of health trade unions to protest over the Pay and Numbers Strategy and condemns the failure of the Minister for Health and the HSE to consult with health trade unions; and
calls on the Minister for Health to:
— lift the new recruitment moratorium under the HSE's Pay and Numbers Strategy and commit to restoring the staff positions abolished in 2023 and 2024;
— fund the additional recruitment needed for appropriate staffing and the expansion of services to account for demographic changes and the implementation of Sláintecare;
— ensure that vacancies that arise in the health service due to normal retirement, career progression and maternity leave, can be filled by local clinical management;
— pass the Patient Safety (Licensing) Bill to introduce safe staffing ratios that will be enforced by the Health Information and Quality Authority, and resource the recruitment of staff to comply with the Framework for Safe Nurse Staffing and Skill Mix; and
— commit to engaging with unions on a safe staffing framework for all departments and grades.
Debate resumed on amendment No. 1:
To delete all words after “Dáil Éireann” and substitute the following:
"notes that:
- this Government recently announced a record €25.8 billion budget for the delivery of health services in 2025, and this represents an increase of over 43 per cent from the €18.1 billion allocated in Budget 2020;
- there has been an unprecedented level of investment by this Government in the health service workforce since taking office, and as of August 2024, there were 27,901 more staff working in our health service than there were at the beginning of 2020, which equates to a 23 per cent growth in staffing numbers in this period and includes:
- 9,375 additional nurses and midwives;
- 6,184 managers and admin staff;
- 4,092 health and social care professionals; and
- 3,330 doctors and dentists;
- growth in the number of health service staff has never been so high, with recruitment in 2023 being the highest since the foundation of the Health Service Executive (HSE);
- the HSE has been funded to continue to expand its numbers by an additional 4,210 staff in 2024, and by more than a further 4,200 in 2025;
- according to the most recent Organisation for Economic Co-operation and Development (OECD) annual report, Ireland had 12.8 practising nurses per 1,000 population, which was the second highest number amongst reported European Union countries (second only to Finland), and the United Kingdom had 8.7 nurses per 1,000 population;
- Ireland is recognised as a global leader in pioneering Advanced Practice for nursing and midwifery, which is an important tool for optimising the capacity of the existing health workforce, supporting the development of career pathways, and supporting workforce retention;
- €5.5 million has been allocated in Budget 2025 to support continued growth of Advanced Practice in nursing and midwifery, and for the first time to also enable its roll out to Health and Social Care Professionals;
- the Pay and Numbers Strategy is a normal feature of how the HSE manages the funding and allocation of staffing each year, it is not a new thing, and it does not constitute a recruitment moratorium;
- a recruitment pause was initiated late last year, as the HSE had hired 4,000 extra staff, over and above what it was funded to hire;
- the recruitment pause ended in July this year, and any obstacle to normal recruitment or replacement of staff has been removed, within budgeted levels; and
- recruitment and budgetary controls are normal and proper in the running of any public service body;
further notes, regarding overall recruitment and funding, that:
- an agreement was reached between the HSE, Department of Health and the Department of Public Expenditure, NDP Delivery and Reform, on funding and staffing levels within the HSE for 2024, and the main details of which are:
- an increase in core HSE funding of €1.5 billion for 2024, on top of the €22.5 billion already allocated to Health in Budget 2024, and a further €1.18 billion in core funding for 2025; and
- the funding of 4,000 previously unfunded posts (Covid-19 and over recruitment in 2023);
- funding has been provided for the recruitment of an additional 4,210 staff into the HSE in 2024, 3,310 funded by Department of Health, and 900 whole time equivalent (WTE) funded by Department of Children, Equality, Disability, Integration and Youth (DCEDIY);
- since January 2020:
- National Ambulance Service staffing has increased by 22 per cent, from 1,933 to 2,363;
- Health and Social Care Professionals working in radiography have increased by 27 per cent, from 1,143 to 1,451;
- the filling of vacancies within the Children's Development Network Teams (CDNTs) remains a Government priority; and
- under Budget 2025, new development funding of €2.841 million has been allocated for further new posts within CDNTs;
further notes, in relation to the recruitment pause, that:
- the HSE Pay and Numbers Strategy is not a continuation of the recruitment pause, and while a recruitment pause was necessary, it has now ended;
the recruitment pause arose on foot of concerns about the level of recruitment in the HSE;
- the HSE was funded to recruit 6,010 staff in 2023, but actually hired 8,239, meaning it exceeded what it was funded to hire by more than 2,200 staff;
- during Covid-19, a further 2,000 staff that the HSE was not funded to hire, were recruited by hospitals and other community healthcare organisations across the country; and
- the recruitment pause came into full effect in November 2023, but came to an end in July 2024, and there is no longer any impediment to normal recruitment and replacement of staff taking place;
further notes, on the Pay and Numbers Strategy, that:
- the strategy has guided the HSE's recruitment policy since July 2024, and the main features of the strategy include:
- the allocation of funding and recruitment ceilings to each of the HSE's regional health areas; and
- Regional Executive Officers (REOs), will have the ability to prioritise recruitment and replacement within their approved staffing number and payroll cost; and
- the approach of devolving autonomy to the regions adopted in the Pay and Numbers Strategy is in line with the Committee on the Future of Healthcare, Sláintecare Report of May 2017, which states that "the HSE and the Department of Health must develop their integrated workforce planning capacity … to deliver care in the most appropriate care setting and … that staff recruitment should take place at regional level, or at a more local level if practicable….";
further notes, regarding the safe staffing framework, that:
- the Framework for Safe Nurse Staffing and Skill Mix (the Framework) provides an evidence-based flexible approach to determine the number of nurses and Health Care Assistants (HCAs) required to provide safe and quality care based on patient need;-
there has been extensive engagement and agreement with unions and international experts in establishing this framework;
- the Government has provided significant investment since 2020, with over €56 million allocated to the HSE for implementation of the Framework on a phased basis nationally;
- it was calculated that an additional 2,000 registered nurses and healthcare assistants were required to achieve implementation, and as of August 2024, 1,500 of this 2,000 had been recruited, and with further funding provided in 2024, for agency conversion and direct recruitment, achievement of full baseline implementation is progressing as planned and expected to be complete this year;
- in August 2024, the HSE reported that the total nursing and midwifery workforce was approximately 47,584; and
- the number of nursing and midwifery staff recruited to our hospitals has increased significantly since the beginning of 2020, for example:
- St. Vincent's University Hospital increased by 49 per cent (+ 498 nurses / midwives);
- Tallaght University Hospital increased by 53 per cent (+ 521 nurses / midwives);
- Cork University Hospital increased by 37 per cent (+ 599 nurses / midwives);
- Mater Misericordiae University Hospital increased by 39 per cent (+ 488 nurses / midwives); and
- Waterford University Hospital increased by 51 per cent (+ 381 nurses / midwives);
further notes, on overcrowding and waiting list challenges, that:
- the Government accepts that waiting lists remain a challenge, and importantly, this Government has made extensive progress on waiting lists, with significant reductions in the number of patients waiting long periods;
- waiting times for outpatient services has reduced from an average 13.2 months in July 2021, to just over 7 months today;
- since the Covid-19 pandemic peak, there has been a 23 per cent reduction in the number of people waiting longer than the Sláintecare targets, 10 weeks for an outpatient appointment and 12 weeks for an inpatient and day case procedure, and this equates to over 147,000 people; and
- there are 17 per cent fewer patients waiting over 12 months since this time last year, and this equates to 23,974 people;
- there has been a significant reduction in the cumulative daily 8 a.m. trolley count over the first nine months of 2024, with numbers down 12 per cent (over 10,000) when compared to the same period in 2023;
- this reduction has been achieved despite an increase in the number of patients presenting to emergency departments, with comparative analysis for January to September 2024, versus the same period last year, showing an 8 per cent increase in overall attendances (91,000 patients); and
- the improved performance follows a reduction in the trolley count in 2023;
further notes, regarding Radiation Therapists and Cancer Treatment, that:
- the Government accepts that there are Radiation Therapist vacancies in radiation oncology centres, and these vacant posts are still available to be recruited, and posts are being advertised for filling;
- a recent independent review of the Radiation Therapist profession published recommendations which aim to help and support the profession into the future, and overcome the current challenges faced by this service;
- measures have been taken to address international recruitment of Radiation Therapists, including a recent change to CORU's requirements for practice hours to bring Ireland in line with international practice;
- additional training places were introduced for Radiation Therapists during the 2023/24 academic year, with plans to further expand courses in Trinity College Dublin and University College Cork, to meet expected future demand; and
- funding for advanced practice posts for Radiation Therapists was recently announced in Budget 2025, as recommended in the Review;
further notes, on agency and management consultant spend, that:
- the agency spend in recent years has been higher than the Government would like, and steps are being taken to address this;
- the 2024 Pay and Numbers Strategy includes provision to convert agency staff to permanent HSE employees; and
- the HSE set a savings target of €34 million in Management Consultant costs, and the HSE is scheduled to meet this target by the end of 2024, with further savings being targeted in 2025; and
finally, in summary:
- the Pay and Numbers Strategy is not a recruitment moratorium;
- the Government has provided extensive funding for recruitment both this year and next; and
- safe staffing targets will be met this year.".
- (Minister for Health)
Amendment put:
The Dáil divided: Tá, 70; Níl, 59; Staon, 0.
Tá
- Brophy, Colm.
- Browne, James.
- Bruton, Richard.
- Burke, Colm.
- Burke, Peter.
- Butler, Mary.
- Byrne, Thomas.
- Calleary, Dara.
- Cannon, Ciarán.
- Carroll MacNeill, Jennifer.
- Collins, Niall.
- Costello, Patrick.
- Coveney, Simon.
- Creed, Michael.
- Crowe, Cathal.
- Devlin, Cormac.
- Dillon, Alan.
- Donnelly, Stephen.
- Duffy, Francis Noel.
- Durkan, Bernard J.
- English, Damien.
- Farrell, Alan.
- Feighan, Frankie.
- Flaherty, Joe.
- Fleming, Sean.
- Foley, Norma.
- Griffin, Brendan.
- Haughey, Seán.
- Heydon, Martin.
- Higgins, Emer.
- Hourigan, Neasa.
- Humphreys, Heather.
- Lahart, John.
- Lawless, James.
- Leddin, Brian.
- MacSharry, Marc.
- Madigan, Josepha.
- Martin, Catherine.
- Matthews, Steven.
- McAuliffe, Paul.
- McConalogue, Charlie.
- McEntee, Helen.
- McHugh, Joe.
- Moynihan, Aindrias.
- Moynihan, Michael.
- Murnane O'Connor, Jennifer.
- Naughton, Hildegarde.
- Noonan, Malcolm.
- O'Brien, Darragh.
- O'Brien, Joe.
- O'Callaghan, Jim.
- O'Connor, James.
- O'Dea, Willie.
- O'Donnell, Kieran.
- O'Dowd, Fergus.
- O'Gorman, Roderic.
- O'Sullivan, Christopher.
- O'Sullivan, Pádraig.
- Ó Cathasaigh, Marc.
- Ó Cuív, Éamon.
- Phelan, John Paul.
- Rabbitte, Anne.
- Richmond, Neale.
- Ring, Michael.
- Smith, Brendan.
- Smyth, Niamh.
- Smyth, Ossian.
- Stanton, David.
- Troy, Robert.
- Varadkar, Leo.
Níl
- Andrews, Chris.
- Bacik, Ivana.
- Barry, Mick.
- Boyd Barrett, Richard.
- Browne, Martin.
- Buckley, Pat.
- Cairns, Holly.
- Canney, Seán.
- Carthy, Matt.
- Clarke, Sorca.
- Collins, Michael.
- Connolly, Catherine.
- Conway-Walsh, Rose.
- Cronin, Réada.
- Crowe, Seán.
- Cullinane, David.
- Daly, Pa.
- Doherty, Pearse.
- Donnelly, Paul.
- Ellis, Dessie.
- Farrell, Mairéad.
- Fitzmaurice, Michael.
- Gannon, Gary.
- Guirke, Johnny.
- Healy-Rae, Danny.
- Healy-Rae, Michael.
- Howlin, Brendan.
- Kelly, Alan.
- Kenny, Gino.
- Kerrane, Claire.
- Lowry, Michael.
- Mac Lochlainn, Pádraig.
- McDonald, Mary Lou.
- McGrath, Mattie.
- Mitchell, Denise.
- Munster, Imelda.
- Murphy, Catherine.
- Murphy, Paul.
- Mythen, Johnny.
- Nolan, Carol.
- O'Callaghan, Cian.
- O'Donoghue, Richard.
- O'Rourke, Darren.
- Ó Broin, Eoin.
- Ó Laoghaire, Donnchadh.
- Ó Murchú, Ruairí.
- Ó Snodaigh, Aengus.
- Pringle, Thomas.
- Quinlivan, Maurice.
- Ryan, Patricia.
- Sherlock, Sean.
- Shortall, Róisín.
- Smith, Bríd.
- Smith, Duncan.
- Tóibín, Peadar.
- Tully, Pauline.
- Ward, Mark.
- Whitmore, Jennifer.
- Wynne, Violet-Anne.
Staon
Tellers: Tá, Deputies Hildegarde Naughton and Cormac Devlin; Níl, Deputies Duncan Smith and Ivana Bacik.
Amendment declared carried.
Question put: "That the motion, as amended, be agreed to."
The Dáil divided: Tá, 70; Níl, 59; Staon, 0.
Tá
- Brophy, Colm.
- Browne, James.
- Bruton, Richard.
- Burke, Colm.
- Burke, Peter.
- Butler, Mary.
- Byrne, Thomas.
- Calleary, Dara.
- Cannon, Ciarán.
- Carroll MacNeill, Jennifer.
- Collins, Niall.
- Costello, Patrick.
- Coveney, Simon.
- Creed, Michael.
- Crowe, Cathal.
- Devlin, Cormac.
- Dillon, Alan.
- Donnelly, Stephen.
- Duffy, Francis Noel.
- Durkan, Bernard J.
- English, Damien.
- Farrell, Alan.
- Feighan, Frankie.
- Flaherty, Joe.
- Fleming, Sean.
- Foley, Norma.
- Griffin, Brendan.
- Haughey, Seán.
- Heydon, Martin.
- Higgins, Emer.
- Hourigan, Neasa.
- Humphreys, Heather.
- Lahart, John.
- Lawless, James.
- Leddin, Brian.
- MacSharry, Marc.
- Madigan, Josepha.
- Martin, Catherine.
- Matthews, Steven.
- McAuliffe, Paul.
- McConalogue, Charlie.
- McEntee, Helen.
- McHugh, Joe.
- Moynihan, Aindrias.
- Moynihan, Michael.
- Murnane O'Connor, Jennifer.
- Naughton, Hildegarde.
- Noonan, Malcolm.
- O'Brien, Darragh.
- O'Brien, Joe.
- O'Callaghan, Jim.
- O'Connor, James.
- O'Dea, Willie.
- O'Donnell, Kieran.
- O'Dowd, Fergus.
- O'Gorman, Roderic.
- O'Sullivan, Christopher.
- O'Sullivan, Pádraig.
- Ó Cathasaigh, Marc.
- Ó Cuív, Éamon.
- Phelan, John Paul.
- Rabbitte, Anne.
- Richmond, Neale.
- Ring, Michael.
- Smith, Brendan.
- Smyth, Niamh.
- Smyth, Ossian.
- Stanton, David.
- Troy, Robert.
- Varadkar, Leo.
Níl
- Andrews, Chris.
- Bacik, Ivana.
- Barry, Mick.
- Boyd Barrett, Richard.
- Browne, Martin.
- Buckley, Pat.
- Cairns, Holly.
- Canney, Seán.
- Carthy, Matt.
- Clarke, Sorca.
- Collins, Michael.
- Connolly, Catherine.
- Conway-Walsh, Rose.
- Cronin, Réada.
- Crowe, Seán.
- Cullinane, David.
- Daly, Pa.
- Doherty, Pearse.
- Donnelly, Paul.
- Ellis, Dessie.
- Farrell, Mairéad.
- Fitzmaurice, Michael.
- Gannon, Gary.
- Guirke, Johnny.
- Healy-Rae, Danny.
- Healy-Rae, Michael.
- Howlin, Brendan.
- Kelly, Alan.
- Kenny, Gino.
- Kerrane, Claire.
- Lowry, Michael.
- Mac Lochlainn, Pádraig.
- McDonald, Mary Lou.
- McGrath, Mattie.
- Mitchell, Denise.
- Munster, Imelda.
- Murphy, Catherine.
- Murphy, Paul.
- Mythen, Johnny.
- Nolan, Carol.
- O'Callaghan, Cian.
- O'Donoghue, Richard.
- O'Rourke, Darren.
- Ó Broin, Eoin.
- Ó Laoghaire, Donnchadh.
- Ó Murchú, Ruairí.
- Ó Snodaigh, Aengus.
- Pringle, Thomas.
- Quinlivan, Maurice.
- Ryan, Patricia.
- Sherlock, Sean.
- Shortall, Róisín.
- Smith, Bríd.
- Smith, Duncan.
- Tóibín, Peadar.
- Tully, Pauline.
- Ward, Mark.
- Whitmore, Jennifer.
- Wynne, Violet-Anne.
Staon
Tellers: Tá, Deputies Hildegarde Naughton and Cormac Devlin; Níl, Deputies Duncan Smith and Ivana Bacik.
Question declared carried.
Cuireadh an Dáil ar athló ar 9.36 p.m. go dtí 9 a.m., Dé Déardaoin an 24 Deireadh Fómhair 2024.
The Dáil adjourned at 9.36 p.m. until 9 a.m. on Thursday, 24 October 2024.