Ms Phil Ní Sheaghdha:

We are very happy to be here. I thank the members for agreeing to our request to address the Joint Committee on Health. We thought it was important when we heard the HSE and the Department of Health address the committee and set out the pay and numbers strategy and the story it paints.

The numbers the pay and numbers strategy are based on are incorrect. The situation is that any vacancy that was in place but not filled in December 2023 no longer exists. Those posts were made obsolete by the stroke of a pen last December. That has a huge effect on nursing and midwifery because it usually takes approximately six months to recruit a nurse. Members can imagine that if we carried vacancies for six months in 2023 and had vacant posts in December 2023 and the HSE decides that the posts cannot be filled in 2024 and that they will not be funded in 2024, that will have a massive effect on our services.

The recruitment as set out by the HSE in the numbers does not take into account the calibration of a whole-time equivalent post and its difference in 2022. In July 2022, nursing and midwifery hours were reduced from 39 hours per week to 37.5 hours per week. However, the number of whole-time equivalent posts remained the same. In other words, the hours loss was not recalibrated. We estimate that there are approximately 1,700 whole-time equivalent posts, when it is translated into hours. We referred that to the Workplace Relations Commission, WRC, as a dispute and had a conciliation hearing in May 2024. We then met the census division of the HSE, which confirmed that one whole-time equivalent post in July 2022 was calculated to be the same as one whole-time equivalent post calculated at the end June. In other words, no provision was made for the loss of nursing hours.

Members might recall that the loss was covered by a national pay agreement and that €150 million was made available by the State to replace the hours lost due to the reduction in working time. The pay and numbers strategy must take into account the recalibration and must be based on the actual number of whole-time equivalent posts. Since 2022, the total growth in net nursing is 547 whole-time equivalent posts. We know this. We have two directors of nursing, our president, Caroline Gourley, who is a director of nursing in care of the older person services and Neil Dunne, who is a director of public health nursing in Dublin, and they can give examples of how the real front-line shortage is affecting services. I have examples. We surveyed our members in recent months and it is clear to us that there is now a huge issue with waiting lists being introduced in, for example, cancer services and nursing-led services, such as children's services, that did not exist. As one might expect, all the services are affected when we are trying to develop community services. They simply will not happen.

The regional health areas have now been established and each of the CEOs has been advised of their budgets. They have not been advised that certain funds, for example, the funding for the framework on nursing and healthcare assistant safe staffing, which was indicated and agreed to be necessary for the maintenance of safe services in acute hospitals, is not protected. In other words, it may or may not happen, depending on the funding that is available. We are told that funding is interchangeable when we meet the regional health areas. In other words, they can decide what post to fill based on the financial allocation they have received and not on the agreements to maintain safe staffing. That is a huge problem because our members went on strike in 2019 to ensure they would have a mechanism to determine safe staffing and that rug has now simply been pulled out from under them.

The current situation is that this year the HSE will not protect any funding for agreements it has brokered on staffing. We also know that the recalibration of the whole-time equivalent hours has not happened. We have a real concern that by placing caps on recruitment, we will score the biggest own goal the country has ever scored, because research now indicates that in 2007 when the last moratorium was introduced, nursing and midwifery suffered the most. It took us until the middle of 2020 to recover the numbers we had in 2007 and that was done by going to all corners of the globe to recruit, because at that point many of our own graduates decided to leave because they were not offered posts due to the moratorium. We are in exactly the same position today. We are imposing caps and refusing to allow recruitment. It is the wrong move.

If the committee has any authority to influence that thinking, we argue that there must now be a system whereby the decision about recruitment is taken away from the financial control of the HSE and Department of Health and based on safety for patients. HIQA must be given the authority under the patient safety (licensing) Bill, which has not been enacted, but the heads of the Bill were published in 2018. We have a list of HIQA inspections I can share, but I am sure members of the committee know them well. All the inspections HIQA has done in the past five years in various acute hospitals point to the fact they are not staffed properly. However, there is nothing it can do about it. It can merely report on it. We want it to have the authority and we are asking the committee to ensure that section of the patient safety (licensing) Bill is enacted. It is imperative that patient safety is measured, not by the amount of money available but by the number of staff required and scientifically determined to provide safety.

From the good research conducted into nurse staffing and patient safety, we know that when the staffing numbers are correct, patient mortality improves, the length of stay reduces, readmission reduces and agency costs also reduce. It makes sense. Already this year we are spending more than €500,000 more on agency staff per month, which defeats the purpose of any moratorium. We estimate that by the end of the year, we will have spent just over €26 million more on nursing and midwifery alone than in 2023. It makes no sense. We should be recruiting and directly hiring. The premise on which the caps are imposed is very damaging to patients and retention. It will increase burnout. Already the number of assaults on front-line staff is increasing and that is always directly connected to the number of staff on duty. Furthermore, development of community services will stall. It will simply not happen.

If committee members want to ask us about any issues, I am happy to take any questions.