Seán Crowe (Dublin South West, Sinn Fein)
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The committee will now commence its consideration of staffing levels in the HSE. From Fórsa, I am pleased to welcome Ms Ashley Connolly, Ms Linda Kelly, Ms Clodagh Kavanagh and Mr. Martin Jennings. The witnesses are reminded of the long-standing parliamentary practice to the effect 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 and it is imperative that they comply with any such direction.

Members are also 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 also 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 members to participate where they are not adhering to this constitutional requirement. Any member who attempts to participate from outside the precincts will be asked to leave the meeting. In this regard, I ask any member participating via MS Teams to confirm, prior to making a contribution, that he or she is on the grounds of the Leinster House campus.

I invite Ms Connolly to make her opening remarks on behalf of Fórsa.

Ms Ashley Connolly:

My name is Ashley Connolly and I am head of the health and welfare division of Fórsa. I will be sharing my time for this opening statement with my colleague Ms Linda Kelly, our national secretary. Ms Orla Carroll, an executive member of our health and welfare division, and Mr. Martin Jennings, chairperson of the physiotherapy national professional committee, are also in attendance, as is Ms Corinne Phelan, who is seated in the Public Gallery.

Fórsa is the largest public sector trade union in the Republic of Ireland, representing over 33,000 members in our health and welfare division. Our submission today is focused solely on staffing levels in the HSE where Fórsa represents all clerical and administration grades and the vast majority of health and social care professionals. We intend to focus on three priority areas, namely the impact of current decision making on service provision, the need to protect public healthcare services and the likelihood of a national industrial dispute during the winter surge.

A survey of Fórsa members conducted in August 2024 clearly indicates that front-line services are being negatively impacted by the HSE recruitment embargo and by its replacement, the so-called pay and numbers strategy. The key results of our survey, Unfilled Posts, Unseen Consequences, are set out in our written submission, so I will not repeat them here. However, I want to read into the record the words of our members who are working on the front line about the impact of the pay and numbers strategy on the services they are providing.

Regarding speech and language services, respondents told us that there has been "an increase in waiting time for paediatrics" and that staff are unable to expand adult services. On occupational therapy, the strategy has resulted in "longer waiting times for patients. Patient length of stay has increased as patients have to wait longer to see OT”. In the clerical and administrative area, "services have fallen behind on essential duties, organisational problems have impacted the services causing problems for patients. Vacant posts hinder clinical teams in their day-to-day duties and some clinical teams are picking up admin work to keep service functioning". The story that the survey results show is very different to that which was portrayed by the joint chairs of the productivity and savings task force in front of this committee several weeks ago. The results of our survey have been reaffirmed at every location where we have held multi-union protests over the last couple of weeks. From Connolly Hospital in Dublin to Midland Regional Hospital in Tullamore the feedback is the same. Services are being curtailed or stopped, morale is on the floor and there does not seem to be any clear plan on how staffing for services is going to be managed under the pay and numbers strategy.

Fórsa is extremely concerned by reports last week that the human resources section of the HSE has directed all vacant posts to be switched off on the SAP payroll system. Such an approach, when coupled with the lack of transparency about the data underpinning the HSE pay and numbers strategy, should be of grave concern to this committee.

I will now hand over to my colleague Ms Kelly.

Ms Linda Kelly:

I am going to move onto the importance of protecting public health services. At a meeting of this committee in September, Mr. Robert Watt stated: "it is clear that it is not sustainable long term to continue to increase the health budget in line with demand every year.” This narrative must be refuted in the strongest possible terms. We know that the population of our country is growing and the over-65 cohort, who need the most services from health, is growing exponentially. We should have a legitimate expectation that staffing to provide those services would increase with relativity. This pervasive narrative, coupled with the veiled insinuation that public healthcare workers are simply not being productive enough must be called out for what it is, a cheap neoliberal trick to provide cover for the privatisation of the public healthcare system by stealth.

The €79.493 million spent on private, for-profit consultancy firms for strategic planning and business improvement in 2023 would fund 1,865 entry-level therapy posts across the country, 2,354 medical secretary posts or over 1,300 psychology posts. That is the scale of the spend. Imagine what difference that level of staffing would make to people when accessing services. Just last week we learned from a Sunday Independent report rather than from the HSE that half of the people involved in the productivity and savings task force are from these for-profit private consultancy firms. One would have to wonder whose interests are being served. There can be no better return on investment for the HSE than investing in its staff. It is incredibly disappointing to Fórsa members that the CEO of the organisation fails to recognise that and instead focuses on policy choices that are short term and short-sighted.

Regarding the current industrial relations situation, the HSE has completely failed its staff in the handling of this dispute. When the HSE presented its service plan earlier this year, Fórsa, along with our sister unions, requested engagement on the pay and numbers strategy before it was finalised.

This request was made again in March 2024 and both requests were ignored by the employer. The HSE claims to have fulfilled its obligations as a public sector employer by making a short presentation online via Teams to the health sector panel of trade unions in July, but this was nothing more than a fait accompliand a tick-the-box exercise. It has blatantly refused to listen to the voices of its own staff, choosing instead to work with outside agencies to craft a plan without any internal input. It is quite simply a recipe for disaster.

One can only conclude on the behaviour to date that Bernard Gloster has no intention of resolving this dispute and is prepared to gamble the health service during the winter months rather than engage with staff on an issue of fundamental dispute. In concluding, I wish to set out that Fórsa is looking for the committee’s support in calling for a negotiation on the pay and numbers strategy that would result in a workforce plan that sets out safe staffing levels for all categories of staff relative to population growth and service demand. Our thanks to the committee for its consideration of this issue.

Bernard Durkan (Kildare North, Fine Gael)
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I thank the witnesses for coming before the committee. I will ask a few questions about the embargo on recruitment and the impact it has had. It is denied that there was an embargo. What is the number of vacancies that were available when the embargo was not in operation? How many deserving posts were being and were filled at that time? What is the total number of people recruited into the health services in the past year or two? What has happened in those sensitive areas, the areas of greatest pressure and greatest concern? This is not to be critical.

Ms Linda Kelly:

No, it is a factual question around numbers. I would love to be able to give the Deputy the data but the HSE refuses to give that data to us or anybody else. I can split it into two timelines. There are the vacancies that were in the health service in 2023. The HSE decommissioned all of those vacant posts. We have requested that information and have been forced to resort to a freedom of information request. We got that FOI response yesterday from the HSE, in which it indicated it does not collect that data. This raises for us an even greater concern, that either the CEO of the HSE signed away a whole load of vacancies without having the data available to us or else the HSE is refusing to release it under FOI. We intend to appeal that. That is a problem area. There is complete disagreement between us and the HSE in relation to that. From our intelligence from members on the ground, there were clearly vacancies right across the service, as there are always vacancies in any employment due to people leaving, turnover and all of that.

In relation to 2024, what we have is a bizarre situation where the HSE is saying recruitment is happening as normal, there is nothing to see here and everybody should move on. That is certainly not the experience of members. We see an attempt in the spin from the HSE to focus on new development posts. That is valid. There are new developments and they are always welcome. When it comes to core service delivery, what we see from the HSE's own census report is that it is not recruiting to actually replace turnover. If I can give the Deputy the example of the therapy grades - speech and language therapy, occupational therapy and physiotherapy - looking at 2024, the data from last year shows that the turnover rate for that group of staff was just over 13%. It is one of the highest rates of turnover for the HSE. There were 6,700 people in post at the end of last year. We will leave aside the disputed vacancies. There were 6,700 doing the job last year. To stand still at that number, the HSE needs to recruit 884 therapists this year. That is pretty clear-cut in terms of the HSE's own figures that it provides publicly. This year, on its census to date, the HSE is down 44 posts, which means it is actually now at a rate of over 900 vacancies for therapists alone, yet we are all to believe that recruitment is happening as normal.

Bernard Durkan (Kildare North, Fine Gael)
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There has been difficulty in areas such as speech and language therapy going back years. Is it getting worse or is it being improved in any fashion at all? For example, there was no maternity leave for speech and language providers. Is maternity leave now provided for, with a person available to drop in to cover for the leave period?

Ms Linda Kelly:

We do not have a formal communication from the HSE on this. The feedback that members on the ground are getting is that maternity leave cover is not going to be provided going forward, particularly for the second half of this year. That is a huge problem in a workforce that is predominantly female. We know from the figures across the workforce that about 80% of HSE staff are women, so the level of maternity cover is significant. We have not seen draconian measures like that since the crash in 2008 and 2009. It is certainly not where a modern employer would be in respect of not covering maternity leave. We anticipate that the impact of that will significantly grow over the next couple of months. I was only yesterday talking to the vice chairperson of our division, who represents the south east of the country, who noted the number of people who are looking to return from career break and are being refused permission to come back into employment.

These are measures that really have to be questioned. Not only are we talking about an annual budget, ceilings and all of that, but we are also talking about a context in which demand is growing and we know there is a crisis in the healthcare workforce at national, European and international level. The idea that we are going to make some sort of short-term gain by having a recruitment embargo or fixed employment ceiling is incorrect. When it comes in five or ten years' time to a really significantly increased proportion of people over 65, we are not going to have anybody. That is the myopic decision-making that is happening at the moment, which is really problematic.

Bernard Durkan (Kildare North, Fine Gael)
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On the €79,493,000 spent on private consultancy firms for strategic planning and business improvement which, if not spent there, would fund 1,865 therapy posts, 2,354 medical secretary posts or 1,334 psychology posts, how is that measured? Was the consultancy work required, would it have had to be provided in-house, or was it subcontracted out to people with expertise in that area, presumably to take the pressure off staff within the services in-house? What is the strategy there?

Ms Ashley Connolly:

That is a very important point. Through an FOI request, we asked for a breakdown of the costs being paid to for-profit companies for the delivery of consultancy services. Rather than actually give us that breakdown, the HSE directed us back to its annual report of 2023. That is the only figure we have. We are concerned that is not the full extent of the spend and extremely concerned that it may be much higher than the €79 million. The HSE needs to invest in its own staff. We do not know what that service is for. We do not know where the benefits to actual service delivery can be gained by spending over €79 million, if not more than €100 million which is what our fear is. A lot of questions need to be asked of the HSE as to why we are spending tens of millions of euro on private, for-profit companies. This is something we have raised on numerous occasions with the HSE. We have sought clarity and transparency on it but unfortunately it is falling on deaf ears. From our members' perspective, every time there is a new initiative there is a member from a consultancy firm in attendance at these seminars and briefings.

We do not know why such people have to be there. We have asked the HSE directly and to date those clarifications have not been forthcoming. The question of why this money is being spent in this direction is, I think, of significant concern to this committee and those who rely on the services.

Bernard Durkan (Kildare North, Fine Gael)
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Do such attendees at the briefing sessions contribute to the sessions?

Ms Ashley Connolly:

No, their job is to facilitate the sessions, take the minutes and draft reports for the implementation of some strategy or other, which I believe can be done in-house.

Bernard Durkan (Kildare North, Fine Gael)
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I refer again to the ageing population, which comes up all the time. I do not think that the number of old people is increasing. I think the number of younger people is increasing at a far more rapid rate. If one looks at the people congregating in supermarkets, stores and shops, with employment in the economy, there are huge numbers of young people coming into the country. We are also retaining a greater number of the indigenous population in that area. Previously, those populations either were not available or left the country, which was a huge problem for this country. Now these people are in this country. The theory the HSE and everybody puts forward is that the number of people in the older age cohort is increasing. It is not. I do not think it is at all. I have challenged that theory for years because all the evidence I see demonstrates the reverse is the case. There is now a much bigger concentration of young people, the ones who are staying at home, have been educated at home or go away for a year but come back again, etc. We also see that cohort in some of the big employers. I think I am right and can be proved right. I have held that view since I was a Minister of State at the Department of Social Welfare, which is a long time ago.

Seán Crowe (Dublin South West, Sinn Fein)
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There has been growth of 300% and 400% in the number of older people in some of the estates I represent because people are living longer. That view is based on census returns, not made-up figures. Do the witnesses wish to respond to that?

Ms Linda Kelly:

Both things are true. The population is ageing and people are living longer with more complex health needs. That is true. It is also true that the population has grown by over 1 million people in the last decade. Deputy Durkan is right and people who say the population is ageing are also right. I certainly would not challenge the figures from the Central Statistics Office, which we included in our submission, but I think both aspects are right.

Seán Crowe (Dublin South West, Sinn Fein)
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I do not think anyone disagrees. The fact is people are living longer, accessing healthcare and staying longer in the system, not because they are bed blockers or anything else but because they need to stay in it for health reasons.

David Cullinane (Waterford, Sinn Fein)
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The witnesses are very welcome and I thank them for their opening statement. I ask them to clear up some confusion in this area. Anyone listening to this discussion in recent months will have seen a lot of smoke and mirrors. On the one hand, the Minister for Health has been telling us we have never had it so good with all of this recruitment that we have seen over the last number of years, including this year. On the other hand, we have the Irish Nurses and Midwives Organisation talking about suppressed nursing posts, SIPTU last week talking about radiation therapists posts where there are vacancies and equipment lying idle, and the witnesses talking today about suppressed posts and a recruitment embargo by another name, the pay and numbers strategy. Earlier, we heard from the Irish Cardiac Society about vacant posts. A number of months ago, the Irish Cancer Society was here and also talked about vacant posts. It seems all of these organisations have one view and the Minister for Health has a different view.

On the important issue of suppressed posts, my understanding is that on 31 December 2023, all vacant posts were essentially scrapped or at least the vast majority of them were, as there may have been some exceptions. Is that the case? Do the witnesses have an estimate of the number of those posts and the impact that had in their area in terms of staff represented by Fórsa? As the Minister has not answered the question, were posts suppressed - vanished, disappeared, gone - on 31 December 2023?

Ms Ashley Connolly:

The Deputy has raised a very important point. It is 100% the case that there were vacant posts in the system on 31 December 2023 which, when the HSE issued the pay and numbers strategy in July, were "decommissioned", which is the word the HSE is using. On its payroll and HR system, the HSE decommissioned the posts and moved them to another category. The vacant posts have disappeared. They are no longer counted in the HSE's census.

We lodged an FOI request. It is regrettable that a trade union has to seek information via an FOI but we did. Fórsa received a response only yesterday evening which states that: “In an effort to locate the records that you sought I referred to the Strategic Workforce Planning and Intelligence who confirmed National HR do not hold the records requested by grade.” I find it very alarming that the national HR system does not capture the number of vacant posts in the country. How do we plan a service? How do we decide what is needed in what area? How do we determine what posts should be suppressed or decommissioned without risk-assessing the impact that could have in any region?

What we are hearing daily from our members is not the impact that this is having on staff because morale is on the floor but the impact it is having on the people they meet on a daily basis. It is the cancelled appointments, the longer waiting lists and knowing that when you receive referral you might not get to see that patient for two years. This is the reality, so I am very alarmed that the information was not captured. I can say that in the same reply to our FOI request the HSE confirmed that there is a minus variance of 2,444 in the number of posts as at yesterday's date compared to 31 December 2023.

David Cullinane (Waterford, Sinn Fein)
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When the Minister for Health was before the committee last week I put it to him that if he disputed the figures from the Irish Nurses and Midwives Organisation, SIPTU, Fórsa or any other organisation on suppressed, lost or decommissioned posts, he should provide the real number and I did not get an answer. Is the lack of an answer because the data is not being captured or does the HSE have a number but is not telling us what it is? Perhaps my question is difficult to answer.

Ms Ashley Connolly:

It is not difficult to answer because I have engaged with Fórsa members who have told me that these reports are available in regions. The nine previous CHOs would have all run their own HR reports and the hospital groups, as they existed, would have all run their own individual reports. The figures exist in those reports. The HSE's response is that there is no national HR gathering of this data. That is regrettable.

David Cullinane (Waterford, Sinn Fein)
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I accept that. Ms Connolly spoke about a lack of transparency about the data underpinning the pay and numbers strategy and the other healthcare trade unions have made a similar point. She made another important point, which should be noted, that HSE HR was directed to essentially switch off the vacancies on the SAP payroll system. If vacant posts are switched off and gone, is the consequence that the HSE can say it does not have the data or it is not there? From Fórsa's perspective, why did the HSE switch off the vacant posts on its SAP system? What was the intention behind that?

Ms Linda Kelly:

If you were being cynical, you would be concerned that it is an attempt to thwart the FOI request we submitted. That is our concern. I am sure the HSE anticipates that Fórsa will appeal our FOI request. There is also an issue of principle here. When these figures are in dispute any attempt to hide or disregard them should be called out because nobody, whether in this room or in the HSE, can make good decisions if validated data is not shared between parties.

David Cullinane (Waterford, Sinn Fein)
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Are these posts that were marked as vacant on the HSE's SAP payroll system?

Ms Linda Kelly:

Vacant, yes.

David Cullinane (Waterford, Sinn Fein)
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They have just vanished.

Ms Linda Kelly:

Our understanding from members we met at some of the protests last week is that a direction has been issued for them to be cleared off the system.

I am not in payroll so I cannot give the detail of it, but somebody has to go in and manually turn those off. A HR manager in an area cannot then go and recruit for that post because the number associated with it is gone.

To come back to the Deputy's earlier point, Fórsa members working in clerical administration were the canary in the coalmine in relation to this dispute. They were the first ones targeted for a recruitment embargo in May of last year. It was extended out to other groups as we went through 2023. As we engaged with the HSE, it told us repeatedly that it was conducting a validation exercise on vacancies right throughout the end of 2023 and into early 2024. When the pay and numbers did not materialise in February 2024, the HSE said it was not finished its validation exercise and it still had to go through it. I find it astounding, then, that for months the HSE was telling us it was conducting this big validation exercise on vacancies and yet the data is not available to everybody.

David Cullinane (Waterford, Sinn Fein)
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Yes. I wish to come back to the concluding remarks in Fórsa's opening statement. Before I do that, another important point was made when it was said that we should not conflate new development posts with core service delivery, the replacement of staff, staff turnover, etc. From what was said, I am assuming that the Minister quite rightly is saying there is recruitment and that the numbers are there to recruit staff for new development posts. This is part of any budgetary process where there are core new developments and current expenditure made available. What we are seeing here, and has been the result of the recruitment embargo and now the pay and numbers strategy, is that in core service delivery areas we have posts that were vacant and needed but that are now gone. Essentially, is this what is being said?

Ms Linda Kelly:

That and also the feedback in this regard. I say this particularly because several of the protests have been outside hospitals in recent weeks. Feedback from hospital management has been that vacancies that have arisen in 2024, despite everything being fine and dandy there according to the HSE spin, are also going up the line to be replaced. There is no feedback coming back and no new people coming in.

David Cullinane (Waterford, Sinn Fein)
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Fórsa is asking that the Minister and the Government, or at least the HSE anyway, would negotiate with Fórsa and other healthcare trade unions on the pay and numbers strategy, which makes sense, have a workforce plan, which makes sense as well, and deal with safe staffing levels.

Another observation I will make is that it is very odd and bizarre that we train so many healthcare professionals and that we have to pay for that training, and rightly so, and yet - and I know there are some exceptions with fourth-year nurses - many graduates are not being offered posts because the posts are simply not there. This is because they are not being funded. They were vacant posts that are now gone. This makes no sense. We are telling those people to go and work in the private sector or emigrate, as opposed to coming to work in the public system. The whole reason we have workforce planning and that we train the healthcare professionals we do is meant to be based on population growth, demographics, demand and all these issues. Yet we do not recruit them and put an embargo in place or we curtail recruitment. I will leave my contribution at that. I support the request from Fórsa in respect of the need to have a proper negotiation concerning the pay and numbers strategy.

Ms Linda Kelly:

To comment quickly on what the Deputy said, which were very articulate, especially in relation to new graduates coming out of training, what we see, and we included this in our substantive submission, when we look at the agency cost for the time of the embargo compared to when the pay and numbers strategy was introduced to replace it, we can see there has been an increase of €29 million. Everybody working in the health sector knows there is always an element of agency involvement-----

David Cullinane (Waterford, Sinn Fein)
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It has more than doubled.

Ms Linda Kelly:

-----but what we see now is that rather than funding direct employment, it is being said there is a cap in place. Yet agency spending is increasing and workers employed by for-profit agency companies are in insecure and often zero-hour contracts with no protections. This is not a way to run the public healthcare system. It is simply not the way to do it. As somebody mentioned earlier, this is smoke and mirrors to allow it to be said there is an employment ceiling in place while not looking at the agency costs that are increasing. It does not make any sense.

Seán Crowe (Dublin South West, Sinn Fein)
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I am conscious that many people are trying to get in to contribute, so I ask that we keep the slots to ten minutes or less if it is possible. I call Deputy Lahart.

John Lahart (Dublin South West, Fianna Fail)
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I thank the members of Fórsa for coming in and for the presentation. I have broad sympathy for many of the points made. I just wish to clarify a few things. Robert Watt was quoted. I was here the day he made that presentation. I can understand why the witnesses would select that quote, but he made many other substantial contributions in terms of trying to not curtail costs, and I get the point about productivity, but just about being smarter and using technology to assist. Those are just one or two of the points he made. I do not think reducing a pretty long contribution down to a sentence accurately captures what he was trying to say, but I do get the point being made. It is not sustainable to continue to grow the health budget every year. This is the point in this regard. I also wish to make some other points. I share the witnesses' perspective because I have first-hand experience in regard to speech and language therapies and occupational therapies. That does not land well with me either because it leads to waiting lists. In relation to one of the new primary care centres in my constituency, the issue of the shortage of staff has been raised with me.

I am just trying to break through some of the narrative here. We can see from the figures we have been given that as of August this year there were almost 30,000 more staff working in our health service than there were at the beginning of 2020. That is a factual figure. It is just one figure. I know there was an increase in population. This figure, though, was over and above natural attrition and retirement, etc. There are 28,000 more staff working in our health service, which is almost an increase of 25% in the staffing levels of the HSE since the beginning of 2020. This is hardly a system that is in a state of stasis. I absolutely get that it is not perfect, but none of what I have said was mentioned. Many of the new staff concerned would be members of Fórsa.

We have had representatives of NGOs and other charitable organisations in here too. These include the section 39 organisations. Complaints were made about the poaching of their staff, as they see it, by the HSE because it is able to offer better terms and conditions. I also get the point made about the contract staff. I would like to drill further down into the detail of this point. The overall number I referred to includes more than 6,000 management and administrative staff, 9,500 nurses and midwives, more than 4,000 health and social care professionals and an additional 3,330 doctors and dentists, among other groups. The witnesses will know that the HSE had a figure in respect of it being funded to recruit 6,000 staff in 2023 but it actually hired close to 8,500 new staff. The organisation, therefore, hired an additional 2,500 people beyond what it was funded for. The Government, however, funded the HSE for those additional 2,500 people. During the Covid-19 pandemic, the HSE recruited a further 2,000 staff that the organisation was not funded to recruit. The cost of that recruitment had to be covered too. These are things the witnesses did not mention. Staffing levels for nurses and midwives have increased by 25% since 2019. The total health workforce has increased by almost 25% since 2019. Management and administrative staffing levels have increased by 33% since 2019 and health and social care professional staffing levels have gone up almost 25% since 2019.

This does not speak to me of a health service standing still. Is it ideal and are all the pieces in place? I see gaps. I see gaps in my constituency. I do see this and I hear the passion of the witnesses. However, I see gaps in the union's narrative as well. One of my questions relates to the union having stated it is "concerned by reports last week that the human resources section of the HSE has directed all vacant posts to be switched off on the SAP payroll system". It was stated that the union has heard reports. This is the Oireachtas health committee and I am concerned about whether the union has evidence of this being the case. This is a straight question. Does the union have evidence in this regard, aside from reports and hearsay? Can the union present this Oireachtas committee with evidence that "the human resources section of the HSE has directed all vacant posts to be switched off on the SAP payroll system"?

Seán Crowe (Dublin South West, Sinn Fein)
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Before the witnesses respond, I ask that we try to avoid mentioning people by name. I am conscious people are not here. They are all big boys and well capable, but we are working to a position where we are conscious people are not here. I do read out at the start of the meeting a note stating people should not be identified. I ask, therefore, that if it is the HSE, the Department of Health or whatever else being referred to, we try to avoid personalising it around people.

I am saying that for all of us.

John Lahart (Dublin South West, Fianna Fail)
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I am glad the Cathaoirleach said it. One of the things I would have said, having been a member of this committee for five years, is that while I am not here as an apologist for Bernard Gloster, I found him to be a breath of fresh air to deal with as CEO of the HSE.

Seán Crowe (Dublin South West, Sinn Fein)
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I am repeating what I said at the start. Could we try not to identify people? I thank the Deputy.

John Lahart (Dublin South West, Fianna Fail)
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That is a question. Fórsa was extremely concerned by reports last week that HSE HR has directed all vacant posts to be switched off on the SAP payroll system. That would alarm me if it is true. Do the witnesses have evidence they can give us?

Ms Ashley Connolly:

We are extremely alarmed. We raised this yesterday with senior management in the HSE and are awaiting a formal response. I can tell the Deputy that our members work in these areas. We have met our members and they have informed us of the instruction. We have raised it with senior members of the HSE for clarification. We await a response from them. I have no reason to disbelieve what we have been told by our members.

John Lahart (Dublin South West, Fianna Fail)
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We are on the record here. That is what I am concerned about. I would like clarification of exactly what that means. How does the SAP payroll system work? Are vacancies visible? Is that what Ms Connolly is saying?

Ms Ashley Connolly:

I have seen reports that would identify the number of posts that were vacant in the system. If this is loaded up in a data run, it would eliminate these posts and they will not exist when you go back onto the system. If you looked at a report in July, it would tell you how many posts were vacant on 31 December across different areas, in each of the CHOs and hospital groups. If the HSE runs this system change, you will not see that data anymore. We know for a fact that these positions existed and have not been replaced, because we can outline the impact that non-replacement is having on various waiting lists throughout the country.

John Lahart (Dublin South West, Fianna Fail)
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To drill down more into that, to whom is that data available?

Ms Ashley Connolly:

It is available within all the HR systems.

John Lahart (Dublin South West, Fianna Fail)
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If we tabled a parliamentary question about vacancies in the HSE, would that be a place the HSE would go to and where it should be able to see vacancies? Ms Connolly is saying now that that data has been removed.

Ms Ashley Connolly:

It is being removed.

John Lahart (Dublin South West, Fianna Fail)
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I am not arguing with Ms Connolly on this. That is alarming if that is the case because if vacancies existed, they are now not visible as existing, so the system is suggesting there are no vacancies.

Ms Linda Kelly:

I will add detail on that. Leaving aside the embargo, if a service wanted to hire a couple of physiotherapists or whatever posts are involved, it would do its paperwork and would get a number regarding that post when it is approved for filling. That would have gone up on SAP or SharePoint and be available for however the service wants to recruit. It was called a funded and approved post. A manager would have in their purview the ability to recruit into that. Those funded and approved posts always had a number and everybody was able to see those. Those are the vacancies we are concerned are being taken off the system. Managers will not be able to recruit and replace those. They will only be able to recruit and replace through the pay numbers, which we also understand is not happening. That is the differential.

John Lahart (Dublin South West, Fianna Fail)
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As a member of the committee, though I am not speaking for the committee, I am sure the HSE is watching and if that is true, I am sure the committee wants to hear an account of what that is about. Either the vacancies are visible or they are not. If they are not, why has that happened?

The other side of this relates to private contractors. I will let the witnesses come back because I am running out of time. The HSE employed 2,000 more people than it was given money for in 2023 and 2,000 more people than it was given money for during Covid. Those roughly 4,000 people were absorbed onto the payroll, as I understand it. The HSE was given a phenomenal amount of additional money this summer by the Government to plug a number of gaps. If there is a cap or limit, that is clearly going to go to the private sector to do that rather than the HSE taking on permanent, whole-time employees. That seems to be what would happen rather than to continue absorbing numbers onto the payroll. What is Fórsa's response to that?

Ms Linda Kelly:

I think it is a policy choice. The money-----

John Lahart (Dublin South West, Fianna Fail)
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The policy choice is to say to the HSE that it can employ 6,000 additional people this year, and the HSE employed 8,500, or that it did not have the budget to employ 2,000 additional staff during Covid, but it employed them, so the Government is going to cover that cost. The Department and Government are saying the HSE cannot continue to employ thousands of people over the budgets it has been given to pay people.

Ms Linda Kelly:

There is no issue from a Fórsa perspective of having a workforce plan that is negotiated and relevant to the service. Every modern organisation should have a workforce plan. There is no issue with that but what we have in the HSE at the moment is that the spend on agency staff is to fill core service provision. It is not for short-term vacancies or situations that cannot be anticipated, which is what agency was always intended for in its original sense. It was for emergencies. It is for staffing, as we hear from managers, and because the HSE is not sharing this information, we can only go by the feedback we get from members across the country. That is that where they cannot recruit an occupational therapist in a hospital, for example, they have to go to the for-profit recruitment firm to ask for an occupational therapist, who will be in the hospital for a year, two years, or maybe longer, providing core services in a non-emergency situation. That is a policy choice which is about reallocating budgets across different lines to make it look like you are not spending as much on staffing as you need to. We need to get to the bottom of that. Everybody wants value for money from the health budget. It is a huge spend for the Government. We are all citizens. We all need health services and contribute to them through our tax. The idea that we are reallocating things to try to hide the true need of the staff cost does not benefit anybody.

Róisín Shortall (Dublin North West, Social Democrats)
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I will pick up on that last point. It is important that we get the full picture. I address this to Deputy Lahart too. We all know that the population is growing and ageing, and the level of dependency is increasing. It is important to bear in mind that the budget allocation to help last year was insufficient. That is not just me saying that; the Irish Fiscal Advisory Council said it when it, unusually, made an intervention. It normally gives out about spending too much money. It stated there was not sufficient funding in the healthcare budget to meet the demographic changes. That was an objective assessment. We started from a situation last year where there was not sufficient allocation of resources or posts. That has a knock-on effect. There is much talk about these 28,000 additional staff. That is only meaningful if you are aware of the base number. What is that working off? Is it a big increase or small increase? That is why it is so important to have objective ratios and safe staffing levels that apply. That is needed right across the board.

I am disappointed and concerned to hear that relations have broken down to the extent they have within the HSE. I am disappointed with the new regime that we are at the point where the witnesses, as key people in the organisation, cannot get access to basic data. If we cannot agree on the facts of the matter and we do not have access to that data, it is all smoke and mirrors after that. I would have thought at this stage, with the development of industrial relations, HR approaches and so on, that there would at least be honesty and openness about the facts of the situation. I do not accept the data not being available. Many of us have come across this over the years. We have often been told in replies to parliamentary questions that the data is not collected in a manner that allows an answer to the question. If we then pursue it, the HSE can collect the data.

The data is there, as the representatives said. It may be broken down by line CHOs or local health offices, but it is a matter of somebody having the time and being allocated to assemble all of that and give national figures. The data is there; it is just that the HSE has come up with a response to give to Fórsa that is entirely unsatisfactory. The idea that a key union representing healthcare workers has to go to the bother of requesting an FOI speaks to poor relations within the health service, and it is a key responsibility of senior management to ensure modern systems are in place to consult all the partners in the health service. It is concerning that this is not the case, and it seems the communication is very poor.

The witnesses made the point about the productivity and savings task force very well. It is not only that there is the potential for vested interests to be at play there; there is also a certain mindset. I would venture that most, if not all, members of that task force were not dependent on the public health service. That is probably the likelihood. They may have very little experience of it. There is a mindset, among a lot of people at political level but certainly at the level of consultancies and management bodies, that the private sector is better and more efficient but we know that is not the case. There is a lot of concern about what is happening in the health service at the moment such that the tendency is to outsource. We can reach a tipping point if we outsource so much that there can sometimes be no going back from that. Moreover, it forces trained professionals to go to the private sector or agencies, if that is where the jobs are, and it is self-fulfilling. We are at a dangerous point in the health service because of the extent of outsourcing and privatisation, which, of course, is about extracting wealth from the health service. We should stop that and take steps to ensure that tendency will not continue.

Turning to safe staffing levels, nurses have those to a certain extent, although they are problematic as well, as we mentioned earlier. We do not have full disclosure of the staffing levels among nurses. What is the experience of establishing safe staffing levels in other sectors within the health service? Is there an example of a country or countries that do that well? Could that approach be adopted within a reasonable time?

Ms Linda Kelly:

My remit is with health and social care professionals but Mr. Jennings may have more to say about safe staffing. Among other jurisdictions, there is nothing that maps straightforwardly to an Irish context, but we can look at key principles. Dietetics, for example, is an area in Ireland where we are very under-resourced because of the embargo in the midlands. There are some counties without any community dietetics service, but safe staffing levels have been developed in the UK. I absolutely believe that there is the authority and ability within this country to get key leaders around a table, from the professional bodies, the unions and the employer, to discuss what that framework would look like in an Irish context, looking at those principles from other jurisdictions. That is not beyond us at all. The problem is that there is a political priority not to do that, because if we were to actually look at safe staffing levels or at a workforce plan, we would find, as the Deputy said at the beginning of her contribution, that the health system is critically under-resourced in respect of staffing.

Róisín Shortall (Dublin North West, Social Democrats)
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Turning to the productivity and savings task force, the expectation is that staff would be well represented on a body like that. What was Fórsa's experience of looking for that representation?

Ms Ashley Connolly:

After we read the media report of the standing-up of that committee, the staff panel of the group of unions wrote a letter seeking engagement on the productivity and savings task force. To date, there have been no meetings with any of the unions regarding this body. We have no idea what the agenda or focus is.

Róisín Shortall (Dublin North West, Social Democrats)
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That is incredible. It is very hard to understand.

Ms Ashley Connolly:

We believe that the best way to bring about change is by engaging with those who work in the service.

Róisín Shortall (Dublin North West, Social Democrats)
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Of course.

Ms Ashley Connolly:

They are the ones who can see the pinch points, who can develop the design and who are focused solely on delivering true healthcare in a public setting, on everything Sláintecare was built on. Like the Deputy, we are extremely alarmed that we are tilting over to be more reliant on the private sector than we are on public health, and we believe that tide needs to be turned.

Róisín Shortall (Dublin North West, Social Democrats)
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It is really important that a cost-benefit analysis be carried out on that within different sectors of the health service. There is a view that private healthcare is more efficient, cheaper and so on but, of course, we know that is not the case in the long run. Even so, we need to have the figures on that.

On the net point about the data on the number of vacancies at 31 December last year, I propose that the committee look for that data as a matter of urgency. The data exists, and while it may not be available to view on the system now, it has to be there. We should look for that. It should be a factual figure. It is not open to negotiation. The question is what the number was at that point. We should look for that because it is key to establishing the base from which we are now operating.

The representatives raised a point, which has been raised previously with us, about people returning from a career break. What are Fórsa's members experiencing in that regard?

Ms Linda Kelly:

It is a small figure because, again, we do not have the total figure for how many people are out on a career break and how many are coming back, but members are making contact with their local branch representatives to say the HSE cannot facilitate their return to work. In our presentation from the HSE in July, it flagged that it was going to ask every area to get a line of sight of its responsibilities in that regard, but there is certainly difficulty there. I am baffled by this because, no matter what way we slice it, there are always people on maternity leave in various professions. There are vacancies in the 2024 pot regardless of whatever row we have about 2023. It is very much coming through as an emerging issue, and as we get more information, we will happily share it with the committee.

Róisín Shortall (Dublin North West, Social Democrats)
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I thank the representatives.

Seán Crowe (Dublin South West, Sinn Fein)
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We will try to follow up on that data and information, and it is also important that we try to find out the direction of HR at the HSE in respect of vacant posts being switched off on the SAP payroll system. I know the union submitted a freedom of information request but we can try to follow it up formally as a committee as well.

Neasa Hourigan (Dublin Central, Green Party)
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I had intended to ask about what kind of engagement Fórsa has had with the productivity and savings group. For clarity, has Fórsa never been invited to make a submission to it? I know the group has had ten meetings, or at least it has issued the minutes of ten meetings. Has the union never been asked for data on the people it represents?

Ms Ashley Connolly:

No, we have not had a presentation on the working of the group, nor have we been engaged with or requested for any submissions to it. I can say that on behalf of the group of unions.

Neasa Hourigan (Dublin Central, Green Party)
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That is a missed opportunity.

Ms Ashley Connolly:

I agree.

Neasa Hourigan (Dublin Central, Green Party)
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Continuing on the issue of agency staff, I have put a question about this at a number of recent sessions. It is not so much the agency staff who might cover for maternity or sick leave but agency staff who are in effectively full-time, long-term roles. A significant proportion of an outpatient team, for example, might be agency staff. The answers I got indicated the HSE is now undertaking a process of moving agency staff to full-time HSE roles.

Two of the numbers given related to a recent moving of 300 people and, prior to that, 500 people. What are the witnesses’ reactions to this? Has it been an ongoing HSE process or is it something that the HSE has just done this year?

Ms Ashley Connolly:

Over the years, there have been conversions of agency workers into direct employees. This could happen in a localised area where a body needs to bring in short-term agency workers to cover maternity leave, long-term sick leave or vacant posts. For nearly 18 months, we have been raising with the HSE our significant concern about the number of advertisements across multiple agency companies. I have recorded at least a dozen different companies that provide staff to the HSE.

Neasa Hourigan (Dublin Central, Green Party)
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To be clear, those job advertisements are going up-----

Ms Ashley Connolly:

With the companies. I do not want to name any particular company, but it would be one that is an agency or recruitment firm will advertise for a clerical officer in a hospital in a county, give an hourly rate and set out the terms and conditions on appointment.

Neasa Hourigan (Dublin Central, Green Party)
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In Ms Connolly’s estimation, is the number of those advertisements increasing?

Ms Ashley Connolly:

Yes. We see fewer with a company once I highlight that company, but if we open up a different website, we see the number increasing there. It is a bit of a cat-and-mouse game. From the previous meeting with the CEO and Secretary General, my recollection is that there are up to 10,000 agency workers in the HSE. That number is alarming and much higher than ever before. We can see that in the figures the HSE provides us through FOI requests. However, it is important-----

Neasa Hourigan (Dublin Central, Green Party)
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That is where I was heading with the question. Some of those 10,000 agency workers are in genuine posts of one, three or four weeks and filling a gap that does not lend itself to long-term employment, but in Ms Connolly’s estimation from working with people in the sector, what percentage of the 10,000 agency workers should we look to convert to full-time staff?

Ms Ashley Connolly:

The majority of them are filling permanent posts. Particular hospitals had to bring in agency workers because they were not allowed to recruit. They applied for derogations via their management streams and requested replacements of clerical officers and grave IV administrative officers. They never received responses, but they had to manage their accident and emergency desks or clinics. A high proportion of those 10,000 are filling vacant posts to try to keep the system running. One of my colleagues might be able to elaborate on the reality in terms of the number of vacancies.

Ms Linda Kelly:

I was going to make the same point. The spend on agency staff is €176 million, but depending on different press releases and events, the conversion rate does not go north of 1,000. One thousand people are not costing the HSE €176 million and the emergency level of cover is certainly not the remainder.

Neasa Hourigan (Dublin Central, Green Party)
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I am trying to make up some time for the Chair, so I will just ask one more question.

Seán Crowe (Dublin South West, Sinn Fein)
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Before that, does Mr. Jennings or Ms Carroll wish to reply?

Ms Orla Carroll:

Regarding the reality on the ground, I used to work in an acute hospital. Fórsa has members who are agency staff. One was pregnant and has gone on maternity leave. She had been working in the service for well over 12 months and was fully trained by management. Management is pulling its hair out because it does not know what she is going to do when she returns. It does not have a crystal ball, so it does not know whether it can give her a job. She now has a new baby at home but has no job security because the agency could only give her two-week rolling contracts. We represent these agency workers as well. The job is still there and will probably remain so, but management cannot guarantee it. A great deal of training has been provided to her. Agency staff, especially in clerical administrative work, are normally job hopping and locums and can slot into different areas, so she would be considered highly trained, but now management could lose her on the basis that it does not know whether it can give her a job.

Neasa Hourigan (Dublin Central, Green Party)
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I appreciate that point. This committee often discusses the cost to the service, but there is also a personal cost to the workers, who do not enjoy the same rights as the people working beside them in the same jobs.

Now that we have technically ended the embargo and are discussing staff ceilings, what is the witnesses’ understanding of the difference between one and the other?

Ms Linda Kelly:

“A rose by any other name would smell as sweet” has been my overriding response. There is a lack of transparency and honest conversation about where we need the health service to be. From a trade dispute perspective, we are talking about vacancies. Members are coming to us because they see the service suffering. That is what they are concerned about. They see their clinics’ waiting lists growing and services being curtailed. Just this week, I spoke to a group of psychology members. According to an audit in September, 30% of psychology posts across all services in the country are vacant. This should alarm people, given the state of our mental health services. There needs to be maturity. Spinning in the media rather than actually getting into a real negotiation about what a workforce plan needs to look like is immature and not what citizens deserve.

The pay and numbers strategy looks very much like an embargo from the ground. Sticking with mental health services, let us say that a vacancy arises within the parameters of the pay and numbers strategy in 2024 because someone retires. There is no dispute about the fact that this was an employee and that he or she is due to be replaced. However, we are hearing that it is taking months for him or her to be replaced and no one is coming into that post. Information goes up the line from the local service but people hear nothing back. There is a sense that this is a fait accompli and we should all just move on. This is problematic.

I wish to reference a matter we included in our submission but have not had an opportunity to discuss. There has been a devolution of decision-making to REOs so that, within their respective regions’ pay and numbers pots, they can decide whether to fill ten vacancies in nursing, clerical administration, the health and social care professions or whatever the mix is on any given day. REOs have the power decide to employ 20 speech and language therapists and no clerical administrators. This is making it a gig economy within healthcare regions. It is about dividing and conquering different services. There is no protection for services in terms of whether their staffing levels are going to continue. Someone referred to it as having become the Hunger Games for staff. It makes it difficult for people to get up and go to work in services. Services should be secure in their staffing levels. They should have a clear idea about whether they will get replacements and if the services they provide will be maintained if people leave. They should not have to go into an REO’s pot, make the case for replacements and not know if the services they provide will still be there in a couple of weeks’ or months’ time, yet that is the reality of the pay and numbers strategy.

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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I will probably only use five minutes of my time, as I have to be in the Chamber in five minutes’ time. How likely is it that this situation could end up in a strike?

Ms Ashley Connolly:

We commenced the ballot on 14 October. It will conclude the week of 25 November. We are aware that our sister union, the INMO, is also balloting.

Not only have I represented members for a long time, I worked in the health service for 20 years. I can tell you from protests and from local engagement with our members that the anger among our members is palpable. It is alarming. They have been asking us for a long time to be their voice because they believe they are not being listened to by their employer. They are concerned that they are being shut out of any process and just being ignored. They are extremely concerned for their ability to deliver services safely but also the fact the waiting lists are now extending by weeks, months and years.

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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It was said in the opening statement that the HSE has not engaged properly. What would a proper engagement look like?

Ms Ashley Connolly:

The pay and numbers strategy was being spoken about for a number of months. On three different occasions the collective group of unions sought engagement in advance of that strategy being finalised. The only response we received was that they would take that away and give consideration to our request. In July we were sent a link to attend a meeting. We were notified the Friday before, I think, that the meeting would take place on the Tuesday. We read in the papers over that weekend what the pay and numbers strategy was. We were met on the Tuesday morning and it was a fait accompli. Despite our numerous requests for engagement there was none. We are on record seeking that engagement.

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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On strategic planning and business improvement, am I reading the statement correctly that there is a figure of €79 million for a year?

Ms Ashley Connolly:

That is what is in the accounts for last year. Our FOI request was for a full breakdown. We were directed to the financial accounts and sent that screenshot. We do not believe it provides the full data that we requested.

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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What did they spend €79 million on?

Ms Ashley Connolly:

That is a very good question and one there is no transparency around.

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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There is no need to name names but in the second paragraph of the statement, it says that private consultancy firms were involved with this business plan. Do we know the composition of these?

Ms Linda Kelly:

We are going on media reports here because of the lack of transparency from the employer. There is an eight-person productivity and savings task force that is co-chaired by the CEO of the HSE and the Secretary General of the Department of Health. The maths mean there are six other people on it. The Sunday Independent reported that a number of members of that task force are employed by a for-profit consultancy firm. I will defer to the Cathaoirleach's comments about naming but that was on public record in terms of the cost of the spend on those workers.

On strategic planning and business improvement, what we know is there is more than one company. When we request contracts or clarity about the tendering process for those companies, we are not provided with same. We have taken a decision as a union that we do not attend meetings where those private, for-profit consultants are also in attendance. That caused a number of meetings not to happen for a long period. Essentially, they are in rooms taking a record of the meeting, dictating the agenda and coming up with the outputs of the meeting. That is really concerning. Why are we spending €79 million on those firms to do the work of the HSE? That is very concerning and problematic.

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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It is an extraordinary amount of money.

Ms Linda Kelly:

It is an extraordinary amount of money.

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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If I am reading this correctly, strategic planning and business improvement is the pay and numbers strategy. Am I reading that correctly?

Ms Linda Kelly:

No. Strategic planning and business improvement is the budget line heading. That is just a general term for every piece of work that these private, for-profit consultancy firms are involved in. It stretches way beyond the pay and numbers strategy, I would say. It is also around looking at various productivity measures and efficiencies. We have no sense of the scope of it other than what we understand ourselves from where we know they are engaged. In all sectors of the HSE, whether community or acute, they are involved in making key decisions about service. They are not employed by the health service but they are getting huge contracts.

Seán Crowe (Dublin South West, Sinn Fein)
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I thank Ms Kelly. We had this discussion when others came in, around the 2,500 extra staff. Bernard Gloster led us off and he talked about deserving posts. When we had the HSE and the Department in, I asked about this. There was an impression out there first of all that we were hiring willy-nilly, that they were not really important posts. Bernard Gloster talked about deserving posts. What are undeserving posts? Is it a cleaner? Do we not need cleaners, secretarial staff and administrative staff? Is there a post that is undeserving, if an organisation is hiring staff and needs them? We had the consultants in and they said they did not have the back-up team or administrative staff around them. They said that if they do not have a secretary, they cannot do their job. They were expressing their frustration.

Everyone thinks in terms of front-line workers, that those are the deserving posts. If you do not have the back-up, the people sending out a letter to patients about their appointments, the system does not work. It is extraordinary that there is this impression out there that there are undeserving people, priorities and so on. The system does not seem to be able to prioritise those posts.

The witnesses talked about mental health. There was a case in my area at the weekend of a young man who tried to commit suicide by throwing himself off a block of flats. He made three attempts and the last one was fatal. I do not know the ins and outs of it. It could be that he should have been sectioned under the Mental Health Act when he was brought to the hospital. The Garda probably had a role. It does not matter. The man is dead. The system failed him and his family. Also in my area there is a mother rearing children, three of whom are on the autism spectrum. One of the children is non-verbal. She is trying to get speech and language therapy. She was told first that he was on a list. Then she was told there was no list because there were no speech and language therapists at the time. The first thing was to get an assessment. She was waiting a year for that. Then there was the assessment and she thought the supports would be put in place. There was nothing. She ended up having to go to the courts to get some sort of supports. That was the first child. She has a another two who are on the spectrum. How do people cope with these things? They are just examples of the everyday challenges people have in their lives.

We have an economy of about €25 billion yet there is no support in the system for a child who cannot talk, or they are waiting years to get it. That is where people find something wrong. We can make throwaway remarks about hiring too many people or whatever but there can be false economy. We are hearing today that the State can pay for agency staff, who are paid more and have flexible hours, but it cannot hire staff. It just does not make sense to those who may be listening in and do not know the ins and outs of it. We have people going around with clipboards and all the rest of it and they think it is probably a waste of time and ask what people are doing in the hospital. If you drill down, in a lot of cases, they are not undeserving posts or undeserving staff. That message needs to be send out loud and clear. This committee can have a role. We can certainly try to find out if the posts are being eliminated.

In the past couple of minutes we have, I am interested in hearing the effect on morale. There are a couple of thousand children waiting for assessments in CHO 7, 33% up on last year. Those are assessments. It is hard to hire someone if they know that there will be thousands of cases on their desk. We talk to people about the difficulty in hiring for posts. That is one difficulty, because there is a huge backlog of cases. No matter how enthusiastic someone is when they come into the job, it will affect them to hear that there are thousands of cases to be dealt with. There is also the pressure of dealing with families who have children who are non-verbal or who are at their wits' end due to all the pressures involved. What is the effect on staff morale? How does impact directly? I presume it is people out sick. I ask the witnesses to explain it to us please.

Mr. Martin Jennings:

I am a physiotherapist manager working in the HSE and chairperson of our national professional committee, so I know more physiotherapy matters, but I know many of the physiotherapy issues are replicated right across our other HSCP services therapy grades. We do not have exact data. I have anecdotal stuff and I also have my own view. The amount of communication I started to receive in my role as chair of the national professional committee in the past 18 months from all grades has ballooned. These people are having major difficulties. They do not see a future in working in their profession, which they like. They do not see an end in sight to the ever-increasing demands. Some of the development posts arrived but some for key areas did not get over the line.

It got worse in recent times. A manager in the south east – one of the many items of correspondence I got – reported that they lost established posts that provided essential services for years that just happen to be empty. That is from a member in the south east. There was an increase in development posts in the years leading up to 2023, from a period where there was very little activity or very few development posts coming on. They kind of turned on at the same time, and many of them are focused on specialist areas such as community cardiology, respiratory services, people with chronic lung disease, diabetes and older person services in ICPOP. Some of those services were filled and some were not. What happened is there was movement. The same staff members from existing established services moved into some of the more development posts. Our members reported to us that while recruitment was ongoing, there was not enough time to be able to fill the vacancies they left in established posts. It was just the luck of the draw, depending on which area you were in and which network or hospital. When the music stopped, you could have been in a bad place or had only a smaller number of vacancies.

Morale is on the floor. People find it hard to get their head around the fact we got these development posts pre-Covid. From a physiotherapy perspective – I am sure the same but I do not have data for the other HSCPs – we were 30% below the European average for physiotherapists in 2018. We got some development posts but we needed that longer period of time. We needed a lead-in period n order to translate from universities to entry-level staff grades, physiotherapists getting their training, building up their expertise and specialties. It was going to take a couple years for that to transfer into filling the newer development posts. Now, when we have expanded and added some additional places in our undergraduate programmes, in many areas right across the country, those entry level posts are not available.

Seán Crowe (Dublin South West, Sinn Fein)
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I am getting the nod from the clerk. We are over time. I was looking at the clock in front of me but, apparently, he is looking at another clock. We are over time. I am conscious of the broadcasting staff and everyone else. I thank the witnesses for coming in. This has been a useful session. For the couple of weeks we have left, we will try to follow up on some of the issues. On behalf of the committee, I thank the witnesses and their staff for all the work they do in the health service. We will try to show our appreciation by attempting to follow up on some of the issues they raised today. I thank Fórsa representatives for their engagement with the committee on staffing levels in the HSE. The meeting is adjourned until Tuesday, 5 November at 4 p.m., when the committee will meet in private session.