Wednesday, 20 October 1999
Seanad Éireann Debate
Minister for Health and Children (Mr. Cowen): I am delighted to have the opportunity to respond  to the request of the Seanad to come into the House to make a statement on the complex and difficult dispute in which we are now engaged. I am not only giving my view of this dispute, but also the view of the trade union personnel who are also dealing with it. If it were not a complex issue we would have found a resolution to the difficulties long before now.
There has been no change in the Government's position, which has been consistent. It has not been a case of calling on the Nursing Alliance to take or leave the Labour Court findings. The Government wants the Labour Court findings accepted and to move on to other issues in the context of the Commission on Nursing report and the principles of social partnership.
On 23 September the Taoiseach outlined a credible alternative to confrontation and a way forward which will provide a better outcome for everyone, including nurses. That alternative is a renewal of our commitment at national level to social partnership and a series of practical steps to a new partnership agreement. That national position must be combined with an approach to public service pay which is imaginative in ensuring that the income of public servants should more closely reflect their performance and not be based on so-called traditional relativities. This is the context in which the aims and aspirations of public servants, including nurses, can best be met. It would also be the best context within which to set the progressive implementation of the report of the Commission on Nursing.
It was not until last Saturday that I heard an explicit acknowledgment from the Nursing Alliance that it recognised that the Government has difficulties in dealing with this matter in the way the alliance had been asking it to do up to then. In the course of being interviewed on the RTE programme, “This Week”, I made the following statement:
I am saying very clearly and it has always been the Government's position that if the Nursing Alliance unions recommit themselves to social partnership, acknowledge that we cannot pursue issues in isolation from the wider public sector pay implications, acknowledge that we cannot tear up existing agreements, if that is the position of the Nursing Alliance, then clearly there is a whole range of possibilities open to them to pursue their agenda.
I have been at pains all along to let everybody know that the problem in dealing with this issue is that existing social partnership agreements must be honoured and that the primacy of the Labour Court as a means of settling disputes must be upheld. At 3 p.m. last Sunday the Nursing Alliance issued the following statement:
The Nursing Alliance wishes to reiterate that it is cognisant of the Government's difficulties in further addressing the outstanding pay issues for nursing grades against the backdrop of existing social agreements. The Alliance also realises that any discussions will have to con sider those difficulties while also providing a forum and process which will address, in a meaningful way, the outstanding pay related issues from the Commission on Nursing.
It said it was available for talks in that context. Later on Sunday I issued a statement noting this recognition by the Nursing Alliance and indicating that if the alliance was genuine in its desire to identify a process by which these issues might be addressed within the parameters of pay partnership, then I would be available to meet the alliance the following day, which was Monday.
I met the representatives of the Nursing Alliance on Monday in the Department's offices. The most important achievement of that meeting was the mutual recognition of the problems which exist on both sides. I found the meeting helpful and constructive and it provided for a useful exchange of ideas. Both parties agreed to go back to their respective social partners in the partnership and seek help in trying to find a process which will allow for the resolution of this dispute.
It is important that the alliance and the management side accept that both sets of problems must be of equal status. I have been at pains to find a way forward that is not prescriptive of the outcome at an early stage. I am trying to put a process in place that will lead to a successful outcome but will not of itself have any harmful or knock-on effects. I am anxious to explore the possibilities of doing business in this way and ensuring that the social partners, Government, employers and Irish Congress of Trade Unions are fully involved. I do not want the social partnership that we have built up to fall down around us during any forthcoming negotiations.
Due to the number of people or groups lining up behind the current nurses' claim, it is important to ensure that arguments which may seem specific to nursing now are not later used by any of these groups to advance their particular case within the next number of weeks or months. I do not see this route as a lengthy process but it should be comprehensive so that both sides do not keep arguing over old scores. I am anxious to ensure that any new process or concepts which might be involved in progressing the situation do not interfere or be seen to interfere with the primacy of the Labour Court. I have always maintained and I still maintain that the Labour Court should be the court of final appeal. While I am anxious to devise a new way of resolving the current problems, I do not see this process operating as if the Labour Court did not exist.
There must be trust in the social partnership model to ensure that both sides in this dispute see social partnership as having the integrity necessary to facilitate a solution and to ensure that binding agreements are honoured. It should be our common agenda, and it is mine, to ensure that we get this process agreed by the social partners and I have indicated to the Government that any such initiative should have the imprimatur of the social partners. We have common ground where  the representatives of the employers and unions would work together quickly to devise such a process which would deal with these issues in a manner that is satisfactory to the parties concerned.
The House will be aware that the nurses' strike has impacted on many people through the cancellation of elective surgery, the closure of day services and the cancellation of outpatient clinics. The Health Service Employers Agency, HSEA, has been in discussions with the unions regarding the provision of emergency and essential nursing cover prior to the strike. Some progress was made at these talks in arrangements for care. While the continued absence of a nationally agreed framework leaves an element of uncertainty regarding the provision of minimum care requirements at all locations for the duration of the strike, discussions at local level closed the gap considerably in the last few days before the strike. The Nursing Alliance has said that it is not the intention to compromise patient care and I am prepared to accept that.
I would also like to put on the record that the co-operation between the management and union sides, where they have agreed and provided emergency cover, is very much appreciated. I know that those plans were put in place to try to keep the inconvenience of the public to an absolute minimum. The reports available to me to date from around the country bear this out and indicate that thankfully there have been no major difficulties on the ground so far. The acute hospital services are continuing to cope with the disruption arising from the strike but constant monitoring and continued co-operation are required for the duration of the strike.
In general, all day services with the exception of dialysis and chemotherapy have been cancelled. Fracture, warfarin and ante-natal outpatient clinics appear to be operating countrywide with additional outpatient services in ophthalmology, paediatrics cardiology, diagnostic breast and hepatitis C available in some regions. Accident and emergency departments are either quieter than normal or no busier than would be expected for the time of year. In-patient bed availability is generally adequate with a high proportion of vacant beds in most hospitals. The level of closed beds varies greatly within and across regions with up to 50 per cent of beds closed in some hospitals and others with all but normal levels of beds open.
Respite services in nearly every agency providing services to persons with an intellectual disability affected by the strike have been cancelled. Day services, where nurses are employed, have also been badly affected. These services would tend to be day services used by those with a more severe level of disability. Some residential services have also been closed, but overall these services are operating, with disruptions and with minimal nursing care. In the community health area, planned essential services are generally being delivered, which includes nursing service to  terminally ill and the long-term sick patients in the community.
In relation to mental health services, psychiatric hospitals are operating with some disruptions while outpatient and day care services are generally not operating. In general, services for older people are operating in accordance with locally agreed plans. Day care and respite services are generally not operating. Residential services and public health nursing services are operating with disruptions. I felt it was important to bring the House up to date on those matters, given the position as of this evening.
It is clear that the report of the Commission on Nursing will feature in the process that we are trying to put in place to resolve this dispute. I reiterate that the Government remains fully committed to the implementation of the recommendations contained in the commission's report. While all the attention has been concentrated on the three pay-related recommendations, the commission made 200 other recommendations which are designed to tackle the underlying problems within the nursing profession and to develop nursing as a key profession within the health service.
I believe the commission has taken full account of the future realities within which nursing must be sustained and developed as a profession. The commission has provided a framework for improving the way that nurses are managed, for involving them more in decision making, for providing them with new career pathways and for empowering them generally. It is important to remember that the nursing profession itself played a central role in informing the deliberations of the commission and in shaping its report as seven of the 14 ordinary members of the commission were drawn from the various strands of the profession.
Despite the ongoing difficulties with the three-pay related recommendations, real and substantial progress has been made over the past 13 months or so in implementing the central recommendations of the Commission on Nursing. I would like to avail of this opportunity to give an outline of the areas in which change has or is taking place in response to the commission's proposals. In the area of nursing education and training, I have established a representative nursing education forum to prepare the ground for moving pre-registration nursing education from the present three year diploma based programme to a four year degree programme. This forum is proceeding with its work and is expected to report to me by late next year. The whole thrust of this initiative is to place the basic education of nurses on a par with that of other professionals in the health service, something which the nursing profession has been looking for and which the Commission on Nursing has endorsed.
I have provided funding of £100,000 to each of the eight health boards for the establishment of a regional nursing and midwifery planning and development unit. These units will be responsible  for strategic planning and quality assurance of nursing and midwifery services in each health board area. They will also be involved in co-ordinating and improving co-operation between health boards and voluntary bodies in the delivery of nursing and midwifery services. Since the Commission on Nursing's report was published, the nursing policy division of my Department has been strengthened by the appointment of five additional nurse advisers. This brings to nine in total the number of members of the nursing profession who are directly involved in contributing to the formulation of overall national policy on nursing. This demonstrates my firm commitment to ensuring that, within my own Department, the profession has a real input into policy development.
Since I became Minister for Health and Children, a particular priority for me has been the greater involvement of nurses and other health care professionals in the management of our health services. Last November I launched the clinicians in management initiative and provided £2.5 million to get it up and running. This initiative is all about running hospitals and other health care institutions better through the participation of clinicians in the decision making process. This involves devolution of responsibility, a process of empowerment for front-line staff and an openness to change. For nurses, it means getting rid of the traditional hierarchies and giving them more power in decision making in their own wards and units. Clinicians in management is an initiative that involves nurses of all grades. My Department and I stand ready to work with nurses in moving this initiative forward and providing nurses with empowerment across a range of hospital and community settings.
My Department is involved in a joint partnership initiative with the Irish Nurses Organisation in relation to a set of training programmes for nurse managers. These programmes were developed in consultation with the Office for Health Management, the agency with lead responsibility for facilitating management development in the health services. They were introduced to address issues raised in the interim report of the Commission on Nursing, which identified a need for a much greater investment in management training and development to prepare nurses and midwives for positions of authority and leadership within the health care system. Last year I provided funding of £100,000 for these programmes and I have made available a similar amount this year.
The objectives of these management development programmes include developing the capacity of nurse managers to lead and manage change, and to formulate and implement action plans for the improvement of their own skills and those of their staff. The feedback from nurses who have participated in the programmes is extremely positive and clearly indicates that the objectives are being achieved. In view of the success of the first round pilot initiatives, my Depart ment, the Irish Nurses Organisation and the Office for Health Management have been engaged in discussions on the next round of developments under the partnership. I am committed to providing further funding to facilitate the expansion of these types of programmes, the importance of which is recognised by all the key players.
I am currently in the process of finalising arrangements for the establishment of a national council for professional development of nursing and midwifery. This new body is a necessary prerequisite for the creation of clinical nurse specialist and advanced nurse practitioner posts, as recommended by the Commission on Nursing. The importance of this development to nurses, particularly staff nurses, cannot be over-emphasised. It will provide them with a new clinical career pathway that does not exist at present, a pathway that will allow them to progress up the promotional ladder without having to leave the patient's bedside. Several hundred new clinical nurse specialist and midwife specialist posts will be coming on stream. These will be promotional posts at ward sister level and staff nurses and midwives with extensive clinical experience, currently in practice, will be eligible for them.
I hope the House will accept that considerable progress has been made in implementing the central recommendations of the Commission on Nursing. This has been done against a background of ongoing industrial relations difficulties since the commission's report was published, in which the three-pay related recommendations have overshadowed everything else. I have been seeking unsuccessfully to engage the nursing unions in a partnership approach to the phased implementation of all the recommendations of the Commission on Nursing. The commission has set out a comprehensive agenda for developing the role of nurses and midwives within the health services. It is my fervent wish that the moves that are currently under way to find a process for addressing nursing issues within the parameters of social partnership will be successful, and that this will allow me and the Nursing Alliance to concentrate our energies, jointly and constructively, on tackling the huge agenda for change set out by the commission. In the final analysis, the commission's report is all about developing the role of nurses and giving concrete expression to the recognition of that role.
What I am anxious to do in implementing the commission's recommendations, and I hope that this will soon be possible, is to involve the nursing unions in identifying the priority areas where action is required and agreeing strategies for dealing with them. We all accept that all of the commission's recommendations cannot be implemented in a single step and that some will, of necessity, take longer than others. That is not to say, however, that we cannot agree a structured programme for the implementation of the report over a period of time.
 I would like to conclude by affirming that the Government is anxious that a process be found as speedily as possible for dealing with the issues raised by nurses in a way that is consistent with existing social partnership agreements and that would facilitate the maintenance of social partnerships into the future. The Government has welcomed the willingness of the Nursing Alliance to work to achieve this.
Yesterday evening, representatives of the Government met the general purposes committee of the Irish Congress of Trade Unions to explore possibilities in regard to agreeing a viable process, consistent with existing social partnership agreements, for resolving the dispute. A further meeting is taking place this afternoon and it is still going on at this stage. I assure the House that I will do all in my power to bring the dispute to an end as quickly as possible, emphasising all the time that it must be within the parameters of social partnership. Once a process is devised with the agreement of both sides, that end result would be in the interests of all our people.
The General Secretary of the Irish Congress of Trade Unions, Peter Cassells, tonight said that he could see no circumstances under which nurses would not provide emergency cover. He said that there is a close bond between nurses and their patients and that the congress would work with the nursing alliance to ensure that the bond is not broken, and that emergency services continue to be provided.
Nurses have already shown their commitment to patients by giving their services free to provide emergency cover. Management must not exploit or abuse this good will and generosity. Any such action by management would be damaging to patients and also make this dispute more difficult to resolve.
As Minister, I make it clear that management will not act in that way. Intensive discussions are still going on between representatives of the Government and ICTU. No one underestimates the difficulties involved in reaching agreement on a process for resolving the issues in the nursing dispute. I reassure the House that I am doing everything I can to resolve the dispute within the context of social partnership.
I would like to conclude by affirming that the Government is anxious that a process be found as speedily as possible for dealing with the issues raised by nurses in a way that is consistent with existing social partnership agreements . . .
I am glad he made that statement but it contrasts with the intransigent messages in the newspapers, for example, “Finance Minister says Government will not change its stance on nurses no matter  what”, “Early deal hopes fade” and “Minister Brian Cowen conceded that it will take a long time to find a formula to settle the dispute”. If I were doing a case study on conflict resolution with a group of students I would like them to know how to resolve disputes and how not to resolve disputes. I would take all the conflicting messages from the Minister for Health and Children and the Minister for Finance as examples of how not to resolve a dispute. It is difficult to find a positive attitude by the Minister in finding a solution.
Last week I outlined the grievances of nurses and I will not repeat them. These grievances were dealt with by the Minister in his statement and he also gave us a run down of all the positive things he has been doing as Minister. I will not go through them all. However, he must have a communication problem with the nurses in relation to the Commission on Nursing and the other matters referred to. If I were a nurse and had listened to what the Minister said, I would see that there are positive developments. He must be doing something right as Minister but it must not be communicated to the body of nurses.
It is extraordinary to link the Minister's contribution with today's situation and the reaction we are getting from nurses throughout the country. Whether we like it or not the strike is on. There is anger and the nurses are resolute. As I said last week, the Minister is dealing with a nursing organisation that is predominantly female and if there is one thing I can say about women, with my hand on my heart, it is that they are tenacious and resolute. They may be naive because they have never been on a picket line and they may be perceived as a naive body that does not understand the long path that they have embarked upon.
I hope the Minister is not playing on the fact that nurses have never had a strike and that sooner, rather than later, he will be able to break them down. I hope that the Minister is not embarking on a strategy of delay and undermining the nurses where he will bring them to their knees. Up to now they have shown goodwill, given emergency cover and are working for nothing. This is not the normal practice in trade union disputes. Nurses are working for nothing and giving emergency cover. They are bewildered and baffled and, from what I can see, they are facing a long strike.
This is not a normal strike. I know I will not have to eat my words when I say that public sympathy for the nurses will not evaporate because the public support them. I hope the Minister does not think the public will change their tune because I do not think they will. Whether we like it or not the public are linking what they have seen on television, day in day out, regarding the spending of money and numerous tribunals with the extraordinary buoyancy of the economy and with the nurses' case. For decades the nurses have not been listened to. They have continued with their work and outlined their issues to the Mini ster and to their unions. It is not their fault that they are in the early stages of union politics.
As a teacher, I know that the teaching unions, the INTO and the ASTI, are strong and they would be in a different category in a dispute because they have had the experience of industrial disputes and having strong union members. Nurses are only now reaching that stage and, therefore, should be treated in a different way. They must be spoken to in a caring and compassionate manner. They must see the Minister as someone who is trying to find a formula and, unfortunately, they do not see him in that light. They see him as the enemy.
I am sure the Minister would not like to go down in history, as we enter the next millennium, as the caring, uncompromising Minister who, for some reason, does not seem to be able to engage in dialogue with the Taoiseach – despite his long experience as a fixer and as Minister for Labour – or with the Minister for Finance, Deputy McCreevy. I hope the Minister for Health and Children, the Taoiseach and the Minister for Finance will get together before the Minister meets Peter Cassells and the various bodies he will negotiate with. Surely the Minister has compassion. Surely he knows he is alienating the biggest percentage of the general public that will ever be alienated on any industrial dispute.
Mrs. Jackman: —who failed to see that people are more important than social partnership. I ask him not to blame the nurses for the breakdown of social partnership. It is not their priority. As far as they are concerned their priority is the elderly—
Mrs. Jackman: Senators on the Government side would not react so aggressively if I spoke to them individually. They would support me. I know they are unhappy to sit on that side of House with this dilemma. They are members of health boards and are in direct consultation with people who are begging them to do everything in their power to have this conflict resolved.
Mrs. Jackman: I am being fair to the Minister. I am even thinking of his political career. I ask him not to face the next millennium as the Minister who had to deal with the most heartrending dispute that will ever happen.
Dr. Fitzpatrick: I thank the Minister for coming to the House this evening. The House debated the nurses' strike last Wednesday and I thought we might have waited to see how matters developed over the weekend, because I am sure there is ongoing contact between the different parties. However, the Minister has come here at short notice and is prepared to listen to Members and put his case. He should be congratulated for that. I am sorry that Senator Jackman used such pejorative language. We are at a sensitive stage in the deliberations and discussions between the various parties and such language does not help. It tends to inflame minds and entrench positions. We are trying to obtain a resolution of the dispute – conflict resolution is the term that has been used – to get the nurses back to work. They do that work excellently and we should all be proud of the nursing profession. If they have a communication problem it is probably from the leadership of the union right down to the rank and file. Perhaps when the strike is over they may examine their experience of being on the picket line and how it helped or hindered their case.
It was interesting to hear the Minister say there were 200 recommendations from the nursing commission of which only three are causing problems. These three are pay related. They were being pursued without reference to the wider picture. Nurses are not the only people working in the health service or in the public service. Each and every other union in the public service is watching what is going on at the moment and they will make their own plans depending on developments. They will not sit by and allow leapfrogging to take place. That is why the difficult discussions are taking place between the Irish Congress of Trade Unions and the Nursing Alliance. We may have to wait until they are sorted out before we can get down to substantive discussions between the Department of Health and Children and the nursing unions. The Minister has presented the picture very clearly and has set it in context. We will get a fuller and clearer picture over the weekend and we will probably be back here again to discuss the problem.
Mr. Ryan: An eminent writer once said that whenever the Catholic Church was about to change its teaching on something it always began by saying, before the new teaching, “As the Church has always taught. . . ”. So, when I read a script the second paragraph of which begins, “There has been no change in the Government's position. . . ”, I take that as a signal that we are on the way to fundamental change. Already we  have had a fundamental change in tone. This is the sort of speech the Minister should have been giving three or four weeks ago, once it became obvious that there was a problem about the Labour Court's recommendation. That was the time for a speech like this, offering possibilities, solutions and routes to people to resolve their differences, instead of the no, no, no, response which we have had from the Government. Such a response is inappropriate to a trade union like the INO whose members are new to this business. One often gets the impression from the Government that it did not realise the novelty of the situation facing the nurses. The Government seemed to believe that the understandable but pointless barracking that goes on between disputants in an industrial relations problem, where both sides are vigorous, experienced and well rehearsed, was appropriate here, but it was not. It was inappropriate because the single biggest union is very new to this sort of activity. It has been driven into the dispute by the neglect of nursing by a succession of Governments and the extraordinary capacity of society to presume upon those who work, for good reasons, to provide care. Because of the degree to which they do it out of choice and commitment we presume upon them and we have done this in many areas. I am glad the Minister has adopted a sensible tone. He should have done it weeks ago but he has at least done it.
This dispute ought to be a signal to the Government that while one cannot dispute the fact that it should not breach the principles of partnership, there is a profound reassessment going on in our society of what precisely partnership is supposed to mean. There is a real question in many people's minds as to whether such a thing ever existed. In the last two years nobody ever said to a builder that for the sake of partnership he should only make a 15 or 20 per cent margin on his housing development. Nobody ever said to an auctioneer that for the sake of the principles of partnership he should not fix his fees as a percentage of the property price. Nobody ever said that to a solicitor or an engineer either. A whole section of our society has become extraordinarily rich on a principle of maximising what one can get from the sacrifices of others. Ultimately, this dispute is about a stance taken by a profession which epitomises the conflict in our society between those who work and care and those who parasitically have become rich on the strength of other people's sacrifices.
I do not want social partnership to break down but we are moving into a phrase where it has got to mean partnership, not just sacrifice and restraint on one side. I would like to see a partnership where some restraint is shown by the many who have done well in our society and who have displayed vulgar affluence. I would like to see it in the language used by the Minister for Finance, who tells us that he – unlike the rest of us, apparently – lives in the real world. I can tell the Minister for Finance, however, that the real  world is on the picket lines outside our hospitals. Those people know more about reality than any member of the Government or, indeed, any member of the Oireachtas, including myself. That is the reality. It is not the reality of a fast-buck enterprise culture, but the reality of people who believe in sacrifice, service and all those things that should mean real partnership.
If the Government wants a partnership in the future it will have to tell those who have done so well during the past seven years that it is now their turn to pay. They got the icing on the cake in the good times when other people exercised restraint. One of the latter group has now had enough. We have to resolve the dispute and I am glad the Minister has taken the route he has. I hope he succeeds in silencing the Minister for Finance whose peculiar pronouncements on all these matters will do more harm than good to partnership. The Taoiseach is a sensible man and I hope, therefore, the dispute can be resolved swiftly. Mr. Peter Cassells and the Irish Congress of Trade Unions are yet again being called in to rescue us from industrial chaos. They will do so, but it may take some time.
The fundamental lesson of this dispute should not be forgotten. It is that a huge section of the population has now concluded that this is a rotten and unequal society in which some carry the burdens while others take the gains. The share of national income that has gone to those who are not in employment has escalated quite spectacularly over the past seven or eight years. Some of that was necessary to free up resources, but we are now so rich that the only choice is whether we make it fair again or whether we institutionalise inequality. If the Minister is telling us that the only partnership the Government understands is the continuing institutionalisation of inequality then that is the end of partnership. The Minister should watch his language carefully. We are not just dealing with an existing partnership. Every trade Unionist is watching the negotiations in the context of the future of partnership. I can tell the Government that the next partnership will have to be real. If there are sacrifices, they must be shared, and if there are gains, they must also be shared. Any other concept of partnership is dead in the water.
Ms Leonard: I thank the Minister for coming to the House at short notice to discuss the nurses' strike action. It is regrettable that it is necessary to discuss the fact that nurses have gone on strike. It is also regrettable that the dispute has been ongoing since 1994. Despite what some people might wish to believe, the blame cannot be laid solely at the door of the Minister. In 1997, when I was a member of the nursing profession, meetings of strike committees discussed an impending strike. It reached the stage where we discussed emergency cover. Thankfully, at that time the issue was passed on to the nursing commission. As the Minister outlined, he has put forward a  number of proposals and made advances on a number of issues since that time.
In apportioning blame for the current dispute, some blame must be laid at the doors of previous Ministers and also the nursing unions. Undoubtedly, they are aware of the advances which are ongoing in the Department. Why has it taken seven weeks since the Minister accepted the Labour Court recommendations for constructive dialogue and negotiations to take place? As the Minister said at the weekend, it was only on Sunday that the Nursing Alliance recognised that the Government had obvious difficulties in dealing with the dispute under the existing social partnership agreement.
However, the fundamental aspect regarding the nurses' dispute refers to the changes which have taken place in the nursing profession over the last ten years. The term “vocation” has been used on many occasions in reference to the nursing profession. However, nursing is no longer a vocation. It is a profession which has undergone radical changes in terms of education, qualifications and the delivery of care over the past ten years. From my perspective as a person who entered the profession 13 years ago, I look back nostalgically at the way I trained. However, things have changed and advances have taken place in the entire profession. Technological and medical advances mean that the profession of nursing must change with the times.
It is incorrect to state that nursing will lose its caring touch with the changes that have taken place. Nurses must continue to change and adapt to changing practices. Part of the reason I believe industrial action is taking place is that nurses feel little acknowledgment has been given to the changes in their working practices during this period. The days when a nurse could survive with one or two qualifications are gone. Due to the advances in procedures, technology and pharmacology, nurses must continually update themselves on new practices and technology, as well as carry out basic nursing care.
We are all aware of the complex issues we face. The Government has put forward its position from the beginning, as the previous Government did in 1997, on its inability to break the partnership agreement. The unions now appreciate that the Government is bound by social partnership. However, there must be ways and means within the agreement which would allow the changes in nursing practices to be addressed. More than anybody else, nurses realise that settling this dispute will not bring an end to their problems as a profession.
The Minister referred to the report of the Commission on Nursing. He said that in the final analysis the commission's report is all about the developing role of nurses and giving concrete expression to the recognition of that role. As far as I am concerned, that is the most fundamental aspect of the Minister's speech because that is what nurses have sought. As the Minister said, the commission is the way to gain the recognition  which nurses so rightly deserve. I welcomed the Government's acceptance of the broad thrust of the Commission on Nursing and its commitment to implement the recommendations over time. Despite the ongoing difficulties regarding the three pay related recommendations, progress has been made on the commission's other recommendations. I hope that greater cognisance is given to the other recommendations rather than solely reflecting on pay related issues.
Nursing is not a vocation. Nurses are no longer the handmaidens of doctors. Unfortunately, the public perception still remains that nurses play the role of Florence Nightingale. I hope some aspects of the Florence Nightingale approach are still in operation in what is a caring profession, but we must remember that it is a profession. Part of the problem is that nurses throughout the years have not been involved in decision making and the Minister referred to this point. I welcome the fact that the Minister has involved nurses specifically in the interdepartmental group which will formulate and implement policies in nursing in the future. He has also involved them in management at unit and ward level. Part of the problem is that people get hung up on the issue of pay. Unfortunately, this creates more hype in the media, but there are other aspects. These are the avenues which must be pursued and where we will be successful.
I have welcomed the fact that the ICTU has become involved in the dispute because it reached the stage where there was a need for some form of objectivity. The ICTU has been extremely successful in negotiations in the past and the time had come for its involvement particularly because the Nursing Alliance, as Senator Jackman said, is inexperienced in negotiations. I welcome ICTU's involvement in dealing with these complex issues. In common with everybody in the country, I hope this dispute is resolved as soon as possible. Morale in the profession is low. That has been the case for a number of years but people will agree that prolonged disputes are not in the national interest or the interest of the profession. There must be ways within the current social partnership structure which would allow some of the issues affecting nurses to be addressed. I hope a solution acceptable to both parties can be reached and I wish the Minister well in his deliberations.
Mr. Glynn: Most of the points one would wish to make have already been made at this stage. However, it is important to recognise and appreciate the alacrity with which the Minister responded to the conciliatory comments of the leader of the Irish Nurses' Organisation. The Minister should be commended for that move. There has been a real effort by members of the Opposition parties to demonise the Minister, Deputy Cowen. I totally reject those efforts. One only need look around the Chamber at the few  Opposition Senators present to realise the importance the Opposition attaches to this issue.
Mr. Liam Doran's comment that he recognised the difficulty facing the Minister and the Government opened the door to talks. It is a pity that comment was not made some weeks ago. The Minister and I know each other for a long time and he knows I am a straight talker. I do not take any prisoners in what I say. In fairness to the Minister, he said all along that he was open to talks if people wanted to talk to him. When the olive branch was extended, the Minister's reaction was instantaneous.
My colleague, Senator Leonard, dealt at length with many of the issues I wished to raise. However, I wish to record my appreciation of the nursing profession, which I support strongly. For a long time the nursing profession and all the disciplines thereof have been taken for granted by successive Governments. It is a pity things have come to this pass, but we must deal with the situation. The Commission on Nursing and the report it produced provides the framework by which many good things can be done for the profession. Many long-term injurious situations pertaining to the profession, for example bullying, can be addressed, and this is to be welcomed. I made a statement in the House to the effect that many young men and women – there are men in the nursing profession and I was proud to be a member of it for 30 years – left the profession because of bullying.
At the Oireachtas Joint Committee on Health and Children and at a meeting of Westmeath County Council last Monday, comments were made by members of the Opposition that patients would die. That casts aspersions on the nursing profession because members of the profession, and all disciplines pertaining thereto, are now providing a service free of charge. Are those people saying that nurses are abdicating their responsibilities to the people in their charge because there is an industrial dispute? I reject that. It is a slur on my colleagues with whom I have worked for many years. They are doing the job now as they have always done and even if they are doing it for nothing they will do it with no less zest.
The Minister has a difficult task and I wish him well. He has my support in trying to come to grips with a very difficult problem. It is not easy to be responsible; it is easy to be populist. Not long ago the Government, headed by the Taoiseach and his colleague, the Tánaiste and Minister for Enterprise, Trade and Employment, provided parity to retired nurses under the last major wage increase. These are the men and women who built up the nursing profession and the care services in the country since the inception of the State and before. I thank the Taoiseach and the Tánaiste for their action. To those members of the Opposition exercising their limbs on the picket line for obvious political reasons I say it was a great pity they did not make such an award when they were in Government. Any benefits  and pay improvements awarded to the nursing profession have, in the main, been granted by Fianna Fáil Governments and, latterly, by the Fianna Fáil and the Progressive Democrats in Government.
Ms Cox: I am glad Senator Ryan is in the House because I welcome the fact that the Labour Party is supporting the stance taken by the Government when it says it does not dispute the fact that social partnership should not be breached and that any resolution must be within its parameters. I also agree with Senator Ryan that the speech made by the Minister should have been made three weeks ago. However, it should have been made by the trade unions talking to the nurses when the Labour Court recommendation was made.
I have spoken privately to the Minster about what I believe Governments have done, but it is not for the Government to do the job of the trade unions representatives of the nurses, or of any other organisation, be they doctors, teachers or whatever. I compliment the Minister for returning to the House tonight and on what he has said. I wish him the best in what he intends to do.
Minister for Health and Children (Mr. Cowen): I thank those who spoke in the debate. Senator Jackman asked if there was a strategy of delay. There is no strategy of delay on the handling of this dispute. Regardless of party political colour, we all recognise the urgency and importance of trying to resolve disputes such as this.
The problem centres on why the dispute arose in the first place. Many of the arguments last week centred on a vehement defence by me of the Government position on why there should not be a dispute. The resolution of this dispute, should we find a process for resolution – discussions are ongoing – will be on the basis of non-confrontation, respect and the upholding of the institutions of State established for conflict resolution in industrial relations matters.
That is why a strike never makes sense. As a former Minister for Labour I have some knowledge of these issues. I have never seen a precedent where a group of workers had before it a recommendation for an award four times greater than what was available to other groups of workers under the same agreement and, more importantly, that in consideration of the acceptance or rejection of that recommendation they had, because of a previous recommendation, a Commission on Nursing report which provides, as stated in its title, a “blueprint for the future”. It also gives nurses a wide range of possibilities in providing the various promotional grades, career paths, the need for the empowement of front-line services and the need to change the post-qualification standards available and the resources and educational attainments required to achieve that end.
 It is all there. So that, apart from the three pay related recommendations, a structure was in place to proceed with the development of nursing in a way that nurses wished to chart their profession by reason of the fact that more than half of the ordinary members of the profession were themselves nurses. It was an outstanding example of a meaningful consultative process and that had a direct input into policy implementation and formulation and the ability to establish – a recommendation of the report – a monitoring committee so that it would not become another report on a shelf.
That is why this strike is unnecessary. However, there is no point going over that ground tonight. We have had those points of view, there has not been unanimity on them and political points will be made about them. Nevertheless, the reality is that the resolution of the dispute will, in broad principle, be within the same parameters the Taoiseach set out in Galway more than three weeks ago. It will be within social partnership because that is something to which the social partners are committed and of which the ICTU is a valued member and to which the INO, SIPTU, IMPACT and PNA are constituent members.
I contest Senator Ryan's assertion that there has never been a real partnership. When people talk about sacrifices it must be conceded that in any democracy there will always be an agenda for change and a need to improve for people who have not come forward or who have been unable to take their rightful place or make a contribution to society. That will be a relevant issue regarding the relative prosperity or poverty of any economy or community. However, in an era of social partnership the real take home pay of workers has improved by 35 per cent. That is a fact. Without the era of social partnership the idea that a Commission on Nursing should introduce such wide ranging recommendations with any possibility of implementation would be an illusion. It would not have been possible in other circumstances.
The fact that we have this major problem which challenges the social partnership does not mean we should throw away the principle. It is a requirement of the social partnership, which is a two way street, to come up with a process to resolve this problem while at the same time maintaining the social partnership now and in the future. This is the challenge for Government representatives and ICTU councils members who are conducting discussions at this time. Were this a simple issue, a solution would have been found before now. However, the issue is not a simple one and every responsible body of opinion within the social partnership, whether they be ICTU members, Government representatives or employers, recognises this fact.
We need to inject a realism into this process. We cannot have a wide ranging agenda which can be funnelled into a process to deal with the issue within the parameters of pay and partnership.  When I met representatives of the Nursing Alliance on Monday I put this point to them and I think they accepted it. The context in which we are trying to devise this process is that it is fair, that is, that both sets of problems must have equal status. The problems they perceive in terms of getting people back to work is a legitimate issue from their point of view. Equally legitimate is the Government's position that this process must be conducted and brought to a conclusion within the context of pay and partnership. That has the effect of squaring the circle and seeking to modify some of the demands. This has the ability to bring forward a process which will not abdicate the agenda of the nursing unions but will put it in a position to be dealt with in a structured way, some immediately, some in another context, some by way of clarification and some by way of referral to a post-partnership agreement.
We face a complex set of problems which are not conducive to a simplistic conclusion. This is precisely why we are in this position which is made all the more difficult against a background of an industrial relations conflict, a strike, as we speak. There is this mass media message which attempts to render simplistic complex problems which does an injustice to the positions of both sides in a dispute such as this. The tendency to personalise, demonise and to attribute blame or doubt is not helpful in the context of the discussions which are taking place at the moment. There is a necessity for people to recognise the context in which we must operate in order to uphold the principles of social partnership. In relation to outstanding issues, whether it relates to this problem or problems generally throughout society, the ability to negotiate future agreements which will take account of these difficulties is precisely what social partnership is all about. This involves discipline and the possibility of improvement by adhering to that discipline.
I believe that the social partnership is being tested here and we must prove it to be a two-way street. There are rights and obligations. Successive Governments, under successive partnerships and because of improved economic conditions over and above the assumptions which formed the basis of these partnership agreements, have honoured in full their commitments in social and economic terms. Indeed they have exceeded their  commitments by way of tax reform and so on where legitimate because of the fact that growth was greater than anticipated. Successive Governments have met these commitments and we must now ensure that other pillars of the social partnership honour their commitments, however difficult it may be, while understanding the pressures, emotions and problems that exist during a strike such as this. Every pillar of the partnership must meet its obligations. This is why the Government, the Irish Congress of Trades Unions and the Nursing Alliance has a great responsibility. None of us can evade this responsibility. We must give equality to the problems that exist but if anyone thinks there is a magic formula or a flick of a thumb which can solve this problem and meet these requirements, they are giving people false hope and reducing the complexity of the issue which does an injustice to those who have a right to withdraw their labour, take part in a peaceful protest and picket outside an institution.
Unfortunately, it is the first time this has happened in the nursing profession. Let no one suggest that anyone in this House thinks less of the nursing profession than anyone else. That is not the issue. I have as son, husband and father, been privileged and honoured to witness the professionalism required to ensure we have a modern health service in this country, of which nursing is a central and critical part. However, at the end of the day, we must not reduce the complexity of this issue to politicising which will do nothing for the nursing profession. We must hope that those currently discussing the issue will come up with a process which will provide the possibility to resolve the issue successfully, realistically, fairly and reasonably, while at the same time meeting the requirements of both the Government and those in dispute. That is what I hope for and will continue to work for tonight and I will not get involved in political stunts to divert me from my responsibilities as Minister for Health and Children.
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