The motion refers to nursing shortages. I am a member of the Oireachtas Joint Committee on Health and Children and it received four submissions on this. Two were presented by Liam Doran, INO general secretary, on 22 April and Oliver McDonagh, national nursing official, on 6 May. The former referred specifically to the areas of recruitment that employers should focus on in terms of marketing nursing to attract young people. Nursing was more difficult to get into in the past than medicine at third level. Over the years young girls said it was impossible to get a place as a student nurse and chose careers as engineers, accountants and so on. It was not made attractive as a profession in terms of being suitable for and easily accessible to young girls. These issues were raised last April in terms of the nursing shortage which has further exacerbated the health service.

The Oireachtas joint committee also received a submission from Eugene O'Donoghue, CEO of An Bord Altranais. He stated that "It is inevitable that the task of filling all training places will become more difficult with demographic changes.". He highlighted the fact that the current figure of 340,000 young people aged between 15 and 19 would reduce to 245,000 by 2011. It is not as if we do not have information regarding this problem. On 17 June the committee heard a submission from the Health Service Employers' Agency again regarding the nursing shortage and related issues. It stated that "While there continues to be great interest in general nursing as a career [I disagree with that remark] there has been a lower level of interest among young people in both psychiatric and mental handicap nursing".

These submissions were received last April and there has little or no acknowledgement of the issues highlighted by the Minister. In April 566 nursing vacancies remained unfilled. What is the current figure? The motion also refers to the 11 per cent increase in public in-patient hospital waiting lists over the lifespan of the present Government and the fact that a proportion of this increase is due to nursing shortages. There are tremendous problems in the Mid-Western Health Board area, which is replicated in every other health board area. The Minister has done the rounds and is aware of the problems. A total of 1,570 people are on the waiting list for Limerick Regional Hospital.

The rainbow Coalition presided over major infrastructural developments in the Limerick area but the facilities which were provided are yet to be utilised because of a lack of human resources. There only two radiological rooms available since 1998 and they will remain unused until the end of June. There are other problems within the regional area with operating theatres not being used. This is replicated in the other health boards. There are two main operating theatres being used out of a total of seven, which is a shame, considering there are five brand new ones not in use. There are two renal dialysis stations which could have been occupied since 1998 but are not.

What is the point not having continuity from one Minister to another, ensuring that the existing facilities can be used, the lack of which is further exacerbating matters in the Limerick area in the Mid-Western Health Board? The result of the inefficiencies of the existing infrastructure is that operations will be cancelled, the relationship between doctors and nurses will be undermined and patients' lives will be put at risk.

Of course, this is not what the Minister or I want, or what the nurses or the general public want. I find that instead of being proactive the Minister seems more concerned with talking to the agency I mentioned about dealing with emergencies if the strike happens, rather than trying to ensure that it does not. It is important that the Minister, from a personal viewpoint and as Minister for Health and Children, should forget the past and consult the nursing unions. There is very little time and the damage caused will be irreparable. It is not an insurmountable issue.

I was in Canada on a Help the Children mission and I found that for nearly two years each national newspaper led with stories on problems regarding nurses. The sympathy of the general public was still strong after two years because of ward closures, the undermining of nursing, a lack of appreciation of their skills and the changing nature of their work. The public is supportive of nurses but it will be a disaster if within a week the Minister does not solve this problem and speak to the nursing professions who do not want to strike any more than he wants them to. I appeal to him to take time to listen and to talk, and to avert a disaster which will affect the whole country and bring undue suffering to many.

Mr. O'Dowd: Fáiltím roimh an Aire chuig an Teach chun an díospóireacht an-tábhachtach seo. This is a very important matter and we believe that the health services are in a very serious crisis, not just a crisis of funding, but one of confidence. The country is in fear of a nurses' strike. People are worried about the procedures that will be in place to ensure that if someone becomes ill their lives will not be affected by it. It is the concern of the Minister and the health service providers, but if both sides continue to play hardball, the only ones to suffer will be ordinary people. It is incumbent on the Minister, this Department and the Government's supporters to make every possible effort to ensure that this strike does not take place.

It is ridiculous that someone quoted in a newspaper as speaking on behalf of the Minister said they did not expect any last minute intervention before the strike went ahead. The public expect every intervention and everybody to work to resolve this matter, whether it is in front of the cameras or on the 'phone from the Minister's office. The work must go on and must be seen to go on and it must succeed. We are politicians and our job is to find common ground and possible solutions. People cannot always get what they want. Politicians try to understand the competition between different demands, but in this case, nothing is more fundamental than the life of a person who may be in a hospital next Tuesday night. The last thing we want is a human tragedy.

Senator Jackman mentioned the considerable, increasing and unacceptable waiting lists. As a politician, I have a succession of elderly people visit my clinic, as I am sure the Minister has in his, who need hip replacements, who are in pain and are on long orthopaedic waiting lists. I met people in May and June who were told that the local orthopaedic hospital was going to close for the summer but for treating emergency road traffic accident cases or trauma cases, but not elective surgery. It is a shame that orthopaedic hospitals are not working throughout the year to reduce the waiting lists. The consultants must have holidays and properly so. We need to examine the way we manage our waiting lists and we need a new approach to the problem. Over a 12 month period we should run our services to their full extent, even if that means that the Minister must create a new posts for temporary consultant orthopaedic surgeons who would travel around the country to different health board areas during the summer. This is a career structure that would have to be properly worked out, but in principle it makes sense.

We need to spend more on our health services. In Ireland we spend less than the European average, which is a disgrace. Our population is living longer - many more people will live into their eighties and nineties. That creates its own demand within the health service, and I acknowledge that it contributes to the increase in the waiting lists. Nevertheless we need a strategy to deal with it.

Senior citizens in acute hospital beds should occupy other beds when they do not need high-tech care. I know of a patient in County Louth who is ready to be discharged from hospital but she cannot go home because there is a crisis in home help services. There are no home helps available in Drogheda to look after these patients and I understand this is a crisis countrywide. Who would work for £3 an hour? Those who do home help work do not do it for the money but they should be paid a decent amount. We must look again in our health services at a new strategy for home help and carers in the home. There are training programmes available for them but we need a system where they are offered more of a job than a few hours part-time. I know of people who need access to acute care in hospital, yet there are people in acute care in hospital who cannot get out. This must be addressed. In the community care area of Louth and south Monaghan if a child of four or five years of age has a serious speech impediment he or she will get the attention of a speech therapist 12 months down the line. I have letters from people who cannot send their children to school because they cannot speak. The health board cannot provide the services.

The reality is, as with our nurses, there is a crisis with people who are badly paid in our health service. Speech therapists are much better paid in the private sector and we cannot hold on to them. These are the issues the Minister must tackle. We need a hands on approach from the Minister to these issues. It is not good enough to produce waiting lists month after month. The people are sick of it. They want action from the Minister. In this time of great wealth, when we were never better off financially, when there is so much money around and so little for those who need it most, the ordinary people who built up this country, ordinary taxpayers cannot get the services to which they are entitled. The people who work in that health service, in particular the thousands of nurses who have dedicated their lives to their community, are paid a miserable wage. I believe public opinion would support their exceptional case and that the Minister should find a mechanism through the Labour Court to do a deal to keep the nurses working, thus ensuring the people get the services they so badly need. If the strike goes ahead our waiting lists will be crippling for thousands of people. The Minister must not allow it to happen.

To delete all words after "That" and substitute the following:

"Seanad Éireann,

- acknowledging that the Government has accepted Labour Court Recommendation No. 16261 of 31 August, 1999 on nurses' pay and allowance claims;

- noting that the Labour Court itself has stated that Recommendation No. 16261 is 'the culmination of many years of discussions and negotiations on nurses' pay and conditions';

- recognising that the Government is committed to implementing the recommendations of the Report of the Commission on Nursing, which are designed to address the underlying problems within the profession and develop nursing as a key profession within the health services;

calls on the four nursing unions to call off the threatened all-out nurses' strike and to pursue their case in the context of forthcoming discussions between the Government and the Social Partners on a new national programme to succeed Partnership 2000."

Listening to the Opposition Senators one would think the health services were falling apart. We have an excellent health service staffed by excellent people. Nothing is perfect in this world and glitches occur. There are areas that need to be attended to but by and large we can hold our head up with anybody in Europe on a comparison of the quality of our health services.

As a matter of interest, I am not about to quote the Minister but a recent article in The Irish Times which states that our nurses are not the worst paid. After Denmark, Sweden and France they rank fourth. The three countries mentioned have a higher per capita income. We are also taking into account Irish punts. After Ireland come Germany, the UK, the Netherlands, Portugal and Spain. Things are not that bad. There may be differences in the cost of living but comparing like with like the nurses are doing reasonably well. Nobody is paid enough for the job they do. Everybody can make a case for it.

I welcome the Minister to this debate. I agree with Senator O'Dowd that this is probably the most important debate we will have this term, but not for the reasons he mentioned. We are coming up to the negotiation of the next partnership contract between all the social partners - farmers, business people, unions. They will set the standard for the next three or four years. I was here in 1987, some people were here before in the early 1980s, when the public finances were, to put it mildly, going down the tubes. Different Governments over the years put their minds to sorting out the finances and the economy so that everybody could have a reasonable standard of living. Not one Government but all Governments since 1987 can take credit for our standard of living today.

We have arrived at a situation where, before the negotiations begin, one group in the public sector is trying to run a coach and four through and to set the agenda before their colleagues in the other unions have agreed it. I have the highest regard for nurses. I depend on them every day of my working life. Individually and collectively they are an outstanding group of people. I could not find any complaint against them. They are highly trained, highly motivated and deliver a first-class service. The problem is they are poorly led. We have to look at the leadership of the nursing alliance for the present contretemps.

The Labour Court judged in 1987 that nurses were a special case. It proposed a 17 per increase for staff nurses and a 14 per cent increase for promotional grades and proposed a nursing commission to examine a number of issues concerning the profession. When the commission published its report, containing over 200 recommendations, only three concerned pay and they went to the Labour Court. In September, at the end of the holidays, when the Labour Court published its findings, the entire claim came to £200 million. Following a Cabinet meeting it took the Government 24 hours to deliberate and agree to it while it took the nursing alliance three hours to reject it. That denotes a thinking and reflective leadership. There is room for further development in nursing. I agree it is coming from a long way behind, but the way to progress is at the next forum, though the discussions which are beginning between all the interested partners. It is said that nursing is not an attractive job or vocation. This year there were over 5,500 applicants for 1,000 places. Therefore, there were 1,000 vacancies in the student nursing schools.

The major problem which the Government and the social partners face is that the other public sector unions are unwilling to allow special status to, or financial recognition of, the nurses' special place in society without a financial quid pro quo for themselves. I have no doubt that if nurses were to get an increase outside the accepted norms, Senator O'Toole would be leading his teachers down to Tyrone House and leaders of every other public sector union would do likewise. That is their business. I agree nurses are a special case but there is no point in my saying it. There is no point in the Government saying it, the Minister cannot say it, unless they are partners, unless the public service unions agree they are a special case and are prepared to stand back and allow the nurses special status. There is no sign of that. The silence of the Trade Union Congress is deafening. It may prefer to go ahead next week and sanction pickets. However, I ask the nurses to stand back and look at this.

I read in the paper the other evening that the INO has £500,000 in its strike kitty for 27,000 nurses. However, it will not spend it on strike pay but on publicity. I question a leadership that looks after its publicity before looking after its membership and I would have serious questions to ask.

Dr. Henry: I welcome the Minister to the House. Naturally, I am extremely glad I do not have his job at the moment because there is a grave number of problems in the Department of Health and Children, the situation with the nurses being one of them. There has been much concentration on the financial side of this argument because the Labour Court dealt mainly with it. It is important that we recognise that there is more to the argument the nurses are having with the Minister than money. I do not know how many Members have read the recommendations of the Commission on Nursing. It is three enormous tomes which have been very densely researched and contains a considerable amount of national and international information and reams of recommendations. I thought of bringing the three copies I have to the House and of reading some of the recommendations into the record of the House, but I wondered which ones I would start with because there is a large number. It is not only the financial recommendations which are important.

Are we in this situation because insufficient progress has been made in the areas which do not involve money? It seems to me from working in the health service that there has been little progress in all the areas which involve recommendations other than finance. Listening to my colleagues in the nursing profession, I cannot help but think of Yeats's line - "Too long a sacrifice makes a stone of the heart". I cannot help but feel that a considerable number of nurses believe they are in jobs in which they are working in difficult conditions and, worse still, sometimes with staff shortages. If their other problems were looked at more quickly, we might manage to get somewhere on the pay front. I understand the Minister's difficulties but one can never say enough about what nurses do. I do not know how I would quantify what is enough to pay the people who work with me, but certainly it is more than they are being paid. Is it more than they are being offered?

A serious problem is the fact - and this is well recognised - that the structure of nursing has totally changed in the past 20 to 30 years. Nursing was a nice job for nice girls. In fact, I believe a Member of this House used to advertise nurses' dances.

Mr. Cassidy: They were very successful.

Dr. Henry: They were a very successful sort of superior dance-----

Mr. T. Hayes: Some of us went to them.

Dr. Henry: ------ because they implied that a superior sort of girl would be there. They were extremely successful, as I remember from being in an area where the nurses' dance were held. It was a short-term job with good marriage prospects. All these issues are in the report of the Commission on Nursing. It was not a long-term career, but this has totally changed.

The majority of nurses are women who go into nursing looking for a life-long career, and thank goodness for that. I could not describe the competence of the people working at staff nurse level, in particular. I do not believe one would get such a high level of competence and training among staff nurses in a large number of European countries or even in the United States. We have been terribly fortunate in the way nursing has evolved. Women who trained as nurses and who married local businessmen, farmers, teachers and so forth have been accommodated, and often well accommodated, by smaller hospitals around the country in part-time and flexi-time jobs. They are absolutely superb at their job. To see that these people, who are of such importance, have reached such a pitch, is very worrying. To see the votes in favour of strike action which came in from provincial hospitals, where a large number of nurses realise the value of the job they do, is one of the most worrying aspects of all.

This short-term career for a woman has now totally changed. We must recognise that these women are very badly paid. Women have traditionally been badly paid and have always been paid 70 per cent of the average industrial wage and, guess what, after nearly 30 years of equal pay, we are now up to 74 per cent. These jobs have not been recognised as being as valuable as they would have had they been male jobs only. That is a psychological problem which we have to get over. It is unfortunate that recommendations on pay are tied in with other groups outside the health service because it is, without a shadow of a doubt, within the health service that they are seeking their gradations to be tied. It is not reasonable to have them tied in with people outside the health service. If that cart could have come before the horse, it would have been extremely helpful.

The Minister has a serious problem in that the market is in the nurses' favour. Without a doubt, the nursing shortage in the Dublin hospitals is very serious and it is worst in the operating theatres. Within the last few years, I have had complaints from Tallaght, Beaumont, the Mater and St. Vincent's about operating theatres being closed, and I do not mean one or two. Operating theatres have been closed because of the shortage of theatre nurses. This is an appalling situation when one thinks of the cost of constructing operating theatres and of the medical staff and ancillary staff to carry out the operations, yet list after list is cancelled. Frequently, a type of entente cordiale is struck between consultants who agree to cancel Monday one week and Tuesday the next, so that we do not have a situation with at least some sense of order. One hears of four out of nine or four out of seven theatres being cancelled, and this has been happening in our major teaching hospital for a long time.

The lack of recognition for post graduate degrees and post graduate diplomas in terms of payment is important.

An Cathaoirleach: The Senator has one minute remaining.

Dr. Henry: This is the trouble; I could speak for hours on the issue. This recognition is important and these area badly need to be redressed. If areas of intensive activity, such as neonatal care and intensive care, are short staffed, the stress among those remaining is appalling. So what happens? Those who remain feel they must go.

The front-line staff in the health services are seriously demoralised. All of us like to have a feeling of worth, and I would like to relay a little anecdote. I went from Sir Patrick Dun's to the Adelaide and nurses went with me. We were told to barely unpack as we would be gone to Tallaght in a year. Ten years later we were told to transfer to Tallaght. We were to transfer in June but the previous April I asked myself if I had lost my reason. I stood in the middle of a clinic which was about 150 per cent to 200 per cent of what I should be trying to do. The two nurses and I resigned, but nobody asked why we were going. They just said thanks and asked if we would be going at the end of the month or if we were waiting to work out May. That type of demoralisation is hard.

When I started in the health services, administration was less than one to one on the front-line. It then became one to 1.1 in the early 1990s. Now I believe it is one to 1.6 or 1.7. I do not pretend administration is not needed because they seem to be busy all the time but this situation makes those who I describe as front-line workers feel their efforts are not being considered.

I urge the Minister to accept even the last part of the Fine Gael motion that there be a cooling off period because, without a shadow of a doubt, patient care will be affected within days. It has been affected already because operations have been cancelled since last Monday as hospitals cannot bring in anyone who has to stay more than one week. If we do not manage to co-ordinate emergency care, we will find ourselves in a situation where, even with the best will in the world, it will be difficult to avoid accidents. I sincerely hope the Minister manages to do something between now and the start of the strike next week.

Minister for Health and Children (Mr. Cowen): I am delighted to have the opportunity to debate some of the issues raised by Senators on the important matter of whether the Nursing Alliance will step back from the strike action they propose to take on Tuesday next and rather adhere to procedures which they agreed to enter in the first place.

The Seanad always gives one an opportunity to debate the issues as the questions arise, unlike the Lower House, where one has to put certain things on the record. If they have not done so already, I am sure Senators will take on board the detailed address I gave to the Lower House last night in the debate on the Bill put down in the name of Deputy Shatter and other Fine Gael Deputies. I always like coming to the Seanad because one can debate the issues being raised in a way that is not a pro forma debate.

The most important point to make in this debate is that when it comes to defending the wider common good, it is important to remind everyone that the same fundamental considerations continue to apply regardless of where Members sit in the House.

Mrs. Jackman: Does the Minister have a script?

Mr. Cowen: I do not have a script. I am speaking ex tempore. Is that allowed in the Upper House? I would like to address some of the issues the Senator raised. I am sure it will be on the record and she can bring it home for a good read.

There are wider national interests involved here which all Members must be cognisant of. The simple thing to do, and usually the predictable thing in a political assembly is to take a partisan position, curry some favour, recognise where the difficulties are, make partisan points and hope one goes away feeling a bit better. I want to ask Opposition Senators a simple question: are they in favour of social partnership or are they not?

Mr. Connor: We are.

Mr. Cowen: It is a simple question and if, as Senator Connor says, Fine Gael is in favour of social partnership, I remember that when we authored it in 1987 his now leader was very much opposed to it. However, once in office he saw how well the economy was run through social partnership and he became a great adherent of it, in name if not in practice. If one believes in social partnership and its principles, presumably one will adhere to procedures which will enable social partnership to work. We have a new way of doing business in this country. That way consists of identifying priorities, taking common ownership of common problems and addressing these issues in a way that will enable those priorities to be recognised and achieved. It also involves setting up procedures, where there are differences, whereby we can resolve problems. We resolve problems on the basis that we enter into these discussions where there are problems and that there is an independent third party for arbitration. I read what Senators said when the Industrial Relations Bill, 1990, was debated here and I hope to hear consistency in views on this issue. General principles have to be upheld, which is that the Labour Court is the court of last resort in relation to industrial relations.

I can go through the long history of this issue and other issues which have arisen as a consequence of it, but I want it clarified here, in a way that it has not been in the Lower House, that all parties in this Government agree with the principles of social partnership. If we can at least agree on that much it might help us put out a coherent message, not just to nursing unions, which represent a highly valued and respected profession, and rightly so, but to all public service unions and all organised unions throughout the country. If we want another partnership agreement, which will depend on agreement among all the social partners as a result of detailed discussions, one cannot move into that procedure on the basis that present agreements are breached in the event of having another one, because there will not be another agreement. There will not be another partnership agreement if we breach the present one. Understandably, speakers at conferences tell their own people about imaginative solutions, but the Government has an imaginative solution to this problem which is consistent with the principles of social partnership.

However, one cannot have it both ways. We must be clear and decide if we are going to allow a situation where a battering ram is brought to the edifice-----

Mrs. Jackman: The language-----

An Leas-Chathaoirleach: The Minister without interruption.

Mr. Cowen: -----which has been carefully constructed over the last dozen years and which will basically throw out those agreements and the parameters we have all agreed on. There are parties in the Dáil and Seanad telling people that their prosperity will be preserved by throwing out the very system that has brought us the prosperity that was unknown a dozen years ago. I want that cleared up. We can have rhetoric and currying of favour with sectional groups, but I want to know what each party's assessment of the national interest is. That is what is motivating this Government and the taking on of those responsibilities has led the Government to its present position.

Regarding the specifics of this dispute, we have gone through a series of negotiations and arbitrations. I am not aware of any group that has refused a 23 per cent increase at a time when inflation has averaged 3 per cent over the past five years. I recognised, as the Labour Court did in its series of recommendations, that the special position of nursing had to be understood and it has been. That is why there has been remarkable restraint shown by trade unions generally - it is in recognition of that special position. What is the way forward? It is very simple - one abides by the procedures which both parties entered into.

Senator Henry wondered why we have not made progress on the 199 non-pay recommendations of the Commission on Nursing. There has been some progress on that and I will return to that, but the main reason is that the Nursing Alliance has insisted that the three pay-related recommendations be dealt with first, before we move on to those issues. That is what has brought us to the 31 August recommendation in relation to the three pay-related issues. At that time Mr. Doran, chairman of the Nursing Alliance, insisted on due process. I can quote what he said, as I did last night in the Dáil. He wanted to refer it to the Labour Court and refer it to due process as it was the way they did business, day in, day out, to paraphrase him.

That is what we did. Having entered into that process and come forward with the 31 August recommendation which was three times more than what was offered in direct negotiation between management and unions, we have had it rejected by the Nursing Alliance and three out of four unions within 48 hours. That is the situation we are at and that is why we have had a strike ballot and the prospect of a strike next week - it is because of the unilateral action of unions in walking away from the negotiation and arbitration procedure and their failure to recognise the negotiation and arbitration success which, on any objective assessment, that Labour Court recommendation represents. Yet I am being asked what other gestures I have.

Part of the Opposition propaganda last night and tonight has been to refer to me and the language I have used in this matter. I am a great believer when dealing with problems in asking if someone can be specific. The only time I have been criticised by the Nursing Alliance in relation to anything I have said - and Brendan Keenan suggested in the Irish Independent during the week that there was a severe reaction because it was the truth and may have hurt - was when I stated that if we go back to the pre-1987 position of high nominal wage demands and free for alls, though we have seen it in the past and we should have learnt from the experience, we will have cutbacks in the health services, as 70 per cent of the total health budget is pay. If we are to have a free for all, of course there will be serious problems at the front line of services. It will cost more to employ people who are delivering services.

That is not for one moment to suggest - and this Government would never suggest - that we are not in the business of entering into the procedures to make sure people get their rightful wage, but on the basis of objective assessment, not subjective grievance. That is the basis on which we have an ordered society. We can all have a view of what people earn or do not earn, or what various professions earn, but the fact is that where there are differences under the social partnership model, which has served this country well, where the national interest has been preserved, we go to arbitration. That is what has happened in this case and the Government has abided by every procedure and has honoured every commitment it has been asked to honour under those third party arbitration procedures. I am asking a simple question of the body politic which feels there is a political advantage or partisan opportunity here. I am asking if it is in favour of that system or not.

Mr. Connor: Of course we are.

Mr. Cowen: If they are in favour of the system, then let us be clear. The system is exhausted. In fairness to Deputy Rabbitte, the Labour Party spokesperson on enterprise and employment, he has been honest enough, as a man cognisant of trade union matters, to recognise that one cannot solve this problem in isolation from the existing pay determination system. That view has put his leader in a somewhat embarrassing position because Deputy Quinn, probably with an eye on the Dublin South-Central by-election and the fact that he feels under threat or pressure because he did not get as many local representatives elected in the last election as he should have - and I am being as cynical as that about his approach, and I will prove it in a moment------

Mr. Ryan: This is addressing the issue?

Mr. Cowen: Deputy Quinn said-----

Mr. Ryan: The Minister should talk about the problem.

Mr. Cowen: I know that Senator Ryan is a new member of the Labour Party but I want to make this point.

Mr. Ryan: The Minister is not addressing the issue.

Mr. Cowen: I am addressing the issue. I am addressing the issue precisely.

Mr. Ryan: The Minister should talk about the problem.

An Leas-Chathaoirleach: The Minister without interruption on the motion.

Mr. Cowen: I am addressing the issue but the Senator does not like to hear it. Deputy Quinn is saying, "Pay and deal with the relativities later." It is important that people know what others are saying. Let us have some consistency. Let us not treat people tritely or insult their intelligence.

Mr. Ryan: Precisely.

Mr. Cowen: Precisely, and let us see what the body politic is saying.

An Leas-Chathaoirleach: Senator Ryan you are the next speaker after the Minister.

Mr. Cowen: On 12 November 1996, when he was Minister for Finance, Deputy Quinn said, when suggesting that £50 million was sufficient to deal with this issue, that:

As far as the Government's management is concerned we have exhausted all the room for manoeuvre that existed for us as one of the signatories to the PCW and I would not like any impression to be given that one extra push or shove might result in additional moneys being put on the table. That would be an error of judgment if people were to think that such an additional movement or push would bring about extra money.

I will leave it at that because the record speaks for itself.

Mr. Connor: What did the Minister say in 1996?

Mr. Cowen: The record speaks for itself.

Mr. Connor: The Minister was Opposition spokesperson on health.

Mr. Cowen: I am a former Minister for Labour and, with respect to Senator Connor, I have a lot more experience in these issues than he does.

Mr. Connor: That is the kind of patronising statement we expect from the Minister.

An Leas-Chathaoirleach: The Minister without interruption on the motion.

Mr. Cowen: Is Senator Connor speaking in this debate?

Mr. Connor: Yes.

Mr. Cowen: Then he should wait and we will listen to him. The point is simple and I am here to debate the issues as raised with me. I have given enough respect to the House to do so.

Mr. Connor: The issue-----

Mr. Cowen: I am speaking to the issue. The way to resolve this problem is simple. One accepts the Labour Court recommendations as being the maximum available under the PCW restructuring clause agreed between the unions and the rainbow coalition Government, as providing a maximum of 5.5 per cent - it has emerged as a 24 per cent claim for the nursing unions. One then proceeds, as suggested by Senator Henry, to deal with the medium and long-term non-pay issues dealt with in the Commission on Nursing. Many of these issues have not been addressed because of the prevalence of having to deal with the pay-related issues which have gone through the process. Nurses comprised 50 per cent of the Commission on Nursing which set out the future career path for nursing and which has been accepted by the Government. We wish to enter discussions on an implementation phase for the commission's recommendations which will provide for improved pay and non-pay elements of increased specialisation and qualifications in nursing.

One also states in a constructive manner that it is for the nursing unions, as part of the public service union group, to proceed with the continuing discussions on devising a new public sector pay determination system and with any further issues concerning a post Partnership 2000 agreement. That is the way that the agenda for change which nurses seek can be constructively addressed without involving hardship to the public. Presumably, that is why the House is holding this debate. This House, presumably, is seeking alternative means, apart from the blunt weapon of strike action next Tuesday, to advance the cause of nurses.

On behalf of the Government I wish to state that, given the wider implications for knock-on effects on public service pay and the major and fundamental implications it will have for continuing partnership, which has served this country so well in the past and has been exercised by all parties in this House in Government and Opposition, that the only way is to proceed as I have outlined. This is not being prescriptive to nurses about the outcome, but it explains the route map available to pursue the agenda of change in a way which does not involve hardship to the public. At the same time it allows nurses to pursue their campaigning issues.

No one familiar with industrial relations would disagree or walk away from that proposal. That is the way forward. If one does not take that route then one takes the blind alley which is strike action next Tuesday. That will not advance the issues because the Government is consistently committed to, and will defend the principles of, social partnership, so that all workers can benefit from the increased prosperity it has brought about. Any objective assessment of social partnership confirms that the real take home pay of workers increased by 35 per cent since the late 1980s. Real take home pay was reduced by 6 per cent during the free-for-all, high nominal increases in the early and mid 1980s. I have outlined what constitutes real social solidarity and that is the way this issue should continue to be developed.

That is the position. The Government is not being irredentist or confrontational. The absolutist and confrontational position is emanating from nursing alliance unions who are walking away from procedures they agreed to enter. Social partnership is the agenda for change in this country. Sectional strike action has never delivered change but has brought temporary ups and downs. This is the way of bringing all parts of our community together and improving their chances of prosperity and social and economic improvement. This is the way to achieve that, as proved by the last 12 years. All Members, regardless of party affiliations, have seen the work being done in our health services. The body politic is quick to suggest crises, disimprovements and problems but, in comparative terms, we have a good health service in which good and professional people work.

I am anxious to address the agenda of getting rid of hierarchies and giving more say to the front-line staff on how we deliver services. That is precisely what I want to do, but I cannot do so if I am being asked, in this instance, to break every rule in the industrial relations book to deal with a particular sectional problem which will set all our progress at nought. A Taoiseach, Minister or leader of SIPTU or ICTU cannot contest the fact that should we, under our pay determination system, exceed the Labour Court recommendations in this case, we will bring about knock-on effects throughout the public sector with all the attendant problems that will bring. I have said that Deputy Rabbitte has been prepared to acknowledge that truism. The question is how we solve this problem without a strike. I have explained how we do so, which does not impose a prescriptive solution on nurses.

If the nursing leadership feels that going on strike next Tuesday, with all the hardships it will bring, will solve this problem in a way which attacks the edifice of social partnership, then I say with all the clarity at my command, as a member of the party that authored it and of a Government which exercised it in the most difficult circumstances, that will not provide a solution to their problems. Therefore, let us recommit ourselves to the principle of social partnership. Let them step back from the brink represented by strike action. Let them come forward in the way I suggested, which upholds the integrity of their position while not determining it, as there will be further procedures to be entered into with their social partners in trying to come to a determination on outstanding issues. The conciliatory gesture is precisely that. In the meantime, should strike action proceed, I, despite meetings today, do not have a national emergency plan in place. It is unacceptable to the public or their representatives of whatever political affiliation that, given the seriousness of the situation contemplated, we still are unable to say with certainty or uniformity to every patient, regardless of where he or she lives, that there will be precise emergency arrangements in place which are not dependent on interpretations by local strike committees. The nursing profession are anxious to address that issue in the same way as we are, which is not to compromise patient care. Given that is the case, I see no reason it is not possible to decide at national level the level of cover so people are allowed to understand the position.

That is not an unreasonable request by Government or management. We have never had an all-out strike before. This is uncharted territory and on the basis that patient care is concerned, it would be remiss to take a medium or high risk strategy. We do not need any risk strategies. In principle we all agree what way such a strike should be conducted. Let us put it on paper and inform people of the situation in good time.

That is not to say I am looking forward complacently to the inevitability of a strike. Unfortunately the nursing leadership has spoken about the inevitability of strikes. Members talked about language. I have not stated anything on a precise issue that could be regarded as belligerent. When I delivered a 22-page speech at the Irish Hospital Consultants' Association, a three-page introduction related to social partnership generally and I made the point I made earlier, that clearly if we go back to a free-for-all situation we are putting at risk the ability to develop and maintain health services which cost more yearly on a no policy change basis regardless of any developmental trends involved. People do not like to hear it but it is true. In relation to language, unfortunately the general secretary of the PNA, on the date the Labour Court recommendation was rejected, was asked the position. He replied, "War on the streets". That is the statement he made. Others talked about upping the ante and minimum cover to provide maximum leverage against Government. They are unwelcome and unrepresentative comments, made in the flurry of the moment and uncharacteristic of those who made them. They are unwanted and unwarranted.

The Government seeks no confrontation with nurses. The Government wishes people to abide by agreed procedures, to uphold the principles of social partnership and to ensure the role of the Labour Court is not undermined. The Government is anxious and ready to pay the award which, by independent and objective assessment, is due to nurses and it is providing an alternative route forward which can keep the public away from this issue. They need not be involved disadvantageously in this issue if nursing alliance unions are prepared to recognise that the process in which they have been engaged has provided for them more money and a greater step forward than any public sector union recognised by the Labour Court as valid and justified. That being the case under that restructuring clause, they should accept it and move on with their campaign in so far as they see a justification for it. It is not for me to prescribe the outcome. They should move forward to negotiations for a new pay determination system that will get us out of the iron grip of relativity and to a new partnership agreement which, clearly on the basis of our prosperity thus far, will provide greater increases for workers and the opportunity to conclude a tax reform policy of benefit to nurses and workers generally.

We need to ensure the partnership which has served this country well is upheld by everybody. I ask, perhaps forlornly, that whatever one's view of the issues, we uphold the principles of social partnership, as is the stated position of every party in this House. It would do far greater credit in providing a coherent message to everybody. Having applied the discipline which has brought us from the brink of bankruptcy, we should apply the discipline that will provide us with the fruits of prosperity, for this and future generations in terms of employment opportunities and up-skilling. Specifically in relation to nursing it would allow us the prospect of fast track implementation of the Commission on Nursing's recommendations. This would be a daydream in an era without social partnership.

This is the issue. Those are the problems and that is the Government's constructive way forward to deal with these issues.

Mr. Ryan: I thought I would begin by saying I would leave out the silly bits in the Minister's speech. Then I realised that if I left them all out I would probably have very little to talk about. The Minister reminds me of somebody caught in a thunderstorm whose only response to the thunderstorm is to say he wishes he was not in a thunderstorm, nobody told him there would be a thunderstorm, nobody told him it would happen and, to use the famous phrase, if he was going to X he would not start from here. The Minister is here.

Mr. Cowen: That is a university lecturer talking.

Mr. Ryan: The Minister is here in this moment. He does not wish to be there. Believe it or not, and he may not believe it, I would not wish him to be there. He serves no useful purpose talking about what he wishes would happen when he knows as well as everybody else that it will not happen. Nothing along those lines will happen. The strike will not be called off. I wish it was called off or postponed and people were talking to each other. I wish a lot of things but I at least know I am wishing and not expecting it to happen, because it will not.

Of course I believe in the principles of social partnership. I also believe social partnership involves sharing burdens as well as prosperity. The Government seems unable to respond to the enormous fury that the burden was never shared. At the time other people were making sacrifices and accepting pay restraints, some people, all during the period of our alleged recovery, were on something else. I do not blame anybody. In fact this Minister has a very honourable record in terms of nastiness in his party in the 1980s and he deserves credit for that. However, this is not a political issue, it is statement of reality in Irish society. People are furious. Their conviction is that large financial institutions and individuals operated in an entirely different world.

The real problem the Minister has with the nurses is that they currently represent the feeling of Irish society that the whole partnership was a con, a conspiracy by some people to pretend to be involved in what they were not involved in. I believe in social partnership but let me be clear, social partnership constructed to rescue us from financial crisis cannot be the same as social partnership to deal with the consequences of prosperity.

Mr. Cowen: Could the Labour Court deal with that issue?

An Leas-Chathaoirleach: Sorry Minister, Senator Ryan without interruption.

Mr. Cowen: It is for the purpose of debate.

Mr. Ryan: The Minister is asking questions about the Labour Party again just for the purpose of debate.

Mr. Cowen: The Labour Court-----

Mr. Ryan: No, no-----

(Interruptions).

An Leas-Chathaoirleach: Members, including the Minister, have been allowed speak without interruption. I ask for that, please.

Mr. Cowen: Senator Ryan and I did not have a chance before; I am just asking him.

Mr. Ryan: Let us be very careful.

Mr. Cowen: Let the Labour Court deal with that.

Mr. Ryan: The crucial issue is to stop the nurses from striking and then to deal with the grievances which we do not understand fully yet. I am trying to explain to the Minister that to focus on pay is to misunderstand the undercurrent of resentment which the nurses' dispute manifests, an undercurrent in our society that this is not a fair country, that this is a country where individuals, if they have political or financial connections, can escape the consequences of their own actions and others, because of their connections, can escape their responsibilities to society. To begin the debate about how to have a responsible ethical society by a confrontation with a profession which everybody believes to be based on sacrifice and commitment is politically inept. To follow it through, to go to an Irish Hospital Consultants Association meeting to give the nurses a lecture about social responsibility-----

Mr. Cowen: I did not give them a lecture.

Mr. Ryan: -----in front of hospital consultants-----

Mr. Cowen: I did not give them a lecture. No one has taken on hospital consultants more than I.

Mr. Ryan: If the Minister wanted a lecture in sensitivities-----

Mr. Cowen: Has the Senator read the speech?

Mr. Ryan: I would not give nurses-----

Mr. Cowen: Has he read the speech? No.

Mr. Ryan: I have not read the speech.

Mr. Cowen: Then why does he say it was a lecture then?

An Leas-Chathaoirleach: Senator Ryan without interruption. I would ask Senator Ryan not to invite interruption. Minister, you had a fair hearing.

Mr. Cowen: Fair enough.

Mr. Cowen: I am a Minister. I am at home.

Mr. Ryan: I would not choose that audience to tell the nurses how they should behave. I will withdraw "give a lecture". The Minister spoke in moderate, restrained tones - is that better? However, he still said it to the Irish Hospital Consultants Association, whose members average income is probably £150,000 a year.

Mr. Cowen: I spoke at nursing conferences also.

Mr. Ryan: If the Minister does not understand-----

An Leas-Chathaoirleach: Senator Ryan without interruption.

Mr. Ryan: -----that that is insensitive and provocative and achieves absolutely nothing. He does not understand the way Irish society is today.

Mr. Cowen: So the Minister for Health and Children says nothing? That is the Senator's attitude, say nothing to anybody. Who am I to speak on the health service?

Mr. Ryan: A Leas-Chathaoirligh-----

An Leas-Chathaoirleach: Minister I would ask you to-----

Mrs. Taylor-Quinn: At a meeting in Tullamore would be preferable.

Mr. Ryan: At this specific moment, I wish the Minister for Health and Children would say nothing, I really would.

An Leas-Chathaoirleach: Minister, you had 26 minutes. Senator Ryan without interruption.

Mr. Ryan: The issue is not what we would wish or what should have been done. The issue is not either of those. The issue is a strike next Tuesday and it is going to happen, whether I said it was going to happen or whether the Minister said it was not going to happen. I wish I knew the solution. I have no desire to make party political games out of this - I do not know that there are any party political games. My view is, for what it is worth, that the public will decide it is another sign of politicians copping out and the Minister will not be exempt from that hostility.

Mr. Cowen: I know that.

Mr. Ryan: The Minister's job is to find a way to persuade the nurses that their worth is recognised in Irish society. Let us not make too much of the financial consequences. The Minister should look at the CSO website and look at the escalation in wages, for instance, in the building industry over the past seven or eight years within the so-called structures of partnership. He should find out the average price a bricklayer is paid to put one block on top of another and then come back and tell me about social partnership because it sometimes can appear that it is an excuse rather than a fundamental value.

The Minister has the most eloquent eyes. I must say that, a Leas-Chathaoirligh. Now that you have silenced his tongue, he is now doing a wonderful job of heckling with his eyes.

Mr. Cowen: It proves I am listening.

Mr. Ryan: There is hearing and listening.

The Labour Court is not a court of arbitration and the Minister should avoid using the word "arbitration". The Irish trade union movement would never have accepted the idea of the Labour Court if it was a court of arbitration. I happen to believe it has worked quite well but I also happen to know that there have been disputes through its history which it failed to resolve and none of them brought down the whole edifice of the State. Let us be careful and realistic about this - whatever is finally offered as a settlement will exceed the Labour Court offer. The Minister is nodding his head. What does he expect, that there will be a nurses strike going on for the next six months?

An Leas-Chathaoirleach: Senator, your time is almost up.

Mr. Ryan: I am about to finish. It will be settled by an arrangement which will be better from the nurses' point of view than what the Labour Court recommended. When it is settled we will not have the collapse of social partnership. We will have some difficulties in some areas which will have to be dealt with, but they cannot be dealt with and they will only get worse. What the Minister is threatening will happen and will be worse if this strike continues. Irish society will become polarised and angry and considerable numbers of trade unionists will say "If we cannot recognise and look after the quality of the work of nurses in society, then social partnership is meaningless". If social partnership means confrontation with nurses, then for many people in Irish society it would be meaningless.

It is not my job to work out the details. I do not have either the authority or the contacts. It is up to this Minister to learn a couple of things - sensitivity, imagination and quietness and forgetting about-----

Mr. Cowen: I am sick of that nonsense.

Mr. Ryan: -----apocalyptic visions of the collapse of Irish society-----

Mr. Cowen: I do not bark or shout. I speak the same as the Senator.

An Leas-Chathaoirleach: Senator, I ask you to conclude.

Mr. Ryan: I am about to conclude. We will not collapse our society, our social partnership or our prosperity. Ultimately, it must be settled and the Minister or his successor must settle it.

Miss Quill: The prospect of a nurses strike a week from today fills every citizen with fear and is a truly horrendous prospect. No right-minded person wants to see nurses on the streets at the best of times and, certainly, no right-minded person wants to see them out without even one brown penny of strike pay. I do not think the difficulties which that will present for nurses have yet been fully calculated.

However, there is a bigger picture. There are the actual or potential fears people have about what will happen to patients, many of whom are in a state of acute illness, if a strike goes ahead. Tonight everybody is worried. Everybody I know has the greatest and most profound respect for nurses. Any of us who has been hospitalised feels the same way. I underwent surgery about a year ago and, although I accept it was the surgeons who brought in the chisels, hammer and saw, cut out the offending piece and stitched in another piece - and I was glad to get my spare parts - , it was-----

Mr. Connor: And a good job too.

Miss Quill: -----from the nurses that I got the quality of care which enabled me to become strong and healthy again. There is no family in this country which does not owe a debt of gratitude to nurses because the midwife begins at birth and they are with people in every crisis from the day the child opens his eyes to the day they close the eyes of those who are departing this life. Nurses have a very special place in our affections.

I thought hard and long about this and if I could think of a secret formula, intervention, measure or mechanism of any kind which would break the impasse in which we find ourselves, I would be the first to recommend it. If I could think of anybody who could intervene at this stage, I would nominate that person but I cannot and I must admit that.

When I was thinking about how matters were dealt with by the previous Government when a nurses strike was threatened in 1997, I went over the records of the House to see if the then Government had any particular insight which the current Government does not have. I could not find an ounce of inspiration in the records of the House which would lead me to come up with a formula. That does not seem to be available to us tonight.

Mr. T. Hayes: There was no strike.

Mr. Connor: There was no strike. That is the ultimate difference.

Miss Quill: I will read if I may.

Mr. Connor: Not the Labour Court.

An Leas-Chathaoirleach: Senator Quill please, without interruption.

Miss Quill: I will read, if I may, from the record of the House what was said by the then Minister when the INO announced it intended to initiate strike action. On 10 January 1997 the then Minister, Deputy Michael Noonan, said:

The Government are disappointed that a substantial body of the nursing profession would consider it necessary or appropriate to embark on strike action against the background of independent adjudication and substantial pay offers which have been made.

On 14 January, four days later, the then Taoiseach, Deputy John Bruton, made an announcement at the launch of Partnership 2000. He spoke of the threatened strike and said: "This is a dispute that must be settled. That settlement must be within the freely negotiated and agreed framework for pay,-----

Mr. Connor: Note the different in language.

Miss Quill: -----industrial relations and public finances which I have just outlined. It must be settled in the context of Partnership 2000." I do not see there any evidence of any new insight or initiative that the Government at that stage had at their disposal-----

Mr. Connor: Spoken language and body language.

An Leas-Chathaoirleach: Senator Quill, without interruption.

Mr. Cowen: Perception is-----

An Leas-Chathaoirleach: Senator Quill, without interruption from either side.

Miss Quill: I am not trying to be smart. I am trying to reflect on a dilemma that two successive Governments have found themselves in. I am trying to seek from the utterances of two separate Ministers of two separate Governments any mechanism or secret formula to break the impasse in which we now are because this is such a serious issue. I have failed to find anything. I have failed to pull a rabbit out of the hat of my mind either. Here we are a week away from strike action. From my humble position as a Senator I make a strong appeal to the nurses' union to reconsider their decision. What is on the table now is far from being the final word. The report of the Commission on Nursing has been only tentatively looked at yet. There are a number of key recommendations in that report that need to be and will be worked out. As they are worked out they will prove to be a great benefit to a profession that is now in transition and is seeking to put in place improved and better structures for its members. I believe there is scope in the recommendations of the partnership for an orderly development of this profession. There is scope for improvement and addressing outstanding issues. There are outstanding issues which must be addressed. The context is there in which to address them in a logical and orderly fashion, not alone in the recommendations of the commission, the report of the commission, but also in the context of the upcoming partnership where there will be another opportunity for all public servants for another cut. It is not as if the shutter is pulled down and anyone is saying this is the final offer for in saecula saeculorum. No, there are opportunities there post-Partnership 2000.

I fully sympathise with the nurses. I want to see the outstanding issues resolved in the context that I have outlined. I appeal to nurses to stand back and see that the opportunities are there for them in the context of the report of the commission and in the upcoming negotiations on public sector pay.

Mrs. Taylor-Quinn: The Minister has come here and given us a lecture on social partnership. He also invited us to comment on the principles of social partnership. He invited the nursing unions to recommit to the principle of social partnership while at the same time upholding the integrity of their position and come forward with a conciliatory gesture. I suggest that it is time for the Minister to come forward with a conciliatory gesture. Get off your high horse, Minister. Go and speak to the nurses. They are ordinary human beings with a very specific problem.

He referred to the fact that the agenda down the road is to get away from the iron grip of relativities, but I put it to the Minister that the problem that faces him now is that there is an iron grip in relation to relativities. With regard to the adjudication of the Labour Court on the nurses' problem, particularly in relation to pay, fundamental issues that they requested to have addressed by the Labour Court were not addressed. That is the reality. Because they were not addressed or were unsatisfactorily addressed-----

Mr. Cowen: They were not conceded.

Mrs. Taylor-Quinn: No. That is not true.

Mr. Cowen: Their problems were addressed

Mrs. Taylor-Quinn: The realities are that the payscales were not addressed in relation to the differentiation between a ward sister and a staff sister, specific responsibilities, qualifications and special qualifications and all that goes with that and years of service. The reality is there is dissatisfaction.

Mr. Cowen: They were addressed.

Mrs. Taylor-Quinn: Part of the problem that has arisen relates to something Senator Brendan Ryan already said - and apparently it is not politically correct to use the word "sensitivity" - that approach and attitude is very important. The Minister made the point in relation to addressing the consultants association. You need only go into hospital to see the type of hierarchy that exists in relation to the medical services and to realise that it is the nurses who carry the entire load of the real provision of the medical service. Consultants combine to do a specialist service at a specific time but 24 hours a day, non-stop, it is the nurses who are on the ground. They are the ones who carry the can. When you go into hospital, the coal face you first meet a nurse whether you are in casualty or in a major stressful situation in the height of an emergency. When you reach the intensive care unit whom do you meet? You meet the nurses again. You do not meet the consultants. That is the reality.

With regard to the sensitivity of the hierarchy in relation to the structure of the medical services, to take the consultants meeting as a platform to give the nurses a lecture was not prudent or wise.

Mr. Cowen: Did the Senator read the speech?

Mrs. Taylor-Quinn: The days of Florence Nightingales are gone, the day when the women of Ireland, indeed the women of the world, were prepared to be Florence Nightingales-----

Mr. Cowen: Quit patronising nurses.

Mrs. Taylor-Quinn: ------and take up this wonderful profession. It was always considered a gift to want to nurse and you were taken for granted. Because of the type of training they were given, and thanks be to God that it has changed in recent times, nurses were trained to defer to the medical doctors and the specialists. That situation no longer exists because there is a fundamental change in attitude and an attempt towards more equality with regard to how things operate within the hospital situation. Nurses now are not prepared to sit back, as for too many years they did. They were not considered, they were not militant and they did not have the strong forceful union voice that many other organisations had here.

We can talk about relating the position of nurses, whether they be ward sisters or staff nurses, to other positions within the public service. Most of those matters have been arbitrarily decided by a majority of males. That is the reality. I put it to you, an Leas-Chathaoirleach, that if the gender balance of the nursing profession was reversed we would have a different situation with regard to pay for the nursing profession. The reality is that over the years the overwhelming majority - 80 to 90 per cent - have been female. It is extraordinary that the nurses should become militant. This is anathema to what nursing is about. "How dare they" - that is the attitude. The reality is that the millennium is upon us and in the year 2000 professional women should be treated as professional people. Unfortunately, due to attitudes over the years, that has not happened.

All that is being asked is for a little common sense. Let us forget the bureaucracy, social partnership, arbitration and the Labour Court - all these wonderful things - deal with the realities and see the human dimension involved, the huge responsibility and recognise, above all, that we are talking about people who deal with life and death. No other profession in this country deals with life and death scenarios. These people have huge responsibility. Every move they make within a hospital and within every ward on the administration of medicine could be a life threatening scenario. That is the reality and it has been seen in various negligence cases over the years in different hospitals throughout the world. That should be recognised by the Minister. The situation is highly sensitive.

Due to attitudes over time there has been a hardening of views in the nursing profession in every hospital. A resentment has been adopted because of the attitude towards them. There is a responsibility on the Minister - he is in a position of leadership and he should be the one to make the gesture, the conciliatory act. He should talk to the nurses. They are not unreasonable people. They recognise he has to keep face and they also want to keep face. I am sure if he sat down with them he could thrash the matter out in a sensible and reasonable fashion and come to a satisfactory conclusion. There are many issues that will need to be addressed on the whole improvement within the structure of the nursing profession. They are very important issues which require full recognition and which should be worked out between the practitioners, the immediate people involved, and the Department. I urge the Minister to act urgently because it will be much too late in a week's time.

There is a situation where already a number of operations have been cancelled as well as chemotherapy and various other appointments. The backlog that will create will create further hardship for people on waiting lists. The Minister should give leadership, show responsibility and go and talk to the nurses.

Mr. Glynn: It gives me no joy to speak to this motion. We should be very cautious about what we say because whatever we can do to help the situation, using emotive terms or demonising the Minister for Health and Children or anybody else will not contribute towards the resolution of the problem. I will declare my interests at the outset. I have worked in the medical profession for many years, a profession of which I am very proud. It is important at this juncture to point out exactly what has happened because many of the spokespersons on both sides of the House have addressed the situation pertaining to the strike. I wish to deal with the other issues in the motion.

The first point is that of shortages. The Minister did not create, he inherited, the situation. The difficulties that some health agencies are currently experiencing in recruiting nurses can be traced back to 1993-94 - nurse training through a diploma based programme was made at that time. The need to replace the service contribution of student nurses with registered nurses has impacted significantly on the availability of nursing personnel.

In the not too distant past the joint committee on health and children was addressed by the Department of Health and Children, SIPTU, the INO and perhaps another organisation with regard to nurse shortages. I took a particular interest in the debate because I come from a time when literally thousands of young men and women applied for two disciplines of nursing, namely psychiatric and mental handicap. While there has been an improvement in the number of male students on training courses in general training schools, I would like to see that improved further. From the time that those meetings were held with the various agencies, a total of 1,222 nurses have been recruited, 821 of whom went into the general discipline, 245 into psychiatric and 156 into mental handicap services. That is a very welcome development, especially in the context of the psychiatric and mental handicap disciplines because, as everybody knows, a Chathaoirligh, there were campaigns or efforts launched which elicited an almost negative response in terms of the numbers recruited.

The House should also be aware that the employment of nurses is at an all time high. At the end of December 1998 there were 27,586 nurses, a significant increase of 11 per cent since 1990. Within this upper trend there has been a significant change in that more qualified nurses have been engaged to replace the traditional student nurses whose education has changed from the apprenticeship model to a third level supernumerary basis.

I compliment the Minister for Health and Children, Deputy Cowen. As a member of the Midland Health Board for 14 years I campaigned to have a college of nursing. There were two schools of nursing, two psychiatric schools, one in St. Loman's, Mullingar and the other in St. Fintan's, Portlaoise. Great efforts was made by many people of varying interests to have those schools re-opened when they had closed, but one should not step back into the past but move into the future. It is significant to note that the college of nursing, which is in the course of being established in the Midland Health Board's area, will be associated with and aligned to the Institute of Technology in Athlone. This confers a brand new status in the context of education for nursing.

There is also a popular misconception pertaining to the ratio of nurses per hospital bed here. We have 1.26 per bed whereas in France, an example of a mainland European country, there is 0.42 nurses per bed. That is not a bad comparison for a little island country in the periphery of Europe. A range of initiatives have been taken. Arrangements have been made and agreements with the nursing unions to allow more favourable assimilation arrangements on today's scales for nurses taking up both permanent and temporary appointments. There is a significantly improved regime of allowances in respect of nurses working in specialised areas, such as operating theatres and intensive care units. Other circumstances are also being addressed.

Discussions with the nursing unions are continuing on the introduction of more flexible working arrangements for nursing staff. Standardised overtime working arrangements have been introduced following agreement with the nursing unions. Health service employers have been asked to examine the possibilities on the introduction of term-time working as an option for staff with family commitments - that is a very radical step forward. The availability of return to work courses for qualified nurses who have left the workforce is being reviewed to maximising the uptake and this is important for people who have left the service and who wish to return.

The Department of Health and Children is currently engaged in discussions with the health agencies on the provision of specialists and nurse training courses at centres outside Dublin. The most important point I wish to make - it is a pity that a few Members who have spoken already are not here - is that an anti-bullying policy has been prepared and agreed with the nursing unions and is due to be published shortly. Many young male and female nurses left the nursing service as a result of bullying. There has been a misconception for many years - thankfully it is an outmoded concept now - that a boy or girl of 18 years, fresh out of second level education is fodder for every situation. We are talking about highly intelligent, bright, energetic young people who have been through a selective interview process. They have been driven out by uncaring ward sisters, chief nursing officers and matrons in the past as everybody knows. I do not apologise to anyone for saying that. I could give many instances.

The Minister and the Department of Health and Children are to be congratulated for the work they have done. It has been said that the role of Government is to be constructive, but it is also to be responsible. There is no group of people in this country for whom I have a higher regard than the nurses. I hope, and I pray, that a solution will be found and the nurses will step back from the brink. I do not think a strike will serve any purpose.

Mr. Connor: I wish to share my time with Senator Tom Hayes. I am delighted to have an opportunity, albeit a short one, to contribute to this debate. I am sorry that the Minister has left the House. He gave us a lecture on commitment to social partnership and the functions of the Labour Court, etc. When the Commission on Nursing reported and these particular issues - which I will refer to in a moment - were highlighted, the Minister and the Government said they would not refer such pay issues to the Labour Court. In fact, they created the atmosphere which has led to the present situation whereby neither side is talking to the other. The Minister who claimed a decision of the Labour Court was sacrosanct was the very one who said he would not refer these issues to the Labour Court. That is a little rich and I am sincerely sorry that he is not here to hear me say so.

There is relatively little, in my opinion, between the Government, the Department and the nursing profession on this issue. I know they are pay issues. There are three issues which according to the Commission on Nursing report need to be addressed. If the outcome of that is money, then so be it. The pay differential between ward sisters and the higher grades needs to be addressed. Such pay differentials exist in every area of employment in the private and public service for people of different grades. Another area which needs to be addressed is the allowances for nurses who have gained qualifications in additional specialised areas. That is a given in every employment nowadays. It may take money to resolve that problem with the nursing profession, but it must be addressed. We then come to pay increments for long service by staff nurses. Teachers receive long service increments. They have been part of their pay structure for as long as any of us can remember.

The Minister has to address these problems. If he were to sit down with the nursing profession representatives and address these problems tonight or tomorrow, the strike would never take place. I appeal to him, on the basis that what we are dealing with here are matters on which the principle has been established elsewhere in such an outstanding way that it cannot be ignored. He should end this confrontation. The Minister is, on his feet, a very fine performer but he has an uncompromising and confrontational manner of dealing with people he feels oppose him. That has, in my opinion, done immeasurable damage.

I have always found it amazing that nurses do not have a State-funded health insurance scheme. Such a scheme operates in other countries and should be available here. The Minister should make the gesture of offering the nursing profession a State-sponsored health insurance scheme. That, too, might also improve the atmosphere.

This strike cannot take place. The Minister will not win; the nurses will not be starved out on this one. I know they will not receive strike pay but the consequences of this strike, if it goes ahead, will be disastrous. The negotiations on the contingency plan broke down this evening. That is very dangerous. Effectively, what will happen is that hospitals will close. While I hate to say it, people will die. That is a simple fact. I say to the Minister, get back to the negotiating table, tackle these three issues which are relatively simple and do not let this strike happen.

Mr. T. Hayes: I thank Senator Connor for giving me an opportunity to address the Seanad on what I think is probably the most serious crisis that has ever faced this country. We are dealing with people's lives. There is no doubt that if this strike goes ahead a great hardship will be inflicted on people. The situation facing us is a very serious one.

On my way to Dublin yesterday I called in to Our Lady's Hospital in Cashel and spoke to some of the staff and the matron. The matron told me in blunt terms that no matter what contingency plans she put in place only one patient in four would be dealt, with despite the fact that every patient is a sick person in need of care. The nurses had three very simple demands, pay differentials, long service increments, a huge bone of contention with them, and recognition of courses they attended. Trust has broken down between the two sides. I do not think progress will be made in this area between now and next Tuesday. The Minister should appoint an independent chairman tonight to pull both sides together. There is a war taking place and there is right and wrong on both sides. The Taoiseach should intervene and appoint an independent chairman to deal with this issue.

Ms Cox: I intend to be reasonably brief on this issue. However, Senator Connor's statement that "people will die" is an awful indictment on the nurses who intend to go into the hospitals-----

Mr. Connor: The Minister said that.

Ms Cox: Nobody under the care of nursing staff in our hospitals will die. Any of the nurses I know, regardless of whether they go on strike, will be doing their best to ensure that the people for whom they are responsible will receive the necessary care. That is one of the reasons the health care provided in this country is as good as it is for those obliged to enter hospital for treatment.

It is always sad when industrial relations fail. I completely agree that differentials, payment in respect of specialisation, recognition of courses and pay increments for long service need to be addressed. What seems to be in dispute is how these matters will be addressed. The way is open for the nursing negotiators to come back on board and make their case, under the next pay agreement - if there is to be one - to have these issues recognised because the structures are already in place.

This matter went to arbitration and was referred to the Labour Relations Commission which issued a recommendation and it is unfortunate that the deal hammered out by that independent commission was not good enough to satisfy nurses. I do not believe it was a good deal, I do not believe it adequately addressed their needs. I recognise that a deal was made but I also accept that it had a number of serious shortcomings. In my opinion the way to proceed is to say "We will take what we have now, mark a line in the sand and move forward. There are things that have not been addressed which must be addressed before this situation is properly put to bed."

I disagree with Senator Connor - I did not hear some of the sentiments expressed by earlier speakers - because I do not believe the Minister is being confrontational and I know that is not his intention. However, he is being realistic and honest. The fact is that there is no avenue for any Government - whether it be led by Fianna Fáil, the Progressive Democrats, Labour or Fine Gael - to reopen the negotiations. We must accept what has been agreed and find new avenues to allow us to move forward. Those avenues exist, it is merely a question of reaching agreement with the nursing unions and the other trade unions which must agree not to piggyback on to this issue. That is how we will find a remedy to this situation.

I am heartily sorry for every nurse and every member of the Government. If nurses are obliged to stand outside hospitals or work inside those hospitals as hard as ever they have for no pay, that will be the saddest day we will ever see. That is what is sad about this situation. These women - the majority of nurses are female - will continue to give of themselves to ensure that the necessary services are provided for those who need them. That should be recognised. We must find a way to move forward and bring the union negotiators back into a process which will allow us to arrive at a solution to this crisis.

I am sorry we are facing a strike next Tuesday. I hope the strike does not take place but I believe it will and I am afraid that it will continue for a long period. That will only cause bitterness because the one thing about this situation is that there can be no winners.

Mr. T. Hayes: The Government will not last long if that happens.

Ms Cox: Not the nurses, their unions, the sick or the Government will win. No one will emerge from this dispute smelling of roses, regardless of what happens.

I support the amendment. I recognise that the recommendation came from the Labour Court but I also recognise that there are outstanding issues which must be addressed. I call on the nursing unions, regardless of how it is done, to return to the negotiations and address those issues and do the job they are obliged to do for the people they represent.

Ms O'Meara: Like other Members, I am hugely concerned by the idea that there will be an all out nurses strike next week. We cannot afford to be blithe about this subject, neither can we afford, at this late stage, to take for granted, as the Government appears to be, that the strike will proceed. Even if the strike only lasts 24 hours, it will generate huge chaos and inflict major hardship on people. Those who will endure that hardship will be patients, particularly those who rely on the public hospital service. There will be no winners in this dispute, only losers. We cannot afford to say that this strike is inevitable, we must do everything up to the last minute to ensure that it does not take place.

It is the responsibility of the Government to govern and provide leadership. Leadership is about being generous and creative, particularly in respect of finding solutions. It is about finding new ways of doing things, particularly when existing ways have failed. If Labour Court mechanisms have not succeeded, then other mechanisms must be found because the price is too high to pay, at every level, in the short and long term. I know the nurses have literally been nursing huge grievances, many of them dating back many years. To some extent the Minister alluded to the fact that perhaps the Labour Court is not the proper mechanism for dealing with many of those grievances. The nursing commission has been established for that purpose. However, it seems that there is a deep seated sense of hurt, grievance and anger among members of the nursing profession and it will be extremely difficult for them to release their grip on it without the Government showing a measure of generosity, creativity and leadership.

I appeal to the Minister, who does not appear to realise the extent to which the belligerent and aggressive tone he has been using is causing huge damage, to literally tone down his remarks. I also appeal to him, in the wider context and for the sake of the entire health service and every patient using it, to be creative between now and next Tuesday and come up with a mechanism to ensure that this strike does not proceed.

Mrs. Jackman: I thank all the Senators who have voiced their support for the motion. I am sorry the Minister is not present-----

An Cathaoirleach: The Senator will be aware that this issue is also being debated in the Lower House and the Minister's presence is required there.