As we speak nurses and midwives, members of the Irish Nurses and Midwives Organisation, INMO, are meeting to discuss pay and staffing shortages. The national executive of the Psychiatric Nurses Association is also meeting today to consider the recent report of the Public Service Pay Commission. For years nurses, midwives and their unions have highlighted the recruitment and retention crisis in the health service. They have proposed reasonable and responsible solutions to address it, yet there has been complete disengagement from the Government on the issue.

The Public Service Pay Commission report was supposed to independently analyse and assess the crisis, its causes and how to address the problems. However, as the report conveys, the Minister for Public Expenditure and Reform, Deputy Donohoe, met the commission in October 2017 to emphasise that its work "is not a pay review nor can it be". It is clear that from the outset the Government was determined that a commission mandated to investigate both pay and conditions was to focus solely on conditions and to disregard pay. It appears as if it was determined to establish the conclusions of the report long before the work had even begun. In carrying out its international pay comparisons the report acknowledges the number of nurses and midwives who have chosen to work in Britain instead of Ireland. While acknowledging the fact that pay and conditions vary across England, the report failed to address adequately differences in pay between Ireland and London specifically, a popular destination for our nurses and where entry pay is more than €3,000 higher. A pay comparison that fails to address adequately one of the most popular destinations for our nurses is flawed.

Our nurses and midwives perform an invaluable service to patients in the health service and we should expect their jobs to pay well and to have high morale in their ranks. However, that is not the case. There is only one application for every four nursing and midwifery vacancies in the health service. In the meantime the Government does not wish to talk about pay, but that is the conversation that must take place. It wilfully ignores that this will only worsen the state of the health service and make it impossible to implement Sláintecare fully. All the while the bill for agency staff continues to spiral. In April, the Dáil passed a Sinn Féin motion calling for the introduction of recruitment and retention measures based on realistic proposals which would prioritise pay. It called on the Government to work with the unions to draw up a roadmap for pay equality and how that would be achieved for nurses and midwives, with an implementation plan to deliver pay equality within a short timeframe and not the eight-year timeframe the Government now proposes. Will the Taoiseach commit to acting and engaging with unions in order that nurses and other health professionals get a fair deal?

Absolutely, we always engage with unions. That is the reason we have a public sector pay deal which was agreed less than a year ago. That deal runs for the next three years and it applies to all public servants in the country. It provides for pay increases every year for the next three years at a total cost to the taxpayer of €400 million last year. We made that agreement after engaging with unions and we intend to honour it. We certainly hope all the unions honour the agreement they made with the Government and Irish taxpayer. The agreement runs for three years and all public servants will receive pay increases every year. There are over €400 million worth of pay increases for public servants next year, which is about as much as we can afford. We do not wish to repeat the mistakes of the past and to start borrowing money to pay for pay increases. That is illusory. It would mean going back to the cycle of pay increases followed by pay cuts down the line.

The Public Service Pay Commission report is worth reading, and I am sure the Deputy has read it. It is based on facts and puts forward solutions. Those who are not interested in point scoring or exploiting industrial relations issues will find it very informative. It is independent, incidentally. It was not written by the Government or a civil servant or anybody in the Department of Finance. Anybody could make submissions and many people did so. The report sets out the facts. One of those facts is that the number of nurses working in the public health service has been increasing year on year for the past three years. It shows that pay is comparable with the UK and Europe and that Ireland has a high number of nurses per bed relative to other countries. These are the facts, not my opinion. They are set out in black and white in the Public Service Pay Commission report. The report also points out that many countries are struggling to recruit and retain nurses because there is an international shortage of nurses. Pay measures alone will not change that. Just as there are Irish nurses in Australia and the UK there are nurses in Ireland from the UK, Spain, India and all parts of the world. Those are the facts in the report.

One of the most pertinent facts we should not deny, because it is set out in the report and in the OECD figures, is that Ireland has more nurses per head of population than most countries in the world. It is in the top five or six. If one reduces the number of nurses per bed it is even higher. Any reforms must involve changes to how we deploy our nurses to ensure nurses are used in appropriate roles. For example, in Ireland nurses are doing jobs that would be done by theatre assistants or scrub technicians in the United States and we have nurses doing jobs in outpatient departments that would be done by other grades. Reform must involve those types of changes. Of course we are willing to engage on that type of reform. That is what Sláintecare is about, reform and not more of the same. If more nurses, more pay, more beds and more of the same was the solution we would be improving the health services now. We do not need more of the same but a different approach.

The Taoiseach is not contesting the fact that there is one application for every four nursing and midwifery vacancies in the health service. That is a fact too. The fact is that we train what are said to be the best, brightest and most capable nursing and midwifery staff and then we lose them, specifically to London, Canada and Australia. When one makes a pay comparison one must benchmark the pay rate here with those destinations. Nurses and unions have said loudly and clearly that there is an issue with pay. There is certainly an issue with pay equality and then there is the broader issue of pay if we wish to recruit and retain staff. The Sláintecare report will gather dust on a shelf somewhere unless there are the resources, human resources and the capital to make it a reality.

The report is being considered by the real experts. As we speak, the nurses are gathering in Croke Park and they will take a view on this report. In light of this, will the Taoiseach honour the motion passed by the Dáil, which called on the Government to engage with unions on the issue of pay and to do so in real terms in order that we can recruit and retain the best and, thus, deliver a first-class health service?

I can guarantee that the Government will engage with unions on pay and terms and conditions and on co-operation with the reforms that are necessary to bring about a better health service. It is because of engagement that we have a three-year pay deal with all public servants to increase their pay every year. The sum of €400 million has been set aside for next year alone for increases in pay for our public servants. Two pay increases will be made next year. It is because of engagement that we have negotiated with the Irish Congress of Trade Unions a pathway by which we can equalise the pay scales of those public servants recruited after 2012. As the Minister for Finance, Deputy Donohoe, often states - and he is right - there is only a set amount of money. We have set aside approximately €400 million for pay increases for public servants next year. There is a point at which if we go beyond that, we either have to take the money out of public services, new schools, new hospitals and away from new medicines or borrow it and then pay later. This is not the responsible approach. The Sinn Féin approach will always be to back any demand of any interest group for anything they seek-----

No.

-----but that is not the approach of Government or what is in the interest of the Irish taxpayer or people who use our public services.

So, the Government will not be backing it.