Unfortunately, it looks like the nationwide 24-hour nurses' strike is about to go ahead tomorrow. It is the first time since 1999 that the country's nurses and midwives are going on strike across the health service. It will cause disruption to many patients because of the cancellation of appointments and the cancellation of elective outpatient surgery and it will have an impact generally on the health service.

Nurses and midwives in the Irish Nurses and Midwives Organisation, INMO, and the Psychiatric Nurses Association, PNA, have been seeking engagement with the State for some time. They have given plenty of notice. There is no doubt that the nursing profession is under pressure. I refer to nurses working in acute wards, in intensive care, in theatres and in accident and emergency departments. They are under enormous pressure and morale is low. There is a significant human resource issue and without question pay and conditions are central to the low level of morale, in addition to the impact hospital overcrowding has had over a consistent period on the working conditions and the pressure nurses are under.

It is interesting that agency nurses, for example, cost the health service €1.4 million a week. That tells its own story as to what is going on in terms of shortages. The recruitment and retention of nurses is central to the dispute. There are alternative views on the matter. The Public Service Pay Commission has said there is not a retention or recruitment issue but I have doubts about that. It is important to put down a marker in that we need to have more data on how many graduates are leaving student nursing colleges every year to go overseas. The numbers are significant. We must also examine how many nurses we are recruiting from overseas.

The system is out of kilter by any measure. Entire cohorts of students are moving to the UK, Canada, Australia and other countries. We then have to recruit huge numbers from overseas at significantly greater cost. I refer to the cost of nurses with third-level qualifications and, likewise, the cost of orientation and ensuring that people who come from overseas are properly equipped, sufficiently capable and so on. There are huge costs in that.

I read a very good article in the Evening Echo last week in which Ms Naomi O'Donovan, a midwife at Cork University Maternity Hospital, and Ms Margaret Frahill, a nurse manager in Mercy University Hospital, outlined their concerns regarding patients missing out on certain care. Their concerns are the result of the pressures involved.

The Workplace Relations Commission, WRC, held a hearing. The matter may now go to a full hearing of the Labour Court. The Minister seems to have indicated that he is anxious for the industrial relations machinery of the State to be deployed to help resolve this dispute. It has taken some time to engage that machinery. If the matter is referred to a full hearing of the Labour Court, will the Government abide by the outcome, just as it did in the Garda pay dispute some years ago?

I thank the Deputy. Before I begin, I wish to offer my condolences and those of the Government to the family and friends of the people who lost their lives on the roads in the week gone by, particularly the four young men in Donegal who lost their lives on Sunday last. I know that Míchael, Sean, Daniel and John were very much loved in their communities. Their deaths will be mourned across the entire country. Although their laughter may have been silenced, we remember their lives and the promise that has been cut short. Our thoughts and sympathies are with the Roarty, Harkin, Scott and Harley families at this time.

In answer to the questions the Deputy raised, the Cabinet discussed the pending nursing strike at its meeting this morning. We are very aware that the INMO, the largest union representing nurses and midwives, intends to engage in a 24-hour strike tomorrow. I certainly have no doubt about the depth of feeling on the part of nurses and midwives regarding their pay and their conditions. That was reflected in an overwhelming ballot in favour of strike action. I also have no doubt about the considerable public support that nurses and midwives will have should they choose to engage in strike action. Efforts are ongoing at the Labour Court to see if we can have a full hearing there, with a view to a recommendation thereafter. Obviously, if a recommendation is made, the Government will have to consider it. It would be very rare for the Government to reject a recommendation of the Labour Court, but we would certainly have to consider it if such a recommendation arises or if we reach that point.

Regrettably, I should say that in terms of patients and their care, the damage is already done. More than 1,000 operations and thousands of outpatient appointments have been cancelled. Even if the strike is called off at the last minute, it will not be possible to reschedule those appointments for tomorrow. Unfortunately, in the context of patient care, the harm has already been done.

We want to avert the strike if possible; we want to find a solution. That solution has to be affordable for taxpayers. It has to be fair to all public servants and it has to be fair to patients. When I say fair to taxpayers, what do I mean? A solution must be affordable for taxpayers. We ran a small budget surplus last year and we hope to run one again this year, although that may not be the case if we end up with a hard Brexit and no deal. It would not be fair to taxpayers to borrow money to fund pay increases. There are good reasons a country might borrow money, but borrowing money to fund pay increases is not good policy and only leads to pay cuts down the line. I do not want to subject anyone to that ever again. It needs to be fair to all public servants, other people working in the health service and individuals working in other parts of the public service. If we do a special deal for one group, it will not be possible to do the same deal for everyone. That just would not be affordable. We need to look at the wider picture and be fair to all public servants as well. We also need to be fair to patients. No matter how wealthy the country is, the health budget is limited. I would not like to see money being diverted away from new medicines, equipment or treatments to fund pay increases. We have to bear all those things in mind.

It has to be affordable for taxpayers, it has to fair to all public servants, including other people working in the health service, and it has to be fair to patients. If the Deputy can find a solution in that space, the Government will be happy to be part of it.

One can say that about any additional expenditure or additional tax relief. Ultimately, the taxpayer has to pay for it in some shape or form. The Garda pay dispute some time ago was resolved by the Labour Court. The Government accepted that Labour Court recommendation ultimately and it did not upset or undermine the public service stability agreement and the public service pay norms. There are creative ways and mechanisms through which these issues can be dealt with because it is not today or yesterday that they were raised. I can go back to the time of the former Minister, Senator James Reilly, in the Department of Health, when there was an ongoing row with the INMO and he denied that salary was an issue then or that they were being paid worse than others in other English-speaking countries. It is not today or yesterday that this claim has been on the table. What has been lacking is a proactive, creative way of resolving it, unlike the approach adopted in the Garda pay dispute, which the Government contributed to in the end because I do not believe the Labour Court came up with its recommendation out of thin air. I believe the Labour Court got a nod on high that it could make such a recommendation.

The time is up, Deputy, please.

That is what happened then. The issue has dragged on interminably. We need a resolution to it and we need to prevent any disruption that may occur to patients as a result.

The Labour Court is a Government body and it is part of the State's industrial relations machinery. If there is a recommendation, Government will look at it with that in mind. It would be very unusual for a Government to reject a Labour Court recommendation. I have seen unions doing it. I am not sure I have ever seen Government bodies doing it-----

Or supervisors.

-----or if they have, it has been a rare occasion. No Taoiseach and no Government could commit to a recommendation they have yet to see. The Labour Court does not make its recommendations on the basis of it being mandatory on both sides. That is not the way our industrial relations machinery works.

The Deputy is incorrect to say that the resolution of the Garda dispute did not have a consequence for public sector pay; it did. It required a renegotiation of the existing Lansdowne Road agreement and had a knock-on effect across the public service, which resulted in additional costs for taxpayers of approximately €150 million that year. As the Deputy rightly said, as is the case with any public expenditure, there is an opportunity cost because of that.

Fine Gael did that.