In the past 48 hours the Taoiseach has stated that 25,000 medical appointments have been cancelled due to the nurses' strike yesterday. In some cases, those individuals would have waited months or years for those appointments. Next week, if the strike goes ahead, we will see another 25,000 cancellations. The knock-on effect will be delays across the entire health system, just as we are experiencing the worst weather we have had this year. It will take months to recover those lost times, which will result in prolonged suffering and increased anxiety for thousands of people. It is not as if we do not already have serious delays in the health system.

As the Tánaiste knows, in previous Governments I negotiated two public sector pay agreements. I know all too well the constraints in terms of public spending and ensuring that agreements are adhered to by unions and workers, but by the same token, every single public sector agreement, certainly the ones that I was involved in, always had to deal with anomalies and inequalities that were presented at the time through side deals and special arrangements. That has always been a feature of the agreements. Specific issues have been raised by the Irish Nurses and Midwives Organisation, such as in relation to the acknowledged fact of the difficulty in retention and recruitment. Nurses have expressed legitimate concerns. As others have said, this is only the second strike by nurses in 100 years.

It is quite clear that this is not something they resort to lightly. No nurse, as was evident on every picket line at every hospital yesterday, wants to be on strike. Nursing is a vocation and our nurses are among the best in the world. They want to be back at work but they need to know that their profession will be respected and secure in the future.

The Taoiseach said in this House that all disputes end in a settlement. He is right, but that only happens when both parties are fully engaged in an effort to find a solution that will address the real and genuine grievances set out while sustaining the public finances. It is now incumbent on him and the Government to instruct public officials to engage with the INMO to work through these issues and find a mutually acceptable settlement. The Government cannot stand on the sideline and expect a settlement to be arrived at without its direct intervention. The Labour Court did not intervene yesterday because it judged the parties to be too far apart. It is up to the Tánaiste and the Government to reach out to nurses and find a solution. Will he, therefore, assure patients who are worried about next week's appointments that the Government will make an intervention to resolve this dispute before the strike takes place? That will clearly require flexibility and imagination; all settlements do. Both of those are in short supply in the Government's approach to this issue to date.

I agree with virtually everything the Deputy said apart from the final line. The Government respects nurses. The Government accepts and understands that no nurse wants to be out on strike when he or she could be at work. There is an understanding that the INMO has not done this lightly. The union does not do it often. This is a reflection of the frustration and anxiety in the nursing profession. We want to work with nurses to address those concerns, but as the Deputy has said, we have to do it within the parameters of the pay agreement. We must not unravel that agreement when there is still significant time for it to run and when as a Government we have committed hundreds of millions of euro to the delivery of our side of that agreement.

The Government wants to look at how we can be flexible. That is why we asked the Public Sector Pay Commission to look at this and to look at issues like qualification allowance, location allowance, dual qualification allowance increases and a series of other ways in which we can maintain consistency with the agreement while making a special arrangement within its confines, as the Deputy said. If we move beyond that, other unions will immediately demand the same, as he knows. My clear understanding is that the Government wants to be fair, open and imaginative regarding how we solve this problem, but we have to make sure we can afford any solution we sign up to. We have to make sure it does not fundamentally undermine a pay agreement which is hugely important for the broader economy and for public sector workers across the country. We also have to make sure that it does not involve shifting significant financial resources to salaries from other elements of healthcare. Moreover, it must not require the Government to borrow to meet the pay commitments it signs up to, which would be madness. Most people recognise that. We want to reach out and talk and we want the Labour Court to be allowed to do its job. We want to find a way of closing the gaps that will allow the court to make recommendations that we hope can be a basis for agreement. However, we have to do that within the confines of an agreement that the Government and INMO has signed up to.

Industrial relations are complex and challenging by their nature. The Tánaiste seems to be acting as if the Government is a passive observer and there is an immutable agreement in place that does not have within it the flexibility that is always created to allow for imagination and the resolving of disputes. That is the nature of every single agreement because the public sector is a complex, multifaceted organisation. That flexibility, imagination and creativity has not existed in the Government's approach to this issue to date. The Irish Congress of Trade Unions, ICTU, which wants to protect the overarching public sector wage agreement - it is the ally of the Government in that regard - knows that there is the flexibility in the agreement to address the nurses' genuine grievance. Will the Government talk to ICTU? Will it listen to how flexibility can be found within the parameters of the agreement? Will it cease being a passive observer, because thousands of our people who have been waiting for months, or sometimes years, for urgent medical appointments are anxious?

They have been waiting for years.

I call on the Government to resolve this, address these issues, call ICTU in and solve the problem.

The Deputy knows that we are not passive observers here because he has been in the Department concerned. The State and management interacted with the Labour Court in a significant way, as did the nursing unions. At the time, the demands and the confines of both arguments did not allow for a basis for an agreed compromise. We hope this can change.

If the Government does not do anything, it will not.

We are doing something. Plenty of conversations are happening, as I suspect the Deputy will be aware. The Government speaks to ICTU all the time and we listen to it. We also have to operate within the obvious confines of ensuring that we follow through on the commitments that we have made. We must make commitments that are affordable to the State as a whole, that are fair to public servants across the country and that are fair to nurses. We will do all we can within those parameters to try to find a solution nurses can accept and work with, which respects their profession and ensures they are part of bringing about a more attractive professions for nurses in the future.

We will see.