The health service is still in crisis. The nurses' strike today is discommoding a far greater number of services than the last one. Some 50,000 patients have had their elective procedures cancelled. It is a cause for alarm that emergency departments will come and are coming under extreme pressure today. We know of the comments from the Irish Association for Emergency Medicine. The 50,000 patients, on top of those who were affected last week, amount to a lot of people across hospitals and community services across the country. Respite care and rehabilitation services will also be severely affected as a result of today's action. Disability services have also been brought within the scope of the strike. The Psychiatric Nurses Association, PNA, is escalating its overtime ban tomorrow and Thursday. The ban will now operate for 24 hours and thereby include overnight rosters. Therefore, mental health services will also be severely impacted on.

The Government has known about this for a long time, but there has been an absence of substantive and meaningful engagement on it. I put it to the Taoiseach that last night's initiative, the proposals that emanated from the Ministers, Deputies Donohoe and Harris, at the eleventh hour, has only served to compound the problem, make it worse and escalate it. The proposals concern staff shortages, undergraduate education, future nursing needs and so on, but they were sent via a press release without any engagement with the Irish Nurses and Midwives Organisation, INMO, or the PNA.

The INMO's general secretary, Phil Ní Sheaghdha, described it as "the most cynical move I have seen in a long time". The unions have rejected it as Government spin and said it was massively disrespectful to the nurses and to patients. The Taoiseach cannot solve industrial relations disputes with such cynical PR manoeuvres. The approach that holds optics to be more important than substance will not cut it when it comes to an industrial dispute of this gravity and scale. Meaningful steps are required to be taken. Substance must replace spin in the resolution of this dispute. Being seen to do something by rushing out a press release is not the approach. Why not engage in mediation to create a meaningful process to set in train a process that would come within the aegis of the industrial relations machinery? Why not deploy somebody of the calibre of Kieran Mulvey, for example, to engage with both sides to develop such a process that would bring the Government and the unions together under aegis of the industrial relations machinery to resolve this issue? The resolution of this dispute will require creative approaches and solutions. It has happened in the past in other similar disputes. The Taoiseach has to engage substantively with the issue. I ask him to take an initiative similar to that which I have just suggested.

On my own behalf and on behalf of the Government, we profoundly regret the disruption that has been caused to patients, users of our disability services and people with mental health problems who have been adversely affected by the strike action today and last week. We will do all that we can once this dispute is resolved to catch up on the lost work that was done, as we did last year when a number of days' work was lost as a consequence of the storms. I want to recognise that cover is still being provided in maternity hospitals, for palliative care, for most cancer care and in our emergency departments. There has been considerable engagement in efforts to resolve this dispute before now. For example, the whole issue of recruitment and retention was examined by an independent body, the Public Sector Pay Commission, which made recommendations for a €20 million package of allowances and additional increments and career progression for nurses, at a cost of €20 million a year. That was rejected by the nursing unions, or at least by two of the three nursing unions. There was an engagement at the Workplace Relations Commission, WRC. There was also an engagement at the Labour Court. We are open to further engagement and will be happy to have it, either at the WRC or the Labour Court, should it decide to intervene.

I appreciate that the nurses' unions felt that the offer to engage in further talks at the WRC was discourteous as they heard it through a press release rather than through a letter or direct contact. We will make sure that does not recur. At the same time, though, we should not forget that tens of thousands of people found out through the media that their respite care was being cancelled this week and that their day care was being cancelled, too.

The Taoiseach should stop while he is ahead.

The Taoiseach is digging a hole for himself.

He was never ahead.

In terms of the resolution of this dispute, I believe it can be resolved. I spent a little bit of time reading about the last major nurses' dispute which happened in 1999. Deputy Micheál Martin was in government himself at the time and he may remember better than I can.

It was resolved.

It went on for nine days and was ultimately resolved in the Labour Court at huge inconvenience to patients. I do not want that to happen again. I certainly would not like to see a repeat of 1999 when a strike went on for nine days. I believe it can be resolved. That requires engagement and the Government is open for engagement through the WRC. However, it can only be resolved in a way that is affordable for taxpayers and fair to all public servants with whom we have a pay deal already. We have to honour that deal. We are not in a position to break it by doing a special deal with one group of staff and saying to the others that there is nothing for them. That would not be right. They are the parameters under which this can be resolved and I am sure that if all sides accept those parameters, we can resolve this dispute swiftly.

It is the same script but a different day. The Taoiseach mentioned that the Government will help patients catch up. The only catching up that will be done will be done by nurses and doctors when this strike is over. The Taoiseach and his colleagues will not have to play catch-up. Did I hear the Taoiseach correctly when he said that he did not send any direct letter to the nursing unions in terms of last night's offer and that no direct contact was made? The Taoiseach said he will make sure it will not happen again. Is the Taoiseach serious? This is a very grave dispute, and that is a pathetic response. Has the Taoiseach reprimanded his Ministers? What were they doing last night? Was it just a cynical PR exercise? It is not good enough to say that unions did not engage. The unions have been engaged with the HSE about strike action for a long time. It is appalling that the Taoiseach should come here today and effectively say that the Government engaged in optics over this issue last night and that it did not make any direct contact with the unions over the offer that was announced last night. He clearly just wanted to be seen to be doing something. It was all done for the optics. That is appalling and a pathetic way to approach such a grave dispute. The Taoiseach should read up on the issues and not remain in denial about the recruitment and retention crisis. It is very real. We are haemorrhaging so many graduates from our colleges to the UK and other countries. I suggest that the Taoiseach should appoint someone of the calibre of Mr. Kieran Mulvey to engage in mediation and to create an environment in which both sides can get together.

The offer to engage in talks at the Workplace Relations Commission, WRC, was sincere. Whether it was made through a public statement or directly or indirectly should not matter.

Of course it matters.

It was a sincere offer to engage in talks, and that offer stands. The only way this dispute will be resolved is through engagement and through talks.

The offer to engage in talks at the WRC stands, and the Government is willing-----

It was industrial relations via Twitter.

-----to do that, with the HSE and others. The Government is also open to the possibility of a Labour Court intervention. Of course we have had consultations with the Irish Congress of Trade Unions, ICTU, and others about the possibility of an intervention. However, everyone feels that an intervention can only happen at the right time, when there is adequate space and adequate agreement so that we can proceed into a process. As I have said before, the parameters that have to be agreed are twofold. First, any agreement we reach has to be affordable for the taxpayer. We are not in a position to engage in borrowing to fund pay increases, and it would not be responsible to do so, particularly at this time. Second, any agreement we make, especially anything concerning pay, must be done under the existing Public Service Stability Agreement, with the involvement of ICTU. It would not be fair to 300,000 other public servants, with whom we have a pay deal and who are not on strike, if we gave a special deal to one group and then say to others that we cannot do the same for them. That would not be fair.