Tá an cosc earcaíochta sna seirbhísí sláinte ag cruthú go leor deacrachtaí agus anois tá 70% d’altraí ag rá go bhfuil sábháilteacht othar i mbaol. The effects of the Government's recruitment embargo are to be seen right across the State. They are to be seen in the number of patients forced to languish on trolleys in hospitals. They are to be seen in the number of patients across the health service whose appointments are being cancelled, as well as in the length of time they are being forced to wait for critical care. Those who are working at the coalface - our nurses - are very clear about the impact the recruitment embargo is having on the health service. The impact is not just on them, but also on their patients.

Yesterday, the Irish Nurses and Midwives Organisation, INMO, published the results of its member survey. It tells us that 70% of nurses and midwives said they were concerned that patient safety was now at risk as a result of staffing shortfalls. It is shocking that this is the view of those working in our hospitals. It is, however, an inevitable consequence of the Government's recruitment embargo. According to the survey, 63% of nurses and midwives have considered leaving their jobs in the past month, and one in five nurses have presented to their GP because of work-related stress. This is simply unsustainable. Karen McGowan, the outgoing president of the INMO, said yesterday, "the Government has failed to make progress on hospital overcrowding, and conditions for staff and patients in many places has gotten far worse than we could have imagined". These are health professionals who want to do their very best for their patients and our people, but in many cases the Government is making it impossible for them to do that. It is causing many of them to leave Ireland and seek work abroad, denying this country their skills and service. We need them here.

Sarah contacted us recently. She is a recently graduated care professional who said that it is horrible to have to sit in interviews only to be told at a later stage that there is no job because of the embargo. Dylan contacted us. Speaking about the embargo, he said he would love to come back home to Ireland and work as a nurse, but it is impossible to get a job because of the Government's embargo. Lorraine got in touch with us and said, “I am desperate to move home, but this embargo has left me stuck abroad. Please get me home.” The recruitment embargo the Government has imposed is making matters go from bad to worse. It is impacting every area of our health service. We were contacted by a young pharmacist from Waterford. She applied for a job last year and she was so enthusiastic about this job, but she is now being told that her interview will not be progressed because of the recruitment embargo. In her own words, she said that she has been left in limbo. We were contacted by a speech and language therapist who was offered a dream job last year. Everyone in this House knows that if we need one thing, it is more speech and language therapists. She was offered a dream job last year. She is working through an agency while waiting for the contract to come through from the HSE, but she has now been told that the job that was offered to her has been withdrawn as a result of the recruitment embargo. Under the recruitment embargo, job offers in our health services were instructed to be withdrawn. That is a fact.

It is patients and staff who are suffering as a result of this. Trained professional health service staff who want to come home are being locked out of that opportunity because of this embargo. It is now May and the Government still has not approved the workforce plan for the health service this year. It is five months into the year, but it still has not approved the workforce plan. When will the Government get its act together? When will it approve the workforce plan for our health service for 2024? Will it lift the recruitment embargo that is so badly damaging our health service and locking so many of our trained health professionals out of the potential to work in the health service, roll up their sleeves and care for the people they are trained to care for?

First, ní aontaím go hiomlán leis an Teachta. Ní dóigh liom go bhfuil an méid atá ráite aige cruinn maidir leis an méid daoine atá ag obair sna seirbhísí sláinte, go háirithe agus an méid banaltraí ag dul in airde. Is é fianaise an scéil go bhfuil i bhfad níos mó daoine ag obair anois sna seirbhísí ná mar a bhí anuraidh agus an bhliain roimhe sin.

In the first instance, I will deal with the so-called embargo that is being touted about the place. We now have 9,614 more nurses and midwives working in our health service than we did in December 2019. A 2023 OECD report shows that Ireland has the second-highest number of practising nurses per 1,000 head of population among the reported European Union countries. We are second only to Finland. Over the last three years, we have increased the number of undergraduate education places for nurses and midwives by nearly 600 places. For the 2023-24 year, there are more than 200 additional places in higher education institutions in the Republic. Moreover, in 2023, there was a once-off arrangement for approximately 130 students to study in Northern Ireland. We are committed to doubling nursing and midwifery undergraduate education places over the next five to eight years.

The hiring of graduate nurses, qualified nurses and midwives committed to and coming through the international recruitment pipeline, ED, ICU, maternity and community nurses are all exempt from the recruitment pause. Recruitment of nurses has continued. An additional net 3,168 nurses and midwives have been recruited since May of last year. Overall, in terms of the broader health service, 28,500 more staff are now working in our health service than at the beginning of 2020. These are very substantial increases.

I make the further point to the Deputy, who is his party's finance spokesperson, that the level of expenditure in health continues to grow apace. The figures in the first three to four months of the year show a significant increase in expenditure, even above profile. It is significantly above profile, which means that spending is continuing within the health services, mainly in the areas of acute and trauma services. That is the reality. There was a very substantial increase in health spending in the first three to four months of this year. It is substantial in its own right because of the budget, but even ahead of what was profiled in the budget, we are looking at very substantial increases in health expenditure. More than €7.5 billion extra has been allocated to the health service over the past four years.

To be fair, the waiting lists are coming down. Additional services across the health service have been provided as a result of that, both in primary care community services and in the acute hospital sector.

About 4,200 extra health and social care professionals have been recruited over and above what we had in 2020 and about 3,000 extra doctors and dentists have been recruited. Across the health service, there has been a very significant increase in people employed. We need to focus on whether deployment correlates with outcomes in certain areas.

Are 70% of nurses and midwives who work in our hospitals wrong when they say they are concerned about patient safety because of the levels of staffing? Is the outgoing president of the INMO wrong which she says that things are far worse now for patients and staff in hospitals? There are people in Australia and elsewhere who cannot come back and get a job as nurses owing to the embargo. The HSE cannot recruit a nurse from abroad. Are those people also wrong? A person got a job offer and is now working for an agency. It costs the HSE 30% more to employ her because it is through the agency. Is she wrong when she says she was told that her offer of a job was withdrawn because of the embargo? The Tánaiste talks about the so-called embargo. He needs to open his eyes and look around at what is happening. There is an embargo.

Regarding the numbers of professionals that were to be recruited this year, the Tánaiste is responsible for this because he will be part of the Government making this decision. The Government does not have its act together. It is the month of May and the Government has not sat down to look at the workforce plan for 2024. The HSE is in limbo and does not know how many it can employ. Robert Watt was before the committee and said it is over to the political level. There is a dispute there. When will the Government sign off on the workforce plan? Will it lift the recruitment embargo so we can allow our nurses and other professionals to come home from Australia and elsewhere and work in our health service?

I made the point already that graduate nurses, qualified nurses and midwives committed to and coming through the international recruitment pipeline, emergency department, ICU, maternity and community nurses are all exempt from the recruitment pause. Recruitment of nurses has continued. The other point, which the Deputy did not seem to pick up on, is that expenditure within the HSE in the first quarter of this year, as confirmed by the Department of Health, is way ahead of profile. Spending in the HSE has not stopped. Spending has not stopped in the health service. The Deputy is his party's finance spokesperson. There needs to be an evaluation of all of this, too.

A system in crisis will always cost more.

An additional €7 billion has been invested in the health service since 2020. When people say it is worse, I do not accept that because our survival rates have improved significantly over the past decade. There is room for significant improvement in certain locations. We need very rigorous examination of certain sites as to how people are deployed to get optimal outcomes and improve quality.