First things first. Anyone who has ever spent time in hospital, or whose loved ones have – and that’s most of us, I suppose – will know how much patients rely on nurses. And that the care and expertise provided by nurses often makes a creaking health system work. This was especially true during Covid, when many nurses played a truly heroic role. But it was true before and after Covid, too. So if there is a real crisis in nursing, that is a grave matter for the health service, and a serious issue for us all.
This week, the main nurses’ trade union, the INMO, met for its annual conference in Killarney. Even by the standards of rhetoric customary at trade union conferences – and boy, that is a high bar to reach – the nurses were painting a vivid picture.
General Secretary Phil Ní Sheaghdha said action was needed as nurses “could not endure another winter” like recent ones, as they were “breaking people”. A survey of 2,000 its members found that almost three-quarters of nurses had considered leaving their current jobs in the previous month, mostly because of stress or exhaustion.
Well, it sounds as if things have never been so bad. There won’t be a nurse left in the country soon. But is that really true? A quick recap of previous nurses’ conferences reveals familiar themes.
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In 2018, nurses’ leaders said their members were “fed up”, “angry”, “badly treated” and “let down” in relation to their pay and conditions.
In 2017, threatening a national strike if pay rises were not forthcoming, one delegate from the Mullingar branch said people cleaning floors in hospitals were earning more than nurses.
“I work in an emergency department and am four years qualified. There are people cleaning floors earning more money than me. I am not saying they do not deserve to be paid €19 per hour. They do. They work really, really hard. But I deserve to be paid more than that,” he said.
In 2016, the union’s vice-president Mary Leahy said nurses had shouldered much of the burden during the economic crisis but had been “disrespected” by the State. “We have given enough,” she said.
“It’s time nurses and midwives were respected. I’d go as far as to say we feel abused and we feel the Government owes us an apology,” she said.
‘Prepared for war’
In 2013, in the midst of austerity, the nurses declared that they were “prepared for war” with the Government.
And so on. Go back even further into the mists of history to before the economic crash, and you find a similar pattern. Then Minister for Health Mary Harney got a frosty reception in 2007 when she declined to pony up a 10 per cent pay rise and a cut in weekly hours. As a general election approached, union president Madeline Spiers told Harney: “Our votes are up for sale – I make no bones about it.”
Luckily Enda Kenny, then leader of the opposition, was on hand to make a bid for those votes. “The answer today is a resounding no. With Fine Gael in Government that answer will become an unqualified yes,” he told them. Luckily for Kenny and for Fine Gael, the auction failed; he lost the 2007 general election and therefore avoided being blamed for the economic catastrophe that followed.
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Anyway, the point of all this is that hyperbolic declarations from the nurses are not unusual: in fact, they are very much the norm. Of course, overstatement is the currency of these things. And the nurses’ union is more than entitled to make a case for its members being a special case and deserving special treatment – that is its job.
But the job of politicians and senior officials is a different one: to judge the competing claims for public resources and make the best judgments they can about where the public interest – rather than the interest of the public sector unions – lies.
I have no wish to sit in judgment on the nurses’ claims. Good luck to them. But three short points strike me as relevant.
First, it’s very hard to make the case that the nurses are uniquely badly paid. Like all public servants, there is a large salary range, from about €33,000 for graduates up to about €138,000 for a hospital group director of nursing and midwifery. . But allowances, overtime, special payments, etc, bring the real salary up considerably. Averages are tricky, but publicly available HSE data suggest the all-grades average (including allowances, overtime, etc) pay for a nurse is about €63,000-€65,000.
Second, while there are undoubtedly localised shortages, the claims of a recruitment crisis seem generally overdone. On net figures, over 6,200 nurses have been added to the public system since before Covid. There are 85,000 nurses and midwives on the register, with 45,000 whole-time equivalents working in the public sector. Moreover, we are not under-nursed – at least, not according to the OECD, which says Ireland, at 14.7 nurses per 1,000 of population, has the highest ratio in the EU.
Third, nurses get a pretty good press. And fair enough, they deserve it. But the Government is going to be overwhelmed with demands from all sorts of groups – many deserving, some not so much – in the coming months as the powerful special interests which are so much a part of our politics vie with each other for the biggest possible slice of the biggest pie any Irish minister for finance has had at his disposal.
If the Government is going to make sensible and prudent decisions in the long-term interest of the country – and not just give in to the loudest voices, or the best media campaigns – their multifarious claims will have to be subjected to an unsentimental interrogation. This general principle is by no means confined to the nurses. But uncomfortable as it may be, that’s not a bad place to start.