Minister,
Thank you for taking the time to attend our conference and address our delegates, all of whom are working nurses and midwives and here as delegates of branches, professional sections, and forums, representatives of their colleagues INMO members working in public and private healthcare settings around the country.
I want to thank the First Vice-President, Ester Fitzgerald, Second Vice-President, Elizabeth Egan and the rest of the Executive Council for their support over the last twelve months. I also wish to thank Phil Ní Sheaghdha and the INMO’s senior management team for their guidance. I wish to also acknowledge my mother and daughter Alana who are here today.
I know this is your first INMO conference as Minister for Health. We truly wish you well on your term. We depend on you being successful, not just for the patients of Ireland but also for the betterment of the nursing and midwifery professions and for a stronger health service.
Minister, nurses and midwives work 24/7, 365 days of the year, in in our health system. We account for just over one third of the total workforce and are the largest single predominantly female workforce in this state. That demographic is slowly changing as more men join our professions, which is welcome.
Our priority is always to try and deliver timely, up-to-date, appropriate, high-quality, and compassionate care to our patients, care that we have been trained and educated to provide. We would like to see significant improvements in the delivery of this care.
Before I elaborate on these issues, I would like to offer sincere condolences to the families and loved ones of all our colleagues we have sadly lost since last year’s conference.
We are also thinking of the patients and their families we have cared for and helped through difficult times over the last twelve months.
We are all thinking of our international colleagues and take this opportunity to express our full solidarity with our colleagues who are providing life saving care in conflict zones.. Since we last met we have looked on in horror at the targeting of hospitals and other healthcare facilities. Healthcare workers, including nurses and midwives, deserve a safe environment to provide life-saving care to those most need it. We are thinking of course of our colleagues in Palestine. This summer we will welcome 6 paediatric nurses from Palestine to Dublin, so they can learn from colleagues in the Irish health service. Their workplaces should be off limits. Those who target healthcare workers or their workplaces must be held accountable and brought to justice under international humanitarian laws.
Inclusion Starts With Us
Minister,
The theme of our conference this year is Inclusion Starts With Us. Our Executive Council thought it was incredibly important this year to recognise the important work that happens outside of the hospital and organised community healthcare services.
This year’s conference focuses on the impact of inclusive healthcare on our society.
You’ll know that many nurses and midwives work in homeless health, migrant/refugee health, Traveller health, mental health, disability health, forensic and prisoner health and addiction services. Many of these services are interconnected and a lifeline for many service users.
As the national and geopolitical landscape continue to change, as the trade union representing nurses and midwives, we believe we must remain steadfast in our commitment to those on the margins of society.
It is often through the compassionate and skilled interactions of our nurses and midwives—caring for those who find themselves outside the traditional care system—that we see the most profound and lasting impacts on health and well-being.
As we are living in a world that seems to be more divided with each passing day, I am proud to be a member of a trade union movement that resists those who wish society to be divided and that leaves the most vulnerable behind. If we are serious about creating an Ireland for all, then the integration of inclusion health to reach our most vulnerable must be a priority factor in all strands of public healthcare policy and provision.
Minister this requires 3 things on the part of the State:
- Ensuring we focus on the true underlying principles of unviersal healthcare through SláinteCare
- Looking After Healthcare Workers to ensure they can look after the most vulnerable
- Getting Staffing Right
SláinteCare
Sláintecare, launched in 2018 with ambitious reform goals, promised a brighter future. But progress since then has been too slow. The measures introduced so far, while welcome, fall short of the systemic transformation we urgently need. If we are to meet our commitments under the UN Sustainable Development Goals—and, more importantly, deliver fair and accessible care to every community—we must fully implement Sláintecare and ensure the public service delivery model is maintained as we see too many services now being funded but not delivered by the public health service.
Efforts to further expand services are undermined by a critical issue—staffing. Recruitment cannot be a patchwork quilt of private and public. This is not safe
The 2018 Capacity Review forecasted a need for 700 additional Public Health Nurses by 2031 without reform—a number that is now likely an underestimation. Yet, we’re training only enough PHNs yearly to maintain the status quo, not grow the service.
Budget 2026 must reverse this trend. It must incrementally expand the PHN workforce, aiming for a critical mass of 2,500 WTEs. This means training at least 75 additional nurses annually, on top of those required to replace retirees and those leaving the service. We must also address barriers to training. Currently, there are only three universities offering public health nursing programmes. We need to expand that number and improve regional accessibility.
Community general nurses have been working in the community for over two decades without adequate recognition for their clinical expertise. A career pathway that rewards and values this nursing contribution in community healthcare is long overdue.
Beyond numbers, we must empower our professionals. The role of advanced practice nurses and midwives is pivotal to delivering on Sláintecare’s vision. These highly skilled clinicial staff are already providing safe, cost-effective, patient-centred care. It’s time to let them practice to the full extent of their expertise—without unnecessary barriers.
Let us be clear: Sláintecare is not about building new structures simply to outsource them to private providers. It is about building a sustainable, public health system that serves everyone—regardless of income, geography, or background.
Now is the time to move from plans to action. Let’s ensure that Ireland’s health service reflects the values of fairness, quality, and universality—values that every person in this room believes in.
Care of the Older Person Services
Minister, I am proud to be a Director of Nursing in Care of the Older Person Services. Getting older is inevitable for us all, as much as many of us would not like to admit it.
As we look to the future of healthcare in Ireland, we must face a critical demographic reality: our population is ageing rapidly. By current projections, Ireland is on course to have the highest old-age dependency ratio in the European Union. This will place unprecedented pressure on our health service, especially on long-term care systems which are already stretched thin.
And while these figures may sound abstract, the implications are deeply human. Most people, quite understandably, want to grow older in the comfort and familiarity of their own homes. Yet, we are failing to provide the kind of person-centred, at-home support that makes this possible. Today, over a quarter of people report that caring responsibilities are the reason they are not in paid employment. That’s not just a statistic—it’s a reflection of an unmet need, a system falling short of both carers and those they support.
To meet this need, the Government must accelerate progress on developing regulated, high-quality, and publicly delivered home care services—services that are available consistently and fairly across the country. The growing trend of outsourcing home care to private providers undermines this goal and should be reversed. We must prioritise care, not profit, particularly for our older citizens.
That said, we must also be realistic. Home care, while essential, is not a solution for every circumstance. Long-term residential care will always be a vital part of a well-functioning continuum of care. However, the increasing privatisation of these services is deeply concerning. The INMO firmly rejects the privitisation of care for older people. We cannot continue down a path where essential care is left to the forces of private capital.
Today, 74% of all long-term residential care beds in Ireland are in private facilities, and just 14 large private operators now control about 40% of all LTRC beds nationally. Meanwhile, smaller private nursing homes—particularly in rural communities—are closing at an alarming rate. Between early 2020 and the end of 2022, nearly one in five shut their doors. Simultaneously, nearly 700 public beds were also lost. This is not progress—it is a growing inequality in access to care.
This two-tiered system is not what Sláintecare envisioned. It is not aligned with the principles of universal, equitable healthcare. And most importantly, it is not working for the most vulnerable people in our society—those who rely on us to ensure they can continue to live and age with dignity in their own local community.
Let us be clear: the care of older people is not a commodity to be bought and sold. It is a public good. And it must be treated as such. We have motions at this conference calling for an immediate rethink of the privatisation of elder care, and an independently chaired task force on this crisis evolving in our older care services. Minister, this is a real runaway train, and it needs to be put back on track. We hope you will work with us to achieve this
Nurse and Midwife Wellbeing
We all know and readily accept that hospitals and healthcare settings by their very nature can be stressful environments. But what I refuse to accept is that it is accepted and tolerated that 12 nurses every single day are assaulted, either verbally, physically, or sexually, in Irish healthcare settings. Unfortunately we know this figure is lower than reality as many of these assaults go unreported. Despite laws being in place for harsher penalties for assault of healthcare workers, not one prosecution has taken place under Section 185 of the Criminal Justice Act 2006.
Let’s face it, over 91% of our profession are women. In what other profession would 12 women being assaulted in the workplace every day be accepted? It’s even more shocking that these types of assaults are happening against the backdrop of the very important conversations we are having in society about violence against women.
While it is great laws are in place, it is clear that this needs to be dealt with on a local level. Employers must uphold their responsibilities under the health and safety legislation. This includes staffing areas of care correctly and safely. Working short and overcrowding workplaces are the ingredients that add to the dangerous environment we are now witnessing daily.
The health, safety, and well-being of nurses and midwives directly impact healthcare employers' ability to recruit and retain staff. As consistently outlined by the INMO, there is a critical recruitment and retention problem within the Irish health system. The continued lack of a multi-annual funded workforce plan incorporating robust recruitment and retention strategies contributes to problems already evident due to the baseline shortage.
Safe Staffing and Legislation
Minister, you’ve rightly pointed out the growth in the number of nurses and midwives. Yes, the total number of nurses has increased in the public sector since 2021, however we started from a very low base. the moratorium introduced in 2007 slashed nursing and midwifery numbers that were not regained until July 2020. In the meantime, demand on the public health service has increased substantially since COVID, coupled with rapid population growth. The INMO’s daily trolley count figures have ceased to even raise eyebrows as the numbers are so consistently high.
When people attend hospitals in the coming months, they should ask how many other patients are there, how many nurses are on duty, and what the safe number of nurses should be rostered. The INMO is of the firm view that this information should be on display across emergency departments and wards. Patients and their loved ones should be aware of the staffing shortfalls that exist in our public health service.
Minister, the recruitment delaying issues introduced by the pay and numbers strategy which led to the recent dispute remains at the top of our agenda. The next six months is the agreed timeframe to enact the WRC proposal and must demonstrate measures to fully implement the Framework on Safe Nurse Staffing and Skill Mix. In 2019, the Labour Court recommended setting a target of year end 2021 for full rollout Level 3 and 2 hospitals have not seen the commencement. This is what we mean when we say we hope you are a reforming minister, when the science shows that its good for patients, good for retaining nurses, saves money, reduces length of stay then it needs to be funded and fully implemented.
One of your core asks in the upcoming budget must be to seek funding and get to the centre of the issue that causes delays in care delivery in Irish hospitals and community care – staffing. Let’s get on with over the next six months, – we are up for this and we will work with you but we will not tolerate anything less than full implementation.
It is a fact that scientifically based safety staffing ratios will not be in place today, tonight, or tomorrow.
The only way to ensure safe staffing is a given is to pass and enact the Patient Safety (Licensing) Bill in order to give HIQA more powers including the right to measure staffing on duty against the recommended safe staffing frameworks. This landmark piece of legislation gives HIQA the powers to ensure its recommendations are being enacted by individual hospitals and healthcare settings it inspects.
Midwifery
Minister, I want to acknowledge the work that has been done by you and your predecesor in putting women’s health high on the policy priorities of your department. I know that this is something that our Chief Nurse, Rachel Kenna has been very involved in and we believe that we can continue to progress women’s healthcare in Ireland.
Minister, we just celebrated Day of the Midwife. It is clear that midwifery staffing levels in Ireland, and indeed around the world are in crisis. Without sufficient staffing levels it will become more and more difficult to provide optimal care
Women must be at the centre of the care we provide and we need adequate staffing levels to be able to provide optimal care.
Despite the National Maternity Strategy calling for an expansion of women’s choices in maternity care, our system remains overly reliant on consultant-led, hospital-based care. While the strategy is clear, the progress we have made has been painfully slow. Political promises, unfortunately, have not yet translated into meaningful action on the ground.
Moreover, the funding required to support midwives and midwifery-led units like those in Cavan and Louth, remains insufficient, which only deepens the challenges we face. Midwives are vital to the delivery of high-quality care, yet they are often working in a system that fails to truly embrace their role.
Next year, we will see the introduction of a new National Maternity Strategy. This is a moment of opportunity—an opportunity to reshape the way we deliver maternity care, to give midwives the recognition they deserve, and to ensure that women across Ireland have the choice and the care they need. The voice of midwives must be heard, and their expertise must be integral to shaping the future of maternity care in our country.
Pushing Back Against a Culture of Silence
Minister,
You are all too aware that we are a regulated profession and operate under the NMBI’s Professional Code. Senior decision-makers, who are not exposed to the same level of clinical risk that our members are every single day, are making decisions that are only about bettering the bottom line rather than protecting nurses and midwives from worsening conditions that are really impacting our own mental and physical wellbeing.
I was struck by your interview on RTÉ in the aftermath of the HIQA report into scoliosis surgeries in CHI. In it, you said you wanted a culture in the health service where people who see things that are clearly wrong step forward and say them.
Minister therre has been too many instances of nurses being threatened with disciplinary action for advocating patient safety. many times there is blatant disregard for the clinical judgment of the nurses/midwives and the threat of disciplinary process to intimidate and seek to send a message for others in workplaces.
It raises the question of whether the statutory regulatory responsibility of nurses and midwives to advocate for their patients and point out areas of potential harm is being compromised by employers attempting to downplay the clinical risks associated with overcrowding, in inappropriately placing patients in ‘surge’ capacity and understaffing.
Nurses and midwives can be assured that the INMO will speak for and support them when they raise issues of patient safety that are ignored or, worse, suppressed, in the face of threats of disciplinary action. We have moved past that era, and we will not tolerate a regression.
Children’s Hospital and Future of Nursing
Minister, we are all hoping when you address us next year that the National Children’s Hospital will be open and safely staffed. You’ve said that you are having sleepless nights about the thoughts of children moving to the new campus. I can assure you that our members will plan and provide, as they do regularly, a safe transfer of sick children from one site to another. This is the type of event we are competent in, and while training is provided, this will need to be refreshed and practiced, planning is essential; the most important thing is that, when moving, the deadlines are set based on safety, and it must come first.
It cannot be denied that housing those we need to work in the new hospital and indeed all hospitals across the country is one of the biggest barriers to recruiting and retaining nurses and midwives.
We believe that recruitment and retention strategies must now address the immense challenges nurses and midwives face in dealing with the cost-of-living crisis and specifically the issue of housing, or lack thereof.
The rising costs of rent are not keeping pace with the salaries of nurses and midwives. For instance, if a newly qualified nurse or midwife living in Dublin or Cork is paying up to €1800 on rent, that means over 77% of their take-home pay each month is going towards rent. This is not sustainable in the long-term.
We’re calling for the introduction of a housing tax relief system for essential workers. Frontline nurses and midwives are facing massive out-of-pocket costs due to inflated rents and soaring property prices in the areas where they work. This support is urgently needed—not just to ease that financial strain, but to help attract and retain the healthcare staff our communities rely on
Our members work long shifts, there needs to be affordable and quality accommodation is close proximity to hospitals. We know that the Government intends to build elective hospitals in addition to opening the National Children’s Hospital, the provision of housing should be included in any plans to open any additional hospitals.
A significant number of nurses in CHI Crumlin travel from all corners of the country for their shifts and use on-site accommodation. They have stayed with CHI despite the commute, and this is very necessary due to a nature of specialist care in Crumlin, and it is only feasible at present as they have limited on-site accommodation, which is not going to be available in the new CHI site. Many of these nurses have indicated that they’ll leave when the move to the new site in St. James’s happens. Minister, this is the nightmare scenario that cannot happen.
We have students here from every corner of the country. They have borne witness to the chaotic conditions that their colleagues are working in day in and day out. It is no surprise that many of them are now looking towards their future and thinking that working in the NHS or in Australia is a more attractive option – the problem is not just the conditions they are working in Minister, it is that it is impossible to afford to live near any hospital in any Irish city and maintain a decent quality of life between spiralling rents and the cost of living.
In 2022, the Department of Health’s own modelling made it crystal clear: we’re facing a critical shortage in our nursing workforce. To meet future demand, we must dramatically boost the number of nurses we train—by 251%. Right now, Ireland produces just 31 nursing graduates per 100,000 people. To hit the Australian benchmark of 108 per 100,000, and to reduce our reliance on internationally educated nurses to 30% over the next 20 years, action is needed now.
The good news? We’re lucky in Ireland—year after year, we have more applicants than we have places for undergraduate nurse education. It’s time to match that enthusiasm with opportunity.
Minister, you’re just getting started on a very important body of work. We want you to succeed but you can only do that if you listen to the voices of those on the frontline.