Address by An Tánaiste and Minister for Health and Children, Mary Harney, T.D. to the Annual Conference of the Irish Nurses Organisation

It is a great pleasure for me to address the Irish Nurses Organisation for the first time as Minister for Health and Children.

People often use medical analogies to describe roles and jobs. So I think I can say that nurses are the backbone of the health services.

You represent the largest single group of people working in health. There are nearly 41,000 nurses in the public sector and 8,000 in the private sector.

A half of all healthcare professionals in Ireland are nurses.

You are present at the delivery of every aspect of health care, literally from birth to palliative care, from GP practices, to hospital operations, Accident and Emergency, complex surgery, long term care, mental health and rehabilitation services.

There is incredible variety in your profession. There is no typical nurse, there is no typical day for a nurse, there is no single nursing skill; but a great range of all in many different settings.

Patients place great trust in nurses. Real trust is actively earned and maintained, not taken as of right because of status. That is the tradition of the nursing profession.

It is the work you do and the care you give that is the basis of the high regard the Irish public have for nurses.

In a hospital, you are the health professional a patient has most contact with. You are often the first person a patient will call, and the last person to call when others are finished.

Through all the changes and reforms ahead, I am sure this will remain a constant. I am confident you will maintain the trust and the high regard of patients and of the public, as we together develop and reform our health services to work better.

There is no health care that doesn’t involve nurses. And so there can be no health reform without nurses playing your part in change, in reform and in the progress we all seek for patients.

Reform to make ‘the system’ work

The vast range of health care services you and many others provide is often called the ‘health system’.

But how many of us would like to go around saying, ‘I work for the system?’

None of you became nurses to work ‘for the system’.

I would think most of us would prefer to say, and actually do say, ‘I work for patients’. That’s the way I see my job too. Health care policy, health care funding and health care management is not about the better health of the system, it’s about the better health and well-being of patients.

Instead of ‘I work for the system’, I think we would all like to say, ‘The system works to help me work for patients.’ That’s my goal for health care reform. And that’s what I want to hear nurses able to say, wholeheartedly, and with conviction.

At the moment, a lot of people in health feel that they are working hard, but the system is not working well.

That’s true. The system is the collection of rules, procedures, reporting lines, funding mechanisms and work practices, and it is not working well, at all.

A few years ago, there was an ad for a computer company saying it would give the customer ‘the power to be your best’. That’s what the health system should be, that’s how all those rules and regulations should work, but we’re a long way from there.

The question is, how can we change the system? A lot of us feel it has a life of its own, and it can’t be influenced or changed. The truth is that we each play a part in influencing the system as a whole.

As Minister and as a member of the government, I have a primary role in relation to legislation, policy and budgets.

A lot more people than the Minister have influence over how hospitals manage beds, how people roster their time, how people engage in professional development and training, and how patients and their families are treated.

What I am saying is that we can each change the system for the better if we work together.

Since becoming Minister for Health and Children, I have heard very, very few people say that no change is necessary.

We can change the system to support the work you and many others carry out for better patient care, for higher quality services, and for innovation and development in medicine.

Who would not want the system to reward the achievement of these objectives? How could anyone prefer the system to be blind to innovation, flexibility and hard work for patients?

Should every hospital be paid the same no matter how well it organizes patient care? Shouldn’t clinical teams who try to improve patient care with new ideas be acknowledged and supported?

We all like to see others being open to change and innovation, especially when they are providing a service to us. And I would think we should ask the same of ourselves.

Each change we make will add up for better services. We can also identify changes that would make Accident and Emergency provide faster services and a better working environment, for example, by better rostering of everyone working in Accident and Emergency.

It is also fairer to patients – and to Accident and Emergency staff – to allow an escalation policy that would make beds available in wards at certain times. We must put patient care and patient safety first, as I know nurses do. After all, we are nearly all patients ourselves at some time.

It would be a great improvement also to have diagnostic services available promptly seven days a week and throughout the night.

These are some changes that can make a real difference for Accident and Emergency patients. They rightly expect us to do all to all in our power to make their care better.

I say this for every one in health, for myself and for 120,000 others across all areas: we can’t ask the system to change if we don’t change ourselves.

I believe that reform and change in any organization can only work if everyone is involved and if everyone is seen to be involved.

Ministers, GPs, consultants, hospital management, administrators, civil servants, politicians and nurses: we are all involved.

Some groups have already absorbed significant change, for example, arising out of the creation this year of the Health Service Executive. Others, such as GPs and consultants, are preparing for new contract talks.

Nothing will change for the better if each of us sees every change as a threat to our interests. The challenge is to make change work together. This is what social partnership is really about and what made it work for our country from the 1980s: we recognized we all had an interest in the whole economy working better, and we lifted our heads to see the big picture.

In all this, it’s important to be clear both about our goal, and where we stand now.

Our goal is top quality health care for our people.

•Appropriate, prompt, and safe health care in the right setting.
•Health care provided in a way that is fair to patients, fair to taxpayers, fair to health professionals.
•Professional staff ready for the job, in their training, equipment and support.
•Healthier living in a healthier environment.

Nurse staffing, rewards and development

To achieve these goals, we can only start from where are now. And there are many positives to build on.

In relation to nursing, I think we are very well placed for progress and reform. We have, as I said, a tremendous complement of nurses in our country, nearly 49,000 currently working.

We have 12.2 working nurses per 1,000 people, about 50 per cent more than the EU average of 8.5.

Since 1997, the government has invested in more nurses and higher pay for nurses. There are 10,000 more nurses working in the public sector than in 1997 – 7,000 whole time equivalents. And there are 70 per cent more student nurse training places.

In 2002, we introduced degree training for nurses and we are investing €240m capital in 13 nursing colleges. This year we are spending €90 million for this training.

We introduced flexible working times for nurses in 2001, which many thousands of nurses have taken up.

As a result of these and other improvements, I’m pleased to see that the turnover rate in nurses has fallen from 17 per cent in 1999 to 10 per cent last year. The number of nursing vacancies has also fallen.

Skill mix and development

Nursing is a challenging, rewarding and attractive profession. 49,000 people can’t be wrong! It’s also a changing profession with a developing career pattern and skill mix.

Throughout the country and across all health care settings, nurses and midwives are developing new skills and taking on new professional responsibilities.

I believe the focus of continued nurse education should be on the clinical training of nurses in specialty areas such as critical care, emergency care and dialysis.

We have introduced in recent years the roles of Clinical Nurse Specialist and Advanced Nurse Practitioners. They perform complex clinical roles and I’m sure you agree that training and development are of the utmost importance for them. I support their role and expansion into new areas, including care for older people.

I am also supportive of enabling nurse prescribing in legislation. I wish to compliment the people in An Bord Altranais and the National Council for Professional Development of Nursing and Midwifery for their joint work in preparing now a report on nurse prescribing.

The Report of the Expert Group on Midwifery and Children’s Nurse Education was presented to me at the end of last year. I have been very impressed by the work of the group which dealt with the challenging agenda and timeframe under the chairmanship of Dr Siobhan O’Halloran and reported in just four months.

I will be launching the report very soon.

I fully support the thrust of the recommendations of the report that a direct entry undergraduate degree programme should be introduced for both midwifery and children’s nursing.

I am very keen to see these programme in place as soon as possible and I am working hard to ensure that they can be implemented in 2006. I see this as the best way to ensure the supply of both children’s nurses and midwives into the future.

There are other many good ideas in the report. I am thinking for example of the recommendation that nurses who currently wish to undertake the post graduate programme for either midwifery or sick children’s nursing should retain their existing salary and be entitled to incremental credit in return for certain commitments and also that the programmes should be shortened.

The expansion of the nursing role supported by an appropriate skill mix of care attendants, and ancillary staff, is clearly needed in our health service.

I know that an issue is being raised in relation to the health care assistant role.

I believe this is a change for better patient care that the nursing profession can work with. Just as no teacher loses out from a Special Needs Assistant joining the school staff, no individual nurse will lose out from having a health care assistant available.

I would appeal for this to be resolved quickly, so that we can all keep our eyes on the bigger picture, which is better patient services.


We have had tremendous economic success in our country in recent years. We have shot up the world tables in economic performance. We are more confident as a people, confident in our economy, confident in our culture, confident even in our identity.

There is no reason why health can’t be part of this success.   There is no reason why Irish health services cannot rank among the best in the world. There is no iron law that says our hospitals must be stuck with inefficient bed management; our Accident and Emergency wards have to be over-crowded; and our long term care places unavailable or unaffordable.   I was always optimistic that Ireland could perform economically, if only we were given the chance with the right policies. And I am optimistic for health also, if only we give ourselves a chance by the right policies, practices and reforms.   Nurses are pivotal to all this. 49,000 people working for change and for better patient care will make a big difference.

We are only four million people. This is our system, under our control. It does not have a life of its own. There is no-one holding us back from change but ourselves.

This is a great time to achieve lasting improvements for our health services. We have the economy right. We have the resources available. We have the new structures in place.

Most of all, we have the people with the skills who can do it.   It is our challenge and it is entirely achievable.