Address by Micheál Martin T.D, Minister for Health and Children at the North – South Health Services Conference


I am delighted to be here with you today and would like to thank the Irish Congress of Trade Unions and the Health Services National Partnership Forum for inviting me to address you. The opportunity conferences such as this offers key players in our health services to network and share ideas is invaluable. I am confident you will find today’s proceedings informative and stimulating.

North – South Context

Your agenda provides scope for highlighting opportunities for developing a North/South dimension to healthcare as we strive to find new ways of working together and moving forward for the good of all our people.

As Ministers for Health, Minister Bairbre de Brún and I share a mission – it is shared also by health professionals, administrators and service providers in both parts of the island; it is to ensure that health policies are geared to bringing about the conditions necessary to achieve improved access to health services and optimal levels of health for the whole population. The success we can achieve in our mission will be dictated in no small way by the degree of co-operation on a North / South basis that we can bring to bear.

Both of our Departments are currently working to develop new health strategies which will provide a focus and opportunity to take stock and plan for the future; a future which I earnestly hope will bring further and better opportunities for joint co-operation and action between the two administrations North and South.

Before the signing of the Good Friday Agreement over three years ago, there had been a considerable, if relatively quiet, North / South dimension in the health area down through the years. Good relations had always existed between the service providers along the border area and a spirit of co-operation and helpfulness had always been in evidence. A cross-border flow of health personnel undertaking training and clinical placements had also been a regular feature. This was due to the all-island nature of the Royal Colleges of physicians and surgeons and some of the specialist organisations. In addition, good relations had been developed and cemented in recent years through conferences and similar events.

Now, in the post-Good Friday Agreement era, we have at our disposal the necessary tools to enable us to gear up to a higher and more sustained level of contact and focused action. Foremost among these tools, as far as health is concerned, is the North South Ministerial Council. Regrettably, for political reasons that you will be aware of, Minister de Brún and I have not been in a position to meet in the NSMC since last July. I certainly look forward, as I know does the Minister, to being able to resume our collaboration through the Council at the earliest possible date.

Disease, it has often been said, does not recognise borders and on an island so small as our own, this is indeed the case. We share common problems notably the same top three causes of death – coronary heart disease, cancer and respiratory disease. It makes good sense that we should strive for common solutions and joint approaches to tackling these diseases.

Two new cross-border bodies have come into existence since the Good Friday Agreement which are proving to be invaluable resources in the health area and certainly have the potential to help us in our search for common solutions and joint approaches to problem solving. The Institute of Public Health is based in Dublin and the Centre for Cross Border Studies is based in Armagh. In the past few weeks, both have produced valuable reports focusing on key cross border issues. The Centre’s report on Cross Border Co-operation in Health Services in Ireland points out not only the areas of co-operation but identifies certain obstacles to co-operation setting us the challenge of tackling them. The Institute’s latest report is on all-island mortality data and is titled Inequalities in Mortality. As I have already mentioned, we share the top three causes of mortality. The report leaves us in no doubt that there is considerable scope for greater North South co-operation for public health.

In recent years, the Co-operation and Working Together (CAWT) initiative has been playing a significant role in establishing partnerships in various aspects of health care through its member Boards and Trusts. CAWT will have an increasing role in developing the North South health agenda through its hands-on method of Working Together.

National Health Strategy

I have already referred to the work that is ongoing in my Department on developing a new National Health Strategy. To ensure a very wide input into the new Strategy, I embarked on a wide consultation process. The first plenary session of the Health Strategy National Consultative Forum took place on the 23rd of April and the second will take place on the 10th and 11th of July.

The Forum comprises a wide range of service providers, staff representatives and academic experts. It is one of a number of strands of consultation. I know many of you are involved in this process. My hope is that this level of research and consultation will ensure that the Strategy is one which is informed by a wide variety of views and which the public, providers, services users and staff will have ownership of for the future.

The 1994 Health Strategy adopted the principles of equity, quality of services and accountability. Undoubtedly, these are principles which we will be staying with in any new Strategy. However, I believe it is vital to develop a system which is “people-centred”. This means having a service that is planned and delivered on the basis of the best interests and the needs of patients, clients and their families. It may mean changing the way we deliver services. It certainly means giving clearer information to the public about their entitlement and, for health professionals, continuing to improve openness in their dealings generally, with patients or clients.

There has been a major investment in the health services during this Government’s term of office with funding doubling from £2.5 billion in 1997 to £5 billion this year. However, an examination of how much we spend and how we spend it will have to be an important part of developing a strategy for health for the future.

We all know that the staffing shortages in the health system are probably the single biggest potential obstacle to addressing the current service deficiencies. I believe that developing the “people” resource in the system will promote better quality services; give existing health personnel greater motivation and job satisfaction; and make the public service a more attractive place to work.

It is increasingly obvious that there is a need for a more integrated approach to both policy formulation and implementation. This has implications for everyone working in the health services. We will need improved communication, openness to new ways of doing things and a willingness to embrace change. The driving force behind this approach brings us back to the principles I outlined earlier, in particular the idea of a “people-centred” health service.

The job of making sure that everyone living is Ireland has the best possible health is a big challenge for a lot of people and agencies. It is also a challenge for each of us personally, because every day we make choices that affect our health. I attach the greatest priority to making the necessary changes to our health care system to further improve people´s health and quality of life.


The development of the new Strategy has been greatly helped by the Partnership structures established by the National Partnership Forum. Partnership facilitators have played a key role in the consultation process at local level within the health services.

This is very much in keeping with the partnership approach which is about developing an active relationship with flows in both directions. It is about developing joint objectives in an atmosphere of co-operation and trust. It´s about participation and consultation. Ultimately, it is about the delivery of a patient-focused quality Health Service reflecting the needs of the client. In this context, I look forward to the major conference which the National Partnership Forum is organising for the Autumn to lay out its work programme for the next two years or so.

The theme of today’s conference reflects the title of our Partnership Programme – Working Together for a Better Health Service. It makes perfect sense for us to look at partnership in a North – South context.

Partnership in Action – Beaumont and Royal Victoria Hospitals

The joint project between Beaumont and the Royal Victoria Hospitals which will be outlined later this morning is, therefore, very interesting and innovative.

I know that a good working relationship has existed at a professional level between Beaumont Hospital and the Royal Hospitals for many years. With the commencement of formal Health Services Partnership activity down here last year, an initiative was taken by the two hospitals to explore practical applications of partnership that would bring together management, trade unions and staff to work on issues that would add value for patients, practitioners and partners.

I understand that joint groups are working on the development of projects in a wide variety of areas – Human Resources, Infection Control, Bed Capacity and Utilisation, Trauma Management/Telemedicine, and Joint Fundraising – with a view to projects beginning in September next.

I look forward to hearing more about this exciting development.

Developing Skills and Qualifications

I have already referred to the effects of staff shortages and the connection between developing the “people” resource and better quality services. My Department has taken a proactive approach to the issue of workforce planning and a number of initiatives are underway. However, while increasing the number of training places is very necessary, we cannot train professionals overnight. It is also of crucial importance that we ensure professionals are enabled to focus on their professional role – this is important for the professions and the services alike.


The issue of skill-mix within the health and social care professions is one which is only now being addressed. The Expert Group reports on both the Health Professions and the Medical Laboratory Technicians recommend the introduction of a grade of assistant. The role of this grade will be to complement that of the therapist and technician – it will not be a replacement for these grades. Initial discussions have begun with the relevant trade unions in relation to the creation of this new grade.

Under the auspices of the National Social Work Forum, the parties are examining the core role of the Social Worker and working to ensure that the high level of professional training given to our Social Workers is reflected in the tasks assigned to them. A workload management study for the profession is being undertaken and this study will also examine the issue of skill-mix.


In the nursing area, implementation of a clinical career pathway leading from registration to clinical specialisation and to advanced practice is well under way.

The National Council for the Professional Development of Nursing and Midwifery is working closely with the regional Nursing and Midwifery Planning and Development Units to encourage the development of specialist posts based on identified service and patient need. This is a very welcome development and one of benefit to the nursing and midwifery profession and to our health services.

Effective Utilisation of Professional Skills of Nurses and Midwives

This brings me to two very important recommendations of the Commission on Nursing relating to the effective utilisation of the professional skills of nurses and midwives. One recommendation was that the Department of Health and Children, health service providers and nursing organisations examine opportunities for increased use of healthcare assistants and other non-nursing staff. The second was that the development of appropriate systems to determine nursing staffing levels be examined.

A Working Group, representative of nursing unions and health service employers as well as my Department, was established last year to address these recommendations. The Working Group has completed its work relating to the first of these tasks. Its report is being prepared for publication at present.

The Working Group is recommending that the grade of healthcare assistant / maternity care assistant be introduced as a member of the healthcare team to assist and support the nursing and midwifery function. The report explores the complementary roles of care assistants and nurses and midwives, examines issues related to delegation and integration of the healthcare assistant to the care team and makes recommendations related to the education and training of healthcare assistants.

The report´s recommendations are based on the premise that the nursing and midwifery function must remain the preserve of nurses and midwives. For my part I am convinced that nurses and midwives should be allowed focus on their professional nursing and midwifery duties.

A separate group, representative of nursing and non-nursing organisations, was also convened earlier this year to establish standard criteria for the education and training of healthcare assistants as recommended by the Commission on Nursing.

This group has endorsed the Working Group’s recommendation that the National Council for Vocational Awards (NCVA) training programme for healthcare assistants should be the preparation required for employment as a healthcare assistant. As evidence of the importance I attach to this issue, a start is already being made on implementation. The NCVA programme will be piloted in Autumn 2001 as recommended by the Working Group.

This is a very welcome development and will, I am sure, be supported by all nurses, midwives and healthcare assistants. It marks a genuine step forward for the nursing and midwifery profession, for healthcare assistants and for the health service as a whole.

Cross-border mobility

We are beginning to think more and more of cross – border co-operation as a possible solution to workforce issues.

In the nursing area, the University of Ulster, the Irish Nurses Organisation and my Department have co-operated in the development of a Postgraduate Diploma in Education for Nurses and Midwives to help address the nurse teacher shortages down here. My Department is also grant-aiding State Enrolled Nurses who wish to upskill themselves to work as registered nurses in our health services. At the moment, SENs must travel to the North or Britain for such programmes. It has not proved possible to date to run such conversion courses here. This is an area that I hope to discuss further with Minister de Brún.

Work on North / South co-operation regarding the training of social workers has been ongoing for some time now and good progress is being made. In 1998, the National Social Work Qualifications Board and its counterpart in Northern Ireland, the Council for the Education and Training of Social Workers (CCETSW) produced a joint report, outlining the qualifications structure in the two jurisdictions.

Building on this, there has been formal liaison between the staff and board members of the two bodies, aimed at enhancing social work mobility between the two jurisdictions.

One of the projects undertaken by the two agencies involved identifying the knowledge that a social worker who trained in Northern Ireland would need to practice in the Republic, and vice versa. Areas identified included domestic law, social policy and organisation of social services. This first phase of the project culminated in a one-day seminar last November, with participants from North and South, as well as from other countries.

Phase 2 of this project involves the development of a “Social Work Mobility Study and Resource Pack” as a tool to aid cross-border mobility. It will deal with information on the issues identified as crucial in Phase 1 of the project and will provide a very practical guide to allow social workers to move between North and South.

I am hopeful that the contributions from the key speakers today and the workshops to follow will provide further inspiration for mutually beneficial cross border developments in the areas of skills development.


I will now conclude by thanking Inez McCormack for initiating this conference. Unfortunately, I cannot stay with you for the rest of the day as I must be in Leinster House for question time in the Dáil.

I look forward, however, to receiving a report of the proceedings here today and firm proposals, arising from your deliberations, for a North-South partnership approach aimed at enhancing the quality of our health services to the benefit of the people who deliver those services and the people who use those services.