Address by Micheál Martin T.D. Minister for Health and Children at the SIPTU National Nursing Convention
I am delighted to be here with you today and would like to thank you for the invitation to address your National Nursing Convention.
Firstly, I want to refer to recent media reports and commentary concerning bed closures. In relation to the situation in the main Dublin hospitals, officials from my Department, the ERHA and the hospitals concerned are having ongoing discussions.
As you are aware, I had a meeting with ICTU recently to discuss the situation. The meeting was very constructive, and I will maintain ongoing contact with ICTU. We agreed that a process would be put in place to facilitate regular consultation, and allow areas of difficulty to be approached on a partnership basis, as outlined in Sustaining Progress.
I will be meeting ICTU again next week, specifically to discuss a number of issues relating to reform and restructuring of the health service.
The health service, while facing many challenges in recent years, has managed to deliver improved and more complex care to a vastly increased number of clients. This has been accomplished in the face of rapid advances in technology and demographic changes.
It is worth noting the scale of our achievements. In 2002 alone there were 960,000 inpatient discharges – a 23% increase in the number of inpatients treated since 1997.
Since 1997, we have witnessed unprecedented levels of investment in the health service. This investment has covered additional infrastructure, the introduction of new services and improvement of existing services, and substantial improvements in pay and staffing levels. There has been an increase of nearly 30,000 people working in the health service – almost 7,000 of these are nurses.
This investment has been matched with increases in the quantity and quality of healthcare outcomes, and we need to guard against undermining the achievements of all who work in the health service. It is important to remind ourselves, that every day, thousands of people have satisfactory experiences of the health service, and successful outcomes.
While there has been a substantial amount of adverse comment about the health service, no one can deny that the system is providing more and better services than ever before.
The past year has seen a significant number of developments and challenges in the health service. The Audit of Structures has been completed and the Commission on Financial Management and Control has finalised its work. A new Social Partnership Agreement – Sustaining Progress has been agreed. And, the work of the National Task Force on Medical Staffing has progressed, with invaluable input from the nursing profession.
The ambitious reform agenda upon which we are about to embark, will consolidate the achievements of recent years, and lay a firm foundation for the challenges that lie ahead.
I was heartened by the overwhelming (73%) acceptance by SIPTU members of the new Social Partnership Agreement – Sustaining Progress. The importance of these agreements cannot be over-estimated. They provide a framework for stability and growth within which our economy and society can develop, while at the same time promoting an equitable sharing out of the benefits of that development.
The framework for developing these agreements, which is based on partnership and inclusivity, is a practical acknowledgement of the interdependencies that exist in a modern society.
The private and public sectors cannot operate in isolation from one another – the decisions and activities of each have implications for the other, and for the wider community. In a small open economy such as Ireland, we are especially susceptible to the vagaries of the international marketplace. In a period of slowing economic growth and international uncertainty, we have to be sensitive to the prevailing economic factors.
This is the context within which Sustaining Progress was framed. The agreement is divided into two parts. Part 1 deals with the policy framework for sustaining progress, and includes broad guidelines for macroeconomic policy that will help to build, maintain and share economic development and prosperity, while at the same time deliver a fair and inclusive society.
Part 2 deals with pay and the workplace. In addition to the pay aspects, the document sets out a comprehensive modernisation agenda for the health services. The new agreement provides a significant opportunity to improve and develop our health services in the context of much sought after industrial relations stability. For patients and the public at large, it aims to create an environment where change can be introduced without recourse to the threat of industrial action, and the associated uncertainty about continuity service.
As you all know, the past year has been a particularly active one on the industrial relations front, both nationally and locally.
The threat or commencement of industrial action has a destabilising effect on the industrial relations procedures, distracts the attention of both management and unions in the quest for solutions, and causes great anxiety among the users of the health service and the general public. It also leads to a poor public perception.
A great deal of resources has been committed by the taxpayer to the establishment of a comprehensive industrial relations infrastructure which, if used as intended and to the fullest extent possible, will result in mutually satisfactory outcomes.
The new partnership agreement – Sustaining Progress – provides for a strengthening of these procedures. Among the additional measures being taken is the setting up of a strategic, problem-solving group comprised of sectoral representatives from unions and management, which will meet on a quarterly basis to monitor and oversee developments in the industrial relations environment. Your National Industrial Secretary for Health and Local Authorities, Matt Merrigan, has been nominated to represent the union side on this high-level group.
The National Joint Council will be the primary forum for the management of industrial relations in the health service. The role of the NJC will be widened, and appropriate resources will be provided to support this new role. It is expected that the NJC will be fully utilised by all parties prior to any industrial action being considered.
Partnership has a key role in helping to deliver better industrial relations. The mainstreaming of partnership will help realise its full potential in driving and managing the change and modernisation process. This will ensure that a broad range of issues amenable to resolution through partnership will not be allowed to develop into industrial relations difficulties.
Audit of Structures
One of the main conclusions in the Health Strategy was that while the system has served us well in many respects, some significant concerns remain.
These include the need for:-
- stronger co-ordination and integration of functions and services;
- greater consistency in access to, and delivery of services throughout the country;
- greater clarity around levels of decision-making in the full range of organisations, and
- the need for “whole system” effectiveness.
A number of reform initiatives have been undertaken, including the Audit of Structures and Functions in the Health Service. The Audit was commissioned to ensure: –
- Clear lines of accountability and communication within the system;
- No overlap or duplication between organisations, and
- A proper alignment of the structure as a whole to the vision and objectives outlined in the Health Strategy.
The study found that there are a number of barriers to achieving the improvements sought in the Health Strategy. It also identified the need for strengthened frameworks for governance and accountability, as well as the need to develop and enhance supporting processes to secure improved planning, integration, delivery and evaluation of services. It also found that there was too much fragmentation and a multiplicity of agencies.
While the consultants who carried out this audit have identified a number of shortcomings, it is important to be clear that the findings relate to structural issues, and do not in any way detract from the expertise, skill and dedication of the workforce.
The Government is committed to taking early and decisive action on the reform agenda, and I will be making proposals to Government for the implementation of an integrated package of re-structuring measures in the near future.
I am confident that there are gains to be made from a radical re-structuring of the health system. The proposals now being advanced are a considerable challenge. I will not understate the enormity of the task ahead – there are no “quick fixes” for the kinds of changes we envisage undertaking. I would also say that the full potential of the system can only be realised if we continue to invest as we reform.
National Task Force on Medical Staffing
I established the National Task Force on Medical Staffing in February 2002, to prepare an implementation plan for reducing the working hours of NCHDs, and achieving a consultant-provided service in line with a number of previous reports.
The terms of reference of the Task Force are primarily concerned with medical staff. However, it is important to examine the role of other key health professionals such as nurses, health and social care professionals, and other personnel who form a key part of the delivery of healthcare.
In this context, a group chaired by Mary McCarthy, Chief Nursing Officer of the Department of Health and Children, is considering the implications of the work of the Task Force for the development of nursing. The emphasis is on identifying ways in which the role of nurses and midwives can be enhanced, in the context of the developments in nursing and midwifery generally. This work commenced in December 2002 and is continuing.
SIPTU is represented on this group by Mary Durkin, President of the National Nursing Council of SIPTU.
By far the most profound development in nursing in Ireland has been the transfer of nursing education to the higher education sector, and the introduction of the new 4-year degree leading to registration in general, psychiatric and mental handicap nursing. This was one of the key recommendations of the Commission on Nursing, and it is most gratifying to be able to stand here today and report to you that the entire process has been accomplished without any major difficulties. The new degree programme commenced in September 2002 in thirteen higher education institutes across the country, with a record number of places available.
As you know, the Government has committed substantial capital and revenue funding to the degree programme. A new, purpose-built capital infrastructure is being put in place in the thirteen higher education institutes at a total cost of some €230m over the next three years.
The Government´s commitment does not end there. By the time the programme has a full complement of students in the autumn of 2005, the annual non-capital cost of running the programme will be in excess of €90.0m per year. These are very substantial sums in anyone´s book, and reflect the Government’s commitment to the development of nursing and the wider health service.
It is important to point out that the Government´s investment in nursing education did not begin with the degree. Since 1998, we have steadily increased the number of training places available. In that year, 968 places were available across the three divisions at pre-registration level. By 2002, just four years later, this figure had risen to an all-time record of 1,640, an increase of almost 70%.
This is the first year that nursing has been part of the mainstream applications process administered by the Central Applications Office, and has had to compete in the education marketplace alongside all other third-level courses processed through the CAO.
I am glad to report that nursing has performed very well in this year’s applications campaign. Overall, there are 7,200 first preference applications for nursing, of which almost 1,600 are from mature code applicants. These are excellent indications, and I am confident that all places will be filled this year.
These figures are concrete evidence that school-leavers and mature students alike view nursing as an attractive and worthwhile career choice.
I would also like to congratulate the Nursing Careers Centre of An Bord Altranais for the success of their advertising and promotional campaign this year. The newspaper and radio ads were very effective, and they have succeeded in raising the profile of nursing as a career to a very high level.
The transition to a new nursing degree was a complex and difficult process, and congratulations are due to the members of a number of organisations. These are: –
- The Local Joint Working Groups who made things happen on the ground;
- The hospitals and institutes of higher education;
- Regional and national agencies, including health boards and government departments;
- The nursing unions;
- The National Implementation Committee, and
- An Bord Altranais.
This has been a tremendous achievement, and I would like to convey my personal thanks to all involved.
Increased Maintenance Grant
While much of the focus has been on the new nursing degree programme, we must not lose sight of the fact that we still have students completing the three-year nursing diploma.
Recently, I had pleasure in announcing a 7% increase in the annual maintenance grant payable to nursing diploma students from 1 June 2003. The grant is being increased from €4,533 to€4,850 per annum. This increase will cost an estimated€418,000 in 2003 and €344,000 in 2004.
Recruitment & Retention
Our ability to recruit and retain skilled and experienced nurses is a vital component of the Health Strategy. You will be aware of the financial supports for nurses and midwives undertaking post-registration courses introduced as part of my overall recruitment and retention strategy, including: –
- Payment of fees for part-time degrees;
- Payment of fees for courses in specialised areas of clinical practice;
- Payment of fees and salary to nurses undertaking “back-to-nursing” courses.
At a strategic level, the Study of the Nursing and Midwifery Resource was published last autumn and this will help form the basis for the nursing and midwifery input to the implementation of Integrated Workforce Planning, as provided for under the Health Strategy.
I would like to illustrate the improvements that have taken place in nursing numbers generally over the past few years. In 1998, there were 26,611 whole-time-equivalent nurses employed in the public health system. By the end of 2002, provisional returns indicate that this figure reached 33,449. This is an increase of over 6,800 during the period, or almost 26%.
It is clear from these figures that the recruitment and retention measures I introduced are proving to be very effective.
Last January I had the pleasure of launching the Research Strategy for Nursing and Midwifery in Ireland. This is a very important step forward in providing a cohesive and organised approach to nursing research.
I believe that an active research community involving nurses and midwives, in all healthcare settings and third level institutions, is critical to the continued improvement of the quality of our health services. I also know that an active research community is critical to the development of the nursing and midwifery professions.
A Nursing and Midwifery Research Committee has been established to oversee the implementation of the strategy.
The committee, which is chaired by Mary McCarthy, the Department’s Chief Nursing Officer, had its first meeting in March, and is working to develop a project plan for the implementation of the recommendations of the strategy.
New Nurses Bill
We in the Department are currently working on a new Nurses Bill that will amend the Nurses Act, 1985 to address the recommendations of the Commission on Nursing.
As you know, the Commission made wide-ranging recommendations to amend the Nurses Act. Some of the professional issues to be addressed include: –
- That the general concern of An Bord Altranais should be “protection of the public”;
- The provision by the Board of professional guidance and support to nurses and midwives, and
- Revised fitness to practice procedures.
Another important issue to be considered is the extension of limited prescribing rights to nurses and midwives.
I hope to bring proposals for the new Nurses Bill to Government later in the year.
The Health Strategy – Implications for Nurses
Contrary to popular opinion the Heath Strategy is alive and well I am pleased to report that 91 of the 121 actions set out in the Action Plan are currently being implemented. It is after all, a seven to ten year strategy which is only 18 months old.
In relation to the Health Strategy generally, it is important to realise that you, as nurses, are the largest individual professional grouping within the health service. You are also the most frequent channel of communication between the patient and service provision. You are, therefore, uniquely placed to ensure that the service takes on a more people-centred approach to service delivery. Your pivotal role between the patient and the service also provides you with an opportunity to be a force for positive change in the way services are delivered.
Primary Care – A New Direction
Last year, I spoke about the Primary Care Strategy, and I would like to bring you up to date with developments in the past year.
Last October, my Department gave the go-ahead for the establishment of ten implementation projects, and funding totalling€8.4m has been provided in 2002 and 2003 for this purpose.
The projects involve putting in place, at ten locations around the country, a primary care team which will include GPs, nurses and midwives, healthcare assistants, home helps, an occupational therapist, physiotherapist, a social worker and administrative personnel.
As the ten projects are rolled out, more than 80,000 people will benefit from having direct access to an improved range of primary care services; and, as the new model is developed, a wider network of other primary care professionals will also provide services as the needs of the populations in the catchment areas dictate.
It will provide opportunities for nurses and midwives to play a wider role in the delivery of primary care, and will have significant implications for professional development and expansion of scope of practice. These developments will be underpinned by the Nursing and Midwifery in the Community Strategy, which is due to be completed in 2003.
The intention is to have the implementation projects commence operations in the middle of this year and be fully functional by December.
Development of Psychiatric Services
We have seen major changes in the delivery of mental health services in Ireland over the years. Enormous strides have been made and continue to be made in developing a service that is comprehensive, community-based and integrated with other health services. This shift in the delivery of services from predominantly hospital-based care has been extremely successful, and the quality of care for persons with a mental illness has been enhanced as a result.
In the period 1999-2002, an additional €70.7m revenue funding was invested in the mental health services. In the current year, additional revenue funding of €7.6m will be provided for on-going developments, including the areas of child and adolescent psychiatry, psychiatry of later life, liaison psychiatry, suicide prevention initiatives, and support for the voluntary sector for the development of advocacy services.
Overall, about €190m in capital funding is being provided through the National Development Plan to facilitate the development of acute psychiatric units attached to general hospitals, to replace services previously provided in psychiatric hospitals. The latest of these, at St. Luke´s Hospital, Kilkenny, opened its doors to patients in early March.
There are now nineteen general hospital psychiatric units operational throughout the country. A further two units will become available in the near future, two more are under construction, and several others are at various stages of planning.
New Mental Health Policy
The Health Strategy recognises that there is now a need to update mental health policy to take account of recent legislative reform, developments in the care and treatment of mental illness, and current best practice.
The Strategy gives a commitment that a national policy framework for the further modernisation of the mental health services, updating the 1984 document (“Planning for the Future”) will be prepared. Work on this is expected to begin later this year.
Assaults on Nurses
The Report of the Task Force on Assaults on Psychiatric Nurses has recently been completed. The incidence of assaults on psychiatric nurses has been of concern to all involved in the service for some time. It was in this context that I established the Task Force in April 2002, under the chairmanship of Mr Tom McGrath.
The report deals with the causes and effects of violent acts in mental health services, and makes a number of practical recommendations in relation to preventing and minimising the incidence of assaults. I will bring these recommendations to the attention of employers and educators with a view to having them implemented without delay.
The Report also sets out the framework for a scheme of compensation for psychiatric nurses who have been seriously injured as a result of an assault in the workplace. Such a scheme has legal and financial implications and will require careful consideration prior to implementation. Officials from my Department have started discussions with officials from the Department of Finance with a view to working out the detailed administrative arrangements necessary for the establishment of the scheme.
I would like to thank Tom and the other members of the Task Force for their efforts. I would especially like to acknowledge the contributions of Oliver McDonagh and Pat Hughes of SIPTU.
National Patient Perception of the Quality of Healthcare Survey
Last March, the National Patient Perception survey was published by the Irish Society for Quality & Safety in Healthcare. The results of this survey are very encouraging for all involved in the delivery of a quality healthcare system.
This independent study examined key areas of in-patient care including admission procedures; communication with staff; medical procedures and operations; and nursing staff assistance.
Key findings in relation to nursing are:-
- 85% of patients reported that sufficient nurses were on duty always or most of the time;
- 86% of patients considered that nursing care at night was as good as nursing care during the day, and
- Over 90% of patients received the help they needed from nurses in a timely manner.
Overall, 86% were satisfied or very satisfied with A&E services, and almost 93% were satisfied or very satisfied with the overall quality of care they received during their stay in hospital.
The survey also highlights a number of areas identified by patients where improvements might be made but, interestingly, these areas were not linked to any question of resources. For example, communication was identified as an important dimension of quality, and respondents would welcome more written and verbal information in relation to their hospital stay, as well as post-discharge advice.
While no one would claim that the health system is perfect, this independent survey demonstrates that the service is infinitely better than many commentators would have us believe.
The very high levels of satisfaction reported are proof of the dedication and professionalism of all who work in the health service. You, as nurses, have particular cause to be proud of your pivotal contribution to this achievement.
Changing of the Guard
This year we mark the departure of Teresa Cody from Nursing Policy. Teresa has been transferred to Community Health Division. I am sure you will agree with me when I say that her contribution to the development of nursing in Ireland is rivalled by few.
Teresa was instrumental in the establishment of the National Council for the Professional Development of Nursing and Midwifery, and was a member of the Council until recently. She also played a key role in assisting in the resolution of various contentious issues as they arose.
I am sure you will agree with me that Teresa was always willing and available to assist your Organisation with any difficulties that arose. I wish Teresa all the very best in her new role, and I am sure you will join me in expressing appreciation for her outstanding contribution to nursing.
Teresa´s replacement is Eugene Lennon who joins us from the Department of Finance. I welcome Eugene to the Department and wish him well in his new role.
I will now conclude by thanking Oliver McDonagh for his kind invitation to address your convention. I hope you have a successful convention, and that you all enjoy this opportunity to discuss and debate issues of mutual interest with colleagues.