Speeches

Address by Mr Micheál Martin T.D, Minister for Health and Children at the Annual Conference of the Irish Nurses´ Organisation

Introduction

I am delighted to be here with you today and would like to thank the INO for once again giving me the opportunity to speak to you. And I hope it won´t be the last time!

Implementation of the Report of the Commission on Nursing

My absolute priority in the nursing area when I came into office was to press ahead with implementation of the Commission on Nursing´s recommendations in partnership with all of the key stakeholders involved.

There can be no doubting the steady but significant progress made in this area. This is facilitated by the partnership approach between all of the key stakeholders embodied in the Monitoring Committee which is overseeing the implementation of the recommendations.

The Second Annual Report of the Monitoring Committee was circulated last month and is available on the Department of Health and Children website. Work is also well underway on implementing the Action Plan for 2002 and 2003.

National Nursing Council

Last year I said that we can all be confident that the figure of 1,250 Clinical Nurse Specialists recommended by the Labour Court would be met – if not exceeded. I am delighted to say that my confidence was well placed!

As of yesterday morning, 1,354 Clinical Nurse or Midwife Specialists had been approved under the immediate pathway.

The National Council for the Professional Development of Nursing and Midwifery has now moved on to the Intermediate Pathway. This pathway enables the creation of CNS and CMS posts in line with the developing needs of the service.

The National Council has also developed the definition and core concepts of the role of the Advanced Nurse Practitioner (ANP). The process for the establishment of these posts comprises two parts: approval of site preparation and job description and accreditation of the ANP.

I would like to take this opportunity to encourage Directors of Nursing and service providers to maximise the potential for the development of Clinical Nurse Specialist and Advanced Nurse Practitioner posts in accordance with identified service and population need.

I should also mention that prior to the establishment of the National Council, the Nursing Policy Division of my Department initiated a consultative process with mental handicap nurses to determine both the specialist and advanced nursing roles undertaken by the mental handicap nurses and the educational framework needed to support these roles. A report detailing the findings of this project is being finalised for publication in the near future.

Nursing and Midwifery Planning and Development Units

The regional Nursing and Midwifery Planning and Development Units are central to many of the developments the Council is spearheading. I am happy to say that all of the Units are now up and running.

Effective Utilisation of Professional Skills of Nurses and Midwives

I now wish to address two very important recommendations of the Commission on Nursing aimed at 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 care assistants and other non-nursing staff. The second was that the development of appropriate systems to determine nursing staffing levels be examined.

My Department established a Working Group representative of nursing unions and health service employers to address these issues in 2000. The Working Group concentrated initially on the question of the increased use of care assistants and other non-nursing staff. The Working Group´s conclusions are based on the premise that the nursing function must remain the preserve of nurses. Its report was published last Summer following its acceptance by the Monitoring Committee.

The recommendations of the Effective Utilisation Working Group were adopted by the Review Group on Health Service Care Staff which was established under recommendation 4.55 of the Commission on Nursing.

With my approval, a pilot programme for the formal training of Health Care Assistants has been running on a national basis for almost six months. This programme is being run in conjunction with the Further Education and Training Awards Council, and is due for completion next week. Indications to date are that the pilot programme is working very well.

The University of Ulster has been commissioned to conduct a concurrent evaluation of the programme. It is anticipated that the recommendations derived from the evaluation will influence the extension of this particular programme on a national basis. An interim report will be available in June 2002, which will act as an indicator for the final recommendations due in September 2002.

The Working Group referred to above is now being reconvened to begin the second phase of its work in examining the development of appropriate systems to determine nursing staffing levels. I wish them well in this very important and challenging task.

National Research Strategy for Nursing and Midwifery

I now want to refer to another Commission on Nursing recommendation which is close to fulfilment – and that is the recommendation that the Nursing Policy Division in consultation with appropriate bodies, draw up a national strategy for nursing and midwifery research.

In September 2000 the Chief Nursing Officer convened a consultative committee representative of those with a core interest in research to draft a strategy. A consultative document was widely circulated during the latter half of 2001.

The overarching aim of the strategy is to develop a research initiative which as a whole delivers an outcome that can make an effective contribution to:

  • the health and social gain of the population;
  • policy development and formulation;
  • analysis of health, nursing and midwifery issues; and
  • knowledge development.

The final report which is due to be published shortly contains twenty recommendations developed around three distinct but inter-related levels of organisation required for the development and growth of nursing and midwifery research:

  • National Commitment
  • Institutional Commitment
  • Professional Commitment

The Commission specifically recommended that the Health Research Board should establish a nursing and midwifery research advisory division which could assist and advise nurses and midwives on the presentation of projects for financial grants. In advance of the publication of the strategy my Department agreed to fund a joint appointment between the Health Research Board and the National Council to take responsibility for leading the development of nursing and midwifery research. The successful candidate will take up this post next month.

The strategy will play a key role in establishing processes to ensure the development of a research-based culture aimed at ensuring continuous improvement in the delivery of nursing/midwifery care.

New Nursing Degree Programme

I now wish to turn to nurse education.

Last October the Government approved my proposals for the implementation of a new four-year pre-registration degree programme for nursing students on a nationwide basis at the start of the next academic year. This historic decision implements what is arguably the most important recommendation of the Commission on Nursing. It will finally put the education of nurses on a par with that of other health care professionals.

In support of this major development in nursing education, the Government approved a capital building and equipment programme totalling some €223 million for the construction of purpose-built facilities to accommodate nursing degree students at 13 higher education institutions throughout the country. This programme is expected to be completed by September 2004. The 2002 Estimate for my Department includes provision for capital funding of €30.83 million for the commencement of the programme.

The Estimate also includes provision for revenue funding of €5.65 million to cover the net additional costs arising in 2002 from the transition to the degree programme, as well as two related initiatives that I would like to bring to your attention.

The first relates to 93 new nursing training places being created this year as follows:

  • 15 general and 20 psychiatric nursing places at Institute of TechnologyTralee/Southern Health Board;
  • 20 mental handicap nursing places at Letterkenny Institute of Technology/North Western Health Board;
  • 20 mental handicap nursing places at Waterford Institute of Technology/South Eastern Health Board , and
  • 18 psychiatric nursing places at Athlone Institute of Technology/Midland Health Board.

A total of 1,640 places nationally will thus be available from this year on the new degree programme. This is an all-time record, and is a key element of my overall strategy for ensuring that we produce sufficient nurses to staff our health services into the future. It is most encouraging to note the huge rise in the number of applicants who have applied through the CAO for places on the new degree programme. This year, 8,882 applicants applied, a 35% increase on last year’s figure.

The second initiative for which provision is being made is a new sponsorship scheme for experienced public health service employees wishing to train as nurses. Up to 40 sponsorships will be available annually, and successful applicants will be allowed to retain their salary throughout the four years of the degree programme in return for a commitment to work as nurses for their employers following graduation. This exciting new scheme has been warmly welcomed as providing an important new career development pathway for health care assistants and other staff who are involved in the delivery of care to patients and clients of the health services.

Paediatric/midwifery education

I know that you are anxious to see the transfer of paediatric and midwifery education to the third level sector in order to complete the full integration of nursing education.

You will be aware that working groups on paediatric and midwifery education were set up to discuss the transfer of these areas to the third level sector and the appropriate content of the education programmes.

The conclusions and recommendations of these groups are a necessary prerequisite to finalising costings in relation to the transfer. The working group on paediatric education has submitted its report and I expect to hear from the working group on midwifery in the near future.

While my Department is in support of a transfer to third level, obviously the financial implications of same will need to be discussed with the Departments of Finance and Education and Science as well as the Higher Education Institutes.

Midwifery Advisory Forum

The National Midwifery Advisory Forum continues to flourish with practice, management, and teaching staff working towards co-ordinating and promoting discussions in relation to strategic change The chairperson of the group is now Patricia Larkin who took up her post as midwifery adviser in January of this year.

The working group on Midwifery Education is examining three options for frameworks of midwifery programmes. The consultation process is in progress and the group will report in the near future as already outlined. At the heart of all the discussion our main aim is to educate practitioners who will be able to provide competent confident care to women and their families.

Paediatric Nursing Education Review Group

The programme of implementation of the recommendations of the Paediatric Nursing Education Review Group is progressing well.

As already outlined, a strategy for the further integration of paediatric nurse education into third level sector prepared by a working group representative of the relevant stakeholders has been submitted.

A report from the Cork feasibility study into the provision of post-registration Registered Sick Children´s Nurse education in the location is expected in early Autumn. With regard to enhanced recruitment into this branch of the profession the paediatric hospitals are working collaboratively on a video project funded by the Department of Health and Children.

Recruitment and retention of nurses

The recruitment and retention of nurses continues to pose challenges for all of us. The new Health Strategy underlines the essential role played by employees in providing health services which are high quality, responsive and people-centred. The framework for human resources reflects the continuing difficulties being experienced in attracting and retaining a skilled work force in the health system. It must be said that in the area of nursing at least, we are a little ahead of the game.

You will be aware of the financial supports for nurses and midwives undertaking post-registration educational courses introduced as part of my overall recruitment/retention strategy, including:

  • payment of fees for nurses/midwives undertaking part-time nursing and certain other undergraduate degree courses;
  • payment of fees for nurses/midwives undertaking courses in specialised areas of clinical practice;
  • and the abolition of fees for “back-to-practice”courses and payment of salary to nurses/midwives undertaking such courses.

The Department is also engaged in strategic planning through the Study of the Nursing and Midwifery Resource. The focus of this work is on longer term planning. An Interim Report was published in October, 2000 and widely circulated within the health services. My recruitment/retention initiative of 29th November 2000, was an immediate response to a number of the Report´s recommendations. The Final Report is scheduled for publication next month.

Empowerment of Nurses and Midwives

It´s appropriate at this stage to update you on the work of the Empowerment of Nurses and Midwifery Steering Group. As you know, the group identified four central themes to drive its agenda forward:

  • Management Development;
  • Service Planning;
  • The Meaning of Empowerment;
  • Communications.

The Meaning of Empowerment sub-group is gathering exemplars of innovations and good practice in nursing and midwifery which demonstrate empowerment in action. The plan is to develop a publication so that examples of good practice can be shared with all nurses and midwives. Over 150 submissions have been received – many more than could possibly be included in the publication. Consequently an external evaluation has been commissioned to assist in selection of the items to be included.

The Management Development programmes for Clinical Nurse and Midwife Managers 2 and 3 and Middle Managers are also progressing well. The second delivery of these programmes involved approximately 120 nursing and midwifery managers.

Meanwhile, the Service Planning sub-group has completed production of a video for use in briefing sessions. The Nursing and Midwifery Planning and Development Units will play a key role in co-ordinating and supporting this initiative.

A&E Services and Bed Capacity

Last year I referred to the difficulties being encountered by various hospitals providing accident and emergency services and to the related difficulties of bed capacity.

As you will all be only too aware, for some time now the hospital system in general has been experiencing increased capacity pressures. This is evidenced especially through the pressures experienced in A&E where patients deemed to require admission must wait, sometimes for long periods, for a hospital bed. There are a number of factors contributing to the increasing demands being experienced in hospitals including the growth in population, changes in demographics, the increasing number of elderly people who have a higher than average length of stay and the availability of in-patient beds. Available data indicates that about 70% of all hospital admissions are through A&E departments.

Winter Initiative

This Government has taken a number of initiatives to improve services in A&E departments. A €40.63m investment package was provided in the Winter of 2000/2001 aimed at alleviating service pressures and maintaining services to patients, particularly in the acute hospital sector. This investment package provided for the recruitment of up to 29 additional A&E consultants and for the contracting of additional private nursing home places for patients whose acute phase of treatment has been completed but who require additional care in an alternative setting. The ERHA and the health boards contracted more than 700 beds under this initiative in the Winter of 2000/2001. This level of funding was repeated over the period October 2001 – March 2002 and has been of significant benefit to health agencies in responding to the high level of demand for hospital beds over the Winter periods.

A&E Initiatives

I have also provided funding to the ERHA and the health boards to support a further range of initiatives in A&E departments. These include:

  • £5.19 million towards the development of A&E facilities at St. James´s Hospital.
  • The provision of Minor Injuries Units in Beaumont, Mater, James Connolly Memorial, St. James´s and Tallaght Hospitals.
  • Development of A&E department at the Mater Hospital.
  • Extension to the A&E department at St. Columcille´s Hospital.
  • Development of pilot services for deep venous thrombosis in Beaumont Hospital
  • Provision of a chest pain service at St. James’s Hospital.
  • The provision of a pilot discharge lounge in Beaumont Hospital.
  • The recruitment of discharge planners and patient liaision personnel at A&E Sites in the Eastern region.
  • Development of new A&E department at St. Vincent´s Hospital, Elm Park.
  • Development of new A&E department at The Children´s Hospital, Temple Street.
  • Planning of a new A&E department for Cork University Hospital.
  • Development of A&E department at Galway University Hospital.
  • Development of A&E department at Castlebar General Hospital.
  • Development of A&E department at Tullamore General Hospital.
  • Development of A&E department at Portlaoise General Hospital.
  • Appointment of a design team for the development of a new A&E department at Roscommon County Hospital.
  • Upgrading of A&E facilities at Our Lady of Lourdes Hospital, Drogheda, Monaghan General Hospital and Our Lady’s Hospital, Navan.

I would not normally read out such a long list but it´s important to put these developments on the record.

Bed Capacity Review

My Department, in conjunction with the Department of Finance and in consultation with the Social Partners, has conducted a comprehensive review of acute hospital bed capacity needs. On foot of that review entitled Acute Hospital Bed Capacity – A National Review, the Government has decided to provide an additional 3,000 beds in acute hospitals over the next 10 years. This represents an increase of over 25% in acute bed capacity. I was pleased to be in a position to announce in January of this year a €65m investment package for the commissioning of 709 of these 3,000 beds in acute hospitals. My Department has been advised, by the ERHA and the Health Boards that 120 of these beds have been commissioned, with a further 50 beds due by the end of this month. The balance will be introduced on a phased basis over the next year.

This is a first step in implementing the recommendations of the review. The numbers and location of the next phase of beds will be determined following a review of bed capacity by region and specialty. I anticipate that this process will begin shortly.

Primary Care

A major re-focus on primary care services, marked by the introduction of new models of care involving core multi-disciplinary primary care teams, which will work with a wider network of health and social care professionals and which will offer 24 hour cover to patients, has taken place. This will also help to reduce demand from and treat appropriately patients who would otherwise have to attend at an A&E department. This sector will therefore take on a pivotal role in helping to reduce pressures in A&E departments. €17.29m is being invested in the development of this service in 2002.

A&E Service Initiatives in the Health Strategy

A further range of initiatives has been identified in the Health Strategy which are designed to improve the operation of A&E departments. These include:

  • the establishment of minor injury units;
  • the use of chest pain clinics, respiratory clinics and in-house specialist teams to fast-track patients as appropriate; and
  • the re-organisation of diagnostic services to ensure increased access to, and availability of, services at busy times in A&E departments.

Comhairle A&E Report

At my request, Comhairle na nOspidéal has undertaken a review of the structures, operation and staffing of A&E departments. The report entitled Report of the Committee on Accident & Emergency Services not only deals with the staffing of A&E departments at consultant level but also links reform of A&E departments with the need to look critically at hospital processes and patient flows through the hospitals. The report provides valuable advice on the structure of our emergency services and the necessary linkages which will be required to eliminate delays in emergency departments.

Industrial action by A&E Nurses

What I have outlined is a tangible commitment on behalf of this Government and investment in measures to alleviate pressures on hospitals, and A&E Departments in particular.

I was pleased that the INO agreed last week to continue working to implement the agreement reached with the LRC ahead of the review meeting on 17th May. For my part I can assure you of my Department´s continued commitment to work with all concerned to fully implement the LRC agreement.

A&E Forum

Earlier this year I established an A&E Forum to identify steps that can be taken immediately to alleviate current problems in A&E services. The Forum, which met on 20th March and 1st May 2002, was chaired by Dr. Danny O’Hare former President of Dublin City University. I am pleased with the response to the Forum and I am confident that its work will contribute significantly to advancing the existing and proposed policy framework for A&E services as set out in the National Health Strategy.

National Health Strategy: Nursing in the Community

I want, now, to refer to one of the most significant and ambitious aspects of the new Health Strategy, that is, the new model for Primary Care in Ireland.

I don´t plan to go into any great detail today because I´m sure many of you were at the INO special discussion forum on 28th February where the Primary Care Strategy was discussed in detail. I do however want to bring you up to date on developments since then.

Nurses and midwives as you know are central to making the primary care vision a reality. This central role is reflected throughout the strategy but expressed explicitly in Action Number 20 – the development of a National Strategy for Nursing and Midwifery in the Community.

The process for the development of this Strategy embraces the concepts of Primary Health Care:

  • Consultation with and participation of all interested groups, including nursing and midwifery groups and other health & social care professionals has been part of the strategy since the beginning;
  • Under the direction of the Chief Nursing Officer, Mary Mc Carthy a multisectoral/multidisciplinary Strategy Steering Group was established in November. A small multidisciplinary project team based within the Nursing Policy Division is responsible for the day-to-day operation related to the strategy.

Following a Consultative Conference last December, three small working groups were established to focus on practice, education and structure. A fourth group focused on the role of information and technology in the development of community nursing and midwifery services.

All four groups have now completed their work. Special thanks are due to the members and chairpersons of these groups. I particularly want to mention Mary Power, INO Section Development Officer, who did sterling work as chair of the policy/structure group. Mary, I’m sure it seemed thankless work at times – but it is appreciated.

I also want to thank all those who participated in the nationwide consultation which took place over the last three months. The general willingness of nurses and midwives to participate in this process was very striking.

Because of this work, once again, I must say, that nurses, are ahead of almost any other group in their preparedness to meet the challenge posed by the Primary Care Strategy.

I expect that the strategy for Nursing and Midwifery in the Community will be published later this year. The development process will interweave with the progression of the work of the Primary Care Task Force. This small team charged with leading the change and implementing the new model of primary care will have a nursing input and linkages with the Nursing Policy Division ensuring a coherent and integrated approach which reflects and supports the challenges and opportunities for nurses in the new model.

Partnership

I have referred to working in partnership right through this address. Before I finish I want to say a few words about Partnership (with a capital P) in the health sector.

The strong commitment to partnership in the Health Service is underpinned in the new National Health Strategy “Quality and Fairness for All” which sets as a key objective the further strengthening and deepening of the partnership approach in the Health Service. To achieve this objective, the Health Services National Partnership Forum is being used to help develop and implement a People Management Action Plan for the Health Service.

This is recognition of the achievements of Partnership in the Health Service to date and an explicit recognition of the fact that Health Service personnel should be supported in developing a sense of ownership and commitment to the objectives of the new Health Strategy.

It also recognises that those delivering services are often best placed to see how positive changes, meeting the dual objectives of improving patient care and development needs, can be achieved.

One of the realities of partnership is that it takes time to build and develop the sense of trust and co-operation that is essential to delivering change. It is necessary to start with small confidence-building measures, before moving onto broader more far-reaching initiatives. In this regard, the National Health Services Forum has moved forward in a pragmatic manner, allowing Partnership to take root in the Health Service, before moving to set more challenging and demanding goals.

Today, there are hundreds of solid, practical and realistic examples demonstrating that workplace partnership is working around the country. The National Partnership Forum has also established fifteen national projects to improve services in targeted areas and to enhance the working environment for health sector employees. These projects fall into three categories – extended hours, research, and human resource development.

There are 18 full partnership committees are up and running in hospitals, health boards and health agencies around the country.I know that INO members are playing a full part in these various committees. And of course, David Hughes and Mary Power are valued members of the National Partnership Forum itself.

The number of partnership committees is increasing and I believe that this is clear evidence of the growing commitment to Partnership throughout the Health Services, and a belief that the partnership process works.

Changing of the Guard

This section of my script is headlined “Changing of the Guard”. No, I am not talking about my future, but the departure of Bernard Carey from the Nursing Policy Division to pastures new within the Department.

I am sure you will agree that Bernard presided over a period of unprecedented change and development in the nursing area. His energy, drive, and commitment has been an invaluable asset to the Department in driving forward the huge agenda for change proposed by the Commission on Nursing.

Bernard led this change from the front with the support of his excellent team within the Division, and in partnership with the Chief Nursing Officers, past and present, Peta Taaffe and Mary McCarthy, and the professional nursing and midwifery advisers.

Civil servants aren´t normally praised at union conferences, but somehow I think you will join me in expressing appreciation to Bernard for his unique contribution to nursing and midwifery.

I know that some of you met and welcomed Bernard´s successor, Marie Kennnedy, over the last few weeks. You will soon get a chance to meet Marie´s successor, Kieran Feely. Marie is taking up an opportunity to move to another area in the Department which is more family friendly!

I´m sure you will join me in wishing her well and welcoming Kieran. I have no doubt that the good working relationship between the Nursing Policy Division and the Irish Nurses’ Organisation will continue under his leadership.

Before I finish, I should also mention and formally welcome Mary McCarthy who took up the Chief Nursing Officer post last October.

Conclusion

I will now conclude by thanking Clare Spillane again for the kind invitation to address your conference. I look forward to meeting you again next year as Minister for Health and Children.