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

I am delighted to be here with you today.

Well, that´s what it says here, at the top of my script. It´s kind of expected that a Minister, invited to address the annual conference of such a significant body as the INO will say he´s delighted to accept the invitation.

But – on the way here from Galway – a journalist reached me on my mobile phone about another issue. When we were finished, she asked me where I was going, and I told her.

“Oh, you have my sympathy,” she said.

“Sympathy?” I said. “How d´you mean, ´sympathy´?”

And she said: “Those annual conferences are like an oral exam, where the Minister gets thrown a million nasty questions and has to justify what he´s doing.”

I just laughed. But after I turned off the phone, I had a huge urge to ring her back and say “Hey, you´re wrong. You´re ten years out of date. I would hate if I was going to a conference of that kind, but I´m genuinely looking forward to Killarney.

And I decided that´s where I want to start, today. By looking at change. The need for change. Massive change. And the changed way we´re achieving change.

It´s not often, in any country in any part of the world, that a single profession radically and profoundly re-configures its position in society. If you think about it, it´s difficult to even come up with a profession – other than nursing – that has, within a couple of years, so completely changed:

  • How it works
  • How it is perceived
  • Which skills it employs
  • How it develops and validates those skills
  • How it is rewarded and, above all,
  • How it perceives itself.

Of course, the revolution is not complete, and – because we´re all still in the middle of so many inter-related changes – it´s easy to get sucked into the process and bamboozled by the details.

Which is why an annual conference like this is so important.

It offers us a chance to step away from the overwhelming routine rigour of the daily job (and few jobs combine that routine and rigour as much as nursing does) and pause. Not just to observe how very far we´ve come, but to appreciate how much the totality of the change is in our hands.

Nursing, in the public mind, used to be appreciated and disrespected simultaneously. Everybody had their pet nurse – that precious individual who had made a crucial difference to the patient at a time of great pressure and pain and panic. Everybody thought they did a great job.

But the word ´profession´ was rarely used by people other than nurses themselves. When it came to the healthcare pecking order, or being listened to, or being rewarded – that´s where the disrespect came in.

Ladies and Gentlemen – a line has been drawn in the sand.

Nursing has been established as a powerful and pivotal profession. It has been operationally and educationally re-configured.

That´s a hell of an achievement. An achievement we should celebrate and applaud, here today!

In celebrating what has been achieved and what inevitably will be achieved in the coming months and years, we must not lose sight of the way in which it has been achieved.

It has been achieved through partnership and co-operation, rather than partisanship and hostility.

Instead of a series of little Smartie-box concessions and sops, we have a comprehensive, logical and do-able agenda for change in the recommendations of the Commission on Nursing. Plus, we all have the capacity to check precisely where we have got to: the First Annual Report of the Monitoring Committee overseeing the implementation of the Commission´s recommendations was circulated in January and is available on the Department of Health and Children website.

This committee, as you know, is made up of representatives of my Department, the Health Service Employers, An Bord Altranais and the Nursing unions. You are very ably represented by Lenore Mrkwicka, David Hughes and Eilish Hardiman.

As proof of its commitment to the implementation of the report, the Government has provided the sum of £22 million for initiatives under the priority Action Plan over 2000 and 2001. The Monitoring Committee has recently agreed a new action plan for 2002 and 2003.

I know you are all very interested in the work of the National Council for The Professional Development of Nursing and Midwifery.

The Council has circulated the generic definition of the role of Clinical Nurse Specialist, and a formula by which nurses currently assigned to specialist roles could be confirmed in their role. By the end of last month, over 600 Clinical Nurse or Midwife Specialist posts had been approved. More than 500 applications were being processed on that date and I gather the number has grown since. We can all be confident that the figure of 1,250 Clinical Nurse Specialists recommended by the Labour Court will be met – if not exceeded.

The Council finalised the generic definition of the role of Advanced Nurse Practitioner at its April meeting and will speedily be circulating details. It all adds up to pretty impressive progress on the part of the Council, particularly since its full -time Executive only started work at the beginning of this year.

At this point I should mention the Nursing and Midwifery Planning and Development Units which are central to many of the developments the Council is spearheading. The value of these Units is being clearly demonstrated in those areas where the Directors are in post.

I know three Health Boards haven´t yet filled the post of Director of these Units, though not without effort on their part, and I share the concern of all parties to the Monitoring Committee that progress be made and made quickly.

We can also look forward to progress on the provision of clerical information and technology support for first line nursing and midwifery managers. The money coming from Government for this is significant. We´re talking about £14m. That money will help to free up managers to actually manage.

It sounds kind of obvious, doesn´t it? Managers should manage. Nurses should use their professional skills.

But – as everybody here knows only too well – the reality has been very far from that in many situations. Now, we´re moving towards making greatly increased use of care assistants and other non-nursing staff. And at the same time, we´re moving on another Commission recommendation: to develop systems to determine correct nursing levels.

My department set up a joint committee representative of nursing unions and health service employers to look at the non-nursing staff issue and their report’s going to hit my desk immediately if not sooner. The Commission also said a separate working party should be set up to establish standard education and training criteria for care assistants: we´ve set that up, too.

Progress, again. Progress towards a situation where nurses are freed to nurse, midwives are free to do midwifery, and where nursing and midwifery remain the preserve of nurses and midwives.

Now, let me mention the very important Report of the Nursing Education Forum.

It outlined how the four year undergraduate pre-registration nursing degree programme should be implemented. The Government is saying yes, in principle, to this. Starting in 2000 – if we get a few outstanding issues sorted. Those issues are about capital and revenue funding over the long haul and about which nurse teachers are going to transfer to the higher education sector. We´ve put a committee in place to address this, and it´s already at work.

As you know, I got directly involved in discussions with representatives of third level institutions and the nursing unions on how to assimilate nurse teachers into the third level sector. The end result of those discussions was a firm set of proposals and that’s now being balloted on. With luck, it´ll be accepted: I believe Liam Doran and his team of negotiators has secured a very good deal for nurse teachers.

Getting the nursing degree programme up and running, right across the country, is an urgent priority, and so we now have a National Implementation Committee to monitor progress – chaired by Mary Rose Tobin of the Institute of Public Administration. I’ve appointed Ms Siobhan O’Halloran as Executive Director of the Committee – and it had its inaugural meeting on the 11th of April.

One of the areas where progress is clearly being made and the end results are beginning to show is the recruitment and retention of nurses.

We launched a big new initiative in November. £5 million to recruit and retain nurses. You´ll have seen the ads – they attracted a significant number of enquiries.

People are being attracted to nursing. To retain them in nursing, the profession has to become more family-friendly. So, new flexible working arrangements in the public health service came in during February. It´s my great hope that this new flexibility will not only retain nurses and midwives, but attract back some of those who´ve left the profession.

As part of the overall recruitment/retention strategy, a solid range of financial supports for nurses undertaking post-registration educational courses have been introduced. This includes:

  • Payment of fees to nurses/midwives undertaking part-time nursing and certain other undergraduate degree courses;
  • An improved scheme of financial support for Student Public Health Nurses;
  • Enhanced financial support package for Student Midwives and Student Paediatric Nurses;
  • Payment of fees and enhanced salary to nurses/midwives undertaking specific courses in specialised areas of clinical practice;
  • Abolition of fees for back-to-practice courses and payment of salary to nurses and midwives undertaking such courses.

I know that many of you have been concerned that a wider range of courses in specialised areas of clinical practice is not covered by the initiative. The courses actually covered by the initiative are for those areas of Clinical practice where the most acute nursing shortages were identified for me last Autumn.

The whole purpose of the initiative was to provide an incentive to nurses to move into those areas. This was warmly welcomed by the INO as an important step forward in the recruitment and retention of staff in particular clinical areas which were experiencing severe difficulties. However, I am impressed by the strength of the argument made to me by your General Secretary, Liam Doran, that the absence of fee support for other specialist courses, such as diabetes, gerontology, oncology, palliative care and orthopaedics, could in time lead to problems in attracting nurses to work in those particular areas of clinical practice.

I am pleased therefore to announce today that I am extending the initiative to cover all courses in specialised areas of clinical practice as and from the current academic year. My Department will so advise all public health service employers during the coming week. Nurses who are currently undertaking courses and who have already paid their fees will have their fees refunded in return for a commitment that they will continue to work in the specialised area concerned for a specified period following completion of the course.

What we´re seeing is a lot of action on a lot of fronts. And a good payoff: the most recent survey of nursing vacancies done by the Health Service Employers Agency showed the number of vacancies at the end of January had fallen by 5% nationally. That figure fits very nicely with another statistic: the number of applications for nursing is up 21% on last year. Not to mention the fact that there´s been a 24% increase in the number of mature applicants.

But we´re not going to take even that positive trend for granted. We can´t afford to.

We´ve increased the number of training places from 300 to 1,500. Record numbers of people have been coming into training – particularly in the psychiatric and mental handicap programmes. This record increase is the direct result of a recruitment campaign at national and local level. I made just under £800,000 available last year to the Nursing Careers Centre and the schools of nursing and it´s money very well spent.

We´ve got to support nurses in training, and so I´m increasing the annual maintenance grant by £245, increasing the external clinical allowance, the book allowance and the uniform allowance – all starting next month. The full year cost of these and other enhancements is in the region of £1million. Obviously, they´ll benefit students already in training.

The Department is of course also engaged in strategic planning through the Study of the Nursing and Midwifery Resource. The focus of this work is on longer Term planning. The primary objective of the study is to forecast, as far as is possible, future nursing and midwifery workforce needs. An Interim Report was published in October, 2000 and widely circulated within the health services My £5 million recruitment/retention initiative of 29th November last, was an immediate response to a number of the Report’s recommendations.

In February 2000, in recognising the need to blaze a new trail, I established a group entitled Empowerment of Nurses and Midwifery Steering Group; An Agenda for Change.

The agenda is to involve nurses and midwives at all levels in a meaningful Way by empowering and giving them voice in the operation and strategic management of their healthcare institutions.

The group identified four central themes to drive its agenda forward:

  1. Management Development;
  2. Service Planning;
  3. The Meaning of Empowerment;
  4. Communications.

Let´s start with the Management Development. We know that management development programmes make an important contribution to the professional empowerment of both nurses and midwives and encourage greater involvement by them in the management of their services.

The Office for Health Management, in association with my Department and the INO has already put a number of programmes in place in relation to leadership, personal development planning and programmes for nurse and midwife managers.

When it comes to Service Planning, it´s fundamental that staff at all levels be afforded the opportunity of involvement in service planning and be valued for their contribution as legitimate stakeholders.

The vital ingredients for success in developing a shared vision of services are involvement in the planning process, communication through consultation and an effective mixture of top down and bottom up approach.

From the recruitment and retention perspective the example of the so called magnet hospitals in the United States should tell us that to neglecting our staff neabs we lose them.

The label Magnet Hospitals was given to a group of hospitals in the U.S. that was able to successfully recruit and retain nurses during a national Nursing shortage in the early 1980s. Visibility and staff support were reported as important and effective traits of magnet hospital nurse leaders. Among the most important elements of clinical nursing practice were autonomy within clinical practice, status within the organisation, and collaboration. Participative management and support of professional development were traits shared in magnet hospital environments.

Effective leadership through empowerment is crucial to the establishment of a cohesive and efficient work team and ultimately to the success of the service.

Now, I want to touch on the difficulties being encountered by various hospitals providing accident and emergency services. And the related difficulties of bed capacity.

Against this background, I initiated a National Review of Bed Capacity in both the acute and non-acute sectors, on foot of the Commitment by Government in the Programme for Prosperity and Fairness. The review is being conducted by my Department in conjunction with the Department of Finance and in consultation with the Social Partners. It involves the development of a long term investment strategy for the acute and non-acute sectors and will include a detailed assessment of future bed requirements in response to increasing demand and changing demographics.

The shortage of beds in a non-acute setting has also caused problems in That acute hospitals have not been able to discharge patients in sufficient numbers and quickly enough, to cater for new patients requiring admission. In order to meet some of the immediate difficulties in this area, I was pleased to provide a £32 million investment package aimed at alleviating service pressures and maintaining services to patients in the acute hospital sector.

The investment package is being targeted at a number of key service areas, including the recruitment of an additional 29 Accident and Emergency consultants. The recruitment of additional consultants to this key area is designed to reduce any unnecessary delays experienced by patients attending A & E Departments and to ensure that patients have improved access to a prompt senior clinical decision making service. Funding has also been provided for the contracting of additional private nursing home places by the Eastern Regional Health Authority and the health boards. To date over 700 additional places have been contracted under the initiative.

The national bed review is at an advanced stage and will be completed shortly. I will be bringing the findings of the study to Government with a view to agreeing an investment strategy for the development of the acute hospital sector. I should also point out that under the National Development Plan 2000-2006, this Government is committed to investing $1 billion for the development of acute hospital services including new facilities, re-equipping and additional capacity.

Finally, Comhairle na nOspideal has at my request commenced a review of the structure, operation and staffing of A & E services and Departments with the aim of improving the provision and quality of patient care. The review will take into account the Report of the Medical Manpower Forum, policies of the Irish Accident & Emergency Association and the Institute of Orthopaedic Surgeons, international best practice, the views of health authorities, management, medical practitioners and other relevant matters. The findings will inform future policy decisions in relation to the provision of A & E services.

One of the major developments, later this year, will be the publication of the new National Health Strategy. That strategy will set out to create a service that starts and functions on the basis of the best interests and needs of patients, clients and their families.

It´s going to mean changing the way we deliver services. It certainly means giving clearer information to the public about their entitlement. It´s also going to require greater openness on the part of health professionals.

In preparing the strategy, we´re working on themes like Service Delivery, like Quality, like Health Promotion. Eight of them – and an action plan for each of the man services and professional development areas involved.

I´m not going to go into any more detail about the health strategy at this point. I just want you to know that the changes, the developments, the directions we’ve already established for the nursing profession should be matched by changes, developments and innovations on a wider front.

The fact is that we have a great health care structure in this country, but that this country has changed radically since that structure was put in place. It´s time to examine the changed environment since the establishment of the health board structure and the many changes in human resource theory and practice since then.

One of the people who´s experienced many of the massive changes in our healthcare system at first hand is Peta Taaffe, the Chief Nursing Officer of the Department of Health and Children. Peta – as you all know – was the first ever Chief Nursing Officer appointment to the department. And in this pioneering role, Peta has presided over unprecedented change and development in nursing. She has led the change from the front.

On my own behalf, and indeed that of the Government, I would like to express our sincere gratitude to Peta for her professional leadership in developing the role of the Chief Nursing Officer.

Developing roles, raising standards – wherever you look at the nursing profession and the healthcare system in which it operates – we´re making progress. And the minute I say that, I hear an unimpressed voice in my ear saying “So? I s´pose you think that’s great?” That unimpressed voice belongs to my friend and advisor Gobnait O’Connell. I know you´re paying your own tribute to Gobnait this week through the new award. It´s a wonderful way to remember her – and to introduce the reality of her contribution to people who never met her.

Gobnait left me an awful lot of memories of fun and hard work and achievements. But perhaps the best thing she left me was that voice: a permanently unsatisfied voice. Every time I think “Hey, it´s great, we´re winning, we´re making progress”, that voice says “You´re only beginning. Remember, this is nursing!”

Ladies and Gentlemen, I never forget that this is nursing. Or how crucial, how pivotal nursing is in the overall delivery of civilized and respectful healthcare. I look forward to continued partnership with the INO for the benefit of the health services and of nursing.