Address by Mr Micheál Martin T.D, Minister for Health and Children at the Annual SIPTU Nursing Conference
I am delighted to be here with you today and would like to thank SIPTU 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 last week, 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 con-cepts 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 ac-cordance with identified service and population need.
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 profes-sional 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 in-creased 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 this week. Indications to date are that the pilot programme has worked very well.
The University of Ulster was 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.
New Nursing Degree Programme
I now wish to turn to nurse education.
Last October the Government approved my proposals for the implemen-tation 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 ac-commodate 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 provi-sion 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.
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 spon-sorship 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 through-out 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.
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 re-taining 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 un-dertaking 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.
Mental Health Act 2001 – Mental Health Commission
The past year has seen significant progress in the area of mental health. The Mental Health Act was signed into law in July, 2001. The new Mental Health Commission, established under the provisions of the Mental Health Act 2001, held its first meeting on 16th April, 2002. The Commission is chaired by Dr. John Owens, Consultant Psychiatrist and former Clinical Director of the Cavan/Monaghan Mental Health Service. As you are no doubt aware Mr. Padraig Heverin is among the members. The other members of the Commission include representatives of the medical, nursing and paramedical professions, voluntary bodies and mental health service users.
The Mental Health Commission is an independent statutory body, whose primary function is to promote and foster high standards and good practices in the delivery of mental health services. Under the Mental Health Act, 2001, each decision by a consultant psychiatrist to detain a patient for psychiatric care and treatment on an involuntary basis and each decision to extend the duration of such detention will have to be referred to the Commission. The Commission will arrange for an independent review of all such decisions by the Mental Health Tribunals which will operate under its aegis. The tribunals will comprise a consultant psychiatrist, a lawyer and a lay-person. The Mental Health Tribunal will arrange on behalf of a detained person, for an independent assessment by a consultant psychiatrist. A tribunal will be empowered to order the release of a patient if it considers that he/she does not require to be detained involuntarily. A free legal aid scheme for all detained patients will be operated by the Commission. All patients detained in psychiatric hospitals will have their cases reviewed by a Mental Health Tribunal. I believe that the work of the new Commission will be crucial to the development and modernization of the mental health services over the coming years.
Working Group on Patient Escorts
In response to concerns raised by psychiatric nurses and service providers, a working group, which includes representatives of all the various interests involved, was established in October 2001 to review the practice of patient escorts. The review takes place in the context of the continued development of a community-based mental health service and with particular regard to the provisions of the Mental Health Act 2001. The group is expected to make its recommendations shortly.
Development of Psychiatric Services
Significant progress has been made in recent years in the modernization of the mental health services. Additional revenue of €24.447 million has been made available to the mental health services in 2002 to develop and expand community mental health services, to increase child and adolescent services, expand the old age psychiatry services, to provide liaison psychiatry services in general hospitals and to enhance the support provided to voluntary agencies.
Substantial capital funding under the National Development Plan will go towards the development of mental health facilities. Approximately €190 million will be provided over the lifetime of the National Development Plan for mental health services. A significant part of this funding will go towards the development of acute psychiatric units linked to general hospitals to replace services previously provided in psychiatric hospitals. New acute units attached to general hospitals have been opened in recent times in Ennis and in Cork, while units in Kilkenny, Castlebar and Portlaoise will open very soon. A further three units are due to come on-stream in the next 2 years.
A&E Services and Bed Capacity
I now want to refer 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.
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. I have also provided funding to the ERHA and the health boards to support a further range of initiatives in A&E departments.
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.
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.
- 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 SIPTU agreed last week to stay with the process underway to resolve the A&E nurses dispute. For my part I can assure you of my Department´s continued commitment to work with all concerned to fully implement the LRC agreement.
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.
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 and social care professionals has been part of the strategy since the beginning;
- Under the direction of the Chief Nursing Officer, Mary McCarthy a multisectoral and multidisciplinary Steering Group was established in November. A small 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 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 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.
New Mental Health Nurse Adviser
I am delighted to note that Cormac Walsh has joined the Nursing Policy Division as full-time Mental Health Nurse Adviser in the last year.
Cormac is in the midst of establishing a Mental Health Nursing Advisory Forum at present. The forum aims to facilitate consultation and communication between the Department and the Mental Health Nursing Profession on issues of policy, practice and education. A call for nominations to the forum has been made. It is intended that the membership of the forum will be reflective of practice, management and education in mental health nursing throughout the country.
It is also recognised that there is a need to review the current and future structures of mental health nursing in the community in the context of the great change and development in this area since “Planning for the Future”. A group within the Nursing Policy Division is currently drawing up draft terms of reference for this review. It is envisaged that the review will support the future development of mental health nursing practice.
Assaults on Nurses
I share your concerns concerning the number of assaults on nurses. That is why I decided to establish a Task Force to investigate the incidence and the reasons for assaults on psychiatric nurses with a view to designing programmes aimed at prevention. Regard will be had to the recommendations of this Task Force in the consideration of the feasibility of an appropriate compensation scheme.
Arrangements are being made for the establishment of this Task Force. Every effort will be made to ensure that the Task Force completes its work by 1 December 2002.
This issue is of course also being addressed in the context of the A&E discussions.
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 SIPTU members are playing a full part in these various committees.
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 Kennedy, 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 SIPTU 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.
I will now conclude by thanking Oliver McDonagh again for the kind invitation to address your conference. I look forward to meeting you again next year as Minister for Health and Children.