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 this opportunity to speak to you.
One year ago I told you that my absolute priority in the nursing area is to press ahead with the agenda for change recommended by the Commission on Nursing in partnership with all of the key stakeholders involved.
Implementation of the Report of the Commission on Nursing:
I am delighted therefore to acknowledge the major progress to date in implementing the Commission´s recommendations.
The First Annual Report of the Monitoring Committee overseeing the implementation of the recommendations was circulated in January and is available on the Department of Health and Children website.
This committee, as I´m sure 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 Kay Collins and Padraig Heverin. Kay was of course also a member of the Commission on Nursing.
It is with pleasure that I can report that this partnership approach, which was proposed by the Commission itself, is facilitating constructive engagement between all of the key stakeholders in progressing the huge agenda for change recommended by the Commission.
As proof of its commitment to the implementation of the report, the Government has provided funding of £22 million for initiatives under the priority action plan to fund the action plan over 2000 and 2001. The Monitoring Committee has recently agreed a new action plan for 2002 and 2003.
National Nursing Council
I know you are all very interested in the work of the National Council for the Professional Development of Nursing and Midwifery.
This time last year the Council was finalising the generic definition of the role of Clinical Nurse Specialist. This definition and a formula by which nurses currently assigned to specialist roles could be confirmed in their role was circulated on 24 May 2000. The same procedure applied to existing Community Psychiatric Nurses and acting CPNs who wished to convert to the grade of Community Mental Health Nurse.
I am delighted to note that at the end of last month, over 600 Clinical Nurse or Midwife Specialists and 196 Community Mental Health Nurses had been approved. The closing date for receipt of applications under the immediate pathway was the 30th of April. I know that more than 500 applications were being processed on that date and I gather the number has grown since. I am 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. The Council will circulate details before too long.
I must say I am delighted to see the progress made by the Council, particularly since its full-time Executive started work at the beginning of this year.
Nursing and Midwifery Planning and Development Units
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 that three Health Boards have yet to fill the post of Director of these Units, though not without effort on their part. I am hopeful that they can soon make progress. This is a concern shared by all parties to the Monitoring Committee, including the employers.
Clerical and Information Technology Support for First Line Nurse Managers One area where these Units are beginning to have a major impact is in the allocation and monitoring of the funding which the Department has provided for clerical and information technology support to first line nursing and midwifery managers.
Some £14 million has been provided for this purpose between 2000 and 2001. It is crucial that this major investment pays dividends in freeing up managers to manage effectively and efficiently.
Effective Utilisation of Professional Skills of Nurses and Midwives
This leads me to 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 joint committee representative of nursing unions and health service employers to address these issues last year. The Committee concentrated initially on the question of the increased use of care assistants and other non-nursing staff. This report was finalised earlier this month and I expect to see it very soon now. A separate working party to establish standard criteria in relation to education and training of care assistants has also been convened as recommended by the Commission on Nursing.
For my part I am convinced that nurses should be allowed focus on their professional nursing duties. It is essential that all concerned are in agreement with measures taken to address this issue. I welcome the SIPTU´s commitment through its representative, Mary Durcan, to the effective utilisation of professional skills of nurses and midwives.
I understand that the report will be presented to the Monitoring Committee this month. I am confident that all of you will be able to accept the conclusions of the Working Group which are based on the premise that the nursing and midwifery function must remain the preserve of nurses and midwives.
Nursing Education Forum
I now wish to refer to the very important Report of the Nursing Education Forum, which I launched on 24 January last.
This report sets out a strategic framework for the implementation for a four-year undergraduate pre-registration nursing degree programme. The Government has agreed in principle to the introduction of such a programme in 2002 subject to the satisfactory resolution of certain outstanding issues. These relate to the additional capital and revenue funding required to support the programme and the basis on which nurse teachers will transfer to the higher education sector.
The Forum prepared a tentative estimate of the additional recurring and capital costs involved in moving to a degree programme. It recommended that an Inter-Departmental Steering Committee be set up to deal with all policy and funding issues. The Government has accepted this recommendation and the Committee is composed of representatives of the Departments of Health and Children, Education and Science, and Finance, and the Higher Education Authority. This Committee has held a number of meetings since its first on the 15th March, last.
As you know, my Department has also been facilitating direct discussions between representatives of third level institutions and the nursing unions in relation to the assimilation of nurse teachers into the third level sector. I myself was directly involved in leading these discussions to a successful conclusion and a firm set of proposals for the assimilation of nurse teachers onto the Lecturer salary scale of their affiliated third-level institution is currently being balloted upon. I believe that a very good deal has been brokered for nurse teachers and I am hopeful that it will be accepted.
The Government has also accepted the Forum´s recommendation relating to the establishment of a National Implementation Committee to monitor progress in the implementation of the proposed nursing degree programme across the country. This Committee is chaired by Ms Mary Rose Tobin of the Institute of Public Administration. I have appointed Ms Siobhan O´Halloran to act as Executive Director of the Committee. The Committee’s inaugural meeting took place on the 11th of April last.
Recruitment and retention of nurses
The recruitment and retention of nurses continues to pose challenges for all of us.
Last November I launched a major new recruitment and retention initiative, costing in excess of £5 million. An advertising campaign aimed at attracting nurses back into the workforce and at attracting nurses back to Ireland ran from 30 November to 31 December, 2000. This generated a significant number of enquiries.
As part of the overall recruitment/retention strategy the following financial supports for nurses and midwives undertaking post-registration educational courses have been introduced:
- payment of fees to nurses/midwives undertaking part-time nursing and certain other undergraduate degree courses;
- 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 courses in specialised areas of clinical practice;
- abolition of fees for “back-to-practice” courses and payment of salary to nurses/midwives undertaking such courses.
In response to the nursing shortage the number of nursing training places has been increased by 300 to 1,500 until at least 2003. Since 1999 there have been record intakes to nursing training, particularly in the psychiatric and mental handicap programmes. This record increase is the direct result of a concerted recruitment campaign, both at national and local level, which was funded by my Department. Some £765,000 was made available last year by the Department to the Nursing Careers Centre and the various schools of nursing to support the recruitment campaign. It is considered money well spent.
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. The initiative was warmly welcomed as an important step forward in the recruitment and retention of staff in particular clinical areas which were experiencing severe difficulties. However, 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 say that I have extended the initiative to cover all courses in specialised areas of clinical practice as and from the current academic year. My Department have so advised all public health service employers. 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.
This year for the first time ever, the application system for places on the Nursing Registration/Diploma Programmes is being handled by the CAO. The good news is that the number of applications for nursing is up 21% on last year, including a 24% increase in the number of mature applicants. This is a resounding endorsement of the initiatives undertaken by the Nursing Careers Centre and the Schools of Nursing to promote nursing as a career.
Improved Supports for Students
I am pleased to inform you here today that I am improving the package of financial and other supports available to nursing students by over 7.5%.
I am increasing the annual maintenance grant by £245, from £3,325 to £3,570, with effect from the 1st June next.
I am also increasing the external clinical placement allowance by £10, from £30 to £40 per week, from the 1st June.
In addition, I am increasing the value of the book allowance from £250 to £270, and the value of the uniform allowance from £150 to £160
The full year cost of these enhancements is in the region of £1 million. Apart from benefiting students already in training, I am hopeful that these improved supports will help to sustain the interest of this year´s 6,000 applicants in nursing as a career.
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.
Mental Health Bill 1999
I am aware that the proposals in the Mental Health Bill, 1999 are of particular interest to psychiatric nurses. The purpose of this Bill, is to provide a modern framework within which people who are mentally ill and who need treatment or protection, either in their own interest or in the interest of others, can be cared for and treated. However, the Bill also has a second purpose, which is to put in place mechanisms by which the standards of care and treatment in our mental health services can be monitored, inspected and regulated.
The main vehicle for change will be the Mental Health Commission, to be established under the terms of the Bill. The Commission´s primary function will be to promote and foster high standards and good practice in the delivery of mental health services. The existing office of the Inspector of Mental Hospitals will be replaced with the office of the Inspector of Mental Health Services, who will be employed by the Commission. Both the Commission and the Inspector will operate independently of the Minister for Health and Children and of the Department. This independent status will be crucial, in my view, in driving the agenda for change and modernisation in the mental health services in the coming years.
I have considered all of the views on the Bill which have been put before me and a number of amendments were accepted last October at Committee Stage in the Dáil. There are also a number of amendments to be brought forward at Report Stage. I am bringing the Bill to Report Stage later this month with a view to having it enacted before the end of the year.
Development of Psychiatric Services
Alongside this legislation, great changes have been unfolding in the delivery of psychiatric services in recent years and the perception of an institutional style mental health service, standing in isolation and closed from the rest of the community, is thankfully becoming a thing of the past.
Enormous strides have been made and continue to be made in developing a service which 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 undoubtedly the quality of care for persons with a mental illness has been enhanced by this development. I am fully committed to furthering this process.
This year an additional £18.64 million has been provided by this Government for improvements in mental health services Priority is being given to the further development of community based mental health services, the expansion of Child and Adolescent Psychiatry, the development of Psychiatry of Old Age and the implementation of the recommendations of the Task Force on Suicide. All of these cannot be developed without the invaluable role of the registered psychiatric nurse.
Substantial capital funding under the National Development Plan will go towards the development of mental health facilities. Approximately £150m capital will be provided over the lifetime of the plan for the mental health services. A significant part of this funding will go towards the development of acute psychiatric units linked to general hospitals. These units will replace services previously provided in psychiatric hospitals.
At the end of the period of the National Development Plan in 2006, it is my intention to have made substantial progress on completing the programme of acute psychiatric units.
I will also provide funding under the National Development Plan for more community facilities such as mental health centres and community residences, thus further accelerating the phasing out of the old mental institutions.
Nursing in the Community
I should also mention that work has begun on preparing a Strategy Document on Nursing in the Community. This Strategy should reflect the recommendations of the Commission on Nursing. The aim of the Strategy is to reorient and restructure Nursing in the Community so as to facilitate an efficient, effective and integrated client focused service.
Consultation will be a key element of the process of developing this strategy. My Department will be touch with the Nursing Alliance about this in the coming weeks.
Review of the Nurses´ Act, 1985
Work is also ongoing on the review of the Nurses´ Act, 1985. It was not possible to progress this as intended in 2000 due to pressure of work in the Nursing Policy Division. However, I now expect to be in a position to seek Government approval for the heads of a Bill by the Autumn.
I now want to refer to an important strategy document being developed by the Nursing Policy Division in my Department: a Research Strategy for Nursing and Midwifery in Ireland.
This strategy will involve the identification of research priorities, the establishment of mechanisms for commissioning and funding of research together with the development of a database of Irish Nursing and Midwifery research.
I am aware that the issue of patient escorts is an issue of over the last number of years. Negotiation has taken place under the auspices of the Health Services Employers Agency with a view to resolving certain difficulties which have arisen. As a result of these negotiations, a Working Group is being established to review the practice of patient escorts in the context of the future development of mental health services and, in particular, the provisions of the Mental Health Bill and to make recommendations in relation to future practice. SIPTU has been invited to participate in the Working Group.
National Health Strategy
Ireland´s first Health Strategy – “Shaping a Healthier Future” was produced in 1994. It set about reshaping our health services to ensure that improving people´s health and quality of life became the focus of work of health policy makers and providers. While the 1994 document was an excellent beginning to a necessary refocusing of the Irish health services, I believe that the new Strategy needs to be more responsive to the both the existing and the future challenges to be faced in trying to improve the health status of the nation.
I want to ensure a very wide input into the new Strategy. To help achieve this, I have embarked on a wide consultation process. I opened the first plenary session of the Health Strategy National Consultative Forum on the 23rd of April. The Forum comprises a wide range of service providers, stakeholder and staff representatives and academic experts. It is one of a number of strands of consultation. I know that a number of you are involved in this process. My hope is that this level of research and consultation will ensure that the Strategy is one which is informed by a wide variety of views and which the public, providers, services users and staff will have ownership of for the future.
The 1994 Health Strategy adopted the principles of equity, quality of services and accountability. However, I believe it is vital to develop a system which is “people-centred”. This means having a service that is planned and delivered on the basis of the best interests and the needs of patients, clients and their families. It may mean changing the way we deliver services. It certainly means giving clearer information to the public about their entitlement and, for health professionals, continuing to improve openness in their dealings generally, with patients or clients.
Within the Department a number of working groups have been established to examine key themes for the strategy. The sub-groups of the National Consultative Forum which you are involved in are mirroring these groups. The themes being considered are “eligibility”, “funding”, “service delivery/HR”, “e-health”, “quality”, “health promotion/population health”, “futures”, and the “voluntary/statutory interface”. These eight key themes will form the backbone of the new strategy. Building up from this we will be setting out an action plan for each of the main services and professional development areas.
There has been a major investment in the health services under this Government over the past few years with funding doubling from £2.5 billion in 1997 to £5 billion this year. However, an examination of how much we spend and how we spend it will have to be an important part of developing a strategy for health for the future. We especially need to decide, if more money is invested, what should our priorities be for spending that money? In this context, the Deloitte & Touche Value for Money Audit, which will be published shortly, will highlight areas which need to be improved upon.
In terms of your working lives, I believe the working group on delivery systems/HR will be of considerable interest to you. Delivery systems have a very clear impact on the responsiveness of our health care system. We need to be in a position to make more appropriate and sensitive responses to the changing needs of individuals and the rapid pace of new technology. We need to develop delivery systems that are more efficient and facilitate change, innovation and flexibility. Discussion on this theme is going to raise questions about our organisational structures; and questions about the recruitment, retention and training of health personnel who plan and deliver services.
This discussion will inevitably look at the changed environment since the establishment of the health board structure and at the great many changes in human resource theory and practice since then. Clearly, there will also be implications for the way in which the Department of Health and Children is organised.
We all know that the staffing shortages in the health system are probably the single biggest potential obstacle to addressing the current service deficiencies. I believe that developing the “people” resource in the system will promote better quality services; give existing health personnel greater motivation and job satisfaction; and make the public service a more attractive place to work.
Whatever the answers to these questions, they must be framed in the context of the requirements of patients/clients who receive services. Major improvements have been made in this area of serving patients and clients better, but further action is needed. I believe that in the future, systems and structures must be designed from the patient/client perspective.
Existing Initiatives / Service Developments
A lot of important policy work has already been completed in specific service areas. There is no question of reinventing the wheel, and where clear policies are available and accepted, we will incorporate these in the new strategy. I am also conscious of the multiplicity of initiatives underway in different service and professional development areas and I see the strategy as an opportunity to pull these together. However, there are also gaps and areas where policies need to be developed and these will be identified.
What is already emerging is the need for a more integrated approach to both policy formulation and implementation. This has implications for everyone working in the health services. We will need improved communication, openness to new ways of doing things and a willingness to embrace change. The driving force behind this approach brings us back to the principles I outlined earlier, in particular the idea of a “people-centred” health service.
The job of making sure that everyone living is Ireland has the best possible health is a big challenge for a lot of people and agencies. It is also a challenge for each of us personally, because every day we make choices that affect our health. I have indicated to the Government that a new Strategy will be produced mid-year. I attach the greatest priority to making the necessary changes to our health care system to further improve people’s health and quality of life.
Chief Nursing Officer retiring
Before I finish I want to pay tribute to Ms Peta Taaffe, the Chief Nursing Officer of the Department of Health and Children who will be retiring at the end of this month. Peta, as you all know, was the first ever Chief Nursing Officer appointed to the Department. In this pioneering role, Peta has presided over unprecedented change and development in the nursing area. Peta has led this change from the front with the support of her excellent team of professional nursing and midwifery advisers. 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.
Also, I am glad to say that the Department´s team of professional nursing and midwifery advisers will soon be augmented by the appointment of a full-time psychiatric nursing adviser.
Tribute to Gobnait
While preparing this speech I was struck very forcibly by the huge progress made in the last year. One person who sadly is no longer with us was central to so much of this progress whether it be the development of a new Health Strategy or nurse recruitment and retention initiatives. That person is the late Gobnait O´Connell, my dear friend and confidante, who is so sadly missed by me and all who knew her.
I will now conclude by thanking Oliver McDonagh for the kind invitation to address your conference. I look forward to continued partnership with SIPTU for the benefit of the health services and for nursing and midwifery.