Address by Mr Sean Power TD, Minister of State at the Department of Health and Children, at the Psychiatric Nurses Association Annual Delegate Conference
I am delighted to be here with you today and would like to thank you for the invitation to address your 35th annual delegate conference.
The last two years have seen dramatic change in the structure and governance arrangements for delivery of health services in Ireland.
The Government for its part has put in place the legislation necessary to restructure the health service. The Health Service Executive has been established to replace the multi health board structure. National policies and standards are now being applied across the system. The Tanaiste was determined to ensure that the HSE would be directly provided with the funding and also be held accountable for the use of these public funds. The reform process uniquely transferred the Health Vote to the HSE which now has full responsibility for operational matters within the health service. The Chief Executive Officer of the HSE is in fact the Accounting Officer responsible to the Dáil for the utilisation of the Vote.
The Minister for Health (supported by the Department) is accountable to the Oireachtas for health policy, resource allocation and of course results. The Tánaiste approves the HSE’s service plan and capital plan which is prepared on an annual basis.
It is essential that all stakeholders in the system support the reform process and provide a framework for the Health Service Executive to deliver on behalf of patients. A partnership approach (incorporating of course, constructive criticism) is now required rather than a negative attitude. Everyone within the health system must share responsibility for the performance of the system and the quality and appropriateness of services provided to patients.
Despite comment in some quarters, the Government is in fact expanding the health service to meet growing demand. Recent years have seen a major increase in public funding (both revenue and capital), a substantial increase in staff numbers, and a significant increase in the number of patients treated.
Current funding has increased by 10.2% from €11.9 billion since 2005 and by a massive 251% since 1997. Annual capital investment in the health services now stands at €578.5 million and the multi-annual five year capital programme is in excess of €3.2 billion. Public current and capital investment in health services has risen to over €12.75 billion in 2006. Ireland has now become one of the fastest growing OECD countries in terms of public spending per capita on health. By any standard this is a significant expenditure level. Non – capital funding of mental health services has increased by about 500 million euro since 1997
This funding increase has led to major infrastructure improvements and the enhancement of services on a number of levels. Today, almost 120,000 people work full time or part time in our public health services. Of these almost 42,000 are nurses. Between 1997 and end of 2005, there was an increase of 800 whole time equivalent nurses (or over 18%) in the psychiatric grades. Ireland now has one of the highest ratios of nurses per thousand of population in OECD countries. There are 12.2 practising nurses per thousand population in Ireland compared to 5.8 nurses in Belgium in 2003.
Mental Health Services
Developing mental health services to meet the challenges of today’s and the future’s health care environment is essential for a health care system that is responsive to the social determinants of health as well as lifestyle, behaviour and illness patterns.
“A Vision for Change” – the Report of the Expert Group on Mental Health Policy, which was published in January last, sets out an exciting vision of the future for mental health care in Ireland and a framework for action to implement this vision over the next 7 to 10 years. This report is the first comprehensive review of mental health policy since Planning for the Future was published in 1984. I would like to especially acknowledge and commend the contribution of the nursing profession to the publication of the report, both as active participants on the group and through the presentation of written submissions.
In my view the Report is very aptly named. The findings from the public consultation process undertaken by the Expert Group clearly indicated that service users and carers want change and we as policy makers, in partnership with service providers and voluntary bodies must have the vision to drive that change. I fully acknowledge however, that change is not always easy and that developing and maintaining the vision necessary to drive change can be a difficult task. I acknowledge and applaud the work of your members in responding to the needs of the vulnerable and disadvantaged in our society.
One of the fundamental principles of the report is ‘recovery’, in the sense that people with mental illness can and should be facilitated in reclaiming their lives and becoming involved in society – i.e., to be ‘socially included’. To achieve this, people need supportive mental health services, but they also need supportive communities where actions are taken to address basic needs such as housing, employment and education. All of these elements are included in the vision for the future outlined in this report.
A modern healthcare system accepts that each person must play a central role in their own treatment of recovery. It recognises that each individual plays a critical and essential role in the assessment of their own needs and that quality of care is inextricably linked to the involvement of the user in determining their health care.
This policy envisages an active, flexible and community-based mental health service where the need for hospital admission will be greatly reduced. On that basis, it is recommended that steps be taken to bring about the closure of all the remaining psychiatric hospitals which are a legacy of a bygone age and to re-invest the capital resources released by these closures in the mental health services. Again, I acknowledge that this will involve changes to work practices and a transparent process to ensure reinvestment. However, I feel with consultation, all these issues can be satisfactorily resolved. To date, mental health services, both statutory and voluntary have met the challenges of change in recent years with enthusiasm and vigor and I am confident that the further development of our services, in a spirit of partnership between statutory and voluntary bodies, will be approached in the same positive manner.
“A Vision for Change” makes clear recommendations on how the mental health services should be managed and organised in the future. These recommendations include the establishment of a National Mental Health Service Directorate. It is envisaged that this Directorate will play a key role in facilitating the implementation of this policy and thereby developing a modern mental health service that will benefit the entire population.
There are many developments emerging in the field of disability at present. New legislation will provide greater opportunities for individual assessment of need.
The implementation of the provisions of the Disability Act 2005 and the Education for Persons with Special Educational Needs Act 2004, will have very significant implications for the planning and delivery of health and personal social services and educational services for people with disabilities.
Additional funding of €155m has been allocated to services for people with disabilities in 2006. Of this funding €51.5m is being provided to meet costs associated with the various elements of this programme.
Further additional funding amounting to €22.5m is being used to enhance the multi-disciplinary support services for people with disabilities in line with the Government’s commitment to build capacity within the health services to deliver on the various legislative provisions contained in the National Disability Strategy and to address core deficit funding issue.
As outlined in the Multi Annual Investment Programme 2006 -2009, additional Capital funding amounting to €45m is also being provided in 2006 to support these developments
This increase in funding for disability services will improve the Health Service Executive’s capacity to address identified needs. Because services in Ireland have developed historically in different ways, there can sometimes be an uneven spread of services over different parts of the country. With a growing emphasis on equity, the advent of the new Health Service Executive will hopefully bring about a situation where access to services is provided in a manner which is fair to all.
Care of the Elderly
Additional funding for services for older people amounting to €150 million has been allocated in the 2006 Budget. This is the largest ever increase in funding for services for older people. Reflecting the new emphasis on home and day care, almost three quarters, €109 million of the full year costs, are being committed to community care supports. The Budget Day package provides for a number of community- and home-based initiatives, including Home Care Packages.
For those who do require residential care, the standards provided by private nursing homes are currently governed by the 1993 Nursing Homes (Care and Welfare) Regulations and inspections are carried out by the HSE based on these standards.
The heads of the Health Bill 2006 are due to go to Government shortly, and they provide for the establishment of HIQA, incorporating the Office of the Chief Inspector of Social Services, on a statutory basis. The Bill will include provision for investigation, at the request of the Minister or the HSE, into the safety, quality and standards of any service.
In advance of HIQA being fully established and functional, and in light of the fact that the Department’s focus is on protecting vulnerable older people and providing for the highest possible standards of care for older people in all long-stay facilities, the Department established a Working Group to develop the standards for residential care settings for older people. The standards are being developed in line with best international practice and will put the resident at the centre of care and aim to ensure that the older person’s needs are central to the philosophy of the residential care setting. These national standards will be the level which all residential care settings are required to meet, public and private.
It is intended that these standards will be ready in draft form shortly and a consultation process will follow, enabling all interested parties to give their views. It is intended to then pass these standards over to HIQA, once it has been established.
In relation to dementia services the HSE advised that following the 1999 publication of the National Council for Ageing and Older People’s report entitled ‘Action Plan for Dementia’, each of the former Health Boards incorporated the report’s 33 recommendations in their action plans and annual service plans as part of the development of services for older people. I’m glad to say that the HSE has reported that progress has been made in implementing the recommendations in each health service area and, as the implementation of the recommendations will have varied across the former boards, the HSE has established a Working Group to draw together a co-ordinated approach to the implementation. This Group is due to report its findings in the second half of 2006.
Violence in the Health Service
There have been quite a number of very serious assaults in recent years in the health services across a variety of settings including mental health, intellectual disability, and A & E. Research has shown that each healthcare setting provides particular risks of exposure to violence and aggression and the physical and emotional impact on staff can be quite severe. I know that attacks on staff are a matter of grave concern to the members of the PNA. On behalf of the Government I wish to condemn all attacks on healthcare staff. Violent attacks on staff and patients are totally unacceptable. The health and safety of our staff must be paramount. Everybody should be able to work in a safe environment. Greater effort needs to be invested in the prevention of violence and in cases where incidents occur in ensuring the proper support structures are in place for staff who suffer assault while carrying out their duties. I welcome the recent establishment by the HSE – Employers Agency of a working group on Work Related Violence in the Health Services. The PNA are fully engaged in this group along with other health service unions and employer representatives. The group, chaired by an experienced former health board CEO, aims to develop national policies for the health services in relation to staff training, support structures, risk assessment, prevention and dealing with offenders who attack staff. The HSE and Department are fully supportive of the work of this group and the challenge will be to work in partnership to implement the policy recommendations which will emerge.
I know that you have been discussing issues relating to the Taskforce on Assaults on Psychiatric Nurses. The Tanaiste met with the PNA last July to inform its representatives of the Government Decision. As you know the State Claims Agency were asked to examine and report on a new proposal in relation to compensation for nurses who suffered serious physical injury caused by an assault by a patient. I can appreciate your concerns in relation to the delay in reaching a conclusion on this matter. The time approximation has been adversly affected by the underestimation of the process of consultation, the necessary research and evaluation, the restructuring of the health service and changes in personnel in both the HSE and the Department. I can assure you the matter is being pursued and is a high priority for the Department. I also understand that the issue will be discussed at the Labour Relations Commission later this month.
By far the most profound development in nursing in Ireland has been the transfer of nursing education to the higher education sector in 2002. The Government is providing €110m revenue funding per annum to train our future nurses. This is in addition to the €240m capital funding provided to build 13 state of the art schools of nursing around the country. We look forward to the historic graduation of the first students from this programme this June.
The next phase in the nursing and midwifery education revolution will commence later this year. New direct entry undergraduate midwifery and children’s nursing degree programmes with have the first intake of students this autumn. These programmes will take in an additional 240 students per annum in addition to the existing 1,640 student places on the psychiatric, intellectual disability and general programmes. The introduction of the new degree programmes reflects the Government’s ongoing commitment to nursing and midwifery education generally.
I am encouraged that at a time when overall applications to the CAO have fallen, 8,600 applications have been made this year for 1,880 places on nursing and midwifery courses.
Last year the Tánaiste launched the Review of Nurses and Midwives in the Prescribing and Administration of Medicinal Products which was jointly conducted by An Bord Altranais and the National Council for the Professional Development of Nursing and Midwifery.
The changes recommended in the report are all about safe and convenient access to medication for patients. Nurse prescribing will promote the more effective utilisation of the nursing resource, both in terms of nurses time and their skills and will also facilitate the optimum utilisation of the medical resource. In other words, it will assist the development of a service based on the right person delivering the right care in the right setting.
The Government introduced the necessary amendments to the Irish Medicines Board (Miscellaneous) Provisions Act before Christmas to enable the Minister for Health & Children to make regulations to allow for prescribing for certain nurses and midwives. The Department will later this week launch a consultation process on the implementation of nurse/midwife prescribing. This consultation process will be completed before any regulations are drawn up and I hope you will take the opportunity to engage in this consultation process.
The Department of Health is currently pursuing an ambitious programme of legislative reform in relation to the regulation of healthcare professionals. The proposed Nurses Bill 2006 is intended to modernise the regulatory framework for nurses and midwives. It will update and amend the Nurses Act, 1985 in order to reflect and respond to the significant changes which the health services and nursing and midwifery professions have undergone since 1985.
The Nurses Bill, together with the Health and Social Care Professionals Act, Act, 2005 and the Medical Practitioners Bill, will strengthen, modernise and expand the statutory registration of healthcare professionals.
It is the Tanaiste’s firm intention to put in place a comprehensive legislative framework that will help to ensure the highest level of competency amongst nurses and midwives. The primary objective of these measures will be the protection of the public.
The Tánaiste intends to publish the Draft Heads of the Nurses Bill in the coming weeks. Once published a consultation process will be initiated and I would expect that your Organisation will contribute to this process.
The current national agreement, Sustaining Progress, will conclude at the end of June. The agreement has delivered substantial pay increases to nurses (over 13%) in addition to the benchmarking increases of between 8% and 16%. In return for these pay increases nurses and the other parties to the agreement committed to co-operation with flexibility and modernisation. From the point of view of the public a key result of this agreement has been industrial stability within the health services. While there have been disagreements along the way, the partnership approach has worked well and has delivered for nurses and employers alike. It is vital that we work together and where necessary change outdated work practices and reconfigure services, for the benefit of our patients. Discussions are ongoing on a successor to Sustaining Progress. It is hoped that the talks will reach a successful conclusion over the next few weeks and provide the basis for a continuing stable industrial relations environment.
In January the Minister for Finance established the second Public Service Benchmarking Body, as provided for under Sustaining Progress. The terms of reference for the new Benchmarking exercise state that the Body should consider issues arising from two Labour Court recommendations relating to claims by nurses for improvements in pay and conditions. Other public service unions are co-operating with the Benchmarking process. I would ask the Psychiatric Nurses Association to participate in the agreed process. This would allow it to make the case for increases in pay for nurses within the benchmarking framework.
Commission on Nursing
Since your conference last year the death has taken place of Ms Justice Mella Carroll. Her passing was the cause of great sadness. Ms Justice Carroll was a successful barrister and the first female High Court judge. She will be remembered by the nursing and midwifery professions for her role as Chair of the Commission on Nursing in 1997-98. We would all agree that the Report of the Commission on Nursing has proved to be the most significant development in the history of the nursing and midwifery professions in Ireland, and is a testament to the commitment of Judge Mella Carroll and the high regard in which she held those who worked in the nursing profession.
I would like to take this opportunity to commend the nursing profession for facilitating the integration into our health service of a significant number of overseas nurses in recent years. I’d like to welcome and thank these nurses for their admirable contribution to provision of services in many aspects of the health system in different locations around the country.
In conclusion, I would like to congratulate everyone involved in today’s conference and to commend you all for the work that you do. Finally, I would like to stress the Government’s commitment to the development of services for those suffering from mental illness. I am confident that we can build on the substantial progress to date so that we can all work together to bring about a mental health service worthy of the Ireland of the 21st century.
Thank you for your attention and I would like to thank Des Kavanagh, for his kind invitation to address this important conference.