Address by Mr Tim O’Malley T.D. Minister of State at the Department of Health and Children at the SIPTU Nursing Conference, Sligo
I am delighted to be here with you today and would like to thank SIPTU for the invitation to once again address your annual conference. The Tánaiste can’t be with us today as she is currently on her way back from an official trip abroad.
The theme of this years conference is Change – Challenges and Opportunities. The future challenge of nursing and midwifery education relates to expanding boundaries to meet the needs of the population. Education is one of the most powerful developmental engines at our disposal, so clearly both at local and national level nurse and midwifery education must be a priority for all. The Commission on Nursing emphasised education as an integral component of professional development and therefore central to the provision of continuing high quality nursing care.
By far the most profound development in nursing in Ireland has been the transfer of nursing education to the higher education sector, and the introduction of the new 4-year degree leading to registration in general, psychiatric and mental handicap nursing. The new degree programme commenced in September 2002 and the Government is providing €110m revenue funding per annum to train our future nurses. We look forward to the graduation of the first students from this programme this autumn. We expect that majority of these graduates will go on to have rewarding and fulfilling careers in the public health service.
The next phase in the nursing education revolution will commence later this year. Last November the Tánaiste announced plans for the introduction of two new direct entry undergraduate midwifery and children’s nursing degree programmes with the first intake of students this autumn. The midwifery degree programme will be of 4 years duration, and the integrated children’s/general nursing degree programme will be of 4 ½ years duration.
The new programmes will be provided in a total of 7 third level institutions across the country at a cost of €3.8m in 2006 rising to almost €17m in 2011, when the programmes will have a full complement of students. The direct entry midwifery programme will offer 140 new places per annum and the integrated children’s/general programme will offer 100 places per annum. These places will be in addition to the 1,640 places currently in the system each year for general, psychiatric and intellectual disability nursing.
The new programmes, which were recommended by the Expert Group on Midwifery and Children’s Nursing Education will reduce the time it currently takes to produce midwives and children’s nurses and will put the education of midwives and children’s nurses on a par with that of other nurses.
These programmes are designed to increase the supply of midwives and children’s nurses in response to existing and anticipated future workforce needs within a changing health service. Midwives and children’s nurses are critical in the delivery of services to patients.
These new programmes will provide an exciting and attractive career option for school leavers as well as for mature students wishing to make a career change and their introduction reflects the Government’s ongoing commitment to nursing and midwifery education generally.
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.
This report recommended that prescriptive authority should be extended to nurses and midwives subject to regulations and that the relevant legislation should be amended to enable this. The international evidence is strong that nurse prescribing is effective, safe and improves the service to patients. The US has had nurse prescribing for thirty years and the UK has been developing policy and practice in this area since 1987 with legislative change and the first pilots starting in 1994.
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’/midwives’ time and their skills and will facilitate the optimum utilisation of the medical resource; doctors will be able to focus on more complex cases without being diverted by routine tasks. 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. My Department will shortly 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 all take the opportunity to engage in this consultation process.
It is essential that we make the best use of the people we have by allowing them to work at the level for which they have been trained. Improved skill mix and the mainstreaming of the Health Care Assistant (HCA) role has been a key component of Sustaining Progress . The right skill mix is crucial to achieve an excellent health service, and one which we can afford and which is rewarding for staff. As demand for health services grows, it will be necessary to increase the contribution of Health Care Assistants to the delivery of care. The Government has provided significant funding for the upskilling of support staff in recent years. I know that concerns were expressed that the upskilling of HCAs would lead to a reduction in nurses, in fact the number of nurses in the public health service has continued to increase in line with the expansion of services. The number of nurses employed in the health service continued to grow in 2005 and overall there has been a 36% increase the number of nurses employed since 1997.
In addition to recent initiatives relating to support staff the Government has maintained a high level of investment in continuing education and training for post registration nurses. Specialist nurses play an increasing role in the delivery of services. The National Council for the Professional Development of Nursing and Midwifery has approved almost 1,800 Clinical Nurse Specialist and Advanced Nurse Practitioner Posts over the last six years. There is also an Expert Group on Nursing and Midwifery which is advising on pilot projects to examine the expansion of the role of the nurse in parallel with reduction of hours for junior doctors required under the European Working Time Directive.
New Mental Health Policy
On the 24th January 2006 I, along with the Tánaiste and Minister for Health and Children, Mary Harney, TD, launched “A Vision for Change” – a new National Policy Framework for the mental health services. The report, which was developed by the Expert Group on Mental Health Policy, is the first comprehensive review of mental health policy since Planning for the Future was published over two decades ago in 1984. The new policy outlines an exciting vision of the future for mental health services in Ireland and sets out a framework for action to achieve it over the next 7-10 years.
I established the Expert Group on Mental Health Policy in August 2003 in recognition of the need to review long-standing policy in this area and to formulate a blueprint for a modern, comprehensive world-class service to meet the mental health challenges facing our society. The group was chaired by Professor Joyce O’Connor, President of the National College of Ireland, consisted of 18 widely experienced people drawn from a range of backgrounds within the mental health services. In this context, I would like to especially acknowledge and commend the contribution of the nursing profession to the publicaiton of the report, both as active participants on the group and through the presentation of written submissions.
This comprehensive mental health policy framework outlines a set of values and principles that will guide both Government and service providers as we proceed to develop a modern, high quality mental health service. 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.
A significant feature of this new policy document is the special emphasis which is given to the need to involve service users and their families and carers at every level of service provision. I believe that all interventions should be aimed at maximising recovery from mental illness, and building on the resources within service users and within their immediate social networks to allow them to achieve meaningful integration and participation in community life.
As we are all aware, primary care is the first point of contact that the majority of people have with the health and personal social services. Primary care is the appropriate setting to meet 90–95% of all health and personal social services needs, including mental health needs. All but the most complex and acute health care needs of individuals, families and groups can be effectively met in the local primary care setting. The provision of a wide range of care close to service users represents the most appropriate, effective and user-friendly approach to health care delivery. I believe that the development of primary care services as recommended in the Report will contribute significantly to enhanced levels of care and treatment for those suffering mental difficulties.
Since coming to office, I have taken the opportunity of visiting a number of mental health facilities and have seen at first hand the commitment of staff to the provision of a high quality service. From the outset, I accepted that further investment was required to upgrade or replace some of the physical facilities and that greater capital investment was required to provide a modern comprehensive community-based infrastructure. This Report recommends that steps be taken to bring about the closure of all mental hospitals and to re-invest the resources released by these closures in the mental health service. This is a recommendation which I would endorse and I will support and encourage all endeavours to bring this about.
There are many exciting 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 two major legislative measures which have been enacted recently i.e. 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.
Violence in the Health Service
I note from your conference programme that one of tomorrow’s speakers is Kevin McKenna, project officer on the HSE – North East’s Study of Workplace Violence. The research carried out in the North East has contributed to our understanding of the problem of violence and aggression in health and social care workplaces. Each setting provides particular risks of exposure to violence and aggression and the physical and emotional impact on staff can be quite severe.
There have been a number of very serious assaults in recent years in the health services across a variety of settings including mental health and A & E. Violent attacks on staff and patients are totally unacceptable. The health and safety of our staff must be paramount. More work needs to be done on 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 of a working group on Work Related Violence. SIPTU Nursing are fully engaged in this group along with other health service unions and employer representatives. The group 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.
Nurses and midwives face the challenge along with all of us, of embracing new methods of care delivery which will provide a quality service that is truly people-centred. As the structures of the health service develop, the manner in which healthcare is delivered will continue to evolve. The Health Reform programme has promoted a culture within the health services that emphasises the value of continuous learning and improvement of skills and experience. There is growing evidence of the need to link continuing professional development with organisational goals.
The advent of nursing specialisation and the attendant opportunity for nurses and midwives to expand the scope of practice, the implications of nurse prescribing, and the training and wider deployment of health care assistants present a unique challenge for nurses and midwives to re-define their roles and, in the process, to re-define healthcare delivery. I would like to acknowledge and thank nurses and midwives for the contribution they make to the delivery of services across many different healthcare settings. While we are striving for a world class health service, nobody can deny that the standards of our nurses and midwives are second to none. I hope the rest of the conference is a success and that you all enjoy this opportunity to discuss and debate issues of mutual interest with colleagues.
I will now conclude by thanking Miriam McCluskey, SIPTU National Nursing Official, again for her kind invitation to address your conference. I hope you have an enjoyable and productive conference. Thank you.