Minister Martin´s Address at the Psychiatric Nurses´ Association Annual Conference
Ladies and Gentlemen,
I´m reminded, as I start to address you today, of a comment a friend of mine made to me this week.
This pal of mine had one of those sporting injuries that kept coming up this close to being cured – and then turning nasty all over again. So he was on crutches for what seemed to be months and months and months.
And then, last week, he got his walking papers. Was told he could get rid of the crutches and go it alone. Unaided perambulation. A great achievement. (Of course, my youngest is doing it without medical permission for months now, but toddlers don’t realize they should get signed off by medical experts before they do things like walking..)
So I meet my friend and congratulate him on progress. Yeah, he says. It has good aspects and bad aspects. The good aspect is that he can now carry a pint from the bar to a table. (Anyone here who´s ever been on crutches knows that the transport of beverages is a major problem.)
And the bad aspect of his progress?
No more sympathy. He says that when he was on crutches, perfect strangers offered him help, wanted to hear all about what happened to him, wanted to know how painful it was. Once he came off the crutches, all the attention, all the minding – evaporated. Poof! Gone! He was back to being ordinary.
Listening to him, it suddenly struck me: that´s what my job is like. And the same thing applies to an Association like yours:
- When there are huge problems, everybody pays attention.
- When the problems get fixed – who cares?
But the more I thought about it, the less I bought into the idea. Because – and I´m pretty sure you´ll agree with me on this – there´s a deep satisfaction in radically changing, in fundamentally improving a problem that´s long overdue for improvement.
In time to come, the Report of the Commission on Nursing is going to be seen as the line in the sand: the point at which nursing moved from an underated, under-valued, under-funded job to a profession with all of the structures and public positioning it should have.
Of course, your General Secretary Des Kavanagh, was on the Commission – and he and your President, Gerry Coone are now representing you (very ably representing you) on the Monitoring Committee that´s making sure everything that should happen does happen.
I know politicians are supposed to be big on “the vision thing”, but I think the vision thing is only half the story. The action thing is just as important – and we´re now achieving action on all fronts. Action achieved in partnership, so that we´re seeing constructive engagement involving all the key stakeholders: the only way to drive forward our huge agenda for change.
Vision. Action. And funding. When it comes to funding, the Government has allocated £22 million to allow the initiatives under the first priority plan to happen. And of course, the Monitoring Committee has recently agreed a new action plan for the year 2002 and 2003.
- When you´re launching a product, a first step is to put a clear brand on it.
- When you´re making sure a professional role is properly positioned, a first step is to put a clear definition on it.
That´s what´s been happening in relation to existing Community Psychiatric Nurses and acting CPNs who wanted to move to the grade of Community Mental Health Nurse. A definition and a formula was put in place by the National Council for the Professional Development of Nursing and Midwifery.
In that context, I´m delighted to confirm that at the end of last month, more than 600 Clinical Nurse or Midwife Specialist posts and 196 Community Mental Health Nurses had been approved. Great to know that more than 500 applications were being processed on the 30th of April – and that the number’s grown since then.
Bottom line? We can all be confident that the Labour Court recommended figure of 1,250 Clinical Nurse Specialists will be met. Or maybe even exceeded.
I should also mention that the generic definition of the role of the Advanced Nurse Practitioner will be circulated by the Council very soon.
Progress. Steady, speedy progress – even though the Council´s full-time Executive started work only at the beginning of the year.
We can also look forward to progress on the provision of clerical information and technology support for first line nurse 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, and where nursing remains the preserve of nurses.
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 we´ve worked out 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, but attract back some of the nurses 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.
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. While I´m on the subject of allowances, I´d like to acknowledge how instrumental your Industrial Relations Officer, Seamus Murphy, was – in 1999 – in the introduction of the external clinical placement allowance. (I´m sure Seamus will acknowledge that I´ve doubled the value of the allowance since then)
Now it´s time for me to deal with something I know you have a professional and personal interest in: the Mental Health Bill, 1999. The main purpose of the bill is to put a modern framework around the treatment and care of mentally ill people. But there´s a second purpose to it, too.
The second purpose is to establish mechanisms to monitor, inspect and regulate standards of care and treatment in our mental health services.
The Mental Health Commission will be the main vehicle for change, and it´ll employ the Inspector of Mental Health Services. Both the Commission and the Inspector will be independent of me and of the department – crucial, that independence.
Having listened to all the views on the Bill – including those expressed by your Association – I´ll be hoping to have it enacted before the end of the year.
Great changes have been happening in psychiatric services in recent years. We´ve moved away from the old institutional style mental health service, standing in isolation and closed from the rest of the community. That model is becoming a grim memory – but nothing more than a grim memory.
Instead, we´re moving towards a comprehensive community-based service integrated with the other health services. This shift in the delivery of services from predominantly hospital-based care has been very successful. The quality of care for people with mental illness has been measurably enhanced as a result. This is a direction I´m committed to keep pushing.
In that context, a Working Group is being established to review the practice of patient escorts. I know that this issue is of concern to you and it´s important that it be reviewed in the context of the future development of mental health services and in particular in the context of the Mental Health Bill. And, of course, the PNA has been invited to participate in that Working Group.
The Government has come up with an additional £18.64 million for improvements in mental health services, with priority going 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. None of these could be developed without the invaluable contribution of the RPN.
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 main 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 solid 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.
Oh – and while I mention the departure of one person from the Department, I should also mention that the Department´s team of professional nursing and midwifery advisors will soon be augmented by the appointment of a full-time psychiatric advisor.
That last fact is another element in the multi-faceted progress we´re making. Because, wherever you look at your 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, who died last year. She´s 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 PNA for the benefit of the mental health services and of nursing.