Minister Reilly’s Speech at the INMO conference

Text of Ministers Reilly speech at the IMNO delivered on his behalf by

Dr. Ambrose McLoughlin, Secretary General of the Department of Health.

Theme of Conference: Safe Staffing = Safe Care =  Safe Patients

All of us here today share a common goal. We want to provide the best possible care for every member of the Irish population. As we navigate our way through all the challenges we face in reaching that goal it’s vitally important that we work together. The INMO is one of the largest organisations in the country, representing the largest group of healthcare workers in the health service, and so will play a key role in bringing about the future we are all striving to achieve. So I want to thank you for again inviting me to address your annual conference.

One of the key factors for success in any joint effort is putting the right structures and resources in place to deliver optimum results. Last year, as part of that process, I announced that I would establish a new Chief Nursing Officer role within the Department of Health at Assistant Secretary level.

As you are all aware, Dr. Siobhan O’Halloran has now been appointed to that post. I believe that it is critical that nursing and midwifery plays a central role realising health reform. The appointment of Dr O’Halloran as the first Chief Nursing Officer at this level in the Department of Health ensures that the voice of nurses and midwives is represented at the highest levels of policy making in the health service. This appointment greatly strengthens policy deliberations and ensures that dialogue and collaboration between nurses and midwives and policy makers can be sustained over time.

Strong leadership is needed for problems that do not have easy answers. With this in mind I believe that the Chief Nursing Officer should be supported by specialist nursing and midwifery expertise in order to maximise the contribution to health reform. I am, therefore, pleased to announce that the process of recruiting three Deputy Chief Nursing Officers is underway.

All three posts will focus on all divisions of the nursing and midwifery registers. The three general areas for which the Deputy CNO’s will have respective responsibility are:

  • Patient Care and Systems;
  • Women’s Health and Primary Care Services; and
  • Nursing and Midwifery Policy and Legislation.

The programme of reform currently underway represents the most radical overhaul of the Irish health service since its inception: the Chief Nursing Officer and her Deputies will have a critically important role to play in realising the reform we need to achieve the health service we all want.

The magnitude and complexity of the reform programme means that it is not something that can be implemented overnight, and there will inevitably be a perception that progress is slow. But we should not let perception replace reality. A great deal has already been achieved – for example, we have recently published both a White Paper on Universal Health Insurance, and the Health (General Practitioner Service) Bill; we also expect to complete appointments to the Hospital Group Boards very shortly.

As you know, we face a considerable challenge in the health service: we have to find ways to maintain the highest possible quality of service while operating within a very constrained fiscal environment.

In order to contain health service costs, it has been necessary to reduce the number of staff employed in the public health service, and nursing cannot be immune to these measures.

Deciding on an optimal number of nurses is not easy. There is a delicate and important balance to be struck to meet both economic efficiency and patient safety requirements. It is imperative that patient safety continues to be maintained in the context of these reductions, and achieving this requires that relevant expertise is applied to the decision making process.

It is for this reason that I have approved the establishment of a taskforce to develop a framework to determine staffing and skill mix requirements for the nursing workforce in a range of major specialities. The focus will be on the development of staffing and skill mix ranges that take account of a number of influencing factors.

Phase I of the project will focus on developing a staffing and skill mix framework for general and specialist adult hospital medical and surgical care settings.

The taskforce will be chaired by the Chief Nursing Officer and will comprise relevant experts, including representatives from the INMO. The use of staffing ranges, as opposed to staffing ratios, will retain flexibility in the system while ensuring that patient safety is clearly and rightly the central focus.

As frontline providers of care, nurses and midwives are constantly under public scrutiny in relation to patient safety. I understand and recognise this and want to assure you of this Government’s commitment to creating a better environment to support nurses and midwives in performing their tasks to the highest standard, particularly in the context of the health reform programme.

However, we still face many challenges to ensure that our health and social care services are truly safe and of the highest quality. I’m sure I need to remind nobody here of the stark reminder findings of recent reports, including the HIQA Report into the care and treatment provided to Savita Halappanavar and the Report of the Chief Medical Officer into Portlaoise Hospital.

The recommendations of both of these reports are currently in being implemented, and I am confident they will ensure that patient safety is everyone’s priority and reassure patients that our health services are of the highest quality in terms of care and safety.

One of the key recommendations arising from the CMO report on Portlaoise Hospital is that the health service should develop evidence-based workforce planning tools and data systems for midwives and maternity care assistants, using Birthrate Plus. I am committed to addressing staffing issues and Birthrate Plus works in a similar way to the taskforce on staffing and skills I mentioned earlier, but is specific to midwives and maternity care assistants. Progress is being made on this initiative with data gathering beginning shortly. It is anticipated that a report will be available in the autumn.

My Department is continuing to develop proposals on the organisational structures needed to improve patient safety in our health system. We are working with the Health Service Executive to establish a new Patient Safety Agency (PSA) at the earliest opportunity.

Patient safety is paramount, but it is not the only important factor in patient care, so I also want to talk about the work underway in other areas of patient experience.

Since this Government came to power in 2011, there have been concerted efforts to reduce the numbers of patients on trolleys in Emergency Departments daily. By the last Friday in April, there were 2,113 fewer patients waiting on trolleys in the year-to-date compared with the same period in 2013. Even more encouragingly, there are close to 10,000 fewer patients on trolleys in that four month period in 2014 than in the grim figures recorded for the first four months of 2011.

While that is undoubtedly good news, this is not a numbers game. This is about delivering all round quality patient care.

International evidence tells us that where patients spend lengthy periods of time on trolleys in overcrowded EDs, they have poorer experiences and poorer outcomes. Addressing this problem by moving patients to other areas within the hospital is preferable to the risk of severe overcrowding, but it is not a real solution. The introduction of Ward Watch has been important in bringing a meaningful focus on this issue and in working to find a real resolution. It is welcomed by my Department and the Special Delivery Unit and I hope that the INMO will continue to work with the SDU on finding ways to minimise the use of non-designated bed spaces to accommodate patients.

Tackling all of these problems has required a ‘systems’ response: improved patient pathways in ED, better working across nursing teams, and better working across multidisciplinary teams.

While the reduction in trolley numbers is very welcome, we also need to increase our focus on improving the patient experience in ED.

The national Patient Experience Time (PET) standard is that all patients will complete their episode of care in less than nine hours, and that 95% of patients will complete their episode of care in less than six hours. Of those attending, on average 78% are assessed and discharged, with the remaining 22% requiring inpatient admission. Achieving and maintaining these standards is undoubtedly a challenge. However, with the introduction of Medical Assessment Units, Minor Injury Units and other streams to manage patient pathways, and by ensuring that low acuity patients, who generally do not require admission, are focussed on, I think we will begin to see the same significant beneficial changes we have witnessed in terms of trolley reductions.

At the end of 2013, 99% of all inpatient and day case targets and 95% of all outpatient targets were met. So we know that we can achieve challenging goals.

I know it isn’t easy, and it simply won’t be possible without your engagement, your dedication, your professionalism and an all-round willingness to challenge the system, identify its flaws and work together to find sustainable solutions.

Myself and my Department are determined and committed to playing our part in delivering the structures and support needed to make all of the progress achieved to date sustainable, and all of our aspirations achievable. This includes facilitating the transition of legislation into practice.

Since commencing the Nurses and Midwives Act 2011 in October 2012, my Department has been working with the Nursing and Midwifery Board of Ireland to give full effect to the new legislation.

I am particularly pleased to see that the development and implementation of Standards and Requirements for Education Programmes to meet the current health reform agenda is at an advanced stage of consultation.

I made provision in the Nurses and Midwives Act for a statutory Midwives Committee in NMBI and am pleased that work has commenced within this structure to revise and update the Practice Standards for Midwives (2010).

I understand that this will address the skills required by a midwife to maintain their professional competence to the satisfaction of the NMBI. The Standards and Requirements for Education as a Midwife are also being examined to ensure that future midwives will be fully prepared to meet our evolving health needs, while learning from the lessons of the past. NMBI will consult with you later this year on these projects.

I also understand that NMBI have consulted with you on a revised Code of Professional Conduct and Ethics, and on a revised Scope of Practice. Developing the role of nurses and midwives to support safe access to efficient health services is one of my core priorities. And I am pleased to say that NMBI now has 6 Advanced Midwife Practitioners and 134 Advanced Nurse Practitioners registered, and that a project to review and support this development further in order to maximise the skills of nurses and midwives is currently at an advanced stage.

I have asked the NMBI to prioritise the development of Rules to support nurses and midwives in maintaining their professional competence because I believe that as practicing clinicians in the delivery of safe care such support is of critical importance.

I’ve talked about structures and processes and resources. I now want to talk about Leadership – the vital catalyst required to drive progress and deliver success. Building the leadership capacity and capability of nurses and midwives is essential in delivering a reformed health service. The HSE has invested in providing leadership and innovation programmes for nurses and midwives to support them to play a key part in leading our reform agenda.

Since the establishment – under the Office of the Nursing and Midwifery Services Director – of the National Leadership and Innovation Centre for Nursing and Midwifery (NLIC) in 2011, 1,417 nurses and midwives have engaged in various programmes and workshops, including key initiatives such as the recent ‘Future Nurse Leaders’ programme for 74 Assistant Directors and Directors of Nursing and Midwifery. In response to service needs, the NLIC will be facilitating the Midwifery Leadership to support 60 Senior Midwives, commencing in September 2014.

Programmes like these are much needed as the role of the nurse and midwife becomes ever more developed.

For example, the Nurse and Midwife Medicinal Product Prescribing Initiative continues to go from strength to strength. There are now approximately 660 Registered Nurse Prescribers in the country. This role enhancement, across diverse clinical specialties, contributes to more timely patient and service user care. This is a truly collaborative, innovative and successful initiative and I am committed to seeing nurses and midwives taking on enhanced roles throughout the health service.

This extends to the renewed focus on treating people in the community as opposed to hospitals. I acknowledge that this will have repercussions for community and public health nurses, and that is why I am particularly pleased that 107 public health nursing sponsorships have been approved for 2014.

This represents a significant increase in sponsorships places. We now have the highest number of sponsorships since 2008, a 26% increase on 2013 numbers, and a near 70% increase on 2012 numbers (40 sponsorships).

I’ve said a lot about role and responsibilities. Now I want to focus on the third and equally vital “r” – reward.

Since last year’s conference, the Haddington Road Agreement has been concluded. The Agreement required further pay adjustments in order to correct the public finances to achieve pay savings, and in order to minimise these, a range of productivity measures such as the additional hours nurses and midwives are required to work.

These measures are unavoidable as we must operate within the financial limits of the present economic environment. But there is no denying they have made many tough demands on you, particularly given the reductions in the numbers employed in the health service.

However, it must be said that the negotiations also resulted in positive outcomes for the nursing and midwifery professions, including the regularisation of acting-up posts, and the restoration of the Senior Staff Nurse Scale. In addition, the Agreement provided for the recruitment of up to 1,000 Nurse Graduates on a two year programme. Although the programme attracted some criticism it has proved popular, with around 500 nurses and midwives having commenced employment on the programme and over 200 others going through the recruitment process.

More broadly, the agreement also provided for the assimilation of the 10% reduced new entrant pay scales with the pay scales of those who entered service before January 2011. These revised scales have now been issued by my Department.

I am also aware that under the Agreement, the HSE and the INMO are now engaged in a process, with the support of the LRC, in relation to national nursing and midwifery management structures in the acute, primary care and elderly care sectors, appropriate to the new health care framework.

I sincerely appreciate and acknowledge that nurses and midwives, in common with many professions in the public service, have made many sacrifices over the course of the past five years. I believe we now have an opportunity to focus on putting in place firm foundations for the future of our health services in the context of the establishment of the Hospital Groups and Integrated Service Areas, and the move to Universal Health Insurance.

I can’t stress strongly enough how aware I am of the huge contribution each and every one of you makes to the health service on a daily basis, and how grateful I am for your continued commitment and professionalism through these extremely difficult economic times.

I would like to take the opportunity to acknowledge the manner in which the nursing and midwifery professions have ensured that health service delivery has been maintained and, in many instances, improved in recent years, notwithstanding the challenging circumstances resulting from reduced budgets and reduced staffing levels.

Your devotion to providing your patients with the best possible care when you are often under these considerable pressures is exemplary.

I can assure you that myself and my department are working hard to provide the structures and support to address some of the current pressures and deliver significant improvements for the future.

I’m sure you appreciate that all of this will take time.

However there is one very small act of recognition and I’m in a position to deliver today.

In acknowledgement of both their contribution to our health service, and the difficulties their country has faced following a devastating typhoon, I’m happy to be able to announce today that I have approved an initiative which will allow six Filipino nurses who have volunteered to return home for four weeks to undertake frontline relief work to do so on full pay.

I want to commend the nurses themselves for volunteering for what will be a very challenging but, I hope, ultimately rewarding role. And I want to congratulate the INMO on its fundraising efforts which have ensured that all travel, hotel and living expenses for the volunteers will be covered during their stay.

To ensure that you are supported at home during this initiative, the volunteers’ posts will be filled for the four weeks.

I’m sure you’ll join with me in wishing the volunteers the very best of luck with their endeavours.

And I wish you all well for the remainder of your conference and in bringing and providing health care to the Irish population in the year ahead.