Speech by Minister for Health and Children, Mary Harney, At the INO Special Delegate Conference
Thank you for inviting me here today. I am pleased to have this opportunity to address members of the Irish Nurses Organisation at a Special Delegate Conference, especially as I spoke in recent weeks at conferences respectively of the Psychiatric Nurses Association and SIPTU.
This is a serious occasion and a serious moment for our health services and for the patients and clients we serve.
It is regrettable that we find ourselves here today in the middle of an industrial relations dispute.
No one wins in an industrial dispute like this. Patients are not winning, and will not be the winners. So far, in fact, they are the ones losing, and the only ones losing.
No-one will come out with a victory. In fact, in a dispute like this, it is only if each side leaves aside the pursuit of a victory that a solution is possible.
So, let me say this. The Government and I have no interest in any victory. We want a solution. We want agreement. We want a way forward. And we will work towards it again.
I want to see the role of nurses expanded, developed and re-organised. I want to see nurses at the centre of transformed health services, using the great resources our economy generates to deliver best results for patients.
I want to see nurses leading innovation and change in services to patients and efficient work practices. I want to see them doing this alongside all other healthcare professionals, not separate to, or out on a limb from, their colleagues.
This is why the Government have expanded nurse training in the higher education sector. I was very pleased to introduce two new training programmes – the undergraduate honours degree programme in midwifery, and the undergraduate honours integrated degree programme in general/children’s nursing.
I have taken practical steps to demonstrate my commitment to nursing. I recently signed the regulations providing for the introduction of nurse prescribing. The INO made an invaluable contribution to that process. We have provided funding to the HSE to develop pilot nurse-led chronic disease projects. And I want to see many more nurse-led clinics.
When we jointly celebrated the graduation of the first nurses from the degree programme last November I spoke about the opportunities for change. The nursing degree programme itself was the result of collaborative work between the Government, the nursing unions and other key stakeholders in health and education.
Nurses have a key role to deliver change for patients. And here today, I acknowledge and pay tribute to the role nurses played, with their colleagues, in 35 A & E departments around the country in delivering major improvements in waiting times for patients in the last year.
We had some differences over A& E figures, but we agreed on core items like new beds at A & E, and measures for patients’ safety and dignity. And the improvements were achieved by working together with the HSE hospital-by-hospital.
Collaborative problem solving is, without any doubt, the best way forward for patients. That’s why I am a strong supporter of the idea of a Health Forum, suggested by the Irish Congress of Trade Unions, consistent with the Labour Court recommendation, and endorsed by the Government, where change and innovation in work practices can be worked out together with everyone involved.
In a complex area like our public health services, with perhaps 130,000 people involved, we can’t achieve change for the better if every group ploughs its own furrow in isolation from everyone else.
No complex problems, no complex challenges, are solved by a series of unconnected arrangements with each party. We have seen plenty of evidence of it, in the two central, historic changes in Ireland in the last twenty years: the transformation of our economy and the achievement of peace in the North.
In both these complex areas, progress was achieved at critical moments by everyone moving together. You don’t need me to go over the history of social partnership again, and the dire economic circumstances that gave rise to it, or over the peace process, which has now been brought to a successful conclusion. We all recognise that special deals for one group before others can’t work – but extraordinary things and extraordinary progress are possible by all groups working together.
That is what I want to see for nurses and all other organisations, together, in our health services. It is a positive agenda for change.
And I believe that your demand for a reduced working week can be transformed into a positive agenda for change
- if it is analysed and pursued with management and other stakeholders in health;
- if it is focused on improvements for patients, with no risk of a diminution in services at present or jeopardising service developments in the future;
- if it is supported by a verification process; and
- if we don’t simply present taxpayers with a large bill to pay for it.
That could be the future. But today, we are at a very serious moment in this dispute.
A continuation of the industrial action is likely, in the nature of these disputes, lead to a hardening of positions and a growing sense of embitterment among nurses.
Today is a time and place for plain-speaking. I want to be clear and honest with you about where I stand in relation to the issues involved.
No-one likes the scenario of a deduction of pay. But taxpayers cannot be asked indefinitely to pay for work that is not being done. Over the past five weeks, in the work to rule and the work stoppages, normal work is not being done. And normal pay cannot be paid in those circumstances. Importantly, the cost of €2 million per week cannot be deducted from services for patients indefinitely.
So let us look at how this can be avoided and how solutions can be developed.
The simple reality is that the pay issue can not be dealt with outside the benchmarking process. The Government is clear on this point. Other public sector workers who have signed up for Towards 2016 and Benchmarking II, rightly expect the Government to keep to its side of the bargain by not allowing major special deals for others.
I always believed there was more scope for flexibility and innovation in dealing with the claim for a reduced working week. The current position is that:
- a straightforward reduction in working hours would be equivalent to a pay increase in another form and could only be dealt with in benchmarking;
- however, your union has emphasised its belief that the reduction can be brought about in a cost-effective patient centred manner, and management, for its part, has said that it is prepared to explore whether a reduction in working hours could be achieved on a cost neutral basis: to be clear, management is not saying that a reduced working week is achievable but nor is it ruling it out;
- the proposals tabled at the NIB talks would give nurses an initial reduction of one hour by March 2008 and a time-limited process, to start within a month, which would establish whether, how and over what period a further reduction in working hours is achievable; and
- these proposals would give individual service locations, particularly nurse managers in those locations, flexibility in drawing up a package of local changes which would allow the initial one hour reduction to be implemented on a cost-neutral basis.
I realise you may be worried that this is simply a way of kicking your claim into a process and long-fingering it. I am sure there are ways of addressing this concern by strengthening the process if all parties engage on this aspect: I know the NIB had envisaged the Labour Court playing a key role in the second strand of the process.
To be fair to nurses, I want to acknowledge the scale of the change agenda explored by the INO / PNA and the HSE during the talks. I am already on record as welcoming this. I believe these changes would make a major contribution to transforming our health services. I know you want to work in a health service that delivers the best possible care to your patients and clients. That is the type of health service I want to see also.
To be fair to other health service employees, it is clear that changes in the roles, working pattern, hours of employment and developmental opportunities for any one category of health personnel, especially in acute hospital settings, have direct implications for other professional groups who share the same service and patient responsibilities.
The best way to achieve these changes – which would greatly improve services to patients – is through discussions involving all health service employees in the special Health Sector Forum that has been set by the Government and ICTU for that specific purpose.
The bottom line, as I see it, is that there is plenty of scope in the change agenda discussed by both sides during the NIB talks and there are processes that would allow both sides to work through this agenda.
Unfortunately, instead of working together in this way we seem to be in danger of heading into what could prove to be a long-drawn out dispute. The real pity is that this dispute is unnecessary from the perspectives of both patients and nurses.
Election 2007 and political considerations
Finally, let me be clear with you about one more thing: the general election.
Yes, there are over 40,000 nurses and their families. And you are right – they are voters. But there are over 3 million voters and nearly 1.4 million income tax payers. There are many issues before the electorate and many demands on public resources.
For my part, I will not take any position, or react to any proposal, in this dispute solely on account of the election date.
I am interested in solutions, but not because of the election. I am interested in talks, but not because of the election. I am interested in maintaining order in public sector pay and costs, but not because of the election.
The election will make no difference. The day will come and go. The issues will remain. No responsible government, in my opinion, would deal with them in any other way.
I believe that each political party you have invited to speak today is fully signed up to Towards 2016, including holding to the government’s side of the bargain with public sector workers, private sector workers and taxpayers.
I don’t believe that any party that has been in government, and aspires to be in government again, would, in fact, concede a special pay deal for any group outside of Towards 2016, because it would certainly unravel public sector pay determination. No government could risk that.
There has been a lot of focus on the budget plans of political parties, about what they have costed and by how much. I don’t believe any of these plans include provisions for the costs of the claims being made in this dispute. Implicitly, and perhaps even explicitly (parties can speak for themselves), the political parties do not envisage a solution to this dispute except through Benchmarking and an orderly, cost-neutral, change in working arrangements.
I would be very surprised if political parties aspiring to be in government did, in fact, revise their spending forecasts just before the election itself to reflect a changed position on this dispute.
I don’t expect a complete welcome for all I have said here today. All I ask is that you reflect on what I have said. I do believe we have major areas of common purpose in the development of nursing and better patient services. I do believe a Health Forum will be productive.
We need to find a win-win, not a lose-lose, solution to this dispute. And I firmly believe that is possible.