Speech by Mr. Micheál Martin T.D., Minister for Health and Children, at the launch of The Nursing and Midwifery Resource: Final Report of the Steering Group – Towards Workforce Planning
I am delighted to be here with you this morning. Before the start of the formal proceedings I think that on this day the 11th of September 2002 – one year following the tragic events at the World Trade Centre, the Pentagon and Pennsylvania. Our thoughts are with the families and friends who have been affected by the sad events.
Launch of the Report
I am very pleased to accept this the final report of the steering group examining the Nursing and Midwifery Resource. It gives me great pleasure to formally launch the impressive document Towards Workforce Planning. The report is the result of three-and-a-half years intensive study. The significance of this study should not be underestimated as it presents the first large-scale work on the subject in Ireland.
The Commission on Nursing
Perhaps the biggest single impact on nursing and midwifery in Ireland is the Report of the Commission on Nursing published in 1998. I think you will agree that the ongoing implementation of the recommendations of the Commission is transforming the nursing and midwifery landscape in this country. The Commission on Nursing clearly identified the need to strengthen the workforce planning function in the Department of Health and Children. I am pleased to see how the Study of the Nursing and Midwifery Resource concentrated on this issue.
Set up of the Study of the Nursing and Midwifery Resource
First of all, let me present some background information. In light of the changing professional and economic environment it became evident in 1998 that there was a need to develop a more systematic approach to workforce planning to meet our future nursing and midwifery resource requirements. I would like to pay tribute to Ms. Peta Taffe, former Chief Nursing Officer for her leadership in instigating the study. On her initiative my Department convened a steering group to Study the Nursing and Midwifery Resource in Ireland in December 1998.
The principal aims of the study were to:
- analyse the current position with regard to the workforce,
- advise on methodologies for the projection of future needs and
- recommend how these needs may be met through future planning.
A substantial interim report was published in September 2000, which I know was widely circulated throughout the health system. It contained an overview of relevant literature, profiled the nursing and midwifery workforce and recommended actions on a number of pressing issues. I am happy to report that over the last year and a half intensive action has taken place on each of the recommendations contained in the interim report.
I think you will agree that the broad focus of the study is most impressive – and the approach is not merely confined to the calculation of workforce numbers. I am particularly pleased to read about the strong emphasis placed on retaining the very valuable experienced staff currently employed in the health system, and to understanding the reasons why staff leave any particular organisation. International experience would suggest that clinical nurse managers have a vital role to play in creating good local conditions conducive to staff retention. The importance of individual nurses and midwives taking ownership and responsibility for their role in retaining their colleagues in practice is paramount to the success of any retention strategy. This study clearly highlights the absolute imperative for each organisation to develop a specific retention strategy for nurses and midwives.
The analysis in this report highlights the importance of incorporating “Futures Thinking” into workforce planning methodologies. “Futures thinking” allows us to scan the horizon and foresee likely developments. Anticipated changes in the environment of health care, demands for a workforce that can support the needs of a diverse population, and the impact of information technologies on clinical work create unprecedented challenges for nursing and midwifery practice, management and education.
Supply of Nurses and Midwives
Throughout the report statistical information is collected from a variety of sources and for the first time in Ireland presents the most comprehensive picture available of the composition of the nursing and midwifery workforce in Ireland. The detailed statistical data shows that applications for nursing education have been maintained at a high level in recent years and, in particular, the most welcome attainment of an increase of 34 per cent in applicants for nursing to the Central Applicants Office (CAO) in 2002. One of the pillars in ensuring the continued supply of registered nurses in the future is the introduction, this year, of the four-year undergraduate pre-registration nursing degree programme. This is even more significant as this is the first intake of students to the degree programme. The Government is investing €243M over the next three years in the provision of capital facilities to support the new nursing degree programme, as well as providing for additional student places.
The National Nursing and Midwifery Human Resource Minimum Dataset
Estimating future requirements, particularly for the nursing and midwifery resource, is not an exact science. I believe that a number of issues influenced progress in this study – chief among these was gaps in essential information required for forecasting. The study identified an urgent need to develop a profile of the current labour force, to better understand its dynamics and behaviour, and to highlight variables or indicators that can provide information for monitoring and influencing policy decision making.
To this end a major achievement of the study was the establishment of the National Nursing and Midwifery Human Resource Minimum Dataset. The minimum dataset is a critical element to the successful implementation of workforce planning. I urge all organisations employing nurses and midwives to adopt and use the minimum dataset on an ongoing basis. It is vitally important that the momentum established during this study in obtaining baseline data is built on year-by-year.
I know that many of the staff from St. James´s Hospital, the NWHB and the National PPARS Project Office who were involved in the minimum dataset pilot studies are here today and I would like to personally thank you for your commitment to the study.
The Health Strategy
I am pleased to see that the final report was influenced by the Health Strategy Quality and Fairness: A Health System for You. The health strategy describes the composition and quantum of services that will be developed over the next decade. The action plan of the strategy gives a clear indication of the nursing and midwifery services required to give effect to the goals and objectives of the strategy.
The Health Strategy clearly indicates that Integrated Workforce Planning is the approach to be adopted for the Irish health services. My Department is committed to leading the development of systems for integrated workforce planning aimed at anticipating the number and type of staff required to provide a quality health service. There is a strong recognition in the strategy that strategic, long-term integrated workforce planning must become a core activity of the human resource function of the health services.
Approach to Workforce Planning
What emerged overall from the extensive analysis was the vital need for a formal and comprehensive approach to workforce planning at national, regional and local level. This must be supported by accessible dynamic information systems providing timely and accurate data. A systematic standardised approach is required. Much of the international literature advocates the creation of integrated workforce plans for the entire health service, rather than separate plans for each discipline. The importance of integrating the process of workforce planning with service planning is also emphasised.
For the first time a comprehensive approach to workforce planning for nursing and midwifery is identified in the report. A top-down and bottom-up approach is proposed by the steering group with workforce planning for nursing and midwifery taking place at local, regional and national level on an ongoing basis. I am very pleased to accept the proposal of the steering group that the entire process be lead at national level by a Workforce Planning Function for Nursing and Midwifery within the Nursing Policy Division. One of the key recommendations of the report is that a Steering Group for Workforce Planning for Nursing and Midwifery be established by the Nursing Policy Division of my Department. The role of the group will be to drive, monitor and evaluate the implementation of the recommendations and 118 actions contained in the report.
The ultimate aim is to have the right number of nurses and midwives in the right place at the right time, with the right skills to ensure that the patient receives the highest standard of care when needed. The report recommends the best possible approach, at this point in time, to workforce planning for nursing and midwifery and how this may be kept under review. The steering group have set out a series of recommendations focused on addressing all of the issues identified in the study.
The report contains 118 individual recommendations, mainly focussing on:-
- ensuring the continued supply of nurses and midwives, and
- implementation of workforce planning
I am confident that the recommendations contained in the study will, in conjunction with similar initiatives in other areas, provide a solid foundation upon which to build for the future.
I would especially like to compliment the steering group for the initiative taken in generating debate on the best approach to integrated workforce planning. I welcome the acknowledgement of the role of the Health Skills Group in this matter.
I would also like to draw your attention to two supporting texts which form part of the suit of documents related to the study:
- Guidance For Best Practice on the Recruitment of Overseas Nurses and Midwives, published in December 2001, and
- The Report of The National Study of Turnover in Nursing and Midwifery, undertaken by a research team based at University College Cork.
Guidance for Best Practice on the Recruitment of Overseas Nurses and Midwives
In recent years the supply of registered nurses and midwives has been dependent on augmenting the numbers qualifying each year by recruitment of nurses and midwives from abroad. The document Guidance for Best Practice on the Recruitment of Overseas Nurses and Midwives was published as part of this study. The guidelines are intended to assist health service employers in ensuring that best human resource practice is followed at all stages in the recruitment process. Particular emphasis is placed on the need for appropriate induction, orientation and adaptation programmes for nurses and midwives coming to Ireland from abroad. The guidelines set out five principles: quality, ethical recruitment, equity, inclusiveness and the promotion of nursing and midwifery. The document advocates that the preparation and support of nurses and midwives in adapting to working as members of a culturally diverse team is crucial to the success of international recruitment.
National Study of Turnover in Nursing and Midwifery
Another central component of the study was the completion of the first National Study of Turnover in Nursing and Midwifery in Ireland. The study was commissioned with the assistance of the Health Research Board to inform the deliberations of the steering group. The complete report of the study is published separately as an accompanying document to the main report.
I would particularly like to welcome Professor Geraldine McCarthy here today and the other members of the research team, Mark Tyrrell and Camille Cronin who undertook the study. The National Study of Turnover in Nursing and Midwifery documents for the first time in Ireland the turnover rate and provides the framework for continuing to monitor this important indicator. The findings indicate that turnover in nursing and midwifery varies enormously throughout the Irish health system. A welcome finding is that across hospital bands and services the overall turnover rate has decreased from 17 per cent in 1999, to 15 per cent in 2000 and 14 per cent in 2001. While turnover rates have not generally reached levels experienced in other countries, it is a real issue which requires focused attention.
I especially want to express my sincere appreciation to the Departments Chief Nursing Officer, Mary McCarthy for successfully navigating the study to its conclusion. I pay tribute to each of the eighteen members of the steering group for their enthusiasm and personal contributions to the study. The steering group deserve our thanks for a job well done. I must also thank the nurse research officers Maureen Flynn and Elizabeth Farrell. Today marks the end of a particularly important piece of work insofar as they are concerned. However, for me, for my Department and the Health Agencies it marks the beginning of a very important era with a renewed focus on workforce planning for the health services. I understand that Elizabeth is now working on a nursing project with the Department of Health in Western Australia. I am sorry that she is not here today to take credit for her intensive work. I wish her well in the new position and look forward to seeing her back in Ireland in the future.
I am also very conscious of the major contribution played by personnel from An Bord Altranais, the National Council for the Professional Development of Nursing and Midwifery, the Health Service Employers Agency, the PPARS National Project Team, the eight regional Nursing and Midwifery Planning and Development Units and nurse and midwife managers throughout the system. In case I have left anyone out I would like to thank all who have contributed in any way to the preparation of this fine report.
In every aspect of the health system the contribution of nurses and midwives is pivotal. Irish nurses and midwives have a very proud tradition and history in service delivery and our function is to maintain this as we more forward. Action on this report will form a vital part in planning for the future of Ireland’s nursing and midwifery workforce.
As the title, Towards Workforce Planning, indicates this is just the beginning of an ongoing process. It will continue to focus on setting up structures and processes to plan for future nursing and midwifery resource requirements. I urge you to make this report a working document to be used by nurse and midwife managers, human resource managers, administrators, educators and policy makers throughout the system.
The fundamental purpose of integrated workforce planning is to ensure that the health service has sufficient staff with the requisite skills and competencies to deliver quality care. The challenges for the future are:-
- to be able to recruit and retain skilled personnel in a changing labour market
- to ensure that the education and training processes provide personnel with the skills that the health service needs, and
- to ensure that the available skills and competencies are deployed for maximum efficiency and effectiveness on the ground
The process will require, not only technical supply and demand modelling, but also the adoption of appropriate HR policies in the areas of education, training, pay, skill mix, recruitment and retention, and career structure. We will have to approach this with innovation and flexibility. Each of us, no matter where we are along the healthcare value chain, have a responsibility to make this happen.