Speech by Mr Simon Harris, TD, Minister for Health at the Launch of the Consultation Process on Draft Nursing and Midwifery Policy Papers

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Good morning ladies and gentlemen and thank you for inviting me here today for the launch of these important consultation papers. It is a pleasure to be launching these papers in this state-of-the-art primary care centre which epitomises the policy of my Department and the Government to provide our citizens access to a range of health care services and facilities as close to home as possible.

The Programme for Partnership Government seeks to achieve a decisive shift of the health service from an acute hospital focus to community and primary care. This will see the delivery of enhanced care in every community. This commitment is not a politically contentious decision because both Government and opposition have all supported this goal over recent years but we have to put the building blocks in place to make it a reality.

As you all know the Irish health service has seen many challenges in the past decade. Our population demographics and the health problems we face as a society are changing. As more people live longer and manage several conditions affecting their health, we need services that support each person and family to remain as well as possible for as long as possible within their own homes and communities. With increasing complexity and acuity impacting greatly on an already stretched service, we must be innovative in maximising the potential of all nurses and midwives to meet the population need and provide choices for when and where people can access the health service they require.

I am on record as saying that well-educated, highly skilled and experienced nurses and midwives are an extremely valuable resource within our health service. Our job both within the Government and the Department is to ensure that nurses and midwives are enabled to practice to the full extent of your education and scope of practice.

This is so that you can do what you do best – providing care and getting the best outcomes for patients.  Together, we must create an environment that enables nurses and midwives to provide comprehensive care to individuals, families and communities in a range of appropriate settings.

One of our challenges lies in building the confidence of each nurse and midwife to develop additional competencies as well as embracing new ways of working and innovative methods of service delivery. To this end we need to make sure that strong governance arrangements are in place to support the delivery of care beyond hospital walls.

Our clear intention is to improve hospital avoidance, early discharge, patient flow, waiting lists and timely access to and choice of health services.

Over the coming years, however, we will have to significantly expand the scope of our ambitions as to what health services can and should be delivered in a community and primary care setting. This will involve investment in personnel, buildings, diagnostics, and training, as well as expanding the scope of eligibility for community and primary care services on a phased and prioritised basis, taking account of resources and available capacity.  I have repeatedly made clear that increasing capacity is a priority – that includes physical capacity, staffing capacity and, importantly, harnessing untapped potential in the system.

We have to identify the level of health service capacity required for the future, which is why my Department is currently working on a comprehensive capacity review. This capacity review will extend beyond acute hospital beds, to look at issues like the provision of additional capacity in community and primary care areas.

It is therefore timely that the Chief Nursing Officer, Dr. Siobhan O’Halloran has, as key objectives within the three-year strategy for her Office, developed the two draft policy papers for national consultation, which I am launching here today.

Both papers have been produced based upon national and international evidence including contributions from front line professionals in community and acute health services, academic institutions, policy analysts and health service management. I am also conscious that considerable international expertise informed the development of this work.

The first of these draft policies is:

Developing a Community Nursing and Midwifery Response to an Integrated Model of Care.

  • This presents a model and pathway of care built on a vision of providing people with choices about where care can be delivered. The model proposed has a strong focus on care in the home and community as a first point of contact.
  • It offers the option of utilising the primary health care centre as that first point of nursing and midwifery contact.
  • It promotes a proactive model of care that is both integrated and interdisciplinary allowing the patient to transit seamlessly between acute and community services.

The second draft policy is:

Developing a policy for graduate, specialist and advanced nursing and midwifery practice.

  • This provides a framework to develop a critical mass of advanced nursing and midwifery practitioners in a timely fashion – our target is to move to 2% of the nursing and midwifery population.
  • It proposes significant changes in the way we educate nurses and midwives at specialist and advanced level, with particular emphasis on the length of time. This change recognises and is built on the emergence of an all-graduate profession over the last number of years.
  • The draft policy proposes moving to a credentialing system that facilitates nurses and midwives to practice once they have achieved individual competencies.
  • Critically, the approach proposes a change to how we utilise and deploy the nursing and midwifery resource by moving to providing specific nursing and midwifery services based on national priorities and challenges.

I am delighted to welcome the President and CEO of the Nursing and Midwifery Board of Ireland and to acknowledge the support and the endorsement which the NMBI has provided for the draft policy on Advanced Practice through the adoption of the new Standards and Requirements approved by the Board last week.

I would also like to mention the work being done by the HSE on the development of Integrated Clinical Care Programmes.

I welcome the fact that there are close synergies between that work and the work of the CNO’s Office. We always do better in health when we join forces and build on each other’s strengths.

Community midwifery is also a major focus within the recently published National Maternity Strategy being rolled out through the National Women and Infants Health Programme. This again places emphasis on services being provided in the community, greater integration of community-based and hospital-based services through the development of maternity networks, and appropriate risk assessment to ensure that women’s needs and choices are met in the appropriate settings.

Both of these policy initiatives have the potential to support the delivery of interdisciplinary care, including active case management, by building up greater nursing and midwifery expertise in the community that up to now has been located for the most part in hospital settings. This is notwithstanding the excellent contribution of Public Health nurses.

These policies form part of a suite of policy papers under development within the Chief Nursing Office of the Department of Health. I wish to acknowledge the importance of this work and in particular its centrality to the broader initiatives and debate around new models of care.

I am acutely conscious of the challenging staffing environment our health services are facing. There are many initiatives currently under way and one you may be aware of in my Department is the Taskforce for Safe Staffing and Skill Mix. This policy was also developed in the Chief Nurse’s Office. My Department has recently extended this work from medical and surgical wards to include an exercise on safe staffing and skill mix in the Emergency Department.

Any initiatives and development of nursing and midwifery services requires measurement and analysis of the impact on patient outcomes. That is why the Chief Nurse’s Office is also developing a policy paper on a Framework for National Performance Indicators for Nursing and Midwifery. The draft framework has been approved within my Department and engagement has begun with key stakeholders on its implementation.

Whatever our direction of travel, the views and experiences of our health workforce – health professionals, administrative staff and managers – will be essential to ensure the successful development of appropriate policy proposals. That is why it is so important that your views are listened to and reflected in the development of future health policy.

Therefore, I am delighted to launch these draft policy papers for national consultation. I am also happy to announce the establishment of a steering group to oversee the selection of demonstrator projects. These projects will be established in tandem with the work in progress within the HSE Integrated Care Programme structures to demonstrate and achieve the underpinning principles for putting these policies into practice.  I expect to receive an Interim Report before the end of 2017 and a Final Report in 2018.

I invite all stakeholders to engage in the consultation process and thereby contribute to the development of a world class future nursing and midwifery service. I would like in particular to thank Susan Kent and Dr. AnneMarie Ryan, Deputy Chief Nursing Officers for their commitment to developing these initiatives. It is their enthusiasm and passion for enhancing the contribution of nursing and midwifery that has led us to this point on the journey today. I understand that the first consultation event will take place here after this launch.  I would like to thank you for your attendance and your contributions to the development and direction of future health policy.