Speech for Ms Máire Hoctor, TD, Minister of State at the Department of Health and Children Institute of Community Health Nursing Annual Conference Thursday 11th October 2007 9.10am Croke Conference Centre, Jones Road, Dublin 3


Chair (Senator Ormonde), President, distinguished guests, Ladies and Gentlemen.

I am delighted to be here to give the opening address to the annual conference of the Institute of Community Health Nursing. I would like to start by acknowledging the significant contribution of public health nurses and community nurses and midwives to the health service. In my role as Minister with responsibility for Older People, I am conscious of the key role played by nurses working in the community in the provision of services for our older persons.

I am aware of how significant your annual conference is in relation to the professional development activity of the Institute and indeed your own professional development. This is the 22nd Annual Conference, hosted by the Institute, which itself is also 22 years in operation. The Programme for today is reflective of the current demands placed on nurses working in the community in 2007 to provide a high quality service.

The Institute provides an important forum for health professionals in the community setting to share knowledge, and debate and discuss issues related to population health and primary care. The Institute has clearly identified the need for a much stronger emphasis on community health priorities, quality assurance and governance. The Government’s strategy Primary Care: A New Direction remains a major component of the overall health strategy and sets out a new direction for primary care as the central focus for the delivery of health and personal social services. Public health nurses and community nurses are key personnel involved in the move away from an over-reliance on acute hospital and specialist services to one where people can access a range of health professionals working in multidisciplinary primary care teams. This approach is designed to meet the health needs of the vast majority of people within their local community.

Public Health Nursing
As has been evident in the history of the health service, nursing and midwifery is intrinsic to the health of this nation. Public Health Nurses work in partnership with individuals, families and communities in their area and are well placed to deliver interventions aimed at improving the health and social well being of the local population. Public health nurses, and nurses and midwives working in the community, form an important link between primary and secondary care settings. The integration of the public health nursing service with other parts of the health service and greater levels of intra- and inter-disciplinary working are the keys to the further strengthening of the health service as a whole, and the nursing and midwifery contribution in particular.

It is vitally important that nurses and midwives continue to develop their clinical skills so as to respond to both current and future challenges in health care, for the benefit of patients and clients of the health services. Education plays a significant role in relation to this. Since 2000 the Government has significantly increased investment in public health nursing education. The HSE now provides annual funding in excess of €5m to train students on the Graduate / Higher Diploma in Public Health Nursing programme.

Nurses and Midwives Bill
These are exciting times for nurses and midwives in Ireland. Their roles have expanded since 1985, when the current Nurses Act was brought into law. The scale of this expansion has escalated in recent years in response to emerging health service needs, both in the context of the ongoing health reform programme and the modernisation of nursing and midwifery. The proposed Nurses and Midwives Bill is an acknowledgement that the current legislation is 22 years old and needs to be revised.

The drafting process for a new Bill to replace the current Act is at an advanced stage. It is hoped to publish the scheme as part of the public consultation process, which is necessary for the development of the Bill.

This new piece of legislation for nurses and midwives will provide a modern framework for the regulation of the professions and the practices of nursing and midwifery and the protection of the public and will be an important hallmark reflective of the importance placed by Government on the role of nursing and midwifery practice in Ireland.

An Bord Altranais Elections
As you are aware, An Bord Altranais have just completed their election process. I would like to congratulate Virginia Pye and Deirdre Duffy, on their election under the Administrator and Clinical Practice Categories for Public Health Nursing and wish them well in their endeavours. It would be remiss at this time not to congratulate the members of the outgoing Board for all the work that they have engaged in on behalf of the nursing and midwifery professions in Ireland.

Nurse Prescribing
One significant piece of work that the outgoing Board engaged in related to Nurse and Midwifery prescribing. Following the publication of the Review of Nurses and Midwives in the Prescribing and Administration of Medicinal Products in 2005 and an extensive public consultation conducted by the Department of Health and Children, my colleague Mary Harney TD, Minister for Health and Children, introduced primary legislation in 2006 to allow prescriptive authority for nurses and midwives subject to conditions specified in regulations.

The extension of prescriptive authority to nurses and midwives will improve services for patients, especially in areas such as care of the older person, chronic disease, palliative care, maternity services and palliative care and many more.

Health service delays will be reduced for patients and nurses and midwives will be able to use their time more effectively to give the right care at the right time in the right setting.

In May 2007 Minister Harney signed into law the Irish Medicines Board (Miscellaneous Provisions) Act 2006 (Commencement) Order 2007, Misuse of Drugs Amendment Regulations 2007 and Medicinal Products (Prescription and Control of Supply) (Amendment) Regulations 2007 after they were approved by the EU Commission.

To complement this An Bord Altranais devised practice standards and professional guidance that state the requirements of the regulatory body for the registered nurse of midwife prescriber.

A number of key partnerships were formed to make the implementation of nurse and midwife prescribing a reality, namely: the Department of Health and Children, the Health Service Executive, An Bord Altranais and the National Council for the Professional Development of Nursing and Midwifery, the Higher Education Institutes and the Nursing Unions.

The first nurse prescribers are due to graduate shortly. A total of 50 nurses/midwives are expected to graduate from both University College Cork and the Royal College of Surgeons of Ireland here in Dublin. A further 50 nurses and midwives will start their education programme next month.

By the end of 2008 there will be more than 150 nurses and midwives available to prescribe medications in areas such as Accident and Emergency Departments, Palliative Care, Care of the Older Person, Maternity services and other specialist care areas such as diabetes, respiratory and sexual health to name a few. These are important times for nursing and midwifery as the professions respond to, and take on increasing roles and responsibilities in the further development and delivery of a quality health and social care service.

Quality and Governance
The focus of this year’s Conference, “Governance in Community Nursing” is to highlight quality and clinical practice as being inextricably linked. The Conference provides you with the opportunity to explore and debate matters pertaining to care provision, such as assessment of older people, practice development and governance. While policies have developed in key areas for nursing practice, practice development is now seen as an integral component of the profession. In line with this and the Departments policy function, the Nursing Policy Division has launched a Practice Development Steering Group. The primary focus of this group will be to develop a policy to facilitate the organisation and management of Practice Development that will lead and contribute to the change and transformation agenda for the health service. Your conference programme reflects the importance of practice development as you explore how practice development is contributing to clinical governance in Public Health Nursing.

Today’s Conference provides a forum for you to come together to facilitate discussion in relation to providing nursing care for people in their own homes, in conjunction with a range of health and social care providers.

Patient safety and quality of care are central to the care encounter, and are driving reform of our health services. The provision of high quality care is a hallmark of a modern health service and the responsibility of all to deliver it. Clinical governance of processes and practices is an essential component of this. This conference, in focussing on governance in the community, is highlighting an important aspect of care processes that support maintenance and improvement of standards of patient/client care.

One of the central objectives of the Health Service Reform Programme is to reinforce safety and quality throughout the health and personal social services system. A key feature of this objective was the establishment of the Health Information and Quality Authority. HIQA’s core purpose is to promote safety and quality in the provision of health and personal social services for the benefit of the health and welfare of the public. The establishment of HIQA represents an important step in the continued development of a high quality, safe and effective health care system which will provide a better service for patients. Fundamental to this process is education and professional development, areas of particular concern to the Institute.

New Public Health Nurse Registration Programme
As you are aware, a new Public Health Nurse Registration Programme commenced in September. This programme was developed taking account of An Bord Altranais’ Requirements and Standards for Public Health Nurse Registration Education Programmes (2005).

For the first time, application to the programme is open to registered nurses who do not hold a midwifery registration. This development, I’m aware, has raised concerns amongst you, one of which is in relation to the possibility that the incorporation of the Module on Maternal and Child Health may be at the expense of another module of learning. However, the guidance from An Bord Altranais is clear. This module, comprising both theoretical and clinical instruction, is in addition to the modules that already form a programme of public health nursing. Nurses and midwives who complete this programme will, like yourselves, contribute actively to the vision for primary care. As you are aware, normally the HSE sponsors 130 students annually for this programme, but this year, for the 2007 / 2008 competition, extra funding was provided by the HSE for 28 extra sponsorships, which is good news for the profession and for future recipients of care.

Role as Minister of State – Older Persons
In my role as Minister of State at the Department of Health, I have particular responsibility for health promotion and services for older persons. There are important policy initiatives in these areas in which public health nurses and nurses working in the community play a vital part.

Care of Older Person Services
Given the increase in the age profile of our population, there is an increased need for services for older people. This in turn puts a greater demand on health professionals and family carers alike. I would like to acknowledge the hard work and the commitment of nurses and other health service staff working in this sector.

Significant activity has and is occurring in relation to the specific needs of the older population.

Services for Older People are a priority for the Government. This is reflected in the funding committed to services for older people in Budgets 2006 and 2007. Last year, the Government funded the largest ever expansion in services for older people with a full year cost of €150m. This year a full year package of €255m has been allocated for services for older people. This gives a total of over €400m added to services for older people over two years.

Government policy in relation to older people is to support people to live in dignity and independence in their own homes and communities for as long as possible and, where this is not possible, to support access to quality long-term residential care. This policy approach is renewed and developed in the latest partnership agreement, Towards 2016.

We are moving away from the practise of placing people in residential care as a first option. This philosophy has long formed the core of government policy in the area. I know that this is a view that is supported and shared by the Institute of Community Nurses, whose members are to the fore in implementing this objective.

The key to making this principle a practical reality in the eyes of patients and their families, is the provision of appropriate supports. In this regard, I believe that we have made a good start. The number of home care packages, for example, for older people has been increased. In 2006 a total of 2,000 extra Home Care Packages were provided at a full year cost of €55 million (prior to this date only 1,100 packages had been in operation on a pilot basis). A similar increase in the number of packages will be provided in 2007, benefiting some 4,000 people.

Long-term residential care will always be required in the health system, but places should be more appropriately allocated to patients with a higher dependency who can no longer be cared for in their communities. The problems, such as delayed discharging from acute hospitals and lack of suitable alternatives to residential care will not disappear overnight. But with the right will and the commitment of professionals such as yourselves I am convinced that we can provide appropriate supports in a community setting to those older people who are able to and wish to remain in their own home.

I think it is important at this point to note that another corner stone of public care provision is the Home Help Service. In recognition of the pivotal role of this service in supporting care in the community the Government provided an extra €18m in Budget 2007 to fund the cost of some 780,000 additional home helps hours in 2007. This brings the total funding allocated to home helps to approximately €171 million per annum. This will have a significant positive effect on some of the problems being encountered on a day to day basis by those seeking health care. This represents a marked increase from the €17 million allocated in 1997. However we can not afford to be complacent and we must continue to ensure there is adequate investment in this key service if we are to meet people’s real desire to stay in their own homes.

Education, knowledge, skills, expertise and competence are hallmarks of a modern nursing and midwifery profession. The Institute contributes to such knowledge development on an annual basis in a range of forums, in particular the hosting of the annual conference. I feel confident that the Institute of Community Health Nursing will continue to promote sharing of information and best practice among its members and of course, continue to make significant contributions to the health care needs of individuals and communities in the years ahead. I am confident that together we can build on the substantial progress to date to bring about a health service worthy of the Ireland of the 21st century.

Finally, I would like to thank the Institute of Community Health Nursing for inviting me to deliver the Opening Address at this year’s conference and wish you well in your deliberations today and at your AGM this evening.