Thursday, 14 April 1994
Dáil Éireann Debate
Minister for Health (Mr. Howlin): I assume the Deputy is referred to improvements in the overall conditions of employment of nurses. The position in relation to claims for improvements in the conditions of employment of all grades of health staff, including nurses, is that such claims must be processed through the industrial relations procedure. These procedures provide an equal opportunity for management and staff to discuss the relevant issues in detail and to reach agreement in due course.
Under the recently agreed Programme for Competitiveness and Work, nurses and other health service grades will have two possible avenues for negotiating special claims for improvements in conditions of employment. Claims may be pursued through the grade restructuring approach or via the traditional conciliation and arbitration/Labour Court procedures. Under either option, it is likely that negotiations will take place in relation to the implementation of any award made. These will be concerned particularly with changes in working practice or other issues which management will be pursuing in return for any concessions made.
Mr. J. Higgins: I am not simply talking about monetary rewards for nurses, although they are part of the equation. Will the Minister agree that nurses are the most professional and competent people in the health services, but also one of the most under-valued in terms of pay and working conditions? When people leave hospital they invariably praise the nursing staff. They are the first line of defence in casualty, very often they must bring the bad news of a death to relatives and they are the buffer between the highly paid consultant and patients and their families. In fact, they are the human face of hospitals. Is it not the case that 18 months ago an independent survey showed that the stress level of Irish nurses was the highest in the professions here and one of the highest in the world? What action has the Minister taken in that regard?
Mr. Howlin: I strongly share the view of the Deputy in regard to the professionalism of nurses here. We are extremely fortunate to have a profession of such a high standard in an integral part of the health service. Our nurses are recruited across the world and held in high regard. I disagree with the Deputy that they are under-valued. Any person who interacts with the health services places great value on the quality, standard and work of our nurses.
I outlined the necessary procedures for improvements in respect of pay and conditions. Similar procedures apply to everybody working in the health services. Almost one-half of those working in acute hospitals in the health service are nurses. They are a large and effective group. The issue of stress in that profession was discussed here previously. A report commissioned by nursing organisations highlighted the concern about stress levels in the profession. Most  people in the health services, particularly nurses, work under stress, and those working in accident and emergency are subject to even greater stress. I have had discussions with SIPTU, the Irish Nurses' Organisation, the psychiatric nurses' division of SIPTU and the PNA and I am aware of the concerns. I am working with the unions and nurses' representatives in an effort to reduce stress levels in the profession and improve working conditions for a most valuable cohort of our health service staff.
Ms O'Donnell: Will the Minister agree that the low pay and status of nurses might have more to do with the fact that the work is predominantly carried out by women? The status of women workers in general needs to be examined. Will the Minister comment on the need to change the law in relation to psychiatric nurses who are not entitled to compensation if attacked by psychiatric patients? They must prove negligence against the hospital.
Mr. Howlin: In relation to the Deputies first point. I am not sure whether it is a sociological fact that because nurses were traditionally women this was reflected in their pay structure. Our nurses are reasonably paid by international standards and mechanisms are in place to do comparative evaluations necessary to improve pay levels. I would be anxious to improve conditions for any segment of the workforce involved in delivering quality health care.
In relation to compensation for assault, psychiatric nurses work under similar conditions to other nurses. For example, a nurse in a casualty department may be faced by a drunk or disorderly person or a nurse working with the mentally handicapped may be faced with a disturbed person. All nurses are covered under the normal insurance policies of their employer, the health board or the agency that employs them. The only categories of public servant to which specific compensation procedures apply are the Garda and prison officers. It would be extremely costly to introduce a similar  mechanism for all grades in the public service.
Mr. Howlin: It is not a matter of being worth the candle. For example, should ambulance drivers or hospital porters be included? Where would we draw the line? There are special arrangements including a compensation tribunal for gardaí and prison officers who literally put their lives on the line when facing armed criminals. Regarding other grades of people who may suffer assault I would be anxious to see what mechanisms need to be put in place. I have given specific instructions that nobody involved in an assault case which occurred in recent months should be at the loss of wages, including premium pay by virtue, of an assault and medical expenses are to be covered by their employer and the health board. I want to create the most generous environment possible for health care workers and I have had detailed discussions with representative authorities and bodies to ensure necessary measures are taken.
Mr. Durkan: Given the status and recognition our nursing profession has rightfully achieved during the years both nationally and internationally, will the Minister state how best recognition can be given by his Department to the pivotal role they play by way of better working conditions and a reduced patient-staff ratio to alleviate the main causes of high stress levels?
Mr. Howlin: All employees in the State sector are subject to negotiated national agreements. The current agreement, the Programme for Competitiveness and Work, is binding on all public servants and any improvement in salaries must be dealt with by way of the mechanism outlined. I am not at liberty arbitrarily to  break that agreement, solemnly balloted on and signed by the representatives of all the workers concerned and the other social partners to provide a framework for economic growth and produce resources for substantial improvements in the health service.
Mr. Connor: The Minister will be aware that it is considered desirable for young people, who wish to enter the nursing profession to have some experience of hospital work prior to attending interview or during the period between interview and commencing training. Will he agree it is unsatisfactory that very few places are available and what action does he propose to take?
Mr. Howlin: ——by the question. It is a straightforward one about whether I agree there should be work experience for young people and that is hardly a source of embarrassment. It is a peculiar comment for the Deputy to make.
Mr. Howlin: There is merit in examining this area. In my clinics I receive many representations from young people who wish to pursue a nursing career. A considerable number of young men wish to follow that career. Many young people take private courses to prepare for formal nurse training. I would be well disposed to the notion of involving young people as nurse auxilaries in the normal hospital  routine if hospital management and insurance criteria permit. I will examine this matter.
Mr. J. Higgins: Will the Minister agree that it takes a nurse 40 years to receive her full pension entitlements, that this is not a career span but a life sentence, that many nurses who trained and worked in England get no recognition for their work and that this area must be addressed? Will he also accept that often nurses must do menial, domestic duties and that to deploy highly trained medical staff, in whom much money has been invested to achieve such competence, to do such work is wasteful and there should be a policy of employing more domestic staff and deploying the nursing staff in the medical area for which they are qualified?
Mr. Howlin: I will deal with the Deputy's final point first. I agree nurses are highly trained professionals and they should not be assigned work more appropriate to domestic staff. Most hospital managers are most anxious to employ domestic staff, where possible, to alleviate the burden on nursing staff. This is more cost effective as domestic staff are paid less. That principle is applied on the ground. The career structure of nursing is not unlike that of the teaching profession and the timespan for full pension entitlement is somewhat similar. I am anxious to improve that position and negotiations are underway with professional organisations in that regard. I have received many representations from nursing organisations in respect of career breaks and job-sharing and those matters have been actively pursued during the past 12 months.
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