Tuesday, 27 June 2000
Dáil Eireann Debate
235. Mr. Crawford asked the Minister for Health and Children the number of qualified nurses that are required to fill present vacancies within the health services which are causing ward closures and further extensions to waiting lists; the reason so many nurses are on temporary employment; if there are enough people being trained for nursing here to supply the need; and if he will make a statement on the matter. [18185/00]
Minister for Health and Children (Mr. Martin): It is not possible to be definitive as to the total  nursing complement required to provide adequate staffing for hospitals. The Commission on Nursing recommended that the Department of Health and Children, health service providers and nursing organisations examine the development of appropriate systems to determine nursing staffing levels. The need to address skill mix issues was also highlighted in the Commission on Nursing report. Both of these recommendations are included in the priority action plan agreed with the Nursing Alliance as part of the settlement of the nurses' strike. It has been agreed that these issues will be addressed by a working group representative of nursing unions and health service employers. This working group held its first meeting on 15 May 2000.
The results of the most recent survey of nursing vacancies carried out by the Health Service Employers Agency, HSEA, confirmed again that there is not a nation-wide problem regarding the availability of nurses and that difficulties largely relate to the greater Dublin area.
It should also be noted that nurse recruitment is carried out on an ongoing basis in most hospitals, and the level of vacancies fluctuate accordingly. At any given time, significant numbers of nurses would be in the process of being appointed by employers or moving from one employment to another.
There were 3,236 temporary whole time equivalent nursing posts at 31 December 1998 according to the Department's health service personnel census. This figure represented 12.1% of the total number. While the 1999 census is not yet to hand, I can inform the Deputy that a significant number of temporary posts were converted to permanent positions during 1999 under phase two of the conversion process outlined in the 1997 nurses' pay agreement. Under this process temporary nurses who had one year's continuous wholetime service with their employer at 1 June 1998 or who had worked a minimum of 4,000 hours in the six years prior to 1 June 1998 and were available for work on a full-time or part-time basis were eligible to compete.
Where the number of eligible applicants exceeded the number of vacancies-posts which could be filled-converted, applicants were issued with letters of comfort and offered permanent appointments as vacancies-opportunities arise. Health services management and unions are in agreement that the volume of temporary employment should be reduced to a minimum consistent with operational requirements.
While the recruitment and retention of nurses is primarily a matter for individual employers, initiatives have been taken or are being progressed with a view to stabilising the situation and, where possible, improving it.
These initiatives include the following. New arrangements have been introduced to give better starting pay to nurses taking up employment by giving full recognition for previous experience at home and abroad. A significantly improved regime of allowances in respect of nurses working  in specialised areas such as operating theatres and intensive care units has been introduced. Standardised overtime working arrangements have been introduced following agreement with the nursing unions. Some 11 hospitals around the country provided back to nursing courses in 1999 for nurses wishing to return to the workforce. A total of 304 places were available. The expansion of these courses is aimed at maximising the available nursing workforce. During 1999-00, 16 new post-registration programmes have been developed. This year there will be 660 places on post-registration courses in specialised areas of clinical practice. In response to an identified need, 11 of the 16 new programmes will be located outside the Dublin area. An anti-bullying policy document, prepared by the HSEA and agreed with the nursing unions, was published in December 1999 and has been widely promoted within the service.
The promotional structure within nursing, including the introduction of a clinical career pathway, is being significantly improved on foot of the recommendations of the Commission on Nursing. Up to 1,250 clinical nurse-midwife specialist positions are being introduced for nurses who have recognised expertise in particular areas. These posts attract clinical nurse manager two salary. Nurses are also benefiting from an agreement to upgrade 1,100 staff nurse posts to clinical nurse manager one grade which is being implemented. A study of the nursing and midwifery resource by the nursing policy division of the Department of Health and Children commenced in 1998 with the primary purpose of forecasting future nursing and midwifery resource needs. As part of this project, a national study on turnover in nursing and midwifery has been commissioned by the Department through the Health Research Board and awarded to the Department of Nursing Studies, University College Cork. Agreement has been reached between the relevant Departments on a procedure for fast-tracking immigration clearances and work permits for non-EU nurses. Data maintained by An Bord Altranais indicate that in recent years there has been a net inflow of nurses to Ireland. Inflow figures for 1999 show a dramatic increase to 3,181 in the number of nurses seeking to register here.
Swift progress is being made on the implementation of the agenda for change mapped out by the Commission on Nursing. A priority action plan was agreed with the Nursing Alliance as part of the settlement of the nurses' strike. Additional funding of £10 million has been provided this year for initiatives in the action plan.
From 1 January 2001, nurses working in the public health service who want to undertake nursing and certain other undergraduate degree courses on a part-time basis will have their fees  paid in full by their employing agencies. Fees will be paid in return for a commitment on the part of the nurses to continue to work in the public health service for a period of up to two years after the completion of the degree course. This fees initiative will continue until at least the year 2005 and will act as an incentive to newly-qualified nurses to enter the workforce immediately following registration and to remain in the workforce.
The number of nursing training places is being increased to 300 over last year. This year there are a total of 1,500 training places available – 1,000 general nursing, 300 psychiatric nursing and 200 mental handicap nursing. Further funding totalling £400,000 was made available to the various schools of nursing throughout the country late last year to enable them undertake local marketing campaigns aimed at promoting nursing as a career.
This year there were more than three applicants for every available training place. This is most encouraging bearing in mind that the total number of training places is being increased by 25% over last year and the reduction in the volume of applicants for public service positions generally. The annual maintenance grant for nursing students, which is not subject to a means test, has been increased to £3,325 with effect from 1 April 2000. The grant now is almost double the maximum grant for which other third level students may qualify. In addition, allowances for external clinical placements, books and uniforms have also been increased.
These initiatives represent a very significant effort on the part of my Department to improve the situation. In the longer term, it is hoped that the substantial increase in the number of student places will provide enough registered nurses to fill all vacancies.
236. Dr. Upton asked the Minister for Health and Children if his attention has been drawn to the fact that many women who work as nurses have suffered from long-term back or hip injuries because of heavy lifting and other physical work; the compensation open to these nurses and former nurses; and if he will make a statement on the matter. [18186/00]
Minister for Health and Children (Mr. Martin): The Health and Safety Authority has overall responsibility for advising on and enforcing health and safety legislation and regulations. Health agencies, as with all other employers, have the responsibility for ensuring workplace health and safety. Health agencies need to be aware of the importance of their responsibilities under health and safety legislation. The Health and Safety Authority promote their common objectives in the area of workplace health and safety. The Health and Safety Authority will work with health agencies to identify and prioritise the principal factors affecting safety and health in the health sector and encourage and support the  development of good practices. The question of health and safety provisions is essentially one for the individual agencies to deal with on a day to day basis within their annual determination, service planning process and legal requirements under the health and safety Acts.
The Health and Safety Authority has constantly highlighted – for example, annual reports, advisory committee on the health services sector – the risks involved in heavy lifting. They have been working with the health services employers to identify the hazards, and minimise the risks involved in patient handling. For example, they have produced a guide intended to assist those involved with, and responsible for, patient handling in the health care sector, Caring with Minimal Lifting. In addition, employers carry out a programme of training in this area.
As part of the annual allocation of funding to health agencies I have made resources available to supplement health and safety initiatives which are being undertaken at local level by health boards, hospitals and mental handicap homes. A proportion of this health and safety funding is used to provide training and equipment in the area of safe manual handling. While there is no specific compensation scheme for health care workers in the case outlined by the Deputy, as you can see from the above every effort is made by health service employers to minimise the development of injuries through training, the provision of appropriate equipment and the availability of an occupational health service.
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