I move amendment No. 1:
To delete all words after "That" and substitute the following:
"Dáil Éireann acknowledges and endorses the measures being taken by the Minister for Health and Children to ease the financial and other burdens on student nurses participating in the nursing registration/diploma programmes."
I have no difficulty coming to the House to put the record of the Government before it so that the House can judge whether it has been reasonable in its approach to nursing students compared to its predecessor. The House can also judge what the previous Government's record was in this regard and make comparisons if it so wishes.
My record is as follows. I have increased the grants for students of nursing at third level colleges by 20 per cent; I have provided special payments to students who are doing clinical placements and who must find new accommodation during those periods; where students do not have to move to new accommodation but must take up their clinical placements from their normal base, I have provided transport passes to ensure that students do not suffer financially; my Department has also moved to ensure that students do not have to pay for additional books during their course of studies in excess of the book allowances which my Department provides and that no unnecessary uniforms need to be purchased outside of the uniform allowance which is made available by the Department.
This contrasts with the record of the previous Minister. No increase whatsoever was given during the years 1995 and 1996 and that position continued right up to June 1997 when the previous Government left office. When the previous Minister left office not £1 extra had been given to the students during his term of office. The student grant had remained at £2,500 during this period, having been introduced in 1994, and was not increased until this year when I reviewed it with my officials. There was not even an allowance for a cost of living increase.
In providing additional funding for the student grant I was greatly influenced by the fact that as currently arranged the academic year for students of nursing is more lengthy and the academic week for the students is more crowded than that of other third level students. I am keen to relieve the pressure on the students, especially during their first year, when the academic part of their course is very significant.
I am also anxious that students should not have to sit two sets of examinations. I recently addressed An Bord Altranais and I asked it as a matter of urgency to examine the situation whereby students must sit both sets of examination. I expect An Bord Altranais to report to my Department with a set of proposals to ease significantly the pressures upon students which arise by virtue of two sets of examinations, one of which is set by the third level college and the other by An Bord Altranais. I have no doubt but that An Bord Altranais will report back to me with a positive revised set of arrangements.
Every Government that comes into office would like to give grants to students at third level institutions which would allow them to have more financial security during their period of study. However, that is an ideal situation and we in Government, who are entrusted with the financial affairs of the country, must balance our obligations to third level students while ensuring that our obligations to the taxpayer do not result in the country spending more than it can afford on any group of people with the consequences that would follow for the economy. The House realises that a balanced budget and continuing steady progress in improving our economy is the route to take and, in balancing the needs of students, workers and services, we can only give a certain amount to any one group.
I am here to defend my record of having made a very significant increase in the grant to third level students of nursing. I also moved to ease their financial burdens in areas where it has been brought to my attention that students had in the past suffered financial difficulties. I am proud of the increase in the grant of 20 per cent, which the House will agree is very significant. Deputy Hayes may claim that this is a matter of great embarrassment to him but I do not recall seeing him particularly red-faced that the previous Minister, his party colleague, gave not an extra shilling to student nurses. I am surprised that his embarrassment only arose from the time of the change in Government. We can do without such nonsense in the debate.
The increase I gave is £500 per student. My main message to the House and the Opposition is that I have increased the grant by this high percentage. I emphasise that it is a grant to third level students — it is not a wage nor a salary. It is not and was never intended to be a financial remuneration for work done in hospitals.
What we are seeing is the transition from the old model to the new one. Under the old apprenticeship model student nurses worked in hospitals and were included on the payroll. They helped out from an early stage and were regarded as part of the staff. What we have now are third level students studying nursing who are not nurses and who will not be nurses for a considerable period. Their studies take place not only within the school of nursing in the hospital but also in third level institutions across the country.
When these students do their clinical placement they are not expected to work as part of the general staffing of a ward. Their placements are in addition to the normal staffing. These placements are designed specifically to ensure the students get not only the academic and theoretical part of the course but are also given the opportunity to have hands on learning in the wards with patients to ensure that what we have always regarded as being best in Irish nursing, that is, the nurse/patient relationship, does not suffer and is not diluted in the move to third level status for students of nursing.
I will set the record straight with regard to the level of funding provided for students participating in the pre-registration nursing programmes of education and training, known as the nursing registration/diploma programmes. Prior to 1994 all student nurses undertook the traditional apprenticeship model of training. Deputies opposite made comparisons with other apprentices. We are trying to move away from the apprentice idea. These students were part of the workforce and received an annual salary. For the duration of their three-year programme they had the status of employees. However, in October 1994 the first of the new diploma based programmes of education and training was introduced by University College Hospital, Galway, in association with the National University of Ireland, Galway. Since then the programme has been extended to other sites. The transition from the apprenticeship model to the revised model will be completed this year in all three pre-registration nursing disciplines, namely, general nursing, mental handicap nursing and psychiatric nursing.
The diploma based programmes are operated by schools of nursing in association with third level institutions. Student nurses who complete successfully the three-year programme are awarded a diploma in nursing from the associated third level institute and are eligible to be registered as nurses with An Bord Altranais, the statutory regulatory body for the nursing profession. It is important to understand that the objective of the changeover to the revised model is to enhance nurse education and training and to ensure the quality of nursing care in hospitals through the replacement of student nurses by qualified staff. This approach is in line with key recommendations contained in the report The Future of Nurse Education and Training in Ireland published by An Bord Altranais in 1994. The apprenticeship model was evaluated by the board and a number of weaknesses were identified which militated against a beneficial experience for the student nurse. These included a lack of preparedness for certain duties, insufficient clinical teaching, an emphasis on work rather than learning and an involvement in non-nursing duties.
The main features of the registration/ diploma programme are the following. Students participating in the programme have the status of third level students for the duration of the programme. Students are supernumerary to service requirements and, therefore, they are not paid a salary. Students register with the associated third level institute as well as on the candidate register of An Bord Altranais and have access to the facilities of the third level institution. Students are examined and assessed by the associated third level institute in addition to undergoing the examination and assessment procedures prescribed in the rules of An Bord Altranais.
Students receive an annual maintenance grant of £3,000 which is not subject to a means test. Their third level fees are paid by the Department of Health and Children through the relevant health board, hospital or agency. Principal textbooks up to a value of £200 are supplied free of charge to students by the participating schools of nursing at the commencement of the programme. They are also supplied with free uniforms purchased for them by the relevant health agency. They are entitled to free meals on a seven day per week basis in designated restaurants in health institutions. All health agencies involved in the operation of the programme have been compensated for the loss of the service contribution made by student nurses under the apprenticeship model through their replacement by a skill-grade mix of registered nurses and other grades. It needs to be borne in mind that students on the diploma programme are students, not employees, and the level of financial support they receive must be considered in that context.
When the first programme was introduced in 1994, the rate of the maintenance grant payable to students was £2,500 per annum. As I stated earlier, the grant did not even attract the cost of inflation increases given to other third level maintenance grants when the rainbow coalition was in office during 1995, 1996 and 1997. Deputy Shatter's party was in Government and there was a Fine Gael Minister for Health. I have been accused of discrimination. Fine Gael could not even pay them the cost of living increase given to every other third level student. They were left with £2,500 per year.
It is against this abysmal record of apathy towards the burdens being experienced by students on the nursing diploma programmes that my record since I took up office must be judged. At the first opportunity I secured a £500 increase in the student grant. This represents an increase of 20 per cent and puts the level of the grant well ahead of what it would have been if Deputy Shatter's party had seen fit to increase it in line with inflation when in Government or if the other parties had asked his party to do so.
Not only did I approve a £500 increase in the annual maintenance grant from 1 March 1998, I also introduced a new external clinical placement allowance of £20 per week. I did this specifically to assist students who are required to undertake clinical placements away from their normal base to gain specialised clinical experience. This allowance is paid where it is necessary for the students to find accommodation away from their normal places of residence for the duration of the placements. I also approved the provision of a free weekly travel pass to students undertaking external clinical placements who do not require accommodation.
The substantial increase in the annual maintenance allowance and the introduction of the new external clinical placement allowance reflects my commitment to address the financial difficulties that students on the programmes were experiencing. What did the previous Administration do for them? It was a big duck egg for three years. If Deputies opposite wish to criticise me for what I am doing, I will simply say they were in office for three years and did nothing about it.
I want to be clear about these difficulties. They did not suddenly emerge this year; they have been there since the first diploma based programme was introduced in 1994 but, because of the inaction of the previous Administration, it was left to me to tackle them. I remind the House that the extra costs of the improved package of financial supports that I have put in place for the students is in the region of £1 million in the current year alone. I also emphasise that students participating in the nursing diploma programmes receive a higher level of financial support than other third level students. As I already indicated, each student nurse now receives an annual maintenance grant of £3,000, which is not subject to a means test. In contrast, other third level students are required to satisfy a means test to qualify for a maintenance grant, the maximum rate of which is considerably less than that paid to students of nursing.
Since the abolition of third level fees does not extend to the nursing diploma programme, the students' fees continue to be paid by the relevant health agency on their behalf. The average annual fee per student is about £1,300. As I already mentioned, a book allowance and a uniform allowance is also provided for each student commencing the programme. They are also entitled to receive free meals on a seven day per week basis in designated restaurants in health institutions. Taken together, the average annual value of the various supports, including the new external clinical placement allowance, is £6,000 per student nurse. By any yardstick, this compares most favourably with the level of funding available to other third level students and more favourably with what was available up until June 1997.
I am aware criticisms have been expressed about certain aspects of the diploma based programme, particularly in relation to the front loading of the curriculum and the fact that it requires a 48 week commitment on the part of the students during the three years of the programme. I accept some of these criticisms are justified. Indeed, as recently as last week, when addressing the first public meeting of An Bord Altranais, I urged the board to examine possible ways in which the burden on students might be eased, including a rule change to address the alignment of the board's examinations with those of the third level institutes involved in the delivery of the programme. The board is anxious to be helpful and I am confident of a positive response to my request.
I also refer to the fact that the interim report of the Commission on Nursing identified a number of issues relating to the nursing diploma programmes. The commission's final report, which is due within a few months, is expected to contain recommendations to address those issues. In addition, the nursing registration-diploma programme is currently the subject of an independent, external evaluation being undertaken by the University of Southampton, under the management of the Institute of Public Administration. This evaluation includes both the general and psychiatric nursing programmes and is due to be completed by the end of July.
I assure the House that it is my firm intention, following the outcome of the deliberations of the Commission on Nursing and the evaluation team, to take steps to improve the programme and iron out the difficulties that have emerged in its operation, not least for the students themselves. This will be done in close consultation with the relevant interest groups. Teething problems aside, we should not lose sight of the monumental achievement that the diploma programme represents in terms of enhancing the pre-registration education and training of nurses, and in linking it to third level. It is almost difficult to believe that the complete transition to the revised model in all schools of nursing has been achieved in the space of little more than four years. I pay tribute to all those involved in the health and educational sectors for their tremendous efforts in developing and extending the programme.
Misinformation emerged in earlier contributions, which I am sure were made in good faith. Deputy Naughten suggested there were only 800 places this year compared to 1100 last year. A total of 1,155 training places are available this year — 781 for general nursing, 201 for psychiatric nursing and 173 for mental handicap nursing. Last year, the figures were 734 for general nursing, 121 for psychiatric nursing and 40 for mental handicap nursing. That was a total of 895 places and they were not successfully filled.
Deputy Shatter's motion includes a call for full payment to meet the expenditure incurred in the new fourth year degree programme. I presume he is referring to the one year full time Bachelor of Science Degree in Nursing Studies course being provided by the National University of Ireland, Galway, for students who completed the first general nursing registration-diploma programme which commenced in 1994. Successful completion of the three-year registration-diploma programme by a student nurse leads to the award of a diploma in nursing from the associated third level institution and registration as a nurse with An Bord Altranais. Upon registration the student becomes eligible for employment as a nurse.
Since a degree in nursing studies is not a requirement for registration with An Bord Altranais and subsequent employment as a nurse, such a qualification must be regarded as an optional post-registration qualification. Registered nurses wishing to undertake a course of study leading to the award of a degree in nursing studies are, accordingly, responsible for making their own arrangements for admission to, attendance at and the costs associated with such courses.
My Department has never given an undertaking to students commencing the registration-diploma programme or to the associated third level institutions that it would provide funding for degree courses. This is reflected in the fact that the agreement into which each student commencing the programme enters with the relevant health agency specifically relates to a programme of pre-registration nursing education and training of three years' duration and one which complies with the rules of An Bord Altranais and the relevant EU directives.
The rationale behind the development by the associated third level institutions of programmes leading to the award of a Bachelor of Nursing Studies Degree is to provide those members of the nursing profession who wish to obtain a post-registration qualification at degree level with an opportunity of doing so. A primary objective is to ensure that existing registered nurses are afforded equal opportunity of access to such programmes, either immediately or on the basis of a short access course.
In moving to the new model it is important not to create a two tier system. Existing registered nurses should, on the basis of equity, be equally entitled to access to the degree course as people fortunate enough to start their nursing career under the new model. I reiterate it was never the intention that the possession of a diploma in nursing would be a requirement for admission to such programmes. Such an approach would be totally unacceptable since it would lead to a two tier nursing structure. I regard it as a fundamental principle of equity that nurses who have qualified, or who will qualify through the traditional system of education and training, should not be in any way disadvantaged in obtaining posts, securing promotion or gaining access to higher education programmes as against anyone coming in under the new system. I remind Deputy Shatter that his party colleague and my immediate predecessor as Minister, Deputy Noonan, also supported this principle.
Dublin City University and Trinity College have developed part-time degree programmes. As far as I am aware, the National University of Ireland, Galway, is the only third level institution offering a full-time course specifically for diploma holders. It would be wholly inequitable to provide funding for nurses undertaking a degree course in one third level institution but not to those pursuing a course of study leading to what is essentially the same qualification in other universities. In any event, the current system of pre-registration nursing education and training is currently predicated on a diploma based programme of three years' duration. Any other arrangement is outside the funding arrangements agreed with the Department of Finance.
I have outlined the position of students and the history of the changeover from the old apprenticeship model to the new third level arrangement. I have given the House an indication of what I have done since coming into office a little over a year ago, which is in marked contrast to the inaction of the previous three years. I have made a significant contribution to the funding arrangements for the students, which is reflected in the substantial increase in their annual maintenance grant. I have also moved to ease their financial situation during the period of their clinical placements, through the introduction of a new external clinical placement allowance. Quality clinical experience has always been regarded as an important element of the course, especially in ensuring that the nurses who come through this new programme will be as highly regarded, not just within this country but internationally, as Irish nurses have traditionally been regarded for many years. I have put my record in office before the House and have no doubt it will be judged as being as reasonable as it can possibly be, within the financial constraints that all of us must work. I have also outlined the history of the change from the old model to the new one.
Within the next number of weeks one of the most important reports on nurses ever to be produced in Ireland will arrive on my desk. I am conscious the Commission on Nursing report will be of such significance that it will change significantly the profession as we enter the next millennium. I have already indicated to the trade unions involved and to the nurse managers at their conferences that the report of the Commission on Nursing will form the most significant part of the policy in regard to the development of the profession for the future. I am also conscious that the Commission on Nursing will make major recommendations and will have a considerable amount to say as to the professional training and development which should be provided for nurses as we move into the next century. I will examine these recommendations in the near future because I expect the Commission to report as planned within the next few weeks, certainly before the autumn. I do not intend to make any other changes in the arrangements until I see this report and know the Commission's views. I think that a reasonable and prudent position to take.
These are exciting times for nurses and students. It is important, therefore, that we build on the present considerable financial arrangements for students and continue to reframe the arrangements for professional education and training over the coming years. It would not serve nursing well if, instead of continuing to have students of nursing regarded as third level students and to seek ways of easing the burden in terms of hours and weeks worked, we almost revert to the old apprenticeship model where students were regarded as student nurses doing some nursing work and paid accordingly. It will not serve nursing in the future if efforts are made to revert to a situation where students are regarded as earning wages and being on the payroll during their period of training when they should be regarded as students off the payroll. I hope the conditions of their education and training will become more akin to other third level students. On any objective criteria, there has been a marked improvement in their present position.
We await the outcome of the Commission on Nursing and commit ourselves to deal with their recommendations within the constraints in which we must work. An Bord Altranais should come forward with further modifications to deal with the problem of two sets of examinations and the front-loading in the first year. In my opinion, this is a genuine response which shows the Government's ability to deal with issues which were totally neglected under the last Administration. It is fine for the Opposition to speak a year after being in Government, but for three years not one extra pound was given to student nurses for this purpose, over which so many crocodile tears are being shed.