Written Answers. - Nursing Staff.

Ivor Callely


117 Mr. Callely asked the Minister for Health and Children the level of professional qualified nurses that our services require; the level of current services; the qualification required to enter nursing; the qualification required to enter nursing in the United Kingdom; and if he will make a statement on the matter. [1661/99]

Pat Upton


124 Mr. Upton asked the Minister for Health and Children the number of vacant nursing posts in each health board area; his views on the underlying reasons for nurse shortages; and the proposals, if any, he has to deal with the matter. [1965/99]

John Browne


130 Mr. Browne (Wexford) asked the Minister for Health and Children his views on the scarcity of nursing staff available to hospitals; the discussions, if any, he has had to date with An Bord Altranais in order to encourage young people into nursing; and if he will make a statement on the matter. [26337/98]

Trevor Sargent


575 Mr. Sargent asked the Minister for Health and Children the staffing levels of nurses at public hospitals; and if he will make a statement on the matter. [1665/99]

I propose to take Questions Nos. 117, 124, 130 and 575 together.

The number of nurses employed in the public health service has increased steadily in recent years. Between 1990 and 31 December 1997, the whole-time equivalent number of nursing staff employed in the public health service increased from 24,732 to 27,426 – an increase of 2,694 or 11 per cent.

In addition, there has been a major expansion in the number of practice nurses attached to GP surgeries around the country. There are currently some 455 such nurses working in this area.

A factor which must be taken into account is the increasing trend among health service employers to facilitate nurses and midwives who, for personal reasons, do not wish to commit themselves to full-time work. There are currently some 4,000 nurses working in formal job-sharing arrangements, in addition to the significant number who work part-time.

While the recruitment of nurses is primarily a matter for individual employers, the overall issue of the availability of nurses is being kept under review by the Health Service Employers' Agency (HSEA). In response to current difficulties, the HSEA established a task force to examine the full nature of the difficulties in recruiting nursing staff and to make recommendations on appropriate action.

A HSEA survey of Dublin hospitals showed 448 vacant nursing posts on 15 January 1999. However, a survey of the same hospitals carried out one week later by my Department revealed a significant reduction in the number of vacant posts – down to 384 on 22 January 1999. This downward trend is consistent with the increase in the number of nurses applying to An Bord Altranais for registration.

The returns from the Dublin hospitals indicate that there is a particular difficulty in recruiting nurses for specialist areas such as theatre, intensive care, coronary care, accident and emergency and paediatrics.

Health board and voluntary hospitals outside of the Dublin area reported only a single nursing vacancy on the 22 January 1999; however, this is being clarified with them. They have indicated that while they have no difficulty in filling permanent nursing posts, occasional problems arise in recruiting temporary or locum staff to cover sick leave, annual leave and maternity leave.

It is evident from the returns furnished to my Department that the nursing shortage in the hospital sector is mainly concentrated in the Dublin area. This reinforces the indications given to the HSEA by hospital management that nurses are leaving Dublin and taking up positions in rural areas. The cost of housing, traffic gridlock, and the lack of car parking are seen as disincentives to taking up positions in Dublin.
The strength of the economy is also having an impact on the availability of nurses. Nurses have enhanced mobility by virtue of their education, training and skills. In the current economic boom, they are much sought after by pharmaceutical and related companies in the private health sector, as well as by commercial concerns in other sectors.
Ireland is not in a unique position in relation to the shortage of nurses. The reality is that the United States, the United Kingdom and most other European countries are also experiencing a shortage of nursing personnel. Pay rates for staff nurses are higher here than in the UK and a number of other European countries, including Germany and the Netherlands.
It is worth noting that An Bord Altranais reports an increase in the number of nurses applying for registration which would suggest that nurses are returning from abroad. In 1998, the board received 1,400 applications for registration from nurses abroad, compared with 939 in 1996. Conversely, the number of Irish nurses going abroad dropped from 1,079 in 1996 to 850 in 1998.
Arising from the work of the task group, the HSEA outlined to the nursing unions in November 1998 a number of initiatives to address the shortage, including the standardisation of overtime rates and full incremental credit on permanent appointment for relevant previous nursing experience both at home and abroad.
In addition, the HSEA has agreed to the introduction of more flexible working arrangements for nursing staff. The HSEA expects to be in a position to announce details of this scheme shortly. At present, the only options are full-time work or job-sharing. The absence of more flexible attendance patterns has been identified as a major obstacle to attracting nurses and midwives with family responsibilities back to work. The revised scheme about to be announced by the HSEA is designed to overcome this obstacle.
I might also mention that my Department has engaged a nurse researcher to specifically study nursing and midwifery needs for the coming years, and to carry out research on the reasons nurses are leaving nursing and where they are going. A steering group has been established to oversee this study of the nursing and midwifery resource.
In 1998, the transition from the traditional apprenticeship model of nursing training to the revised diploma based model was completed in all three pre-registration nursing disciplines. Successful completion of the three-year nursing registration diploma programme leads to registration as a nurse with An Bord Altranais and the award of a diploma in nursing studies from the linked third level institution.
Following discussions with my Department, An Bord Altranais has assumed responsibility for the overall management of the nursing applications centre and has renamed it the nursing careers centre in order to give it a broader focus in relation to nursing as a career generally. This transfer of responsibility is in accordance with the strengthened role for An Bord Altranais in the area of pre-registration nursing education recommended by the Commission on Nursing.
This year there will be a total of 1,142 training places available on the nursing diploma programmes – 781 in general nursing, 201 in psychiatric nursing and 160 in mental handicap nursing. Additional funding of £7.5 million has been provided by the Government this year, bringing to some £32 million the amount that will be spent on the programmes in 1999.
Nursing students on the diploma programmes receive an annual maintenance grant as well as other financial supports. The value of this grant was £2,500 when it was first introduced in 1994. It remained at this level until 1998, when I increased it by 20 per cent to its present level of £3,000. On 20 January, I announced a further increase to £3,250 with effect from 1 April next. This maintenance grant, which is not subject to a means test, will therefore have been increased by 30 per cent within the lifetime of the present Government.
I have also provided funding of £350,000 to An Bord Altranais and to various schools of nursing for a promotional campaign, at both local and national level, aimed at attracting more young people to nursing.
As part of the preparations for this year's competitions, An Bord Altranais, with my approval, amended its own rules to revise the minimum educational requirements for entry to nursing training. The effect of this rule change is to expand the range of leaving certificate subjects that may be presented by an applicant for admission to the nursing diploma programmes. This rule change introduces greater flexibility in the entry criteria for nursing training, without reducing standards. In the context of attracting more entrants to nursing, a positive consequence of the recent rule change will be to increase the pool of school leavers and others who will be eligible for places on the nursing diploma programmes.
Broadly speaking, an applicant for admission to the nursing diploma programmes must (a) have obtained in the leaving certificate examination a minimum grade of C3 in two higher level papers and a minimum grade of D3 in four ordinary or higher level papers in the following subjects: English or Irish; mathematics; a laboratory science subject and three other subjects, and (b) meet the minimum educational requirements specified by the third level institution concerned for entry to the programmes.
I understand that it is possible to secure a nurse training place in the United Kingdom with a pass leaving certificate.
I hope Deputies will agree from what I have outlined that a considerable amount of preparatory work has been undertaken on a number of fronts in advance of the announcement of this year's competitions for places in the nursing diploma programmes. I share the hope of everybody associated with the nursing careers centre that these efforts will result in a successful outcome to the competitions and a full uptake of all the available training places.