Vol. 505 No. 5
7 Proinsias De Rossa asked the Minister for Health and Children the plans, if any, he has to deal with the serious shortage of nurses in the Dublin area; the specific proposals, if any, he is considering; the progress in terms of negotiations with the nursing organisations; and if he will make a statement on the matter. [13968/99]
42 Mr. O'Shea asked the Minister for Health and Children if he will make a statement on the state of negotiations on the nurses' pay claim. [13979/99]
I propose to take Questions Nos. 7 and 42 together.
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. The HSEA established a task group in 1998 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 staff nurse posts on 15 January this year. However, a survey of the same hospitals carried out a week later by the Department revealed a significant reduction in the number of vacant posts, down to 384 on 22 January 1999. A further survey carried out during the week ending 5 February provided an almost identical result. This downward trend is consistent with the increase in the number of nurses applying to An Bord Altranais for registration. The returns indicate there is a difficulty in recruiting nurses for specialist areas such as theatre, intensive care, coronary care, accident and emergency and paediatrics. Health board and voluntary hospitals out side the Dublin area have indicated they have no difficulty filling permanent nursing posts, but occasional problems arise in recruiting temporary or locum staff to cover sick leave, annual leave and maternity leave.
A further survey of nursing vacancies in the Dublin area is being undertaken by the HSEA. The results of this survey will be available shortly and will be submitted to the Joint Committee on Health and Children which is considering nursing shortages. Representatives of my Department and the HSEA have been invited to appear before the committee on 17 June next.
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 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 regarding the shortage of nurses. 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. An Bord Altranais reported an increase in the number of nurses applying for registration which suggests 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 is committed to the introduction of more flexible working arrangements for nursing staff. At present, the only options for permanent employment 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 HSEA recently circulated a discussion document on a revised scheme of working arrangements to the nursing unions. A meeting between the HSEA and the nursing unions to discuss the proposals in the document is expected to take place shortly. This initiative is being undertaken under the programme for partnership.
My Department has engaged a nurse researcher to specifically study nursing needs for coming years and to carry out research on the reasons nurses are leaving their profession. When this research has been completed, my Department will be in a better position to further address the issue of nursing shortages.
As regards negotiations with the nursing organisations, the Deputy will be aware the Labour Court recently recommended significant improvements in existing allowances for nurses working in specialised areas and who hold special qualifications. The court also accepted that there are grounds for improvements in the pay of ward sisters and higher grades to reflect the new roles proposed for those grades in the report of the Commission on Nursing. It recommended that the parties enter into immediate discussions on implementation of that report, with those discussions to be completed by 1 May 1999 at which stage the parties were to report back to the court.
I announced on 10 February that the Government was prepared to accept those Labour Court recommendations. Discussions between the HSEA and the nursing unions began on 16 February and an intensive programme of talks was agreed. Difficulties arose when the direct discussions got under way on 25 February 1999 and the Labour Court decided to appoint a chairman to preside over the negotiations. Intensive discussions between the parties concluded at the end of March. While progress was made on the new roles envisaged for ward sisters and higher grades, there was no agreement on the pay issues. The chairman of the talks reported back to the Labour Court which met the parties again on 29 and 30 April. Given the complexity of the issues that have been referred back to it, the Labour Court arranged to meet the parties separately. The court met the health service employers on Thursday, 20 May and the nursing unions on Tuesday last. I understand the Labour Court may arrange a further meeting with the health service employers.
Does the Minister accept there is a critical situation in the Dublin area and that the figure he has given the House of 384 vacancies indicate a serious problem? Does he also accept the nurses' organisations would say that figure is higher and that there are specific problems with Dublin which have not been mentioned? Everyone knows there are shortages in Europe, but there is a greater problem in Dublin which the Minister did not address in his reply. What does he intend to do about the Dublin region where the difficulties mean nurses are unable to work there, even when they want to, because of the cost of living and the difficulty in obtaining accommodation? What is the Minister doing now rather than waiting for reports to ensure attention is given to this problem, be it a city allowance or whatever?
I indicated in my reply what is happening now. Specific proposals from the HSEA have been put to the nursing unions to try to encourage more flexible arrangements agreed with the nursing unions for people who want to be employed in the health service as nurses. At present, they are either full-time or must work in a job sharing capacity.
Not for Dublin.
It is incorrect to suggest that would not be of assistance. The initiatives agreed in November 1998 to address the shortage, including the standardisation of overtime rates and full incremental credit on permanent appointment of people who were abroad and who have previous nursing experience either at home or abroad, have been of benefit. People have been encouraged to take up places because the conditions of employment have been improved. Other conditions of employment would be improved by the further initiatives devised by the HSEA.
The nursing shortage issue has been with us for some time. We took some initiatives to address it in 1998 and are taking more now to address it further. The Minister of State with responsibility for housing in a radio interview gave an excellent outline of the Government's role in trying to deal with other issues affecting nursing, such as housing.
Does the Minister agree there is a critical shortage of nurses, that one of the problems is that school leavers are no longer attracted to the nursing profession because of the almost unbearable working conditions in many hospitals and lack of opportunities for promotion and that the shortage is not confined to Dublin but is throughout the country? Is the Minister aware that nurses are not employed in many hospitals on a permanent basis, that health boards employ nurses for up to 20 years on a temporary basis and that this is contributing to the shortage of people in the profession? What will he do to encourage young people to take up nursing as a profession?
I agree with the Deputy that the non-pay issues she outlined are of equal, if not more, importance than other issues which arise. The Commission on Nursing, which set out to bring about structural improvements and reform of the nursing and midwifery sector, indicated that by the number of recommendations it made. However, its recommendations regarding pre-registration training, continuing education, the need to recognise specialisation and the agreement of Government to recognise that and improve pay rates for those who have specialisations are all issues upon which there is agreement and on which I would like to proceed. At present, sole attention is being paid to three pay recommendations which are before the Labour Court. As I outlined in my reply, there is no agreement regarding the pay issues. However, there are many other matters which have been agreed and on which much work has been done.
The Deputy's statement that there is a severe shortage of nurses outside Dublin is not upheld by the facts based on the surveys conducted by the Department and the HSEA. There is an acknowledgement that there is a problem in Dublin and the HSEA has devised specific initiatives about which discussions are now taking place with the nursing unions to try to address that in the short-term. There is also the commitment from me to increase the numbers of places in nursing training should that be required, especially in the psychiatric and mental handicap areas where we have provided marketing initiatives which have been successful to the point where there are now six people applying for every nursing post available in those areas.
