I move amendment No. 1:
To delete all words after "That" and substitute the following;
"Dáil Éireann endorses the efforts being made by the Minister for Health and Children to bring about a resolution of the nurses' strike by a process through which nursing issues can be addressed within the parameters of social partnership.".
This is a very complex and difficult dispute. In saying this, I am not only giving my own view of this dispute, but I am also giving the view of the trade union personnel who are also dealing with it from their side. If it were not a complex issue, we would have found a resolution to the difficulties long before now.
The first point I want to make abundantly clear is that there has been no change in the position of the Government. Our position has been con sistent throughout. It has never been a case of calling on the Nursing Alliance to simply take or leave the Labour Court findings. The Government want the Labour Court findings accepted and to move on to the other issues in the context of the Commission on Nursing report and social partnership.
On 23 September, the Taoiseach outlined a credible alternative to confrontation and a way forward that will in my view provide a better outcome for us all, including for nurses.
I omitted to say I wish to share my time with Deputy Roche.
That alternative is a renewal of our commitment at national level to social partnership and a series of practical steps to a new partnership agreement. That national position must be combined with an approach to public service pay which is imaginative in ensuring that the income of public servants should more closely reflect their performance and not be based on so-called traditional relativities. This is the context in which the aims and aspirations of public servants, including nurses, can best be met. It would also be the best context within which to set the progressive implementation of the report of the Commission on Nursing.
It was not until last Saturday that I heard, for the first time, an explicit acknowledgement from the Nursing Alliance that it recognised that the Government obviously has difficulties in dealing with this matter in the way that the alliance had been asking it to do up to then. In the course of being interviewed last Sunday on the RTE "This Week" programme, I made the following statement:
I am saying very clearly, and it has always been the Government's position, that if the Nursing Alliance unions recommit themselves to social partnership, acknowledge that we cannot pursue issues in isolation from the wider public sector pay implications, acknowledge that we cannot tear up existing agreements, if that is the position of the Nursing Alliance, then clearly there is a whole range of possibilities open to them to pursue their agenda.
I have been at pains all along to let everybody know that the problem in dealing with this issue is that existing social partnership agreements must be honoured, and that the primacy of the Labour Court as a means of settling disputes must be upheld. At 3 o'clock last Sunday, the Nursing Alliance issued the following statement:
The Nursing Alliance wishes to reiterate that it is cognisant of the Government's difficulties in further addressing the outstanding pay issues for nursing grades against the backdrop of existing social agreements.
The alliance also realises that any discussions will have to consider those difficulties while also providing a forum and process which will address, in a meaningful way, the outstanding pay related issues from the Commission on Nursing.
In the above context we state once again we are available for talks.
Later that evening I issued a statement noting this recognition by the Nursing Alliance, and indicating that if the alliance was genuine in its desire to identify a process by which these issues might be addressed within the parameters of pay partnership, then I would be available to meet the alliance the following day, which was yesterday.
I met the representatives of the Nursing Alliance at 3 o'clock yesterday afternoon in the Department of Health and Children in Hawkins House. The most important achievement coming from yesterday's meeting was the mutual recognition of the problems that exist on both sides. It was a good working meeting and I certainly found it helpful and constructive and it provided for a useful exchange of ideas. Both parties agreed to go back to the social partners and talk to their own sides in the partnership and seek help in trying to find a process that will allow for the resolution of this dispute on such a broad basis.
Having met them yesterday, I feel that the Nursing Alliance is also trying to find a way forward in this matter and they have told me that in finding the way forward the Nursing Alliance is anxious not to undermine the Labour Court findings. The Nursing Alliance is cognisant of the importance of ensuring that existing and current partnership arrangements are not jeopardised and this also concerns the possible knock-on effects, and it has no wish to create additional problems for the Government.
As a first stage, it is important that the alliance and the management side accept that both sets of problems must be of equal status. I have been at pains to find a way forward that is not prescriptive of the outcome at an early stage. I am trying to put in place a process that will lead to a successful outcome but will not of itself have any harmful pay effects or knock-ons.
I am anxious to explore the possibilities of doing business in this way and ensuring that the social partners, Government, employers and Congress, would be fully involved. I do not want the social partnership that we have built up to fall down around us during any forthcoming negotiations. Having met the Nursing Alliance yesterday, I am satisfied that it does not want that either.
Because of the number of people, or groups, lining up behind the current nurses' claim, it is important to ensure that arguments which may seem specific to nursing now are not later used by any of these groups to advance their particular case within the next number of weeks or months. I do not see this route as a lengthy process but it should be comprehensive so that both sides do not simply keep arguing over old scores.
I am most anxious to ensure that any new process or any new concepts which might be involved in progressing the situation do not interfere, or be seen to interfere, with the primacy of the Labour Court. I have always maintained and I still maintain, that the Labour Court should be the court of final appeal. While I am anxious to devise a new way of resolving the current problems, I do not see this process operating as if the Labour Court did not exist.
I also believe there must be trust in the social partnership model to ensure that both sides in this dispute would see social partnership as having the integrity necessary to facilitate a solution and to ensure that binding agreements are honoured. It should be our common agenda and it is certainly mine to ensure we get this new process agreed by the social partners and for my part I have indicated to Government that any such initiative should, as it were, have the imprimatur of the social partners. I believe we should have common ground where the representatives of the employers and of the unions would work together quickly to devise a process which would deal with these issues in a manner that is satisfactory to all the parties concerned.
In the acute hospital sector, the strike means no elective admissions or theatre lists; no out-patient clinics; and no day hospital services. In general, only emergency services are being maintained. Already the strike has impacted on many people through the cancellation of elective surgery, the closure of day services and the cancellation of out-patient clinics.
The Health Service Employers Agency has been in discussions with the unions regarding the provision of emergency and essential nursing cover during the strike. As I informed the House last week, some progress was made in arrangements for care. While the continued absence of a nationally agreed framework leaves an element of uncertainty regarding the provision of minimum care requirements at all locations for the duration of the strike, discussions at local level closed the gap considerably in the last few days before the strike. The Nursing Alliance has said it is not the intention to compromise patient care and I am prepared to accept that.
I would also like to put on record that the co-operation between the management and union sides, where they have agreed and provided emergency cover, is very much appreciated. Those plans were put in place to try to keep the inconvenience to the public to the absolute minimum. The reports available to me to date from around the country bear this out and indicate that thankfully there were no major difficulties on the ground today so far.
The position as conveyed to me from regional centres regarding acute hospital services is that problems to date have been resolved, with services operating in line with emergency plans agreed with local strike committees. In a number of areas, staffing levels have been increased following review by strike committees. Some unresolved issues are being pursued with the relevant strike committees and unions. This will require constant monitoring and continued co-operation for the duration of the strike.
In the Eastern Health Board area, accident and emergency departments are busy but at levels that are, in the main, in line with normal levels for the time of year. Services in all three hospitals in the Midland Health Board area are operating in accordance with emergency plans agreed with local strike committees. Accident and emergency services were operating relatively well in the Mid-Western Health Board area. Routine epidural services have been withdrawn and this matter is being pursued with the relevant unions. All hospitals were very busy in the North Western Health Board area but significant problems have not occurred. Staffing levels in the maternity units in Sligo and Letterkenny were increased by the strike committees following review.
Services in the South Eastern Health Board and North Eastern Health Board areas were operating in accordance with emergency plans agreed with local strike committees. Particular problems have not been reported. The numbers awaiting admission through accident and emergency departments in the Southern Health Board area are low and in-patient bed levels were reported to be adequate today.
Services in the Western Health Board area were generally operating in accordance with the locally agreed emergency plan. Some unresolved issues are being pursued with the relevant strike committee and unions. In addition, management is responding to the strike committee regarding patients scheduled for surgery for tomorrow and Thursday.
Regarding services to persons with an intellectual disability, from initial information it appears that planned respite services in nearly every agency affected by the strike have been cancelled. Day services, where nurses are employed, have also been badly affected. These services would tend to be the day services used by those with a more severe level of disability. Some residential services have also been closed, but overall these services are operating with disruptions and with minimal nursing care.
In relation to community health, planned essential services are generally being delivered, which includes nursing services to the terminally ill and the long-term sick patients in the community. Mental health residential services are operating with some disruptions while out-patient and day care services are generally not operating. Regarding services for older people, in general, day care and respite services are not operating. Residential services and public health nursing services are operating with disruptions.
It is clear that the report of the Commission on Nursing will feature in the process we are trying to put in place to resolve this dispute. The Government remains fully committed to the implementation of the recommendations in the commission's report. While all of the attention has been concentrated on the three pay related recommendations, the commission made some 200 other recommendations designed to tackle the underlying problems within the nursing profession and to develop nursing as a key profession within the health service. The changes proposed by the commission range from reforming the current statutory framework for the regulation of the nursing profession to the introduction of new clinical career pathways for nurses and midwives.
The commission has taken full account of the future realities within which nursing must be sustained and developed as a profession. The commission's report must be viewed as a significant one in terms of getting to grips with the more fundamental problems of nursing. The commission has provided a framework for improving the way nurses are managed, involving them more in decision making, providing them with new career pathways and empowering them generally in the service. It is important to remember that the nursing profession itself played a central role in informing the deliberations of the commission and in shaping its report, as seven of the 14 members of the commission were drawn from the various strands of the profession.
Despite the ongoing difficulties with the three pay related recommendations, real and substantial progress has been made over the past 13 months or so in implementing the central recommendations of the Commission on Nursing. I will avail of this opportunity to give an outline of the areas in which change has or is taking place, in response to the commission's proposals.
On nursing education and training, I have established a representative nursing education forum to prepare the ground for moving pre-registration nursing education from the present three year diploma based programme to a four year degree programme. This forum is proceeding with its work and is expected to report to me by late next year. The whole thrust of this initiative is to place the basic education of nurses on a par with that of other professionals in the health service, something which the nursing profession has been looking for and which the Commission on Nursing has endorsed.
In relation to nursing and midwifery planning and development units, I have provided funding of £100,000 to each of the eight health boards for the establishment of a regional nursing and midwifery planning and development unit. These units will be responsible for strategic planning and quality assurance of nursing and midwifery services in each health board area. They will also be involved in co-ordinating and improving co-operation between health boards and voluntary bodies in the delivery of nursing and midwifery services.
It is unfortunately the case that the introduction of these new units has been held up because of disagreement with the INO over the level of salary to be paid to the nurse director of each unit. The view of the INO is that the post holder should be paid the same salary as the director of nursing of a band one hospital. My Department does not consider that the responsibilities of the new position, which is effectively a Monday to Friday strategic planning job, can reasonably be compared with the onerous responsibilities of the top manager of the nursing resource of a major acute teaching hospital.
On strengthening nursing input at departmental level, since the commission's report was published, the nursing policy division of my Department has been strengthened by the appointment of five additional nurse advisers. This brings to nine the number of members of the nursing profession who are directly involved in contributing to the formulation of overall national policy on nursing. That demonstrates my firm commitment to ensuring that, within my Department, the profession has a real input into policy development.
Since I became Minister for Health and Children, a particular priority for me has been the greater involvement of nurses and other health care professionals in the management of our health services. Last November, I launched the clinicians in management initiative and provided £2.5 million to get it up and running. This initiative is all about the better running of hospitals and other health care institutions through the participation of clinicians in the decision making process. This involves devolution of responsibility, a process of empowerment for front line staff and an openness to change. For nurses, it means getting rid of the traditional hierarchies and giving them more power in decision making in their own wards and units.
Clinicians in management is an initiative that involves nurses of all grades. My Department and I stand ready to work with nurses in moving this initiative forward and providing nurses with empowerment across a range of hospital and community settings.
Ironic as it may seem in the situation in which we now find ourselves, my Department is involved in a joint partnership initiative with the INO in relation to a set of training programmes for nurse managers. These programmes were developed in consultation with the Office for Health Management, the agency with lead responsibility for facilitating management development in the health services. They were introduced to address issues raised in the interim report of the commission, which identified a need for a much greater investment in management training and development to prepare nurses and midwives for positions of authority and leadership within the health care system. Last year, I provided funding of £100,000 for these programmes and I have made available a similar amount this year.
The objectives of these management development programmes include developing the capacity of nurse managers to lead and manage change and to formulate and implement action plans for the improvement of their own skills and those of their staff. The feedback from nurses who have participated in the programmes is extremely positive and clearly indicates that the objectives are being achieved. In view of the success of the first round pilot initiatives, my Department, the INO and the Office for Health Management have been engaged in discussions on the next round of developments under the partnership. I am committed to providing further funding to facilitate the expansion of these types of programmes, the importance of which is recognised by all the key players.
One of the first tasks my Department undertook following the publication of the Commission on Nursing report was to arrange for responsibility for the overall management of the nursing applications centre to be transferred to An Bord Altranais. This transfer was recommended by the commission and is fully in line with the enhanced role for An Bord Altranais in the area of pre-registration nursing advocated by the commission.
I provided funding of almost £400,000 to An Bord Altranais and to various schools of nursing around the country for national and local campaigns to promote nursing as a career. I also provided the necessary resources for additional training places in both general and psychiatric nursing.
I am pleased to report that there has been a highly successful outcome to this year's nursing student competitions. A total of 1,221 training places were filled – 821 in general nursing, 245 in psychiatric nursing and 156 in mental handicap nursing. This is the largest intake of nursing students for several years. I understand from An Bord Altranais that the intakes for psychiatric and mental handicap nursing are records for those nursing streams.
I am in the process of finalising arrangements for the establishment of a national council for professional development of nursing and midwifery. This new body is a necessary prerequisite to create clinical nurse specialist and advanced nurse practitioner posts, as recommended by the Commission on Nursing.
The importance of this development to nurses, particularly staff nurses, cannot be overemphasised. It will provide them with a new clinical career pathway that does not currently exist, a pathway that will allow them to progress up the promotional ladder without having to leave the patient's bedside. Several hundred new clinical nurse specialist and midwife specialist posts will come on stream. These will be promotional posts at ward sister level and staff nurses and midwives with extensive clinical experience, currently in practice, will be eligible for them. These new nurse specialists will have a maximum salary of £27,522 per year, on foot of the latest Labour Court finding.
I hope the House will accept that considerable progress has been made in implementing the central recommendations of the Commission on Nursing. This has been done against a background of ongoing industrial relations difficulties since the commission's report was published, in which the three pay related recommendations have over shadowed everything else. I have been seeking, unsuccessfully, to engage the nursing unions in a partnership approach to the phased implementation of all the recommendations of the Commission on Nursing. The commission has set out a comprehensive agenda to develop the role of nurses and midwives within the health services. I fervently wish that the moves currently under way to find a process to address nursing issues within the parameters of social partnership will be successful, and that this will allow me and the Nursing Alliance to concentrate our energies, jointly and constructively, on tackling the huge agenda for change set out by the commission. In the final analysis, the commission's report is all about developing the role of nurses and giving concrete expression to the recognition of that role.
In implementing the commission's recommendations – and I hope this will soon be possible – I am anxious to involve the nursing unions in identifying the priority areas where action is required and agreeing strategies for dealing with them. We accept that all of the commission's recommendations cannot be implemented in a single step and that some will, of necessity, take longer than others to implement. That is not to say, however, that we cannot agree a structured programme for the implementation of the report over a period.
While the situation is being managed, the Government is continuing to monitor the effects of the strike on patient care. The Government is anxious that a process be found as speedily as possible to deal with the issues raised by nurses, in a way that is consistent with existing social partnership agreements and that would facilitate the maintenance of social partnerships into the future. That is not an easy task. The Government has welcomed the willingness of the Nursing Alliance to work to achieve this.
The Government has asked the relevant Departments and health service employers to explore urgently the possibilities in this regard, so that an early resolution to this dispute may be found. The general purposes committee of the Irish Congress of Trade Unions is being met by Government representatives this evening. I understand that ICTU is hoping to facilitate a process which would help to resolve the dispute. This task, as I have emphasised, is not easy. Talks are ongoing, but very little progress has been made to date.
However, I assure the House that we will do all in our power to bring the dispute to an end as quickly as possible, emphasising all the time that it must be within the parameters of social partnership. Once a process is devised with the agreement of both sides, that end result would be in the interests of all our people.
