Vol. 602 No. 2
56 Dr. Twomey asked the Tánaiste and Minister for Health and Children the proposals she has considered for the new children’s hospital in Crumlin; if she has considered a greenfield development; and if she will make a statement on the matter. [15624/05]
I recently visited Our Lady's Hospital for Sick Children in Crumlin. I met the committee of management and viewed some of the facilities there, which are clearly in need of investment. The infrastructure does not meet current standards for a paediatric hospital facility and the available facilities do not satisfactorily accommodate the range and extent of current clinical and associated activity.
Some time ago, a project team, including representatives from the hospital, the former Eastern Regional Health Authority and my Department, was established to plan for the overall future development of the hospital. Under the direction of the project team, an outline development control plan was prepared by a specially-appointed design team. The ODCP demonstrated the feasibility of accommodating new facilities on the existing Crumlin site. It also, however, clearly set out the implications of such an approach in terms of cost, time and disruption to services.
This has given rise to concern among the management and staff. This reflects my own view on the matter and, accordingly, I have decided that it is now appropriate to examine the feasibility of identifying an alternative site for the provision of a new hospital. The development of new facilities on a greenfield site could have significant advantages, including speedier delivery of the building, with less impact on existing services.
My Department is working as a priority with the Health Service Executive in drawing up terms of reference to guide the process of identifying suitable sites. On completion of a site option appraisal exercise, which will be subject to public tendering procedures and which, it is anticipated, will take four months, a final decision can be made as to whether the redevelopment will commence on the Crumlin site or elsewhere. The work of the project team will help to inform decisions on the level and configuration of services to be provided at the hospital, irrespective of its final location.
I also accept that it is necessary to continue to invest in the upgrading of facilities on the Crumlin site during the development programme, even in the event of the hospital being relocated off-site. In this regard, interim upgrading works in the haematology-oncology department, the radiology department and the cardiology department are currently being progressed on the Crumlin site.
Our Lady's Hospital for Sick Children in Crumlin is the national tertiary hospital for children and I am delighted the Tánaiste and Minister for Health and Children is not opposed to the idea of selecting a well-structured greenfield site for a new hospital. Fine Gael believes that a tertiary hospital for all services should be built on a greenfield site, somewhere like the west Dublin site that is a possible location for this. Will the Tánaiste give her views on this proposal? Should there not be a proper national treatment centre for both children and adults? Such a hospital would deal with neurosurgery, transplant surgery and other specialities that have been tagged on to other Dublin hospitals.
Building a large tertiary hospital would improve access both by road and helicopter for the entire island. It would contribute to freeing up an enormous number of beds in the major Dublin hospitals where, as the Tánaiste is aware, there is a major crisis regarding the availability of beds. Under the national development plan, additional beds are to be opened in these hospitals. Would it not be better to remove speciality services from these hospitals, put them into a national tertiary hospital and develop a proper national tertiary service for the whole island that would treat serious and rare conditions?
There is considerable merit in Deputy Twomey's proposal. We must have more routine services for children spread throughout the country within easy reach of families. On my visit to Cork on Monday to open the new accident and emergency department at Cork University Hospital, I saw that the hospital has a separate child-friendly accident and emergency facility. However, Deputy Twomey's suggestion regarding a tertiary facility for a population of 4 million makes sense. Clearly, we would need to avail of the best expertise in this area. It is always better to bring those providing a national service together in a single location. I will bear that in mind in the context of a decision on Our Lady's Hospital for Sick Children.
Will the Tánaiste tell the House when Our Lady's Hospital for Sick Children will receive an MRI scanner?
There is a clear need for an MRI scanner to replace the current outdated machinery at Our Lady's Hospital for Sick Children. It is intended to provide for that in the capital programme, which I will announce shortly.
57 Ms McManus asked the Tánaiste and Minister for Health and Children the steps being taken to address the serious situation identified in the recent Health and Safety Authority report on a number of accident and emergency departments, particularly the warning that persons seeking treatment were being put at risk of injury, infection and violence; and if she will make a statement on the matter. [15480/05]
I have already welcomed the recent report of the Health and Safety Authority. It adds further impetus to our drive to improve the delivery of accident and emergency services. The authority's report arises from its inspection of 11 accident and emergency departments and its analysis of risk assessments carried out in all hospitals. This is the first nationally co-ordinated analysis of all accident and emergency departments. It is, therefore, critical that action is taken following the recommendations of the Health and Safety Authority. I am pleased the Health and Safety Authority has acknowledged that the hospitals are fully engaged in the process of addressing health and safety in their accident and emergency units.
The Director of the National Hospitals Office has issued interim advice to chief officers-chief executives-hospital managers on the preliminary findings of the Health and Safety Authority audit and the National Hospitals Office's own assessment of the audit. In particular, the Health and Safety Authority recommended that the Health Service Executive should determine, on a hospital by hospital basis, after undertaking the necessary risk assessment and staff consultation, whether extra capacity can be achieved within existing units. The National Hospitals Office has advised hospital managers to examine the potential for using the total hospital capacity, including inpatient wards for patients who require admission. It is a matter for each individual hospital to exercise its own judgment on how to reduce risk within particular hospitals.
The National Hospitals Office has also written to each trade union-staff association requesting that the issue of accident and emergency departments, including the issue of health and safety, should be dealt with by way of a working partnership group between management and trade unions. I urge staff representatives to fully engage in this process.
Both the Health and Safety Authority and the Health Service Executive reports have found violence and aggression to be one of the main risks in accident and emergency departments. Much of this relates to the prevalence of cases of alcohol and drug misuse.
The National Hospitals Office has requested the immediate implementation of guidelines issued by the Health and Safety Authority on dealing with violence and aggression in the workplace. The National Hospitals Office is also examining current policies against workplace violence and will issue a clear policy statement of intent which will recognise the importance of efforts to eliminate workplace violence. I find it totally unacceptable that front-line health care workers might be subjected to threats or abuse. My colleague, the Minister for Justice, Equality and Law Reform, Deputy McDowell, is also determined that everything possible should be done to tackle disorderly behaviour and, in particular, assaults on emergency workers, such as the staff of hospital accident and emergency units. I am fully supportive of the Minister's efforts in this regard.
Will the Tánaiste accept that there is a certain irony in her words, considering that she refused to accept the motion which will be put tonight by Fine Gael on drunkenness in accident and emergency departments? While she welcomed the Health and Safety Authority's report, she did not commission it. Will she tell us when accident and emergency departments will be made safe? What is the timeframe for delivery? Regarding the contentious issue of providing extra capacity by adding beds to hospital wards, how many hospitals have undertaken to do this?
Safety in accident and emergency departments is a matter for the individual hospitals. I do not intend to micro-manage each hospital as they have their own management teams. Hospitals must examine their own circumstances and put in place the best management system taking into account all the risks. This will increase safety. I share a view with others, including accident and emergency consultants such as Dr. Aidan Gleeson, that accident and emergency services must be seen as a wider hospital systems issue. Escalation policies and moving beds from accident and emergency units to wards is sometimes preferable to leaving patients on trolleys overnight.
Virtually every hospital I am aware of spends considerable resources on security. If these resources are inadequate due to the manpower being employed or the scale involved, the matter must be examined by the hospital. Hospitals will receive an extra €387 million this year to run their operations, which is almost half the total increase in health spending for 2005. If a wider hospital systems issue is addressed, including activity in respect of private patients, many of the matters I spoke about yesterday and the problems in accident and emergency units can be dealt with.
We have not ruled out the possibility of addressing the issue of people who present intoxicated as they pose the greatest threat to staff. Everyone presenting, including those who are intoxicated, must be dealt with by accident and emergency units. Someone else could be seriously injured. We cannot move a person out of the way without establishing whether they are intoxicated. Subject to appropriate medical and legal advice, we are open to using innovative approaches to deal with people who have presented in this state to provide a disincentive. As I said last night, 30% of those who appear in the accident and emergency unit of the Mater Hospital are intoxicated.
The Minister for Health and Children veered away from the question. How many hospitals have decided to move additional beds into their hospital wards? The Minister sees this as a good idea but how many hospitals agree and how many are adopting it? Regarding an individual hospital's requirement to make a provision that is beyond its control, surely the Minister has a role there. Nobody expects her to micro-manage our hospitals but many of the problems in accident and emergency departments are outside the management team's control. What provisions will be made to ensure managers can manage their hospitals?
The Deputy's point is fair. Clearly, issues exist with the volume of people who present if there is no access to general practitioner services or any provision of patient appointments. They often end up on hospital beds awaiting tests. However, hospitals can take many actions, such as through their discharge policies. I have cited the respiratory physician at James Connolly Hospital, Dr. Conor Burke, previously. He said that, if everyone was discharged in his hospital when they were medically fit to be discharged, no one would be on a trolley. Discussions are taking place in individual hospitals on the issues of discharge policies and freeing up beds to allow those who require admission to be taken. I do not know how many hospitals have decided to put beds on wards, although some have. I recently met the——
Which ones have?
I understand the Mater Hospital has made this decision. I met with the managers of the Dublin teaching hospitals a couple of weeks ago and put this issue to them. They were to consult on it and most felt that, before the Health and Safety Authority's report, it was probably safer on balance from a patients' safety point of view and a health perspective to put an extra bed on a ward from time to time than to keep patients on trolleys overnight. We want innovative solutions customised around individual hospitals if at all possible.
58 Dr. Cowley asked the Tánaiste and Minister for Health and Children her views on the case of a person (details supplied); her further views on whether it is acceptable that she has no plans to introduce legislation to regulate alternative practitioners and to deal with the situation of this person in a comprehensive way in order to protect the public, requiring such alternative practitioners to be regulated and their activities controlled in order not to be a danger to public health and safety; and if she will make a statement on the matter. [15653/05]
I first express my sincere condolences to the wife and family of the deceased person who died in such tragic circumstances, which is the subject of Deputy Cowley's question. As I have explained to the House previously, a national working group was established by my predecessor in May 2003 to advise on future measures for strengthening the regulatory environment for complementary therapies. I have asked for the group's report to be expedited and expect to have it shortly.
The issue of the regulation of complementary therapists is especially important in light of the increasing number of people who are attending such practitioners, particularly in partnership with conventional medical-professional care. As a result, the often informal nature of how some complementary therapies are practised needs more scrutiny. Greater controls in this area are in the interests of all reputable practising therapists as the presence of any unscrupulous or incompetent practitioners undermines the sector and presents risks to those using the therapies. Ensuring they are trained and qualified to the level required to work safely within their area of competence is the personal responsibility of every individual practitioner providing health care services to the public. As the Deputy will be aware, the provision of all services to the public is also subject to the supervision of the Office of the Director of Consumer Affairs.
I intend to introduce appropriate measures to strengthen the current regulatory environment for complementary therapies as soon as I receive the national expert group's report. In the meantime, I have asked the health promotion unit, in consultation with relevant experts, to explore the possibility of running a public information campaign aimed at persons contemplating the use of complementary therapy. A key message that must be communicated is that patients with undiagnosed conditions should be actively encouraged to seek medical advice in the first instance.
I welcome the information provided by the Minister for Health and Children. Some people are practising acupuncture, reflexology and homoeopathy, which are popular, but the laws that govern doctors and medicines do not extend to these people. Persons can set themselves up as a homoeopath, natural healer, reflexologist or anything else and are not answerable to outside bodies unless they volunteer to be so.
The issue is not one of registration but regulation. I raised the matter of Ms Mineke Kamper, who has been practising for a long time, although I call it "killing". I have been raising the issue of alternative practitioners since 2002 because it worries me. In County Mayo, the local pathologists have proven beyond all reasonable doubt that Mr. Paul Howie and Ms Jacqueline Alderslade died of treatable organic diseases due to alternative practitioners diverting them from traditional medical therapy or giving them a drug that may have led to their demise. These practitioners are unlicensed, untested and bogus. When they give medication, the State Laboratory has proven several times that it is nothing but a placebo composed of starch and sugar with no active ingredients.
While the second inquest into Mr. Howie's death was being conducted, which Ms Kamper did not attend and was fined €6.35 subsequently, she was treating children and using a pendulum to decide what tablets they needed. Where is the legislation to protect the safety and health of our population from the menace of such rogue alternative practitioners? She has killed two people and more will follow. Even the welfare of the snails on a golf course are protected by our laws. What about the health and safety of our vulnerable citizens? Surely homo sapiens are as important as snails.
The Minister said there are no plans to introduce legislation to regulate alternative medical practitioners at present. I am aware of the working group and advisers she mentioned. I am sure Ms Terry Garvey is a fine broadcaster but what does she know about this issue? Two innocent people who should not have died are now dead. This is the tip of the iceberg. For how long will it continue? The Minister mentioned a lack of plans to introduce legislation but the Dáil rushed through legislation yesterday concerning the British-Irish Agreement relating to cross-Border waterways just to save the Government's skin. We did the same with the nursing home charges legislation. People are dying. We need to pass this legislation quickly. We must move beyond all the reports and advice. I agree with informing people about what is happening but we need to pass this legislation. We know what we have to do. People are dying while the Government is interested in protecting the habitat of snails.
Paul Howie had cancer on his tonsil which was visible. I am sure that man would be alive today to see his children graduate had he been given the chance, but he was not. If a law regulating this area were in place, he would have got that chance. Jackie Alderslade, an asthmatic, only needed to take the tablets she was prescribed, but she did not get them. This practitioner in question is all-pervading and so persuasive, she can convince people it is best for them to stay under her care.
What about the rights of the children? It was stated in the Irish Independent that people should know better but what about children? They do not know better because they are brought by parents to these practitioners. I do not know where it will all end. What will the Tánaiste do to ensure the bodily integrity of children is protected in the Constitution — as outlined in the Ryan case — and by the State? The Tánaiste is failing in that respect. I am not convinced by her answer to my question. She is failing to address this issue, as did the former Minister, Deputy Martin.
I do not disagree with much of what the Deputy said. Some of the therapists in question will be regulated under the provisions of the new legislation on health care professionals. It has completed its passage through the Seanad and is due to be taken in this House shortly. That will provide a regulatory framework for many of the professionals to which the Deputy referred, but we need to go beyond that. It is not an easy area to regulate. We do not want to regulate excessively.
I met a group of people last week whose loved ones were the victims of practitioners in the mid-west, one of whom was struck off the register in the United States and another who has been subsequently struck off the register here. Those practitioners do not come from the alternative therapy school. I was astounded at the charges set by these practitioners. One couple told me they paid €30,000 and that their very ill child of 15 years of age was on 60 drugs a day, and when he died they found many of the drugs under his bed because he was not able to take them. That is scandalous.
We will strengthen substantially the Medical Practitioners Act to give the Medical Council more proactive powers to carry out investigations in this area. However, there are difficulties in dealing with the alternative therapists, and we want to await the opinion of the expert group examining this area. That group is due to report at the end of the year. We have asked it to advance that timeframe and I expect to receive its report sooner than that. When I receive it, I will publish it and set about putting in place a system of regulation. We also need to ensure that the courses pursued are accredited by FETAC or HETAC to ensure that the training programmes meet a national standard and, if people are practising in this area, members of the public are entitled to know their level of the accreditation.
We all have a responsibility to try to discourage people from believing in the myth that there are some people who can cure people with serious cancer or other conditions, which unfortunately is what happened in the case of the people I met last week. I heard many cases and it was heartbreaking. It was hard to believe but when people are seriously ill, they will try anything. Not only were they disgracefully treated, they were financially ripped off at a vulnerable time in their lives. We need to strengthen the legislation in this area to protect the public. That is why I said in my reply that we will initiate a public information campaign in the health promotion unit in my Department to inform people of the dangers and issues in this regard.
The Coroner's Act needs to be updated, and the Minister for Justice, Equality and Law Reform is doing that. I received a letter from the coroner in Mayo about the case to which the Deputy referred, highlighting the deficiencies in that legislation.
I call Question No. 59.
A Leas-Cheann Comhairle——
We have spent more than the allocated time on this question. The Deputy must be brief.
The Medical Practitioners Act does not apply to this lady. From what I have read, the new legislation will apply only to medical practitioners who purport to be this or that. However, this lady claims to be a healer and, from my reading of the legislation, it will not apply to her. Will the Tánaiste review the legislation because what is promoted by such people is into the blue yonder, so to speak, and that is not acceptable? I know the Tánaiste is sincere in what she says but the time to act is now and the Medical Practitioners Act will not address this difficulty.
I accept that we need separate legislation to cover alternative therapists but where medical practitioners engage in this kind of activity, which is what was happening in one instance at least, we need to give the council power to investigate proactively rather than for it simply to react.
That legislation will not cover alternative practitioners.
I accept that we need to introduce legislation to cover both types of practitioners.
Paschal Carmody can still practise as an alternative practitioner. He has been struck off the register as I or any other doctor would be because we are subject to the law, but this woman to whom I referred is not subject to it, although she should be.
We have spent four minutes more than the time allocated for dealing with this question. I ask the Tánaiste to take Question No. 59.
59 Dr. Twomey asked the Tánaiste and Minister for Health and Children the health screening measures which have been implemented since 1997; her proposals for the future; and if she will make a statement on the matter. [15625/05]
The national breast screening programme commenced in 2000 and covers the east, north-eastern, midland and parts of the south-eastern areas of the country. Screening is offered free of charge to all women in those areas in the target age group of 50 to 64 years of age. Since the programme commenced in 2000, cumulative revenue funding of approximately €60 million and capital funding of €12 million has been allocated to support the programme. To the end of 2004, the number of women screened by BreastCheck was in the region of 185,000. The cancer detection rate is approximately 7.4% per 1,000 screened and to date more than 1,300 cancers have been detected.
The national roll-out of the programme is a major priority in the development of cancer services. I am confident that the target date of 2007 for the commencement of the roll-out of BreastCheck to the west, north west, south and south east will be met. Last week I gave approval to BreastCheck to advertise for the appointment of a design team to work up the detailed plans for the design and construction of two static clinical units, one in Cork and one in Galway. I also approved the development of a symptomatic breast centre at University College Hospital Galway. The total capital approved amounts to approximately €25 million. Tender notices have already been advertised in the EU Journal.
I am also committed to the national roll-out of a cervical screening programme in line with international best practice. Careful planning and consultation with relevant professional and advocacy stakeholders is required before I make definite policy decisions on a national roll-out. The former Health Board Executive commissioned an international expert in cervical screening to examine the feasibility and implications of a national roll-out. The examination included an evaluation of the current pilot programme in the mid-western area, quality assurance, laboratory capacity and organisation and the establishment of national governance arrangements.
The pilot cervical screening programme commenced in October 2000 and is available to eligible women resident in counties Limerick, Clare and north Tipperary. Under the programme, cervical screening is being offered free of charge to approximately 74,000 women in the 25 to 60 age group.
My Department is now consulting the relevant professional and advocacy stakeholders. The consultation is well advanced and will be completed in a matter of weeks. In addition, my Department allocated a further €1.1 million to the programme in 2005 on an ongoing basis to complete the transition of the remaining laboratories to new and more effective testing and to support the development of quality assurance and training programmes.
It is not often I remind the Government of another initiative it introduced. Heart Watch is a secondary preventative programme that was introduced after 1997. Having been in office for eight years, the Government has only implemented two screening programmes of any sort. With all the emphasis we should be placing on primary care and the role of health promotion in preventing ill heath, only two screening programmes have been implemented. One is BreastCheck which covers only half of the country. The other is the cervical screening programme which is still very much a pilot programme. Heart Watch has been successful because general practitioners supported it. One cannot join the Heart Watch screening programme unless one has had a heart attack. Therefore, there is no primary screening of any condition apart from breast cancer.
Last week or this week, the Tánaiste made an announcement that she saw no merit in prostate cancer screening, yet 1,200 cases of prostate cancer are detected every year and approximately 600 men die from the cancer every year. The Tánaiste should clarify to the public her remarks to the effect that there is no need for prostate cancer screening. There is merit in introducing such a screening programme and research is being done which will show that. By not introducing such a programme we are dismissing screening as a preventative tool in the health care service. We continually focus on the mechanism of dealing with disease after it has arisen and apportioning increasing amounts of money to hospital services. The introduction of such a programme would save money in the long term. The Government parties have been in office for eight years, yet only half the country is covered by the BreastCheck screening programme, the take-up of the Heart Watch programme has been sporadic and that is the sum total of its health screening and prevention programmes. That is a damning indictment of the approach the Minister is taking to primary care. I would like to hear her views on that.
On prostate screening,I took the recommendation from the Cancer Forum. It states that there is currently insufficient evidence to recommend the introduction of a population based prostate screening programme in this country. It goes on to state that this is in line with EU recommendations and that one must introduce cancer screening programmes which have demonstrated their efficacy having regard to professional expertise and priority settings for health care resources.
In regard to Heartwatch or managing chronic illness, which is the big issue in the developed world, managing people who in the past died from the illness now live very good lives for a very long period. Therefore, managing chronic illness is a big challenge, which essentially will be done at GP level. In the context of the new contract, if we can get around to discussing it with the IMO, among the issues I want included is cervical screening, which can be done at GP level, rather than have another parallel programme rolled out with BreastCheck. Many of the issues referred to by Deputy Twomey are appropriate for the development of primary care. At GMS level, the remuneration to general practice has doubled over the past five years, even though the number of medical card holders was reduced by 100,000 in the same period. As we go forward, no doubt more and more money will go to general practice. We want to ensure that we introduce at that level some population screening such as cervical screening.
The Minister just admitted to the success of this approach. We should make an effort to move forward on the issue because it is a winner in overall health care. We must consider other aspects which could be tackled easily in regard to screening, including blood pressure, diabetes and obesity. As these are significant issues which are getting out of control, we should be putting huge resources into this type of screening.
60 Ms McManus asked the Tánaiste and Minister for Health and Children the number of nursing posts unfilled at the latest date for which figures are available; the number of qualified nurses who were offered permanent posts in the acute hospital service during 2004; if her attention has been drawn to warnings from the INO that the number of vacancies would rise to 2,000 over the next 18 months; the steps being taken to deal with the shortage of nurses; if her attention has further been drawn to concerns expressed that further hospital beds may have to be closed later in 2005 due to the shortage of nurses; and if she will make a statement on the matter. [15481/05]
According to the most recent Health Service Executive, employer representative division survey of nurse resources, recruitment remains well ahead of resignations and retirements. Employers reported that 765 vacancies existed at 31 December 2004. The vacancy rate now stands at 2.25%. This could be considered to be a normal frictional rate, given that there will always be some level of movement due to resignations, retirements and nurses availing of opportunities to change employment and locations.
Data on the number of nurses offered permanent contracts in acute hospitals are not available. However, the survey found that in the year ending 31 December 2004, a total of 3,949 staff nurses were recruited by the Health Service Executive, voluntary hospitals and intellectual disability agencies. During the same year, 3,131 staff nurses resigned, retired or moved to another employer. An extra 819 nurses were, therefore, employed in the health service in the year ending 31 December 2004.
The recruitment and retention of adequate numbers of nursing staff have been a concern of the Government for some time. A number of substantial measures have been introduced in recent years. The number of nurse training places has been increased by 70% since 1998 to 1,640 places per year. In excess of €90 million revenue funding is being provided in 2005 for undergraduate nurse training. This is in addition to a capital investment programme of €240 million for the establishment of state-of-the-art purpose-built nursing education facilities on the campuses of 13 higher education institutions. Nursing continues to be regarded as an attractive career. CAO applications for 2005 indicate that 8,155 people applied for nursing, 4,869 of whom gave nursing as their first preference, an increase of 3.5% over last year.
A comprehensive range of financial supports has also been introduced to support nurses in pursuing part-time degrees and specialist courses, including "back to practice" courses. The cost of this in a full year is €10 million. The Department of Health and Children introduced a scheme of flexible working arrangements for nurses and midwives in February 2001. Under the scheme, individual nurses and midwives may apply to work between eight and 39 hours per week on a permanent, part-time basis. Almost a quarter of all nurses now job share or work part-time hours.
Additional information not given on the floor of the House.
There have been substantial salary increases for nurses over recent years. Between 1997 and 2004 the basic salary of a staff nurse increased by 57.5%. In the same period, the salaries of clinical nurse managers increased by between 73% and 89%. The promotional structure within nursing, including the introduction of a clinical career pathway, has been substantially improved on foot of the recommendations of the Commission on Nursing and the 1999 nurses' pay settlement. The National Council for the Professional Development of Nursing and Midwifery has been especially active in this area and, to date, more than 1,650 clinical nurse specialists and 24 advanced nurse practitioner posts have been created.
The measures I have outlined have produced very positive results. Since 1997 there has been a net increase of 7,000 nurses. This represents a 25% increase in the nursing and midwifery workforce in the public health service. Turnover of nursing staff has also declined. The most recent turnover study covered the years 1999 to 2003. The results of this study showed that nationally turnover had decreased by 40% over the five-year period. Ireland now has 12.2 nurses per 1,000 people, about 50% more than the EU average of 8.5 nurses per 1,000 people.
Ensuring that there are sufficient nursing resources in 2005 and 2006, particularly within acute hospital services, is a priority for the Health Service Executive. This will be the transition period between the diploma and the degree programmes. The final group of diploma students graduated in late 2004 and the first group of degree students will graduate in autumn 2006. A national steering group, inclusive of nurse managers and HR specialists, has been established by the HSE to examine and address the issues involved in ensuring there are adequate numbers of nurses in 2005 and 2006. The group is overseeing the work of a project office tasked with running local and overseas recruitment campaigns. Additional funding has been provided for the HSE for nursing recruitment in 2005. Work is well under way on the tender process for overseas recruitment. Registered nurses in Ireland, who are not practising, are being invited to apply and nurses working flexible/part-time hours are being asked to increase their hours. Improved skill mix will also assist in addressing the problem.
That is the exact same reply that was given to another Deputy a couple of months ago. The question I asked has not been answered. I ask the Minister to expand on whether we have a real problem this year, which is unique, because there will be no nurse graduates coming on stream. What precisely will be done about this? Why is she not aware that just one in four nurses from last year got permanent posts? I am amazed that the data are not included in her answer. Does she accept it is very cost ineffective to be so reliant on overtime and agency nurses? Is she aware that it is currently much more attractive for a young nurse to become an agency nurse? There is no incentive to become permanent, which is very expensive and not cost effective.
Does the Tánaiste accept that the shortage of hundreds of nurses has a particular impact in the Dublin region and that some of the problems that arise can be sourced back to the shortage of nurses in the Dublin region? Is she aware that as far back as 2001 the DATs management report indicated that there should be special arrangements, such as Dublin weighting or acuity payment, to deal with the problem?
Some 819 additional nurses were employed last year, many of whom replaced people who retired. CSO statistics indicate that there are 12.2 nurses per 1,000 people in this country. Bord Altranais registration figures indicate that there are more than 15 nurses per 1,000 people. In the EU, the ratio is 8.5 nurses per 1,000 people and in Britain the figure is nine nurses per 1,000 of the population. Nurses represent more than half of all the professionals working in health care in Ireland. In Britain, they represent 28% of professionals and in France, 22.5%. I accept there are issues this year because of moving from the apprenticeship programme to the graduate programme. That is why €2 million was allocated towards recruitment policies, essentially going overseas. To put it in context, 91% of nurses working in Ireland are Irish and just under 2% are from the UK. Contrary to the impression which is often created, approximately 6% are from outside Ireland and the UK.
The Dublin allowance was examined by both the Labour Court and the benchmarking body. There is merit in that and it is used in other countries, but it cannot be ring-fenced around nurses. It would have to apply to other public servants. The cost of that in a full year, at the rate suggested, would amount to approximately €258 million. I said to the INO on Friday, and at the SIPTU conference on Monday evening, that if we could deal with some of the practicalities around individual hospitals, we might be able to have more innovative solutions. The Mater Hospital has 1,000 nurses, as has Tallaght, yet there is no flexibility at hospital level to put in place innovative approaches to try to attract people or retain them. Even though the retention rate in Dublin is higher than in the rest of the country, the turnover rate in nursing has declined from 17% per annum to approximately 10% per annum over recent years. At least we are moving in the right direction.
Many young people, including nurses, are taking the opportunity to travel abroad, some of them to practice nursing and more to travel the world. According to An Bord Altranais, relatively few — approximately 400 — practise nursing because they must register. Many of them travel the world, as do many young people. This is a factor in nursing as it is in many other areas.
