This has been a very helpful discussion and some of it, as has been observed by Senators, is outdated. There have been a remarkable number of improvements in nursing conditions which I shall deal with later. As everybody will agree, the Irish nursing profession is of worldwide repute. Irish nurses are commended all over the world for their efficiency, their dedication and their sense of personal humanity. We have Irish nurses in certain hospitals in England and abroad and it has been agreed that without them the hospital services would collapse.
The pay and conditions of nurses, until recent settlements were made, were behind acceptable standards. I was very glad to play a significant role in encouraging settlements on pay and conditions which would result in a great improvement. I, naturally, have to keep out of most of the disputes over wages and conditions except when I feel there is a need for some particular approach on the matter. However, I was very glad to be of some assistance in connection with the demands made by the nurses which resulted in a settlement at the end of 1970.
Perhaps I should give some general picture as to the number of nurses. There are 5,650 female general trained nurses and about a third of these are temporary. Of the third that are temporary 1,000 are married, 25 per cent of the health board hospital nurses are temporary and 5 per cent of the nurses in voluntary hospitals are temporary. There is quite a large number of temporary unmarried nurses and they are so for private or social reasons and also because nurses like to be able to transfer from one hospital to another very quickly. I wish there were more of these temporary nurses made permanent. I hope there will be a change in regard to that position but, I feel, it is their own personal wish. There are 3,500 students in general training hospitals. There is a very considerable movement of nurses on a fairly continuous basis from one hospital to another, also for reasons of marriage.
We had a recent survey conducted by UCD Social Science Department. They found a rather high turnover of nursing staff, the annual rate varying from a quarter of all staff in district hospitals to a third of all staff, other than students, in voluntary hospitals. In addition to resignation on marriage, which has been reckoned as being about 9 or 10 per cent of nursing staff each year, there are resignations to take appointments abroad, which amount to 5 per cent of the turnover. Retirements on reaching the age limit would be 2 per cent, and this would cause some 400 vacancies annually. The switching of jobs and going for further training would account for a further 500 resignations annually. So there is a very considerable movement of staff.
I am sure that some Senators would like me to say something about what would happen if the Government adopt the Report of the Commission on the Status of Women. The report recommends that the retirement on marriage of a public servant in this country should be a personal decision and not a decision of the State or of the local authority. It would obviously have some effect on the recruitment and the movement of nurses. However, I should say that the effect of the removal of the marriage bar would be a fairly long-term operation. For example, there would be a still greater turnover of nurses when nurses retire for maternity reasons, as married nurses, and then return at a later date. It would be quite impossible for me, or for any Minister for Health or for An Bord Altranais, to predict what will happen if this report is adopted by the Government. No decision has been made about it yet.
Nurses would not be required to leave the service on marriage, but naturally they would have to retire, temporarily at least, for maternity reasons. This again would cause a shifting in the pattern, in the movement and in the turnover of nurses, an element which I could not possibly predict.
Reference has been made in this debate already to the shortage of nurses. We had a report on what is described as the manpower of the nursing community. I do not know why the word "manpower" is used in that connection. The report was prepared by the Department of Social Science in UCD, and it quite evidently indicated that there is no shortage of nurses as a whole in this country. They examined the positions of 4,955 nurses, in other words, nearly the whole number to which I have already referred. If one adds up the actual number of shortages, it came to 123 or 2.5 per cent.
As Senator Belton has said, there is an actual shortage in a small number of hospitals. Some hospitals have a high turnover and there would be apparent shortages of nurses in those hospitals because of the high turnover, and the decision to appoint new nurses to relieve temporary shortages. There is a shortage in relation to certain geriatric hospitals.
I agree with Senator Belton that in nursing homes where old people are ambulant non-nursing personnel are appropriate, and this should be looked into, if it has not been already, by the health boards concerned. In the case of bedfast chronic sick old people, nursing still comes very much into the reckoning and it can be particularly important to avoid deterioration in the patients' conditions. For example, in relation to the development of bedsores, which is a continuing problem, the rotating bed has now been invented which eliminates bedsores, but it will be some time before those are available in sufficient numbers. Nevertheless there are two types of old people, those for whom non-nursing personnel are appropriate, and those for whom fully trained nurses are essential.
In this connection, I should say that the number of patients going to Baltinglass from Rathdrum would be about the same, and I do not expect a nursing shortage in Baltinglass. Those who come from the surrounding areas, including County Carlow, would be glad to work near their homes in this new hospital, which is largely of a geriatric character. Senator Belton referred to State-enrolled nurses. There are 95 of these employed. The Irish Nurses Organisation are opposed to any encouragement in the enrolment of State-enrolled nurses and I am not prepared to take any action in regard to the matter.
There is a further question which relates to geriatric nursing and the training of student nurses. An Bord Altranais and my Department are conferring on this matter, to see whether, without great difficulty, some more geriatric trainees or student nurses can be encouraged, which will perhaps eliminate some of the shortages of nurses in geriatric hospitals in Dublin, of which the Senator spoke. We have not yet made final progress in that, and it relates, to some degree, to the appointment of geriatricians. We are to have geriatric student training on a definite scale and by then we should be able to appoint more geriatricians. Some geriatricians have been appointed to hospitals: there is still a vacancy, of which I think Senator Belton would know, in the Dublin area and the appointment was refused. Now another person is being offered the appointment and we hope to establish a greater geriatric service in Dublin and in other areas. A geriatrician was appointed to Cork some time ago and he has been operating very satisfactorily.
The information that I have at the moment is that there is an actual shortage of nurses in a small number of hospitals, but no acute shortage, and the position will be reviewed again. If we have 123 actual vacancies out of nearly 5,000 nursing positions, it obviously does not amount in any sense to a crisis.
Some Senators referred to non-nursing duties. Quite rightly, one Senator pointed out that non-nursing duties varied between clerical duties and duties of a domestic kind that are not appropriate to the work of a nurse. Now we are going to form reginal hospital board before April next. Resolutions will come before the Dáil and the Seanad as to their constitution and powers. They will be working with a work study unit which is already beginning to form in my Department, and they will be going into all the questions that have been raised by the Senators in this debate—the nurse/patient ratio in hospitals of different kinds, what one can do in order to eliminate unnecessary nursing duties, and to establish ward orderlies or domestic staff of one kind or another in their place, if they can be obtained. Unfortunately, there are some places in Ireland where it is difficult to find the domestic type of staff to do some of the work which nurses are compelled to do in these hospitals. That is not the case everywhere.
As well as this action being taken, some hospitals have already made an examination of the position, as referred to by Senator Keery. There has been some work study effected in various hospitals, and they have looked into the question of which non-nursing duties could be eliminated from the work of nurses, so there has been progress in regard to this. But more progress should be possible as a result of the circular which I addressed to every hospital in the country asking that a nursing committee be formed within the hospital, which will be representative of the management, the nurses and the student-nurses.
The purpose of these committees should be twofold. First of all, they should discuss local and minor grievances that need not be discussed on the basis of some complicated union procedure. Secondly, they should examine how the organisation of the nursing in the hospital can be improved on the basis of the training, advice and experience of the nurses. They should also get the points of view of the student nurses who come fresh into the hospital and who should be able to give a useful contribution.
I am glad to say many hospital now have these nursing committees. They will take time to develop. Their effectiveness obviously depends on the matron and the administrators of the hospital. They can become mere talking shops, where the next dance is discussed, or they can be fully effective committees, examining as closely as possible the operation of the hospital in relation to nursing duties, the rosters of nurses and so on. I should like to see these nursing committees developing. I have always believed in this kind of communication, and when I was in charge of eight State companies I was constantly addressing those where I felt there should be more immediate communication at local level within a State company as between the management and the employees. I was pleased to address these letters to all the hospitals, and they have had a considerable response. A reminder letter should be sent to the hospitals, which are mostly voluntary hospitals, where these nursing committees have not yet been appointed.
In relation to the duties of nurses, their general effectiveness, the waste of nurses' time because of excessive movements through the hospital, all the work study connected with the placing of drugs and tissues, the removal of drugs and tissues and everything concerning the nurses' movements should in time result in greater efficiency without loss of service to the patients and should help us to deal with nursing shortages and to give the feeling to nurses that they are making good use of their time in the most economical way.
When the health board management is fully set up there will be a programme manager for the general hospitals in the area and he will be responsible for taking up a better form of administration and management for all the health board hospitals, which is clearly indicated in the McKinsey Report, most of which has been found satisfactory in that regard by the health boards. We need better management of the hospitals and this can be obtained by a proper management structure and by the appointment of an executive committee for the management of a number of small hospitals.
Some Senators mentioned the disciplinary code in relation to nurses. I remind the House of the recommendation sent out on the instance of the late Deputy Donogh O'Malley in April, 1966, recommending a relaxation of discipline, such as changes in the type of uniform worn by nurses, et cetera. I have had a number of discussions with the Irish Nurses Organisation, but the suggestion that the disciplinary code throughout the country is still too harsh has not come to me. I am sure the nurses' organisation would make this point at their meetings with me, which take place at least annually, if there were still an excessively hard disciplinary code. I have no great complaints about this and I do not believe it is a matter of great moment now.
There should be placed on the record of this House the very great improvements that have taken place in the salaries and conditions of nurses between April, 1964, and January, 1971. The maximum of the basic salary scale for a staff nurse increased from £840 to £1,375 or by 64 per cent, in that period. The increase in the salary of a student nurse at point of entry was 84 per cent in the same period. In addition to that, there is an allowance of £2.24 per week for night duty. There are two long-service increments of £47 each after 14 and 18 years of service. There is a new allowance of £47 per annum for nurses in long-stay institutions, in county homes, in intensive care units, in cancer hospitals, in hospitals associated with special facilities for paediatrics, orthopaedics, midwifery and mental handicap. There is a special allowance of £2.10 per patient for emergency operating theatre duty. The hours have been reduced from 90 to an 80 hour fortnight. Present negotiations in respect of student nurses are resulting in a reduction to an 85 hour fortnight which will come immediately in some hospitals and by the end of February it will apply to the remaining hospitals.
Full increments are allowed for previous service in respect of nurses who have been in voluntary hospitals and who are taking up permanent appointments in health board hospitals. Pension rights can be transferred from a nurse enjoying pension rights who is attached to a voluntary hospital and who goes to a health board hospital, or vice versa. Senator Belton is quite right when he states these privileges do not apply to nurses who have been employed in private nursing homes. There is nothing I can do about that at the moment. In respect of voluntary hospitals and health board hospitals there is now encouragement of free exchange of appointments because they carry their increment rights and their pension rights with them when they move from one type of hospital to another. Married nurses have up to five increments allowed when they re-join the service and they now receive increments for each year of service that they did not previously receive.
The cost of all this in one year was £1,150,000 to the ratepayers and taxpayers. It was money well spent. At present the maximum salary for a general trained nurse, excluding all the allowances I have mentioned, is £1,375. The rate in the United Kingdom is £1,281. The reduction for accommodation facilities in the United Kingdom is £309 against £191 in this country. We can say there has been a fairly substantial improvement, very much deserved, in the salaries and conditions of the very splendid nursing community we have in this country.
I am not the employing authority for nurses. I intervene as little as possible in matters that should come before the conciliation and arbitration facilities and, having said that, I am glad to remind the House that there is now appointed a local government staff negotiating board where meaningful staff negotiations should be facilitated. This change will alleviate many of the difficulties and frustrations that arose through the absence of proper modern negotiating machinery. Nurses in health board hospitals and the health board service can have their claims examined by this negotiating board and the terms of operation of this board enable their services to apply to nurses in voluntary hospitals. When there are requests for changes in salaries and conditions I hope the voluntary hospitals will agree to use this new local government negotiating board procedure so that there can be a parallel movement as between the voluntary hospitals and the health board hospitals.
Now I should like to say a few words about a college of nursing. This I do regard as a possible future development. It is being considered by An Bord Altranais, who are responsible for it, in conjunction with a committee representative of all the nursing organisations, of whom there are four or five different associations. The proposal is being examined that there should be a faculty of nursing at the Royal College of Surgeons for post-graduate education. I am glad to tell the House that we learn that in a tentative way the nurses in the north of our country would like to be involved in this post-graduate scheme and we would very greatly welcome this. An Bord Altranais are responsible and I am encouraging them to examine the whole of this proposition. I agree with Senators that this is in line with the whole of the growth of medical and hospital techniques and is another stage in the development of nursing education.
Having said that, there are a great many post-graduate courses already operating. There are so many courses that An Bord Altranais say they need a new building and they are discussing the question of some premises with the Eastern Health Board at the present time. There are courses for public health nurses, management courses, courses for ward sisters and charge sisters, courses held in the maternity hospitals, refresher courses for tutors and public health nurses.
Incidentally, in relation to the public health nurses who are doing such splendid work in this country, I should mention that in relation to their demands for good conditions we are having the working load of the public health nurses examined in order to see what a public health nurse does in the week and how best her work can be facilitated. This is an essential form of study because their duties have been extended, their nurse training has been extended and we want to see the public health nurses, who are so absolutely essential, operating in the best possible way and in a way which to them means a meaningful and very happy career. There are inter-hospital courses in seven hospitals. There are evening courses held in chemistry, biology and physics. Special courses are held for coronary care, theatre work and intensive therapy in the Mater Hospital and for renal dialysis in Jervis Street. I am sure I have not got to the end of the courses that are held in one way or another in hospitals or under the auspices of An Bord Altranais.
Then, of course, there are hospita administrative courses for middle-management. I agree with those Senators who say that we need to have management courses for nurses and for other personnel developed to a greater extent. This will be one of the matters that will come to the attention of the regional hospital boards when they are set up—what we can do to improve management courses over and beyond what is already being done by the Institute of Public Administration and one other institution. Finally, there are also post-graduate courses for social workers and public health nurses held in University College, Dublin. We have provided additional promotion posts for nurses by arranging for the appointment of junior ward sisters in training hospitals. We have doubled the number of ward sister posts in ten years in health board hospitals by some 400 appointments. That covers the ground fairly well.
I have not dealt yet with one very important question in relation to the life of nurses, namely the accommodation facilities. Accommodation some years ago was very deficient, but I am sure the Seanad would like to hear that nurses' accommodation in general hospitals, mental hospitals, county homes and institutions for the mentally handicapped in the last five years has been increased by 1,261 nurses' beds in new nurses' hostels. Under construction are 341 places for better nursing hostel accommodation and in planning are another 453 places. So we are making progress.
I am aware that there are some nurses who are still living under antiquated conditions but the programme of providing better accommodation continues steadily, will continue in the future, and arrangements are being made for some of the capital to be invested in the health and hospital services to be attributed to the improvement of nurses' accommodation.
I wish to conclude by saying just a few words about the recent strike of psychiatric nurses. I want to say first of all, and I hope I have the agreement of the House as a whole, that strikes in hospitals, county homes and institutions for the mentally handicapped are totally and absolutely unjustified in any circumstances whatever. In a great many countries in Europe arbitration is normally accepted for a great number of essential industries and strikes never take place. There is a different system of trade union organisation, a different mental attitude to industrial disputes as can be found, for example, in Switzerland, Germany, Sweden and the Netherlands. In most of those countries strikes have taken place from time to time. In some cases there have been outbreaks of strikes. In Switzerland and Austria, for example, there are almost never any strikes.
I do think that the trade union movement here could make up their mind that they would be yielding nothing in relation to the general right to strike if they decided they would accept arbitration in regard to all strikes whose only effect is to exploit the sickness of infirm and ill people who are unable to help themselves.
In the case of the psychiatric hospitals strike, the point had almost been reached when the Labour Court was to have a final hearing. I know the dispute had lasted a long time and it had lasted a long time because for ten years the managing authorities for the mental hospitals had been trying to relate the agreement to make permanent a great number of posts among psychiatric nurses, had been trying to link this with a system of promotion by merit and not by seniority. The system of promotion by seniority is the only case of which I know that exists in the whole of the public sector, both local and national, for persons whose occupations could be compared, in regard to the skills required, with psychiatric nurses.
It has been impossible to get any agreement. The final offer made by the CEO before the Labour Court conciliation took place was that one out of every two promotions would be by seniority as in the past and that one out of every two would be on a combination of suitability and applicability for the job in hand, with a content of 30 out of 100 points for the numbers of years of service. I regarded that as a very reasonable compromise.
I am speaking about this because I have got to let everybody know that I agree with the promotion of psychiatric nurses on this basis. The whole of the mental hospital world has changed in the last ten years through the use of tranquillisers and also the use of new methods of activating patients. It requires a skill that is not given to every single person, and is given more to one particular psychiatric nurse than another, to be able to engage in meaningful activation of the patient, to be able to engage in group therapy, to understand the patient, to understand how to enliven or tranquillise the patient, to understand how to deal with an institutionalised mental patient. It also applies to the psychiatric nurses who leave the mental hospitals and who rotate through the country looking after patients who can be kept at home but who require a vistit by the psychiatric nurses at intervals. I can find no psychiatrist of any note in this country or in any other country who will not agree with me that, if you have a given number of personnel, the situation is exactly the same as for female nurses employed in general hospitals where the system of appointment by merit exists. If it is regarded as desirable that there should be appointment by merit among female general trained nurses in hospitals, nobody can argue with me that it is not equally desirable that promotion should be on the basis of merit in psychiatric hospitals.
This compromise was offered. I have to make the decision yet about sanctioning this arrangement and I have to take into consideration all the matters that took place during the strike, but I want everybody to know my view about it. It is very rarely that I, as Minister, would have to comment on the particular situation in relation to an industrial dispute. But it would be grossly dishonest of me just to sit down and say nothing and not to let the community and the Seanad know what I think of the system of promotion by seniority in the year 1971 in our mental hospitals. I am totally opposed to the concept. But the arrangement has been made by the Labour Court; it is before me and no doubt I will have to sanction this agreement. But I hope there will be a change in the future. I should like to repeat that it seemed to me that the compromise offered which was connected with the making permanent all of these posts that have been left temporary so long—because the two questions were linked together in discussions—was that one out of every two appointments should be promotions by seniority. The appointment which was not by seniority but on the basis of merit had an element of service included in the markings.
I want to say also that the settlement, as presented to me, means absolutely nothing. This arrangement for making comments and reports on the nurses which can be noted in connection with their promotion is not a promotion system by merit, and very few psychiatrists would be able or would want to work it as the basis for an alternative to a system of promotion by merit.
Having said that, I think I have answered all the questions that have been asked of me so far in the course of this debate. May I finally say that I am tremendously interested in the development of the nursing profession here? I can say without fear of contradiction that the organisations concerned with nursing have found me ready to meet and discuss matters with them and that I do regard the 15,000 nurses in this country—between psychiatric nurses, general hospital nurses, female nurses, male nurses, and nurses in student training—as playing a very vital and wonderful part in our health and hospital services.
