I am obliged to you Sir, for allowing me raise in the Seanad on the Adjournment today the question of the need for the Minister for Health to indicate his plans for the introduction of a full and proper system of integrated nursing in the psychiatric nursing service. I raise this matter because of the fact that the whole question of integrated nursing is one which has been discussed within the nursing sphere for some time, because of the fact that the system is currently being introduced in some of our psychiatric hospitals and because of the fact that there is a certain amount of worry among nursing staffs and, indeed, among patients at the manner in which it is being implemented.
It might be no harm to reflect on the fact that in 1972 the report of the working party on psychiatric nursing services of health boards indicated as one of their recommendations that a system of integration be introduced. In chapter 13 of that report the problems in relation to integration were spelled out. But, above all, the need from a social point of view, from a medical point of view and from a caring point of view for the system to be introduced was fairly well spelt out.
In 1976, the European Community, in a directive which reflected upon the need for equality in legislation, also commented that legislation of this nature should be introduced. This was followed up here by the 1977 Employment Equality Act. It might be no harm to comment on the fact that that Act excluded certain things. Section 11 (2) of that Act provided that access to employment as a midwife or public health nurse to people of a particular sex was not to be deemed in contravention of the Act. Section 17 (2) (c) (d) dealt with the non-application of the Act in relation to the employment of a person where the sex of that person is an occupational qualification. Occupational qualifications were defined further in the Act and included particularly in section 17 (2) (d) "where either the nature of the duties attached to a post justify on the grounds of privacy or decency the employment of persons of a particular sex." Those provisions of the Employment Equality Act were in turn repealed by the European Communities Employment Regulations, 1982. The repeal of those provisions by the 1982 Regulations, in effect, made it mandatory upon health boards to see that a system of integrated nursing was introduced within their areas.
It is important to reflect on that background but I raise the matter because there is a great deal of concern at the manner in which it is being introduced. The issue has been raised with me by members of the nursing staff at St. Mary's Psychiatric Hospital, Castlebar. They are concerned as on the one hand they see consultation with management has taken place, which they regard as their right and which they appreciate but on the other hand they see that despite the consultation the system of integrated nursing has been introduced in a way that does not take full cognizance of their wishes, affairs or worries. They are concerned that their views as to the manner of the introduction of integration are not being properly considered and that there is no proper educational programme available to nurses before they involved themselves in integration. This is one point which the Minister's Department must examine very carefully within all health board areas. While the nurses in Castlebar, as everywhere else, accept that the chief nursing officer has powers and functions in relation to rostering, so far as rostering for integrated purposes is concerned, the nurses believe that before any nurse is rostered that nurse should be properly educated and trained within the integrated system. This is important for the more senior nurses and for people who have not had any experience of integrated nursing.
It is also important that the views of patients be taken into account. Many patients in our psychiatric hospitals are long stay. The very excellent report on the psychiatric services, Planning for the Future, produced by the Minister in 1984 indicated that. On Table 5 of that report, page 163, there was confirmation that over 61 per cent of those patients resident in public psychiatric hospitals as of 31 December 1983 had been there for more than five years. The majority of patients in our hospitals are there as long stay patients. It can be unfair that patients suddenly have a new system of nursing imposed on them. On the one hand, the nurses who operate the system must be properly educated and trained and also the views of the patients must be accounted for. Secondly, no proper guidelines have issued from the Department with a view to guiding nurses into the whole syustem of integration. There is an urgency that proper guidelines be issued in this regard.
Thirdly, despite the legal obligations which the 1982 regulations impose, the nurses should have a right to opt out of integrated nursing if they wish to do so on ethical or moral grounds. I say this in the light of the psychiatric service and against the view the Minister has expressed. Planning for the Future states that the role of nursing in the psychiatric service should be a broader one. In so far as certain aspects of integrated nursing are concerned nurses should have the right to opt out on ethical or moral grounds.
Another point to be borne in mind — I say this in relation to older nurses — is that no moneys have been made available for the purposes of converting psychiatric hospitals to the needs of integrated nursing. If our psychiatric hospitals are to work under an integrated system, the necessary funds to make the buildings and structures suitable for accepting such a system must be made available. I understand from the Western Health Board that they are attempting to introduce the system in Castlebar, as elsewhere within the Western Health Board region, in a manner which takes account of the views of all members of the nursing staff. Accepting that one has also to accept the views put forward by individual nurses that they have been forced into a system which they find difficult to deal with without due regard to their views.
For these reasons I would ask, first, that the system of integration be proceeded with but in doing so the resources be made available to allow that system operate in a proper and full manner. The problem existing at present is that these resources are not available. Resources should be made available for the training of nurses who participate in the system and that no nurse who is not trained be forced into integrated nursing. Secondly, I would ask that proper guidelines be laid down to ensure the manner in which integration is introduced and the manner in which it operates. Thirdly, I would ask that it be introduced in a way that is acceptable to the patients. When the system was initially introduced in Castlebar it was introduced in relation to those who were in the mentally handicapped, geriatric and the long stay areas; the system was not introduced in relation to those who were short stay patients. In other words, the system was introduced and imposed on those patients who were least able to accept it.
I would like a response to these specific points. I raise the issue because there is concern that the system be introduced in a meaningful way. There is also concern that the system at present is not being introduced in a way that is helpful to either the nursing staff or to the patients.
