I am delighted to have the opportunity to respond to the request of the Seanad to come into the House to make a statement on the complex and difficult dispute in which we are now engaged. I am not only giving my view of this dispute, but also the view of the trade union personnel who are also dealing with it. If it were not a complex issue we would have found a resolution to the difficulties long before now.
There has been no change in the Government's position, which has been consistent. It has not been a case of calling on the Nursing Alliance to take or leave the Labour Court findings. The Government wants the Labour Court findings accepted and to move on to other issues in the context of the Commission on Nursing report and the principles of social partnership.
On 23 September the Taoiseach outlined a credible alternative to confrontation and a way forward which will provide a better outcome for everyone, including nurses. 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 an explicit acknowledgment from the Nursing Alliance that it recognised that the Government has difficulties in dealing with this matter in the way the alliance had been asking it to do up to then. In the course of being interviewed on the RTE programme, "This Week", 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 p.m. 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 con sider 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.
It said it was available for talks in that context. Later on Sunday 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 Monday.
I met the representatives of the Nursing Alliance on Monday in the Department's offices. The most important achievement of that meeting was the mutual recognition of the problems which exist on both sides. I found the meeting helpful and constructive and it provided for a useful exchange of ideas. Both parties agreed to go back to their respective social partners in the partnership and seek help in trying to find a process which will allow for the resolution of this dispute.
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 a process in place that will lead to a successful outcome but will not of itself have any harmful or knock-on effects. I am anxious to explore the possibilities of doing business in this way and ensuring that the social partners, Government, employers and Irish Congress of Trade Unions are fully involved. I do not want the social partnership that we have built up to fall down around us during any forthcoming negotiations.
Due to 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 keep arguing over old scores. I am anxious to ensure that any new process or 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.
There must be trust in the social partnership model to ensure that both sides in this dispute 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 mine, to ensure that we get this process agreed by the social partners and I have indicated to the Government that any such initiative should have the imprimatur of the social partners. We have common ground where the representatives of the employers and unions would work together quickly to devise such a process which would deal with these issues in a manner that is satisfactory to the parties concerned.
The House will be aware that the nurses' strike has impacted on many people through the cancellation of elective surgery, the closure of day services and the cancellation of outpatient clinics. The Health Service Employers Agency, HSEA, has been in discussions with the unions regarding the provision of emergency and essential nursing cover prior to the strike. Some progress was made at these talks 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 that it is not the intention to compromise patient care and I am prepared to accept that.
I would also like to put on the record that the co-operation between the management and union sides, where they have agreed and provided emergency cover, is very much appreciated. I know that those plans were put in place to try to keep the inconvenience of the public to an absolute minimum. The reports available to me to date from around the country bear this out and indicate that thankfully there have been no major difficulties on the ground so far. The acute hospital services are continuing to cope with the disruption arising from the strike but constant monitoring and continued co-operation are required for the duration of the strike.
In general, all day services with the exception of dialysis and chemotherapy have been cancelled. Fracture, warfarin and ante-natal outpatient clinics appear to be operating countrywide with additional outpatient services in ophthalmology, paediatrics cardiology, diagnostic breast and hepatitis C available in some regions. Accident and emergency departments are either quieter than normal or no busier than would be expected for the time of year. In-patient bed availability is generally adequate with a high proportion of vacant beds in most hospitals. The level of closed beds varies greatly within and across regions with up to 50 per cent of beds closed in some hospitals and others with all but normal levels of beds open.
Respite services in nearly every agency providing services to persons with an intellectual disability affected by the strike have been cancelled. Day services, where nurses are employed, have also been badly affected. These services would tend to be 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 the community health area, planned essential services are generally being delivered, which includes nursing service to terminally ill and the long-term sick patients in the community.
In relation to mental health services, psychiatric hospitals are operating with some disruptions while outpatient and day care services are generally not operating. In general, services for older people are operating in accordance with locally agreed plans. Day care and respite services are generally not operating. Residential services and public health nursing services are operating with disruptions. I felt it was important to bring the House up to date on those matters, given the position as of this evening.
It is clear that the report of the Commission on Nursing will feature in the process that we are trying to put in place to resolve this dispute. I reiterate that the Government remains fully committed to the implementation of the recommendations contained in the commission's report. While all the attention has been concentrated on the three pay-related recommendations, the commission made 200 other recommendations which are designed to tackle the underlying problems within the nursing profession and to develop nursing as a key profession within the health service.
I believe the commission has taken full account of the future realities within which nursing must be sustained and developed as a profession. The commission has provided a framework for improving the way that nurses are managed, for involving them more in decision making, for providing them with new career pathways and for empowering them generally. 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 ordinary 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 would like to 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. In the area of 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.
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. Since the Commission on Nursing'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 in total the number of members of the nursing profession who are directly involved in contributing to the formulation of overall national policy on nursing. This demonstrates my firm commitment to ensuring that, within my own 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 running hospitals and other health care institutions better 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.
My Department is involved in a joint partnership initiative with the Irish Nurses Organisation 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 on Nursing, 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 Depart ment, the Irish Nurses Organisation 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.
I am currently 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 for the creation of 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 over-emphasised. It will provide them with a new clinical career pathway that does not exist at present, 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 be coming 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.
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 overshadowed 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 for developing the role of nurses and midwives within the health services. It is my fervent wish that the moves that are currently under way to find a process for addressing 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.
What I am anxious to do in implementing the commission's recommendations, and I hope that this will soon be possible, is to involve the nursing unions in identifying the priority areas where action is required and agreeing strategies for dealing with them. We all 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. That is not to say, however, that we cannot agree a structured programme for the implementation of the report over a period of time.
I would like to conclude by affirming that the Government is anxious that a process be found as speedily as possible for dealing 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. The Government has welcomed the willingness of the Nursing Alliance to work to achieve this.
Yesterday evening, representatives of the Government met the general purposes committee of the Irish Congress of Trade Unions to explore possibilities in regard to agreeing a viable process, consistent with existing social partnership agreements, for resolving the dispute. A further meeting is taking place this afternoon and it is still going on at this stage. I assure the House that I will do all in my 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.
The General Secretary of the Irish Congress of Trade Unions, Peter Cassells, tonight said that he could see no circumstances under which nurses would not provide emergency cover. He said that there is a close bond between nurses and their patients and that the congress would work with the nursing alliance to ensure that the bond is not broken, and that emergency services continue to be provided.
On Monday last, Peter Cassells said:
Nurses have already shown their commitment to patients by giving their services free to provide emergency cover. Management must not exploit or abuse this good will and generosity. Any such action by management would be damaging to patients and also make this dispute more difficult to resolve.
As Minister, I make it clear that management will not act in that way. Intensive discussions are still going on between representatives of the Government and ICTU. No one underestimates the difficulties involved in reaching agreement on a process for resolving the issues in the nursing dispute. I reassure the House that I am doing everything I can to resolve the dispute within the context of social partnership.
