I move:
That Seanad Éireann:
requests the Minister for Health in the review of the undergraduate nursing degree to give serious consideration to the proposal that the degree programme should include more training in the area of gerontology, sociology of ageing, dementia and quality of care aspects for older people;
recalls that the review of Nurse Training is due to conclude its findings in September this year and that it will report on (a) the content of undergraduate programmes and (b) the structure of the current degree programmes including the separate points of entry, clinical placement requirements and governance arrangements;
is mindful that Nursing Home Ireland (NHI) has called for increased incorporation of Gerontology into nursing programmes, eg. specifically the sociology of ageing, quality of care aspects and person centred care;
notes that there are specific training courses for those who wish to qualify in the area of psychiatric care which said qualification is recognised;
recognises that there are a significant amount of vacancies in private nursing homes for qualified nurses and that there is a poor uptake of these vacancies by newly qualified nurses;
notes that according to a report published by the All Ireland Gerontological Nurses Association that:
the care needs of residents are becoming increasingly complex which means that a skilled workforce is required;
the relationship between quality of care in nursing homes and factors such as workforce structure are inextricably linked;
most older people in residential settings live with multiple pathologies and the range of medical diagnoses for people currently in residential care is extensive;
recalls that private nursing homes provide care for over 21,000 residents and that there are over 8,000 residential care beds in public nursing homes;
notes that under the HIQA guidelines, each nursing home is required to have a set number of nurses on call depending on the number of patients in residence in the nursing home;
recalls the recently published Law Reform Commission Report on Professional Home Care and is mindful of the findings that:
the majority of people aged over 65 wish to continue living in their own homes for as long as possible;
the proportion of people living in Ireland that are over 65 has been increasing in recent years and is projected to increase at an even greater rate over the next two decades;
notes that the 2011 Census indicates that the total number of people in Ireland over the age of 65 is 535,393;
recognises the urgent need to introduce a streamlined training course specifically for elderly care nursing at all levels so that health care graduates can access the care professional labour market without difficulty;
notes that by taking measures to ensure that there are more suitably qualified carers in Ireland this will reduce the burden of front line services in Hospitals and other primary care units.
Calls on the Minister for Health to consider options of:
that the current general nursing degree programme should include more training in the area of gerontology, sociology of ageing, dementia and quality of care aspects for older people;
introducing a specific Elderly Care (Gerontological) Nursing Degree Course in third level colleges;
that clear guidelines on the codes of practice required for care assistants working in nursing homes be established; and
review how care workers can provide the best care possible for elderly people outside of hospitals.
I welcome the Minister of State, Deputy Kathleen Lynch, to the House and thank her for setting aside time in her busy schedule for dealing with this motion.
Thirteen higher education institutes deliver 44 undergraduate degree programmes in partnership with 57 main health care agencies. This accounts for 1,570 places in nursing and midwifery at pre-registration level. The National Qualifications Authority of Ireland, NQAI, has placed nursing and midwifery undergraduate programmes at level 8, honours bachelor degree with bachelor of science, BSc, as the academic award. Five programmes are delivered at undergraduate degree level. There are degree courses for children's and general nursing with 100 places, general nursing with 860 places, intellectual disability nursing with 180 places, midwifery with 140 places and psychiatric nursing with 290 places. There is no specific degree course designed for elderly care, however. According to the 2011 census, there are over 535,393 people aged over 65 years of age. This will continue to increase and over the next 20 to 25 years this figure will reach over 1 million. The greatest growth is going to be in the age group over 80 and we now need to start planning to cater for their needs.
In the motion I have outlined the difficulty that many private nursing homes are having in recruiting qualified nurses. In August 2011, there were over 500 vacancies in private nursing homes and Nursing Homes Ireland organised a national recruitment seminar to deal with this shortfall. In a survey carried out, it indicated that 61% of the nursing homes surveyed had one or more nursing vacancies while 71% said they would be in a position to offer nursing employment in the next 12 months. Those surveyed indicated they would require 1,364 fully qualified nurses over the following 12 months.
The private nursing home sector caters for over 21,000 residents with a further 8,000 residential care beds in public nursing homes. This clearly sets out the demands that exist and also the urgent need to review current training practices. A review group was established by the Minister for Health, Deputy James Reilly, in 2011 and it is to report to him on or before September 2012. Its role is to oversee the review of nursing and midwifery programmes having regard to the objectives of the health reform programme, the future workforce needs of the health system and the need to achieve value for money. The review is to examine the content of the undergraduate programmes and examine the structure of the current degree programmes, including the separate points of entry, clinical placement requirements and governance arrangements. It will also analyse the number of student places required to ensure sufficient numbers of nurses and midwife graduates for the new patterns of service delivery in the public health system.
This review, I hope, will also take into account the needs of the private health care area and, in particular, the requirements of private nursing homes. It is acknowledged that Irish graduates are recognised as being well qualified and this is evidenced by the number of overseas recruitment agencies which visit Ireland annually. However, those who are involved in the elderly care area have a strong view that there is insufficient exposure to appropriate person-centred gerontology or older-person-specific environments and limited exposure to private health care environments particularly private and voluntary nursing homes. It is the view of some people that the co-ordination of clinical placements and the overuse of public placements, predominately in acute settings, does not provide ample opportunity to prepare graduates for employment in primary or community care settings where the focus is on preventive health care, chronic disease management and palliative care.
General nurse graduates commonly have poor knowledge of the process and elements of medication management to include prescribing, supply, storage, administration, stock control and the disposal of unused or out-of-date medicines. Again, this is predominately due to the majority of clinical placements being acute or hospital focused. I have already referred to the demographic changes that will occur. In addition, the dementia advisory committee report, Creating Excellence in Dementia Care 2012, projects that up to 140,580 people will be living with dementia in Ireland by 2040. These demographic changes in the population of older people and those living with dementia indicate the general nursing undergraduate programme must be adapted accordingly. Many of the people who are already working in this area are of the view that general nursing graduates are ill-equipped in accessing and care planning, recognising and responding to symptoms of dementia and communication with patients who have varying degrees of cognitive impairment.
Having consulted several people who specialise in this area, they have suggested the following changes in the nurse undergraduate programme. It must incorporate more gerontology, sociology of ageing, quality of care and person-centred care. It should include a greater emphasis on mental health conditions, particularly neurological conditions such as dementia. There also needs to be an increased understanding and awareness of the role and function of allied health professionals, such as occupational therapists, physiotherapists, speech and language therapists, etc, to enable rehabilitation needs and potential of residents to be recognised and to continue the delivery of therapies outside of specialist inputs. Those clinical placements should include experience in gerontological nursing including caring for those with dementia and more private and public nursing homes should be utilised for clinical placement. The nursing home care sector is highly regulated and therefore it could be argued that the standard of nursing care in these settings is being monitored and approved on a more frequent basis than in acute hospital settings.
The timing of placements should be carefully examined and, for example, should students have a placement in the care of an older person in their first or second year when they do not have the requisite nursing skills or confidence to engage in the full range of nursing duties? In some cases this can result in a poor experience and contribute to a negative view of nursing of the elderly. It is suggested that these placements should not occur until the third or fourth year of the degree programme. The academic year runs from September to June, thus reducing the time available for placement, so should placement take place during the summer months? There should be more direct monitoring during the internship placement to make sure that students are gaining the maximum experience and that they are not being used as a resource to reduce labour costs.
These are some of the issues which require careful examination in the review of the undergraduate nursing degree programme. It is now accepted that we will require over 2,650 additional nurses in the elderly care area in the next ten years. Now is the time to plan to accommodate the changes that are required in existing training programmes and, if necessary, to develop new programmes of education to accommodate the needs of those involved in the elderly care area. We will need growth in the numbers in the next few years. I thank the Minister of State for taking the time with us in dealing with this issue.