Adjournment Matters

Nursing and Midwifery Board of Ireland

Senator John Crown

I thank the Minister of State who has certainly been serving above and beyond the call of duty in Seanad Éireann today.

The working conditions of nurses are a source of particular concern to me. I know that in a health services such as ours we are absolutely blessed by the presence of an extraordinary cohort of nurses. That they are so much in demand internationally is not a coincidence. We have extremely high standards in terms of education, professionalism and culture.

From the perspective of nurses, it looks as if they are under a sustained assault by the Government. I am sorry to have to say this, but these points have been made to me. Nurses have seen their salaries decrease by 15% or more; they have experienced the same increases in tax that others have, with the impact of the universal service charge, water and property charges. They have found that they have to work harder. One of the unappreciated side effects of the downturn in the economy has been that a number of specific policies which have been put in place have affected the working conditions of nurses who are still in a job. As there has been an embargo on nursing numbers, units that may have had a number of staff above what was officially sanctioned suddenly experienced the non-replacement of staff who had left their jobs. In addition, there has been a rowing back in the use of agency nurses to fill the gaps, jobs that in truth were filled to try to circumvent issues related to the embargo. As a result, nurses are doing more of other nurses' work. The cutbacks in other professional categories in hospitals have meant that nurses are not getting the support of other allied professions and are doing other work that they should not have to do.

I have previously voiced grave concerns about the graduate nursing scheme. It is very difficult from where I sit to see this as anything other than an opportunity to get increasing numbers of nurses working at a lower pay grade. It must be acknowledged also that it is not Civil Service or HSE officials who have to face people when they are confronted with deficiencies in health services as delivered to them. It is usually nurses who have to bear the brunt. In the face of all of this why are they being asked to accept another increase in their registration fee to the Nursing and Midwifery Board of Ireland? This most recent increase means that in a two year period the fee has increased by 80% at a time when the general rate of inflation is approximately 1%. What extra service or what extra duties are being included in the job description of the Nursing and Midwifery Board of Ireland?

The representations I have received from nurses and their representatives suggest the two functions of the Nursing and Midwifery Board of Ireland are, first, to take their money and, second, to discipline them. Nurses are not seeing anything such as career advancement, the protection of the profession or the setting of appropriate standards. They are very troubled by this. They believe the board has not been a powerful advocate for their working conditions. For all of these reasons, they are wondering why they are being asked, uniquely among the health professions, to accept such an extraordinary increase in their registration fee compared to other allied professionals or those involved in medicine. I remind the Minister of State, as a long-standing supporter of trade unionism, that nurses are still a very highly represented group.

I am glad about this. If it had not been for the strength of the representative organisations conditions of employment would have been worse. It is important to realise that nursing organisations are very concerned about the latest increase and consider it a bridge too far. There has been a march towards increased austerity, deteriorating working conditions, less worker satisfaction and increased contribution demands. Nurses are now being asked not to pay the full newly increased retention fees that are being demanded. They are suggesting the standing orders be amended to pay the old fee. If this happens a huge number of nurses would not be able to turn up for work the next day because they would not be legally registered and would not be indemnified for professional activities.

I ask the Minister of State to use her good offices to look at this matter critically and find out why this body needs such a large increase in such a short period at a time of low general inflation. What is being done with the money? I ask that the actions of others be followed and that there be a freeze on allied health registration fees for at least three years and until there is a change in the working conditions of some of the most hard-working, under-appreciated and unrewarded members of our health service.

Minister of State at the Department of Health (Deputy Kathleen Lynch)

I concur with the Senator but doubt nurses are under-appreciated. As both the Senator and I know, they spend most time at people's bedsides in hospital, no matter what kind of traumatic event has occurred. Not only do nurses deal with the person in the bed but they usually deal with concerned relatives too so I do not think they are unappreciated. In different circumstances no Government would contemplate doing what we had to do - everyone had to take a share of the burden. Nurses are not unappreciated; they are hard-working and have had to do extra work due to the fact that the Government had to lower the number employed. The moratorium is being eased and we hope that in the near future we can convert some agency staff to the status of full-time staff, though many agency staff do not want full-time contracts, as the Senator knows. Some people prefer to remain as agency staff as that status can allow flexibility to deal with family obligations and the like. We hope to convert some graduate nurse contracts into full-time contracts as this is only right and proper. The measures we took were necessary due to the circumstances facing the country. I do not wish it to be thought that the Government does not appreciate nurses because it very much does.

I am responding to this matter on behalf of the Minister for Health, Deputy Leo Varadkar, and on conclusion of my formal reply I will convey to him the Senator's concerns on this issue. The Nursing and Midwifery Board of Ireland, NMBI, is a self-funding regulatory body with powers to charge such fees as determined by the board in accordance with the Nurses and Midwives Act 2011. As such it must generate its own income to meet its statutory requirements. The board is an independent body answerable to the Oireachtas. It has the responsibility to ensure it has the financial capacity to undertake all its legal obligations. These costs include an enhanced regulatory process with supporting systems for continued professional development and certain education and training requirements for the professions.

The Department of Health is responsible for oversight of the governance of the Nursing and Midwifery Board of Ireland. The Department has no role in setting or approving registration fees. It was also made clear at the time of the legislation that the board would continue to be self-funding and needed to plan and cost how it would fulfil its legal obligations. Following detailed negotiations with the Executive and board members in 2013, it was agreed in October 2013 that an initial once-off sum of €1.6 million would be granted by the Department to the board to cover 2013-14 costs and that the board would have to increase its income in 2015 to undertake its commitments in the legislation.

On 17 September 2014 the Nursing and Midwifery Board of Ireland voted to increase to €150 the annual retention fee of each registrant nurse and midwife for 2015 from the retention fee level of €100 for each registrant in 2014. The annual retention fee in 2013 was €88 and this, as the Senator already pointed out, amounts to an 80% increase in two years. In a recent letter to all nurses and midwives the president of the board explained that the "decision to increase the fee was taken after a democratic vote and much debate" by the board. He stated the increase was necessary "to ensure NMBI can continue to perform its regulatory functions effectively."

The Minister is aware that a campaign not to pay the new fee is actively underway among the staff associations. His Department has written to the president of the NMBI indicating concerns regarding the possible implications for the health service and patient safety should this action continue. It is therefore imperative that the board proactively engages with the staff associations at the earliest opportunity with a view to reaching a negotiated resolution to the current impasse. The necessity to avoid a scenario where non-payment of the fee will potentially become a serious matter for both publicly and privately-funded health services must be an urgent priority for the board.

The Minister has requested that the board give this matter very careful consideration at its meeting on 18 November, with a view to agreeing and implementing a course of action most likely to achieve a satisfactory outcome. It is understood the staff associations have sought discussions with the board in this regard. We ask the board and the staff associations to take appropriate steps to reach a satisfactory resolution to this situation in the interests of patient safety and continuity of care. Irish nurses are some of the best-educated and most sought after in the world and we also ask for such steps to ensure this reputation remains intact.

Senator John Crown

I am grateful for the attention the Minister of State and the Minister will give this matter. I am reassured by the personal attention of the Minister of State and therefore wish to raise some specific questions. Nurses are troubled by the board's lack of transparency. I do not refer to vagueness or waffle in terms of transparency; there are specific concerns. How much is being spent on external consultants? What is the hourly rate? How much is being spent on public relations and legal fees? The professional competence assurance scheme is a statutory duty of the board that was set up by legislation three years ago but it still has not been implemented. This is becoming embarrassing. Nurses believe the board does two things: it takes nurses' money and it disciplines them. Nurses need to see something in return for this money.

National Children's Hospital

Senator Mary Ann O'Brien

The health of children and future generations is in our hands. It is important we do everything in our power to ensure the national children's hospital is built as soon as possible with as little cost to the Exchequer as possible. In the light of the fact that planning permission will not be sought for a maternity hospital at the same time as the new national children's hospital, when will an application for planning permission for a maternity hospital be submitted?

The Minister for Health, Deputy Leo Varadkar, was in this House recently and there was a good debate. I mentioned that Dr. Finn Breathnach contacted me to say how vital it is that a specialist maternity hospital be co-located with the national children's hospital. The life of a baby could be at risk if he or she must be transferred by ambulance rather than pushed across a corridor to the national children's hospital.

The site at St. James's Hospital has become controversial. It is a brilliant adult hospital, but we are trying to build a children's hospital in its car park. I hope the national children's hospital gets planning permission, but I am worried because the board of that hospital has obviously told the Minister that there is insufficient time for architects to have plans ready in time to submit the two planning permission applications together.

What if we get planning permission for the national children's hospital but in a year's time fail to obtain planning permission for the national maternity hospital? It would be a complete mess. I am interested to hear the Minister of State's response.

Deputy Kathleen Lynch

I am taking the matter on behalf of the Minister for Health, Deputy Leo Varadkar, but I have already dealt with it on foot of another question which was raised. It is a pertinent question. Not alone is it a pertinent question, but those of us with an interest in children's health are terribly worried about any other barrier being put in the way of the national children's hospital. We have had too many obstacles and need to push ahead.

As decided by the Government in November 2012, the new children's hospital will be co-located with St. James's Hospital in Dublin 8. The National Paediatric Hospital Development Board has responsibility for planning, designing, building and equipping the new hospital. A project brief has been approved and a design team is in place. The aim is to make a planning application in June 2015. The Government's intention is that a maternity hospital will be developed on the campus in the future, achieving tri-location of adult, paediatric and maternity services and providing comprehensive health-care services to drive improved clinical outcomes for children and mothers. The project brief for the children's hospital acknowledges this key policy recommendation and, accordingly, provides for consideration of future maternity hospital requirements in certain shared service areas. This will underpin future efficiencies in shared services.

Tri-location is consistent with the recommendations of the 2008 KPMG independent review of maternity and gynaecology services in the greater Dublin area. In 2008, the proposal in the report was that the National Maternity Hospital be relocated to St. Vincent's University Hospital, the Coombe Women's Hospital to Tallaght hospital and the Rotunda hospital to the Mater hospital, achieving co-location of maternity and adult services in all cases and tri-location of adult, paediatric and maternity services at the Mater Hospital. With the decision to move the children's hospital to the St. James's Hospital campus, previous plans must be reviewed in respect of the Coombe Women's Hospital and the Rotunda hospital. The relocation of the National Maternity Hospital is already under way. That review is being commenced and will be completed in early 2015. This is the first step in progressing the future tri-located maternity hospital.

As I stated last week in this House, the National Paediatric Hospital Development Board's planning experts have advised that, for a project of this scale, any planning permission application would require significant preparatory work. This, in the board's view, could not be done by June 2015. The Minister for Health has no intention of introducing a delay to the project by requesting the board to seek planning permission for a maternity hospital at this stage. The development board has advised that in submitting its planning application for the children's hospital it intends as a matter of good planning practice - and this is key and was stated in last week's answer - to provide full information on all known future developments for the St. James's Hospital campus, including the tri-located maternity hospital. This will enable An Bord Pleanála to consider the children's hospital planning application in the context of these future plans for the campus.

That is key. We have had the KPMG report since 2008, which is what makes this such a frustrating issue. However, letting An Bord Pleanála know that it is intended to apply for a maternity hospital on the site as well should allow it to do the pre-planning preparation that is needed. In an ideal world, the hospital would have been built by now, but it is not.

Senator Mary Ann O'Brien

"Ideal world" is the correct phrase. The Dolphin report recommended that a master plan should be provided by whatever hospital was chosen. I have written to the Minister for Health, Deputy Leo Varadkar, and made a freedom of information request and the only master plan I could find from St. James's Hospital dated from 2008. It has never had a master plan including a maternity hospital.

We are all human beings and this is vital to the future. We all care so much about children and the future generations and we should be prepared at this stage to take a step back. I go back to St. James's Hospital, the idea of wasting time and the idea that the Minister might consider swapping to Connolly hospital or Blanchardstown for a site. A media report yesterday said the Minister, Deputy Leo Varadkar, had written to the Minister for Public Expenditure and Reform, Deputy Brendan Howlin, to say he did not have the money to put the information technology systems into the children's hospital. The money is only sufficient to build it, not to kit it out. I have not spoken to him since I saw that. If we went to Connolly hospital, we would not only have the space for the maternity hospital, but the cost would be €500 million as opposed to €650 million. I remind the Minister of State that with St. James's Hospital, we started with a budget of €485 million and are up to €650 million now. It was admitted yesterday that we do not have anything in our budget.

Acting Chairman (Senator Marie Moloney)

Please put a supplementary question.

Senator Mary Ann O'Brien

The Minister of State is at the Cabinet table. Why can we not consider a move at this stage? St. James's Hospital has 200,000 tonnes of soil and grit to be removed, which is 10,000 lorry loads. It will take nine months before building can even begin and that is after the planning permission has been obtained. The site is rife with problems and there are signs that we should take a step back and look at the more cost-effective site, which is the greenfield site where we know the space exists now and for future expansion. Whether it is in Texas or Toronto, they have doubled their children's hospitals in size in every decade since they were built. I thank the Acting Chairman for her patience.

Deputy Kathleen Lynch

Having looked at the lack of progress on a national paediatric hospital, there is a terror in saying one will move again given the possible delays it could cause. I understand what the Senator is saying, but I have an awful fear of further delay. We will not be completed in any event until 2019. I do not believe the equipping of the hospital will be an issue at that stage. Hopefully, the economy will have recovered sufficiently. Everyone involved in the project has an awful dread of moving again.

Senator Mary Ann O'Brien

The Minister of State was probably looking forward to having the Mater children's hospital built but that planning permission application was turned down. I hope I am incorrect in my worries and anxiousness that the application in respect of St. James's Hospital will be turned down by An Bord Pleanála. God help us all if that happens.

Acting Chairman (Senator Marie Moloney)

That is a supplementary question.

Family Support Services

Senator Lorraine Higgins

I ask for a review of the policy to no longer fund Home-Start services in Athenry, County Galway. In light of recent Exchequer figures and the more healthy economic position, it may be a good time to review cuts to such essential services.

Home-Start, Athenry, is a scheme through which volunteers offer support to parents and young children through weekly home visits. Volunteers offer emotional support and practical help to parents struggling to raise their children due to lack of support in the context of mental health issues, ill health and relationship breakdown. The scheme has been operating since 2005 and is embedded in the community. People are aware of its existence and it has aimed to help parents become more independent and confidant in order that they no longer need support in the future. There is no doubt about its value. Up to 50 families a year use the scheme through home visits to 15 families at a time, parent and toddler weekly support groups and courses in parenting, stress management, play and cookery. Families find the programme most beneficial on foot of the informality of the home visits undertaken and the way in which it is tailored to the needs of each individual parent.

There is a total of 18 active volunteers and five new ones have just completed preparation courses. They are ready and willing to continue to help families in the area who need their support. Unfortunately, Home-Start, Athenry, has financial support only up to December 2014 and it is fundamental that extra funding of €30,000 is provided as that is what the scheme reckons is required to facilitate its work supporting families in the Athenry area into next year. The funding would be put toward co-ordinators' salaries, travel expenses, training and support and other miscellaneous expenses required to permit this badly needed service to continue to be provided in the area.

It is fundamental that it receives extra funding of €30,000 as that is the amount it reckons it will need to carry out their work in supporting families in the Athenry area into next year. The funding received would be put towards co-ordinators' salaries, travel expenses, training, support and other miscellaneous expenses required to continue with the service that is so badly needed in the area.

There is no doubt it is an essential service for the area. I urge the Minister to consider refunding the scheme for 2015 to allow Home-Start Athenry to continue to provide aid and services for families in need.

Deputy Kathleen Lynch

I am taking this Adjournment matter on behalf of the Minister for Children and Youth Affairs, Deputy James Reilly, and will ensure the Senator's remarks and the reply are conveyed to him. The Minister is not directly familiar with the organisation in question but the Department of Children and Youth Affairs has sought clarification from the Child and Family Agency on the issue raised. l understand Home-Start is an organisation which provides support, friendship and practical help for families with one or more children under five years of age in their own homes. The establishment of the agency on 1 January 2014, as a key priority for the Government, brings together family support services which previously were the responsibility of two State organisations - the HSE and the Family Support Agency. It provides a platform for better integration of these services. With the establishment of the agency we now have, for the first time, a situation where support services for families who need assistance are being provided under one roof and in a more co-ordinated and integrated way than before.

The establishment of the agency forms part of an ambitious programme of reform of services to children and families to which the Government is committed. The reform programme involves a series of initiatives which, taken collectively, are designed to radically overhaul the services for which the agency is responsible. In the area of family support, the responsibilities of the new agency include that of supporting and encouraging the effective functioning of families, with a particular focus on preventative family support services and early intervention. A number of priority objectives are being progressed which will inform future service developments in the area of family support. These include: the development of a strategy for family support and parenting to complement my Department's national policy framework; the alignment of the family resource centres with the overall agency approach to prevention and early intervention; a quality review of the implementation of family support processes in each area as well as the integration of family resource centres within the service delivery framework; and the introduction of Meitheal, the national practice model for all agencies working with children and young people.

Family is the most important influence on a child's life. From birth, children depend on parents and family to protect them and to provide for their needs. Often parents need help and support. Family support services offer a flexible programme of interventions which are provided through a broad range of skilled family support staff. The Senator will appreciate that decisions with regard to the recognition of family support organisations for receipt of funding, are appropriate to the Child and Family Agency in the first instance. The agency has authority under the Child and Family Agency Act 2013 to distribute funding to organisations providing services for children and families.

At local level the agency is in the process of realigning its services across Galway city and county. As part of this process, the Child and Family Agency opened a family support service in September 2013, based in the Athenry primary care centre. The service covers the greater Athenry, Oranmore, Gort, Craughwell, Ardrahan and Claregalway areas. This is being done in partnership with Foróige and the service has five full-time staff. Plans are also advancing to open a similar community based family support service in the greater Loughrea area later this year. The agency is also undertaking a wider review of commissioning arrangements generally with a view to ensuring funded services are provided in line with agency priorities and to ensure there is ongoing evaluation of value for money. The strategy will also ensure best practice and evidence-informed interventions. The commissioning strategy is nearing completion and is due to be rolled out in 2015. The scope of the agency to provide any additional support for organisations engaged in the provision of both family support services such as Home-Start, will be informed by the analysis and decisions on the allocation of funding available to the agency in 2015.

I will ensure the Minister responsible, Deputy James Reilly, will have the Senator's remarks and the reply conveyed to him. I hope that will be of some help.

Senator Lorraine Higgins

I thank the Minister of State. While I acknowledge the references to value for money and best practice it is a pity that all the expertise built up by Home-Start Athenry and the knowledge of the people it has served in recent years had not been integrated into the new service. A mistake may have been made and perhaps it is an issue the Department needs to look at.

Schools Building Projects Applications

Senator Trevor Ó Clochartaigh

Gabhaim míle buíochas leis an Aire as ucht bheith linn anseo anocht agus it cannot be said anyway that they are not getting their value for money out of the Minister of State. If ever a value for money audit is conducted on the number of Adjournment matters and debates she has taken in the Seanad, she will be at the top of the list.

Deputy Kathleen Lynch

Does the Senator think I should get a pay increase?

Senator Trevor Ó Clochartaigh

Táim ag ardú ceiste maidir le Gaelscoil Riabhach, Baile Locha Riach. This is a gaelscoil in Loughrea, County Galway which has made a request for a new school building. I understand it has made a formal application for a departmental review of whether it is a building project, as set out in the Department's three-year building plan, that merits inclusion in the rapid delivery projects. The board of management is extremely concerned that the school build will not go to construction in the 2015-16 school year and believes, for the following reasons, it needs to be included in the list of schools that are part of the rapid delivery project. Gaelscoil Riabhach was included in the ministerial announcement in December 2011 to progress to the construction of a 12-classroom school in 2015-16. Since that date, Galway County Council has assisted the Department in the identification and acquisition of a suitable site in the town for the school.

Sites were investigated through 2012 and a suitable site was identified in 2013. Negotiations failed at an advanced stage. I am informed that another suitable site has been identified and that negotiations are again at an advanced stage. However, even with the speediest expedition with contracts, four months for planning permission and sale would still be required. Following this, a tendering process would mean that it would be late 2015 before any construction might commence. If the project was included in the rapid delivery projects it would ensure an earlier commencement in construction and a project completion date prior to September 2016.

The school has 30 confirmed enrolments for September 2015 and 24 for September 2016. This is prior to its official enrolment period of December to January, during which it envisages an additional enrolment of at least ten children for each of the years. The board of management is tasked with planning for school improvement and has been working on the basis that a school building will be provided by September 2016. Additional accommodation was required last September owing to the appointment of an administrative principal and this was declined by the Department. Additional accommodation will be required in September 2016 on its present site if the new building is not available. Leasing prefabricated buildings at that stage on a year-by-year basis will be expensive for the Department and will require major groundwork on the present temporary site.

At least three of the classrooms are inadequate for the provision of the primary school curriculum in a manner that does not compromise the health and safety of the students. In the past two years the school has implemented the Aistear programme and the volume of the classrooms is limiting its ability to provide this central aspect of the curriculum in a safe manner. By 2016 it envisages that it will be necessary to remove two of the four classrooms, which are less than 45 sq. m. Its landlord, Coiste Dúiche, will remove the buildings but the leasing of two classrooms on short-term leases will require an application for additional funding from the Department. I would appreciate if the Minister of State clarified the position and, in particular, if this application could be forwarded to the rapid delivery project section.

Deputy Kathleen Lynch

I am taking this Adjournment matter on behalf of my colleague, the Minister for Education and Skills, Deputy Jan O'Sullivan. I thank the Senator for raising the matter as it provides me with the opportunity to clarify the current position on the major capital project for Gaelscoil Riabhach, Loughrea, County Galway.

The Senator will be aware of the demographic challenge facing the education system in the coming year. Primary enrolments which have already risen substantially in recent years are projected to rise by almost 37.000 pupils by 2016 and they are set to continue to rise, with a likely peak in 2019. In order to meet the needs of the growing population of schoolgoing children, the Department must establish new schools as well as extending or replacing a number of existing schools in areas where demographic growth has been identified.

The delivery of these new schools, together with the extension projects to meet future demand, will be the main focus of the Department's budget for the coming years. Loughrea, County Galway, has been identified as an area of demographic growth. In that context, the project to provide a new school for Gaelscoil Riabhach is included in my Department's five-year building plan and listed among those to proceed to construction in 2015-16.

The site acquisition for Gaelscoil Riabhach, Loughrea, is currently under way. The Senator may be aware that a memorandum of understanding between my Department and the County and City Managers Association was signed in 2012. This memorandum fosters increased levels of co-operation and formalises the local authorities' part in identifying and securing suitable sites for educational use. In that context, officials from my Department have been working very closely with officials from Galway County Council on securing a suitable site for a new school building for Gaelscoil Riabhach. I can confirm that a suitable site has been identified and the site acquisition process is at an advanced stage. However, as I am sure the Senator will appreciate, there are sensitivities associated with land acquisition which limits the information which can be provided. At this time I am not in a position to provide further information about the site acquisition.

In the interim, an application for office space was received from the gaelscoil. However, it was advised that it was not possible to accede to its request in view of the general need to prioritise the provision of essential mainstream classrooms for demographic growth and the short-term need, given the inclusion of a new building for the gaelscoil in the five-year plan. I wish to advise the Senator that, subject to no unforeseen issues arising, it is anticipated that the project for the gaelscoil will be advanced into architectural planning with the aim of bringing the project to tender and construction as soon as possible. In that regard, the accommodation project brief for the new school building is currently being finalised and the Department will continue to liaise with the school authority on progress. I again thank the Senator for giving me the opportunity to outline the current position on the major capital project for Gaelscoil Riabhach, Galway.

Senator Trevor Ó Clochartaigh

I thank the Minister of State for her comprehensive reply. She might relate to the Minister for Education and Skills, Deputy Jan O'Sullivan, that there is a fear about slippage. If there is any slippage, it will cost the Department more money and that would be money down the drain. If it is feasible to include it in the rapid delivery project section under the school buildings unit it would be good because it seems everybody wants to try to meet the same deadline.

Deputy Kathleen Lynch

The building of a new school commenced quite near to where I live in April 2014. The children were in it by September. It was quite incredible to watch. Having the same structure and architectural drawings in place for six, eight, 12 or 16 classrooms works. The buildings are not prefabricated with sections being dropped in, rather, they are good quality school buildings with good environmental features. They are well placed and surrounded by good areas. I did not think it was possible to complete a building so quickly. It is a well designed, modern and cheerful building, all the things we expect for our children. Sometimes we forget that the building industry, like everything else in this world, has advanced considerably.

The Seanad adjourned at 8.35 p.m. until 10.30 a.m. on Thursday, 13 November 2014.

Seanad Éireann debate - Wednesday, 12 Nov 2014