Dáil Éireann Debate, Wednesday - 3 March 2004
91 Ms McManus asked the Minister for Health and Children the steps being taken to address the continuing serious shortage of nurses; the number of nursing positions unfilled at the latest date for which figures are available; the steps, in particular, being taken to ensure that qualified nurses remain in the hospital service; the steps being taken to reduce the over reliance on agency nurses; and if he will make a statement on the matter. [7164/04]
View answerThe Health Service Employers Agency undertakes quarterly surveys of nursing vacancies, the latest of which is for the year ending 31 December 2003, a copy of which will be forwarded directly to the Deputy. The survey shows that there were 994 extra nurses employed in the health service in the year ending 31 December 2003 and 788 nurses were recruited from abroad. The vacancy rate now stands at 1.73%, nationally.
While all sectors reported that recruitment was well ahead of resignations and retirements, employers reported that 675 vacancies existed at 31 December 2003, a decrease from 1,021 vacancies in December 2002. However, the combination of utilising agency nurses and overtime adequately compensates for this shortfall. Since the surveys began, the number of vacancies on 31 December 2003 is the lowest recorded. The highest was at the end of September 2000, when employers reported 1,388 vacancies. The latest figure represents a reduction of 51% on September 2000.
The current vacancy rate of 1.73% has been declining steadily in recent years and could be considered to be a normal frictional rate, given that there will always be some level of movement due to resignations, retirements and nurses availing of opportunities to change employment and locations. The recruitment and retention of adequate numbers of nursing staff has been a concern of this Government for some time and a number of substantial measures have been introduced in recent years. The number of nurse training places has been increased by 70% since 1998 to 1,640 from 2002 onwards. A comprehensive range of financial supports has been introduced to support nurses in pursuing part-time degrees and specialist courses, including back to practise courses. Since 1998 nurses have been paid for overtime. Previously they were given time off in lieu and the introduction of payment represents a further significant financial incentive for them.
I introduced a scheme of flexible working arrangements for nurses and midwives in February 2001. Under the scheme, individual nurses and midwives may apply to work between eight and 39 hours per week on a permanent, part-time basis. The figure of 33,442 whole-time equivalent nurses working in the health service translates into 39,119 individual nurses. Of these, some 28,366 work full time, and 10,753 work job-sharing or other atypical patterns. Thus, over one quarter of the nursing workforce avails of family-friendly work patterns.
There have been very substantial improvements in nursing pay since 1997. For example, a staff nurse on the maximum point of the scale has seen a 51% increase in basic pay up to 1 January 2004. There is an increase of over 8,200 during the period from 1997 to the present.
Additional information not given on the floor of the House.
It is clear from these figures that the recruitment and retention measures I introduced are proving very effective. The promotional structure within nursing, including the introduction of a clinical career pathway, has been substantially improved on foot of the recommendations of the Commission on Nursing and the 1999 nurses' pay settlement. The National Council for the Professional Development of Nursing and Midwifery has been especially active in this area and, to date, 1,522 clinical nurse specialist and advanced nurse practitioner posts have been created. Figures from An Bord Altranais for the same period indicate that there is a steady stream of new entrants into the profession, over and above those graduating from the Irish system, thus further increasing the potential recruitment pool. Since 1998, the total number of nurses newly registered by An Bord Altranais is 19,945. Of this number, 13,658 were overseas nurses.
The continuing attractiveness of nursing as a career for school leavers and mature code applicants alike is clearly evident from the number of applicants for such courses. For example, there were 7,507 applications for 1,640 places in the autumn 2003 intake. This means that applications for courses were oversubscribed by a factor of 4.6. This is most encouraging, given that our third level education system provides an ever-increasing array of attractive alternatives. My Department recently gave approval to the roll-out, on a national basis, of the health care assistant training programme. This fulfils a key recommendation of the Commission on Nursing. The main objective of the programme is to upskill health care assistants so that, working under the supervision of nurses, they are enabled to take on a wider range of duties, thereby freeing up nursing resources to concentrate on exclusively nursing tasks.
The HSEA surveys to which I have referred also contain data on the use of agency nurses. The average number of agency nurses used per day in 2001, 2002 and 2003 was 434, 401 and 312, respectively. These figures demonstrate a continuous and substantial downward trend in the use of agency nurses. I am confident that the extensive range of measures I have outlined, including the substantial increase in training places, the recruitment of overseas nurses, the more effective utilisation of the professional skills of nurses and midwives, in addition to close monitoring and assessment of the situation on an ongoing basis, will continue to prove effective in addressing the nursing workforce needs of the health services.
Would the Minister not accept, despite the spin he is applying to make the figures look good, that there are approximately 700 vacancies in nursing posts? Is it not true that by 2005 the 1,500 nurses will not be qualifying yet the Minister is not preparing for or making changes to meet that shortfall next year? Does he not accept that we are not going to be able to depend on overseas nurses coming here? In the Philippines, Ireland is no longer seen as an attractive option. It does not compare well with other countries now who are effectively attracting overseas nurses much more than we are. Would he not accept that the employment ceiling on health boards is having a negative effect on filling nursing posts and that because of it, health boards are being forced to use much more costly agency nurses? Would he not also accept that the promise to open more than 190 beds to deal with the accident and emergency crisis has not been fulfilled partly if not solely because there are no nurses to look after patients in these beds, particularly elderly ones, and therefore beds remain closed?
I am not applying spin. I am stating the facts. These can be ascertained objectively and independently —they are not my figures. Since 2000 there has been a dramatic improvement with a reduction in the nursing vacancies. There has been a dramatic increase in the numbers of nurses in the service by 8,200. In addition there are now only 675 vacancies, or less than 2%.
The Minister should answer my question.
All the partners were anxious to have a degree programme for which we provided substantial funding. While we will work to prevent problems, if such a problem occurs, it should manifest itself in spring 2006. The window of difficulty will occur between spring 2006 and autumn 2006. Under the new degree programme nursing students will be employed in the health service for a 12-month period during their training and will receive a salary. They will commence their rostered service from spring 2005 until spring 2006. They will make a significant contribution to the health services and will help to address some of the difficulties. In addition there will be a cohort of graduates available by autumn 2006. We are working with the Health Service Employers Agency and the employers to ensure that we make provision for that period.
The Deputy is incorrect in suggesting we are not competitive in attracting nurses from abroad particularly from the Philippines. We have attracted substantial numbers of overseas nurses last year and will do so again this year, mainly from other countries.
It is unreal for the Minister to think that is the case. Everybody knows there are difficulties concerning Filipino nurses and that those problems will increase. Is the Minister aware that the nurses qualifying this year are not being given guarantees of work even though the vacancies exist and even though hospital beds remain closed? Due to the employment ceiling, health boards and hospitals are not able to offer any guarantee of work to people who are soon to qualify and who we want to retain in the system despite the great need that exists even though the Minister does not seem to be fully aware of the shortage in meeting the needs of patients in hospitals.
The facts do not bear that out. Almost 1,000 extra nurses were appointed last year alone.
How many extra beds have opened?
The ERHA is working to commitments it has made in this regard. For example the Dublin teaching hospitals recently succeeded in recruiting 135 nurses from India.
We had to go the Philippines and now we have to go to India.
The Deputy is wrong in what she said about the Philippines.
They cannot do without nurses in India.
It is completely unethical.
That has been checked with the Indian authorities and the Deputy is wrong in that regard.
I am sure.
While there has been considerable polemic, comment and campaigning, nursing in this country has been transformed in the past five years because of the implementation of the recommendations of the commission on nursing and because of new practices that have been introduced. We have worked with the partners to achieve this. We have made it a profession by introducing a degree programme and have committed in excess of €250 million towards it.
However we have no nurses.
It is time some of this was acknowledged by all concerned. Back in the early 1990s when Fine Gael and Labour were in power they did not provide adequately in their nursing manpower policies.
The Minister always wants to blame somebody else.
The Government should just open the beds and employ the nurses.
