asked the Minister for Health if he will make a statement on the serious industrial dispute in the Midland Health Board area which has led to the disruption of health services in the region.
Private Notice Question. - Irish Nurses' Organisation Industrial Dispute.
(Laoighis-Offaly) asked the Minister for Health the action, if any, he will take to help to remedy the very serious situation in the Midland Health Board area arising from the one day stoppage by nurses which has brought most services to a standstill in Portlaoise, Tullamore and Mullingar general hospitals and is seriously affecting patients and their families.
asked the Minister for Health the action, if any, he is taking to resolve the industrial action being taken by nurses in the Midland Health Board area and particularly at Mullingar general hospital, County Westmeath.
The issue of the deployment of staff, within ceiling and budget, is a matter for the management of the respective health boards. Individual health boards are in the best position to determine how best to deploy their personnel, having due regard to the different priorities and service requirements throughout their area of responsibility.
The Midland Health Board received approval for the recruitment of 63 additional staff in 1995, which posts related to specific service developments accorded priority within the board's area. The number of nursing staff in the Midland Health Board increased by 4.5 per cent from the end of 1992 to the end of 1994, the latest date for which figures are available, in line with the increase in nursing staff across the whole of the health sector.
The issue of strengthening staffing levels will have to be considered by the board within the general context of balancing all service developmental priorities with the total amount of available funding. In the normal course, staffing levels for individual units within each hospital are adjusted regularly to take account of overall service demands.
The Midland Health Board has agreed to assign a minimum of five additional nursing posts to acute hospitals in 1996 at a cost of £100,000 per annum. It has also agreed to review its staffing levels, in the context of any developmental funding available in 1996, with a view to further increasing the number of nursing staff. The board will also consider what further additions to nursing staff numbers might be required in subsequent years in the context of overall service demands and available resources.
In such circumstances it is a matter of deep disappointment that the Irish Nurses Organisation has seen fit to take industrial action on the scale of their withdrawal today. I should like to be associated with the expression of regret by the Midland Health Board for the inconvenience caused to patients and their families by the action taken. I can assure Members the Midland Health Board has put arrangements in place to minimise the effects of this industrial action. Out-patient clinics have been cancelled, as have all elective admissions, and nurses are manning an emergency service. There has been no report of any breakdown in these arrangements and the hospitals are coping adequately.
Nobody regrets the inconvenience caused more than members of the Irish Nurses Organisation who were forced to arrive at a decision to take industrial action today.
Will the Minister of State say how many of the 63 additional posts within the Midland Health Board area to be filled this year have been allocated to general nurses in whose sphere this dispute has arisen? Will he confirm that none of those 63 additional posts has been allocated to general nurses and state why nurses have not been allocated to acute hospitals within the Midland Health Board area since his Department was prepared to sanction those additional 63 administrative posts?
The health board sets its priorities in regard to its services at any given time. Posts in accordance with the list I have here are not ones that were accorded priority by the health board. Over the past couple of years priority has been given to ear, nose and throat and orthopaedic services within its area of responsibility. Priority accorded to services is set by the health board itself. Following a ballot held in October, the board has offered to provide a minimum of five additional posts in the coming year. I must emphasise that it is incumbent on all parties to avail of the industrial relations processes in their endeavours to resolve this problem and I appeal to them to take that route as a matter of urgency.
(Laoghis-Offaly): Does the Minister of State agree it is most unfortunate that the negotiations being conducted between nurses' representatives and the health board have not yet yielded agreement on this issue? Our hope was that the meeting held on 9 November would lead to agreement. Will he assure patients and their families in the midlands that his Department will do everything possible to get those negotiations back on track, get the two sides together and have this dispute resolved without further delay?
Any disruption of the health services is a matter of deep regret to all public representatives. We regret the parties involved were unable to reach an agreement on the issue before today but I can assure Deputies that the good offices of my Department are available to the parties if it can be of constructive assistance to them. I must stress, however, that the allocation of staff is a matter for the health board itself and that the resolution of this type of dispute must be pursued through the normal industrial relations processes. It is incumbent on both parties to get together and resolve this difficulty in the interests of patients and their families. Today's disruption is something we do not want, and it is incumbent on all parties to see that it does not happen again.
Will the Minister confirm that the Midland Health Board is the only one without a neonatal unit in operation, and that the extra staff required in Mullingar is for this unit? They have a well equipped unit, a lovely building and the expertise to run the unit. All that is needed is the nursing staff. Will the Minister intervene to try to restart negotiations because all there is between the two groups is five additional posts costing, at most, £100,000? Will the Minister assure the House that this unit in Mullingar which will serve the midlands generally will be brought into use?
I would be fully supportive of the provision of broadly based services in any part of the country. I would stress, however, that the requirement in Mullingar has not been listed as a priority by the health board and that must happen before it can be considered. As to the request that the Department make known its goodwill and its wish that both parties engage in meaningful discussions to bring the present impasse to an end, I can confirm once again that this will be done.
In or out of office, we all clap ourselves on the back when there are fresh developments within the health services, particularly the opening of new clinics and the development of new technologies which lead to earlier diagnoses, cures etc. This has happened in Mullingar with the neonatal facility. The Minister is merely stating what he has been told, but I have been informed that the fact that nurses have not been allocated for this particular speciality in Mullingar Hospital is a major part of the shortfall in question. The Minister should check his facts. I read an account of a Midland Health Board debate in one of the local papers which gave that issue high priority. It is extraordinary, therefore, that we are talking about five extra posts over three major hospitals catering for a huge number of people with, over the last three or four years, very large developmental services augmenting the core services in those hospitals. It is the old story; the area with the biggest muscle gets the personnel and those who do the work, in this case, the general nursing staff, do not get their due reward. What they have put forward is the minimum. They did not go all out and ask for 40 or 50 new posts. They said their base line was 21 and what is being offered is five posts over three general hospitals. It is a ridiculous offer and I would ask the Minister of State and his senior Minister to come up with something more realistic.
I would stress again that the prioritisation of areas is a matter for the health board.
That is a cop out.
It is no cop out. It is up to the health board to make the Department aware of its priorities. If that recommendation comes to the Department of Health it will be examined. There is a raft of services that each health board provides, and it is up to the health boards to list their priorities.
They are understaffed and underfunded, and the Minister of State knows it.
I note that Government Deputies are expressing regret at the situation. Is the Minister aware that at a public meeting in July, attended by public representatives from the Government and Opposition, it was indicated by Government representatives that they had full confidence that the Minister would seek to rectify the situation and meet the legitimate demands of the INO representatives at the meeting, that a meeting was offered with the Minister, that such a meeting did take place in August as a result of which the INO representatives were informed that the additional posts would be made available in 1995 and in 1996, and that when they went back to the health board to discuss the detail of that they were told there could be no increase in staff until 1996? Is the Minister aware that that is the understanding of the INO representatives who attended the meeting in the Department of Health?
Regarding the health board itself, the Minister suggests that this is all a matter for the health board. Would the Minister agree that, through all the rationalisations of the 1980s, the Midland Health Board, including all its members from all political parties, has been the most responsible and co-operative health board in the country? Would he agree also that, year after year, the Department of Health refused to give increased allocations based on requests made by the management of the health board for extra resources, particularly extra nursing staff? Will the Minister agree also that the nursing levels in these three hospitals are way below the national average and that the offer being made by the INO to agree to an interim measure of ten posts is the minimum that any representative organisation could, in good faith, be asked to accept? Rather than engaging in a typical departmental cover of suggesting that it is a matter for the health board, the Minister should fulfil the commitments given by public representatives on the Government benches. Will the Minister agree that a fair and honest appraisal of the situation should mean that the five posts for 1995 should now be allocated as indicated at the meeting with the Department of Health? Will he agree to find the funds for a much stretched health board which has been the most co-operative health board in years?
I cast no aspersions on the Midland Health Board. Regarding the meeting the Minister had with the Irish Nurses' Organisation which took place at their conference in Drogheda in August 1995, he listened carefully to the comments made. During the course of the meeting he explained the framework within which the provision of any additional staff has to be considered. This includes the consideration of the current Government policy on public service recruitment and the observation of budgetary constraints. That is my report of the meeting to which the Deputy referred.
Is the Minister suggesting that the Government's own embargo is stopping the making of these appointments?
I am making the record clear.
It is good that the public should know that.
Health boards make their priorities known to the Department of Health. The provision of nursing staff for a maternity/neonatal care unit has not come through to the Department as a priority. That is the point.
I would ask the Minister to check his facts.
The Deputy is speaking about comments made at a public meeting as distinct from what has come through to the Department from the health board.
It was a meeting of the health board.
It was a public meeting of the health board.
They are all supposed to be public, and accountable, transparent and open.
Fianna Fáil are when it suits them.
The Government never is.
The Minister need not talk about that.
They are open and transparent when it suits them.
Can we keep to the debate about the nurses?
I can give the Deputies opposite a few examples.
The Minister of State should take a tablet or send for a nurse.
There is the Horgan's Quay site——
I know the Minister of State, Deputy Doyle, will want to help the Chair in ensuring that we get through this business.
We have moved a long way from the subject matter of the question.
There is an inordinate number of Deputies offering and I wish to facilitate all of them. However, I can only do so with the co-operation of their colleagues. If I get that co-operation and Deputies are brief I will facilitate all those who wish to contribute.
Is the Minister aware that in the general hospital in Tullamore two nurses look after 52 patients, some of whom are in acute wards, between 8 p.m. and 8 a.m? The Minister, his Department and the Midland Health Board have been informed about this problem. Does the Minister not agree that these patients are entitled to a better service? In regard to acute, accident and emergency services there has been an increase in output of 48 per cent. This has been achieved by the overstretched nursing staff, consultants, doctors and other personnel involved. My information is that at least five additional nurses are required in the Tullamore hospital alone. Even though all the machinery for dealing with industrial disputes has been looked at, we have the regrettable situation where clinics have been closed down today. Will the Minister allow the dispute to continue to the extent that it becomes acute? Does he think it is proper that two nurses should have to care for 52 patients between 8 p.m. and 8 a.m?
The Minister seems to think it is.
This is an industrial relations issue and I am not going to get involved in debating the nitty-gritty of the problems which gave rise to it. I agree with Deputy Connolly that the dispute is regrettable but we should seek to be constructive and encourage the parties to reach a resolution so that the difficulties which have arisen for patients today do not arise again.
Why has the matter been allowed to reach this stage?
If Deputies are to be allowed one more round of questioning then brevity is essential.
The Minister of State failed to answer my first question. Will he explain why not one of the 63 posts filled by the Midland Health Board this year was in general nursing, the area where this dispute has arisen? Why was the INO proposal, under which it was willing to accept half its original claim as an interim solution, not taken up? What action did the Minister take in his Department to try to avert this dispute since he met with the INO on 31 August last?
He took no action.
Let us hear the Minister's response.
The service provision required is a matter for the health board and industrial relations between the health board and its staff rests at that level. When the health board identifies within its consultation process particular priorities they are sent forward to the Department of Health which looks at them as favourably as possible in the context of the funds available at that time. There is no embargo on posts in the health service.
I am glad to hear it.
That means there is no reason additional nurses cannot be appointed.
In other words, there is an open playing field.
I wish to conclude my remarks on this point——
What about the 63 posts, none of which was in the general nursing area?
There is a time limit on the debate.
The posts were provided in line with the priority requirements of the health board.
So the health board is the baddy.
The increase in nursing staff in the Midland Health Board area between 1992 and 1994, the last period for which figures are available, was in line with that which obtained across the entire health service.
That is not true.
We can argue these points in the House but at the end of the day it is the parties on the ground who will have to resolve the dispute. If and when other priority proposals are submitted to the Department of Health by the Midland Health Board they will be considered in the context of the funding available at that time.
What the Minister is saying is that the Department has no responsibility.
The Minister was told about the matter on 31 August.
I agree with my colleagues that the Midland Health Board has been severely penalised for complying strictly with the guidelines laid down by the Department of Health. It has received very little thanks for this co-operation. Does the Minister agree that the nurses, the front line providers of the health services, are working under extremely severe pressure in the three general hospitals in the Midland Health Board area?
We know that.
Steps must be taken to upgrade the nursing levels on the wards to those comparable in other hospitals. The problem is clearly being caused by a lack of nurses to provide the services. Will the Minister consider utilising the machinery available in the Department of Enterprise and Employment to try to get the parties back to the negotiating table immediately so that they can solve the problem? The kernel of the problem is that while the services have been expanded and the capital provision has been increased — these are very much welcomed — we have failed dismally to provide a similar increase in the number of staff to keep pace with these improvements. I appeal to the Minister to utilise the machinery available to try to get both sides back to the negotiating table immediately.
We all want to do everything possible to get the parties back to the negotiating table and hopefully reach a solution which will ensure no further interruption in services. I will do everything possible to be of assistance in this regard.
The Minister has done nothing since August.
Please, Deputy.
During his discussions with the INO in Drogheda in August, the Minister made it clear that their grievance could be dealt with by the industrial relations machinery and he pointed them in that direction.
With regard to the new services provided in the Midland Health Board area this year, it would do all of us good to look at the facts. The extra funding was mainly provided for child care and mental handicap services. Nevertheless there are many other priorities. I was responding to Deputy Penrose when I was interrupted——
The Minister of State welcomed the interruption.
When one is lying on one's back in hospital it is a nurse that is needed.
I do not accept that Deputy Flanagan is a baddy, which is what the Minister is painting him as.
(Interruptions.)
Deputy Flanagan did his best but he did not get the money from the Minister.
I am afraid we will not be able to complete this business.
In response to Deputy Penrose, if there are gaps in the services the health board and the Department would wish to deal with these as soon as possible. However, there are competing priorities, which is the problem in this case. The information available to me in the Department is that maternity services have not been made a priority.
The Minister of State is wrong.
As a member of the board I share the concerns of Deputies about the difficulties in the Midland Health Board area. I would be pleased if the Minister of State could prove me wrong on this matter. Does he accept that there are fewer nurses per patient in the acute hospitals of the Midland Health Board area than in any other health board area? If he accepts that, will he assure the House that, before making a decision on the non-capital allocation for 1996, he will meet officials of the Midland Health Board with a view to remedying the problem and making available sufficient funds to bring up to the national average the patient-nurse ratio in that health board?
I am glad the Deputy confirmed I got the figures correct.
I understand that nursing levels in that health board area are roughly equivalent to those of the Eastern Health Board area, but may be lower than others.
They are lower.
If the health board outlines its staffing level difficulties to the Department and pursues the matter by way of priority, we will examine the matter. I will respond to Deputy Flanagan in more detail at a later stage.
The Minister of State is confirming that the figures are correct.
We are talking in circles on this matter. What the Midland Health Board wants is more money to employ much needed nurses. Will the Minister of State ensure that necessary finance is provided for that purpose and forget the blather about intervening priorities. Additional nurses are needed in the Midland Health Board area for which money is required.
All the blather is not coming from this side of the House.
The Minister of State was most unfair to Deputies Penrose and Gallagher.
(Interruptions.)
Let us hear the Minister.
There are many problems in the Midland Health Board area.
The Deputy confirmed that.
This is an industrial relations problem that must be resolved within the health board. The matters prioritised from internal consultations within the health board and brought to the notice of the Department will be considered in the context of the 1996 allocation. Five additional posts in the accident and emergency area are being provided. We should deal with the matter step by step and not try to take all the fences at once. The problem must be resolved within the health board, following which it should outline its priorities to the Department.
I am grateful to the Minister of State for spending some time on this matter. Will he confirm that the overall allocation to the Midland Health Board is more than £60 million a year and that we are talking about an additional £100,000 to solve this problem? Will he confirm that is the scale of the money being sought as an interim measure? He stated on a number of occasions that this is a matter for the health board in the first instance. At what stage does the Department believe it has primary responsibility? This evening nurses are on picket lines in Tullamore, Portlaoise and Mullingar and clinic and in-patient facilities are not being attended to so that those nurses may highlight a problem on behalf of their patients. The Department of Health must come off the fence at some stage instead of shoving the responsibility down the road to Tullamore.
I understand the figure to be approximately £20,000 per nurse. From my long experience in the trade union movement I learned that political interventions are seldom, if ever, helpful in resolving industrial relations disputes. We must allow the health board to resolve the matter, following which it can outline to the Department the areas it wishes to expand.
They want nurses.
The board has the primary responsibility in this matter.
The chief executive officer of the health board informed the Department that a figure of only £100,000 is required to resolve the problem and if that had been granted by the Department there would not be an industrial dispute. The Minister of State was informed of this on 31 August, but as usual, after causing much duress to the patients and nurses, he will now state that after detailed negotiation he will agree to it. He cannot say he was not warned about this problem.
I have not agreed to anything. I described the position and indicated how the dispute should be processed and resolved. It is up to the parties involved to resolve the matter. The difficulties outlined by the Deputies from the constituency regarding service provision should be submitted to us through the proper channel, the health board.
That has already been done.
I am referring to the priorities decided each year by the health board. We should await what is submitted to the Department in that context.