Dáil Éireann díospóireacht -
Tuesday, 16 Jun 1998

Vol. 492 No. 4

Private Members' Business. - Student Nurses: Motion.

Mr. Shatter

I move:

That Dáil Éireann calls upon the Government and the Minister for Health and Children to bring forward a package of improved financial support for student nurses which will allow them to undertake their courses in nursing in a proper educational context without undue strain, stress and financial hardship and, more particularly, calls on the Government to provide a weekly non-means tested grant of £75 per week to student nurses; free meals for the duration of their three year programme whether in the designated base hospital or whilst undertaking an external clinical placement or academic studies; full payment to meet the expenditure incurred in the new fourth year degree programme and full reimbursement of the cost of any second temporary accommodation required by student nurses when undertaking external clinical placements away from the base hospital; and further calls on the Government to acknowledge that student nurses are not in a position similar to other third level students as they have a 48 week year working commitment at 35 hours each week and are, as a consequence, unable to take up any part-time employment from which they can generate any meaningful income without undermining their study programme.

I wish to share my time with Deputies Hayes, Naughten and Perry.

An Ceann Comhairle

Is that agreed? Agreed.

Mr. Shatter

In moving this motion on behalf of the Fine Gael Party, I express the view that student nurses have over the years and are currently effectively treated as the Cinderellas of our health system. It is time for us to move away from the Cinderella syndrome and to acknowledge the value of the work undertaken by student nurses and to recognise and alleviate the hardship and difficulty which many of them suffer during the course of their study years.

Nurses play a vital and fundamental role in the delivery of health services and the care of patients. For many years I have been of the view that the role of nursing has been undervalued and under-recognised, and that nurses have not been granted the status recognition to which they are entitled. That this was articulated by many of whose who made submissions to the Commission on Nursing should come as no surprise.

It is in the public interest that student nurses are provided with the highest level of education and training possible to enable them to utilise their skills upon qualifying to the maximum benefit for the patients under their care. It is only in recent years that the need to modernise and revitalise the training and education of student nurses has been addressed. A revised programme for basic pre-registration nursing education and training was introduced in Galway in 1994, replacing the traditional apprenticeship model. This programme was extended to four schools of nursing in 1995, a further nine additional schools of nursing in 1996 and a further 13 in 1997. In 1997, 27 schools of nursing offered a pre-registration nursing diploma programme based on the Galway model. The remaining schools of nursing, of which there are a small number in mental handicap and psychiatry, are completing the transition to the diploma programme in 1998.

The programme is of three years' duration and provides for 4,600 hours of theoretical and clinical instruction. The theory content of the programme, including study time, is of 58 weeks' duration. A total of 86 weeks is allocated to clinical placements, that is nursing practice. Thus, the programme now in place is not simply an academic programme or simply a programme of practical training. It is a mix of both which over a three year period requires student nurses to undertake a 35 hour, 48 week working year.

Over the decades student nurses have played a crucial role in running our hospitals. Today they continue to play an important role within the health system in the clinical placements in which they are involved.

Student nurses are unique compared to almost all other third level students. They undertake a course which is partly academic but which also, over a three year period, involves a substantial practical commitment which greatly benefits the general community. This commitment renders it virtually impossible for student nurses to generate any substantial, separate and independent income by taking up part-time employment. To do so can only undermine their study programme and their capacity to undertake their practical duties.

While, according to the Department of Health and Children, student nurses are no longer officially part of the workforce and are under the new system, to use the bureau-speak in which we engage, "supernumerary and paid a grant", the reality is that while undergoing their practical training and placement work, they are more often than not still providing a nursing service from which the general community benefits. Moreover, the practical training and placement work which is required of nursing students means that they are not integrated fully within the general student body and find themselves perched awkwardly between the education and health sectors. Student nurses have also discovered that the unique and anomalous position in which they find themselves has facilitated an ongoing game of ping-pong between the Departments of Health and Children and Education and Science with regard to the issue of responsibility for the provision of their education, its funding and their grant income.

The Commission on Nursing in its interim report has described the current education system applicable to nursing students and documented numerous concerns and criticisms about the current system which it is expected will be addressed by it in its final report when published in July. It is not unreasonable to expect that the commission will recommend radical changes to the current system. It can be reasonably anticipated that the Commission on Nursing will seek to separate the academic from the practical and provide for an educational system for student nurses which has in its separate components an academic portion and a practical portion. It can be anticipated that in the context of the academic side, student nurses will be fully integrated within the thirdlevel education system, while I hope that in the context of the practical, they will be recognised as not only undergoing a learning and training process but also, while doing so, making a valuable contribution to the health service. This is a contribution which should be properly remunerated.

The recommendations of the commission with regard to education are unlikely to be implemented in full until at least the year 2001 or 2002. Accordingly, it is vital that difficulties with the current structure of education as it affects nursing students, and the inequalities apparent within it, are addressed in the interests of current nursing students and those who will turn to nursing as a career during the next two to three years.

In 1998, approximately 900 nursing students are undertaking the nursing diploma programme. Over the last few months student nurses have been involved in a public protest. They should never have been put in a position where they felt it necessary to engage in such protest. Their protest is understandable. They are rightly critical of the inadequate provision made for them by the State while undertaking their diploma course. In response, with effect from 1 March 1998, the Minister for Health and Children increased the annual maintenance grants from the sum of £2,500 per annum to £3,000 per annum. On a weekly basis, the maintenance grant is worth £57.69 per week. An external clinical placement allowance of £20 per week is also paid to a student undertaking an external clinical placement for the duration of that placement in any case where it is necessary for the student to find accommodation away from her or his normal place of residence and where the health board, hospital or other agency in which the placement is being undertaken is not in a position to provide such accommodation. A student undertaking an external placement who does not require accommodation different from their usual residence is provided with a free bus pass. A book allowance of £200 and a uniform allowance of £120 is also provided for each student commencing the diploma programme. While they are entitled to receive free meals on a seven day per week basis in designated restaurants in health institutions, the reality for many students is that in the context of their academic studies or their practical placements free meals are not available.

The reality for many student nurses is that they are obliged to rely on hand-outs and parental financial assistance and are forced to obtain temporary work during unsocial hours and at weekends, from which they receive limited remuneration. Having regard to their work commitments and practical placements, it is highly undesirable that nursing students be placed in such a position. Official recognition has not yet been given to the fact that in the context of the manner in which the diploma course is currently run, nursing students are not like other third level students. It is not only in their interest but in the public's interest that they should be treated differently.

In reply to a succession of parliamentary questions, the Minister for Health and Children suggested that the total value of supports currently provided for nursing students amounts to approximately £6,000 per annum and that this "compares most favourably with the level of funding available to other third level students". This does not properly reflect the position and is grossly misleading.

The Minister for Health and Children seeks some kudos for the fact that student nurses' fees continue to be paid by the relevant health agency on their behalf and he stated in reply to various parliamentary questions that the average annual fee is £1,300 per annum. The reality is that third level fees for many thousands of other students have been abolished in their entirety. Accordingly, the fee that the relevant health agency is now paying on behalf of nursing students is merely an accounting mechanism. The health agency is effectively paying this fee while the Department of Education and Science is meeting the fees of other third level students.

The Minister in reply to parliamentary questions emphasised that the £3,000 grant paid to nursing students is "not subject to a means test" and he contrasted this with the grant payable to other students. The maximum rate of this grant is £1,624 and it is means tested. However, the Minister is not comparing like with like. The other students to whom he referred are not required to undertake employment or practical training, a 35 hour week for 48 weeks of the year over a three year period, or work under the aegis of a health agency or any other agency.

There are hundreds of student nurses who, if they undertook third level education in a different area, would qualify for the maximum maintenance grant on a means tested basis. They would thus, without having to undertake any practical placements or work, be entitled to £1,624 per annum by way of a grant. How many of the thousands of other students in our third level colleges who are currently in receipt of this grant would undertake a 35 hour working week for receipt of a further sum of £1,400, which equals £26.92 per week?

Unlike other third level students, student nurses must maintain their own rented accommodation for a full year during each of the three years they are undertaking their training and studies. Other third level students need only do so for a maximum period of nine months each year. The additional sum of £20 per week which is made available to student nurses in the event of their having to obtain alternative accommodation while undertaking a clinical placement remote from their own residence is grossly unrealistic. It does not remotely address the real economic cost of providing alternative accommodation for six to eight week periods during their second and third year studies while continuing to maintain the availability of their original accommodation.

The reality is that many student nurses are confronted with real financial hardship. This was clearly illustrated by the fact that 1,000 student nurses recently marched on the Department of Health and Children to call for specific financial improvements to facilitate their undertaking their studies. In this motion, Fine Gael is asking the Government to give to all student nurses the non-means tested grant of £75 per week they are seeking. As already stated, the current grant amounts to £57.69 per week. The increase would give student nurses an additional £17 per week in round figures. The overall effect would be to increase the annual grant from £3,000 per annum to £3,900. I am calling on the Government to agree to so increase the grant.

It is unfortunate that, in opposing the motion, the Minister has merely tabled a brief countermotion congratulating himself on the minimal increases he provided on 1 March last.

Mr. Cowen

How many increases were provided by my predecessor, Deputy Noonan?

Mrs. Owen

That is not relevant, the Minister holds the purse strings now.

Mr. Shatter

It is worth putting the current grant into a certain perspective. The current sum of £57.69 payable to student nurses can be contrasted with what each student nurse would presently receive if in receipt of unemployment assistance. A recipient of short-term unemployment assistance is entitled to £68.40 per week while a recipient of long-term unemployment assistance is entitled to £70.50 per week. Consequently, we currently pay a larger sum weekly by way of unemployment assistance than we make available to student nurses undertaking practical courses and effectively working for the benefit of the community for 48 weeks in the year.

The position of solicitors' apprentices, with which I am familiar, can be favourably contrasted with that of student nurses. When the Minister for Health and Children increased the student nurses' grant on 1 March l998 to £57.69 per week, by coincidence, the Law Society of Ireland issued its revised scale of salaries for solicitors' apprentices, which are also applicable from the same date. During his or her first six months in a solicitor's office, an apprentice solicitor must be paid £135 per week, for the second six months £145 per week and thereafter the sum of £155 per week. These salaries are paid to solicitor's apprentices after they have completed a six month academic course in the Law Society. However, even before undertaking the professional course in the Law Society, if a solicitor's apprentice undertakes practical work in the office to which he or she is apprenticed, the solicitors' guidelines recommend that he or she should receive a minimum sum of £105 per week. As a member of the legal profession, I do not believe it is correct that as a society we attach greater value to work of solicitor's apprentices than we attach to that of student nurses during their study years.

The demand made by student nurses for a non-means tested grant of £75 per week can be seen to be exactly what it is: extremely modest, when contrasted to payments made to those apprenticed to professional legal practices. It is even more modest when contrasted to the payments we make in respect of unemployment assistance.

The Fine Gael motion before the House not only calls on the Government to increase the grant to £75 per week to student nurses but also calls on it to ensure that the free meals to which they are entitled are made available to them. The fact that free meals are not being provided where lectures are being undertaken in third level institutions and that the Department of Health and Children has declined to meet the cost of such meals is a clear breach of the original terms surrounding the interim model for nursing education.

The final issue to which I will refer is of substantial importance, namely, the refusal of the government to abolish the fees for students undertaking the Bachelor of Nursing degree course — a one year course in UCG — which will be offered by at least two other universities, commencing in 1999. I understand that 52 students are currently enrolled in the course at UCG. In reply to parliamentary questions to the Ministers for Education and Science and Health and Children to provide an exemption from fees for those undertaking this course, the Department of Education and Science essentially washed its hands of the issue stating that nursing education is a matter for the Department of Health and Children. The Department of Health and Children also washed its hands of the issue by stating that, having previously completed the diploma course, student nurses are entitled to register as nurses and are not compelled to undertake the degree course.

The fee for the degree course amounts to £1,965. The course comes under an undergraduate category and the general rule is that students do not incur fees for the first full-time undergraduate course undertaken by them in university. At least that is the general rule applied by the Department of Education and Science. Nursing students undertaking the one-year degree course are essentially the only full-time undergraduate students in a State-funded college in the Republic who do not qualify for free fees. It is entirely unjust and inequitable to single out one group of students, whose additional training and education is profoundly to the benefit of the community and health service, in this way.

I predict that the recommendations of the Commission on Nursing — to be published in July — will ultimately provide for an educational system in which nurses undertaking training in the future will first enter into our third level colleges to obtain appropriate degrees of an undergraduate nature, which will be fully funded by the State. Why should those nursing students who this year are participating in the degree course in UCG and who during the coming years will undertake such degree courses having completed the diploma course, not be exempted from undergraduate fees as are all undergraduates at present and as also will those who follow them following the implementation of the anticipated recommendations of the nursing commission?

As medicine becomes more specialised, as medical technology becomes more complex and as greater emphasis is placed on community services there will be an increasing number of jobs for nurses in the coming years. We are already experiencing a shortage of nursing staff throughout the hospital system. In 1997 the total intake of student nurses was 1,139 as compared with 1,368 in 1995. There was a drop in 1997 of almost 200 in the numbers of those who see their future in nursing undertaking studies in this State. While this year there may have been an increase in the number of students over and above those in 1997, there is a growing crisis in the numbers available for nursing within our health services.

There are many reasons for the shortage of nurses and for the reduction in the number of students undertaking nursing as a career. It must be an objective of our health and education system to encourage young people into nursing. However, the Government's actions are having the opposite effect. If the House was to reject this motion it would send the wrong signals.

I ask the Minister to withdraw his amendment and invite the Government parties to join with the Fine Gael Party in their support for the motion. They should provide student nurses with the additional resources they require. I call on the Independent Deputies, on whose votes the Government is dependent, to back the Fine Gael Party in the vote on the motion in the interests of the well-being of our health service and its student nurses who, in their professional careers, contribute so much of value to all of those who come under their care.

Mr. Hayes

I speak for Members from all sides of the House when I say it is a great source of embarrassment to the Dáil and to politicians who represent constituents on a daily basis that this issue must be debated here. The sum of money involved is not colossal. It will not change irreparably the Estimates for a given year. A small amount is involved and the issue should have been resolved through consultations between the Departments of Health and Children and Education and Science. It is a matter of embarrassment that a university and student group in Galway had to take an action against the Minister for Education and Science.

There is support in the country for nurses, especially those entering the fourth and final year of their course, which is the only course at university level to charge tuition fees. The motion seeks to apply a level playing pitch because it is wrong to discriminate against a relatively small group of people in college. Unlike other students, who have only 15 hours of lectures per week and a few tutorials and hang about lobbies drinking coffee, student nurses work 35 hours-plus per week and make a valuable contribution to the health services. It is wrong that a bureaucratic mess between the Department of Education and Science and the Department of Health and Children should have been allowed to get to this stage.

It is critical that the career of nursing be made attractive to young people. There is ample evidence that insufficient numbers wish to pursue such a career. By virtue of the fact that the tuition fees row has been centre stage as a result of the UCG case and this motion such a career is less attractive to school leavers. That is dangerous and damaging for the caring tradition and the support for it in the community.

I ask the Government to rethink its position. The matter can be resolved overnight. There would be support in the community if the Government lifted its embargo on fourth and final year students and made a concession to nurses.

Mr. Naughten

I compliment Deputy Shatter for moving the motion. We have reached the ludicrous situation where health authorities now have to advertise nursing posts in countries as far away as Iceland and Finland. Matrons are unable to find nursing staff and the position is reaching crisis point in some hospitals. For example, a hospital in Dublin has 46 nursing vacancies.

The drop in intake of students from 1,133 in 1989 to fewer than 800 this year, and the increasing cost to students of the new training scheme for nursing staff, is compounding the problem. Student nurses are now in the unfortunately unique position of being the only university students not in receipt of free fees for the duration of their undergraduate degree course.

The Department of Education and Science, the Department of Health and Children and the Higher Education Authority have engaged in discussions on this issue since last October, yet no decision on funding has been made. Both Department are pen-pushing the issue by passing the buck from one Department to the other. Student nurses are suing the Minister for Education and Science for discrimination as they face fees of up to £2,000 for the final year course in UCG. Those students, who have just completed a three year diploma course funded by the Department of Health and Children, are caught in an internal power struggle between the Minister's Department and the Department of Education and Science. It is time for the two Ministers to stop the petty bickering and provide funding for final year nursing students.

The cost to a student of living away from home is approximately £5,500 per annum, yet even the maintenance grants of £3,000 per annum, generous by comparison with those available to other third level students, cannot cover the overheads facing nursing students. With increasing costs of rented accommodation fuelled by the Government's recent new housing policy and the suggested 10 per cent rise in CIE fares many student nurses find themselves forced into taking up second and even third jobs doing unsocial hours and at weekends to help make ends meet. This is untenable when one considers that the nursing course is 35 hours per week, 48 weeks per year.

I urge the Minister to provide adequate funding to ensure the survival of student nurses while in college. He should immediately introduce a weekly non means tested grant of £75 per week as recommended by the INO. This amounts to something short of £4,000 per annum and is a meagre sum compared with the cost of going to college, which can range from £5,500 to £6,000 per annum. Even with this grant student nurses would still have to be subsidised by their families. However, it would provide a basic weekly wage for students who are currently providing cheap labour for our health service.

The Minister must also provide additional student places to curb the staffing shortfall within many of our hospitals. Even with the current inadequate level of funding many of our prospective nurses must travel to England to receive their education. Many of them remain in the British health service on completing their studies. It is morally wrong to see so many of those young people heading to England when there is a severe shortage of nursing staff here. It is the Minister's duty to ensure additional places are provided in the current academic year and I urge him to do so.

In the current economic climate the Minister has the opportunity to meet the demands of the small number of students concerned, a group who are vital to ensuring the provision of a proper health service which meets the needs of communities throughout the country. I urge the Minister to provide the necessary funding. It is ludicrous that students in NUI Galway are taking the Government, the Minister for Health and Children and the Minister for Education and Science to court to get their basic right to free fees to which every other student in a university is entitled. It is another argument whether other courses should be provided, but the students concerned will have a university degree on completing their studies and they should be given adequate funds which they deserve. I urge the Minister to do that.

Mr. Perry

I call on the Minister to review this matter and to bring forward proposals to deal with it. Student nurses who have a 48 week academic year and work 35 hours a week are seeking a non-means tested grant of £75 a week. They should be entitled to free meals for the duration of their three year programme, whether based in a hospital or undertaking external clinical placement or academic studies, and full reimbursement of the cost of any temporary accommodation required when undertaking external clinical placements.

Given the current rate of inflation, our booming economy, the number of jobs, the difficulty of retaining nurses and the INO's warning about the serious shortage of nurses, we should be encouraging students to train as nurses. While nursing is a fantastic profession, it is hard work which demands a great deal of skill. Often student nurses have to rely on getting money from their parents or have to take up jobs outside the hospital. It would be appreciated if the Minister would consider increasing support. While there is an intake of only 800 student nurses this year, increased support would make nursing a more attractive career to students. In this technological age and with the advancement of other careers, nursing is no longer perceived as the be all and end all of jobs, as was the case in the past.

A newspaper article states that it has always been a problem to retain nurses. Hospitals find nurses who have completed three years' training leave to go to university to complete the fourth year of the degree programme and it is difficult to replace them from within the hospital. There has been a growth in the number of nursing homes in rural areas and many nurses opt to work in those homes. That puts constant pressure on hospitals to maintain the level of their nursing staff.

Often nurses working in private nursing homes complain they are paid less than the minimum wage. That also presents a problem. Nurse training involves 156 weeks and demands great dedication and major commitment. There is less incentive for students to pursue a nursing career when trained nurses are paid such a low wage in the private nursing home sector. I ask the Minister to consider the wage levels in that sector and I appeal to him to increase the level of support for student nurses. The State has benefited from an excellent health service and dedicated hospital staff, particularly nurses. Irish nurses working abroad are instantly recognised as dedicated and well trained. The allocation to student nurses must be increased if the nursing profession is to be sustained by making it attractive to students.

The registered nursing diploma programme involves 156 weeks, including 58 weeks of theoretical training. As outlined in the nursing board's 1994 syllabus there are 29 weeks theoretical training in the first year, 18 weeks in the second year and 11 weeks in the third year. Two thirds of the three year programme involves nursing studies, one sixth involves biological studies and one sixth involves social science. The application of the biological and social science studies is incorporated in nursing studies and nursing practice components of the programme are completed in years two and three. Nurse training involves a major level of commitment and hard work. Student nurses have a demanding role working at the coalface in theatres and caring for patients at the bedside. They work 48 weeks of the year and nurse training cannot be compared to university or institute of technology courses. Student nurses are practically doing a full-time job. While student nurses on completing their training will have a qualification, nursing may not appeal to young people because of the level of commitment required and the fact that student nurses only have net income of £60 per week. Second level students who work part-time in my supermarket earn £2.50 an hour, but giving young people of 18 years a net income of £60 per week for three years while training means their lives are very confined. If we are to entice good students into nursing, we need to increase the level of support to make nursing an attractive career.

I am aware that nurse training will be more university-based in the future, but to make that adjustment in the short term the Minister should increase the level of support. Student nurses get an allowance of £120 per year for books and £200 per year for their uniforms, but their travel costs are their responsibility. Often students live quite a distance from the hospital and their travel costs can be prohibitive. An adjustment in the level of support would be very much appreciated by the INO. In the long-term the Department of Health would benefit considerably because it would entice students who are willing to make the commitment. Nursing is a vocation. In the past it was glorified on TV, but nursing is hard work, particularly during the training years. The competition is high and the bright ones pass the qualifying examination. Nursing is not an easy profession in which to qualify. Every encouragement should be given to the students. It will be of great benefit in the long term.

Minister for Health and Children (Mr. Cowen)

I move amendment No. 1:

To delete all words after "That" and substitute the following:

"Dáil Éireann acknowledges and endorses the measures being taken by the Minister for Health and Children to ease the financial and other burdens on student nurses participating in the nursing registration/diploma programmes."

I have no difficulty coming to the House to put the record of the Government before it so that the House can judge whether it has been reasonable in its approach to nursing students compared to its predecessor. The House can also judge what the previous Government's record was in this regard and make comparisons if it so wishes.

My record is as follows. I have increased the grants for students of nursing at third level colleges by 20 per cent; I have provided special payments to students who are doing clinical placements and who must find new accommodation during those periods; where students do not have to move to new accommodation but must take up their clinical placements from their normal base, I have provided transport passes to ensure that students do not suffer financially; my Department has also moved to ensure that students do not have to pay for additional books during their course of studies in excess of the book allowances which my Department provides and that no unnecessary uniforms need to be purchased outside of the uniform allowance which is made available by the Department.

This contrasts with the record of the previous Minister. No increase whatsoever was given during the years 1995 and 1996 and that position continued right up to June 1997 when the previous Government left office. When the previous Minister left office not £1 extra had been given to the students during his term of office. The student grant had remained at £2,500 during this period, having been introduced in 1994, and was not increased until this year when I reviewed it with my officials. There was not even an allowance for a cost of living increase.

In providing additional funding for the student grant I was greatly influenced by the fact that as currently arranged the academic year for students of nursing is more lengthy and the academic week for the students is more crowded than that of other third level students. I am keen to relieve the pressure on the students, especially during their first year, when the academic part of their course is very significant.

I am also anxious that students should not have to sit two sets of examinations. I recently addressed An Bord Altranais and I asked it as a matter of urgency to examine the situation whereby students must sit both sets of examination. I expect An Bord Altranais to report to my Department with a set of proposals to ease significantly the pressures upon students which arise by virtue of two sets of examinations, one of which is set by the third level college and the other by An Bord Altranais. I have no doubt but that An Bord Altranais will report back to me with a positive revised set of arrangements.

Every Government that comes into office would like to give grants to students at third level institutions which would allow them to have more financial security during their period of study. However, that is an ideal situation and we in Government, who are entrusted with the financial affairs of the country, must balance our obligations to third level students while ensuring that our obligations to the taxpayer do not result in the country spending more than it can afford on any group of people with the consequences that would follow for the economy. The House realises that a balanced budget and continuing steady progress in improving our economy is the route to take and, in balancing the needs of students, workers and services, we can only give a certain amount to any one group.

I am here to defend my record of having made a very significant increase in the grant to third level students of nursing. I also moved to ease their financial burdens in areas where it has been brought to my attention that students had in the past suffered financial difficulties. I am proud of the increase in the grant of 20 per cent, which the House will agree is very significant. Deputy Hayes may claim that this is a matter of great embarrassment to him but I do not recall seeing him particularly red-faced that the previous Minister, his party colleague, gave not an extra shilling to student nurses. I am surprised that his embarrassment only arose from the time of the change in Government. We can do without such nonsense in the debate.

The increase I gave is £500 per student. My main message to the House and the Opposition is that I have increased the grant by this high percentage. I emphasise that it is a grant to third level students — it is not a wage nor a salary. It is not and was never intended to be a financial remuneration for work done in hospitals.

What we are seeing is the transition from the old model to the new one. Under the old apprenticeship model student nurses worked in hospitals and were included on the payroll. They helped out from an early stage and were regarded as part of the staff. What we have now are third level students studying nursing who are not nurses and who will not be nurses for a considerable period. Their studies take place not only within the school of nursing in the hospital but also in third level institutions across the country.

When these students do their clinical placement they are not expected to work as part of the general staffing of a ward. Their placements are in addition to the normal staffing. These placements are designed specifically to ensure the students get not only the academic and theoretical part of the course but are also given the opportunity to have hands on learning in the wards with patients to ensure that what we have always regarded as being best in Irish nursing, that is, the nurse/patient relationship, does not suffer and is not diluted in the move to third level status for students of nursing.

I will set the record straight with regard to the level of funding provided for students participating in the pre-registration nursing programmes of education and training, known as the nursing registration/diploma programmes. Prior to 1994 all student nurses undertook the traditional apprenticeship model of training. Deputies opposite made comparisons with other apprentices. We are trying to move away from the apprentice idea. These students were part of the workforce and received an annual salary. For the duration of their three-year programme they had the status of employees. However, in October 1994 the first of the new diploma based programmes of education and training was introduced by University College Hospital, Galway, in association with the National University of Ireland, Galway. Since then the programme has been extended to other sites. The transition from the apprenticeship model to the revised model will be completed this year in all three pre-registration nursing disciplines, namely, general nursing, mental handicap nursing and psychiatric nursing.

The diploma based programmes are operated by schools of nursing in association with third level institutions. Student nurses who complete successfully the three-year programme are awarded a diploma in nursing from the associated third level institute and are eligible to be registered as nurses with An Bord Altranais, the statutory regulatory body for the nursing profession. It is important to understand that the objective of the changeover to the revised model is to enhance nurse education and training and to ensure the quality of nursing care in hospitals through the replacement of student nurses by qualified staff. This approach is in line with key recommendations contained in the report The Future of Nurse Education and Training in Ireland published by An Bord Altranais in 1994. The apprenticeship model was evaluated by the board and a number of weaknesses were identified which militated against a beneficial experience for the student nurse. These included a lack of preparedness for certain duties, insufficient clinical teaching, an emphasis on work rather than learning and an involvement in non-nursing duties.

The main features of the registration/ diploma programme are the following. Students participating in the programme have the status of third level students for the duration of the programme. Students are supernumerary to service requirements and, therefore, they are not paid a salary. Students register with the associated third level institute as well as on the candidate register of An Bord Altranais and have access to the facilities of the third level institution. Students are examined and assessed by the associated third level institute in addition to undergoing the examination and assessment procedures prescribed in the rules of An Bord Altranais.

Students receive an annual maintenance grant of £3,000 which is not subject to a means test. Their third level fees are paid by the Department of Health and Children through the relevant health board, hospital or agency. Principal textbooks up to a value of £200 are supplied free of charge to students by the participating schools of nursing at the commencement of the programme. They are also supplied with free uniforms purchased for them by the relevant health agency. They are entitled to free meals on a seven day per week basis in designated restaurants in health institutions. All health agencies involved in the operation of the programme have been compensated for the loss of the service contribution made by student nurses under the apprenticeship model through their replacement by a skill-grade mix of registered nurses and other grades. It needs to be borne in mind that students on the diploma programme are students, not employees, and the level of financial support they receive must be considered in that context.

When the first programme was introduced in 1994, the rate of the maintenance grant payable to students was £2,500 per annum. As I stated earlier, the grant did not even attract the cost of inflation increases given to other third level maintenance grants when the rainbow coalition was in office during 1995, 1996 and 1997. Deputy Shatter's party was in Government and there was a Fine Gael Minister for Health. I have been accused of discrimination. Fine Gael could not even pay them the cost of living increase given to every other third level student. They were left with £2,500 per year.

It is against this abysmal record of apathy towards the burdens being experienced by students on the nursing diploma programmes that my record since I took up office must be judged. At the first opportunity I secured a £500 increase in the student grant. This represents an increase of 20 per cent and puts the level of the grant well ahead of what it would have been if Deputy Shatter's party had seen fit to increase it in line with inflation when in Government or if the other parties had asked his party to do so.

Not only did I approve a £500 increase in the annual maintenance grant from 1 March 1998, I also introduced a new external clinical placement allowance of £20 per week. I did this specifically to assist students who are required to undertake clinical placements away from their normal base to gain specialised clinical experience. This allowance is paid where it is necessary for the students to find accommodation away from their normal places of residence for the duration of the placements. I also approved the provision of a free weekly travel pass to students undertaking external clinical placements who do not require accommodation.

The substantial increase in the annual maintenance allowance and the introduction of the new external clinical placement allowance reflects my commitment to address the financial difficulties that students on the programmes were experiencing. What did the previous Administration do for them? It was a big duck egg for three years. If Deputies opposite wish to criticise me for what I am doing, I will simply say they were in office for three years and did nothing about it.

I want to be clear about these difficulties. They did not suddenly emerge this year; they have been there since the first diploma based programme was introduced in 1994 but, because of the inaction of the previous Administration, it was left to me to tackle them. I remind the House that the extra costs of the improved package of financial supports that I have put in place for the students is in the region of £1 million in the current year alone. I also emphasise that students participating in the nursing diploma programmes receive a higher level of financial support than other third level students. As I already indicated, each student nurse now receives an annual maintenance grant of £3,000, which is not subject to a means test. In contrast, other third level students are required to satisfy a means test to qualify for a maintenance grant, the maximum rate of which is considerably less than that paid to students of nursing.

Since the abolition of third level fees does not extend to the nursing diploma programme, the students' fees continue to be paid by the relevant health agency on their behalf. The average annual fee per student is about £1,300. As I already mentioned, a book allowance and a uniform allowance is also provided for each student commencing the programme. They are also entitled to receive free meals on a seven day per week basis in designated restaurants in health institutions. Taken together, the average annual value of the various supports, including the new external clinical placement allowance, is £6,000 per student nurse. By any yardstick, this compares most favourably with the level of funding available to other third level students and more favourably with what was available up until June 1997.

I am aware criticisms have been expressed about certain aspects of the diploma based programme, particularly in relation to the front loading of the curriculum and the fact that it requires a 48 week commitment on the part of the students during the three years of the programme. I accept some of these criticisms are justified. Indeed, as recently as last week, when addressing the first public meeting of An Bord Altranais, I urged the board to examine possible ways in which the burden on students might be eased, including a rule change to address the alignment of the board's examinations with those of the third level institutes involved in the delivery of the programme. The board is anxious to be helpful and I am confident of a positive response to my request.

I also refer to the fact that the interim report of the Commission on Nursing identified a number of issues relating to the nursing diploma programmes. The commission's final report, which is due within a few months, is expected to contain recommendations to address those issues. In addition, the nursing registration-diploma programme is currently the subject of an independent, external evaluation being undertaken by the University of Southampton, under the management of the Institute of Public Administration. This evaluation includes both the general and psychiatric nursing programmes and is due to be completed by the end of July.

I assure the House that it is my firm intention, following the outcome of the deliberations of the Commission on Nursing and the evaluation team, to take steps to improve the programme and iron out the difficulties that have emerged in its operation, not least for the students themselves. This will be done in close consultation with the relevant interest groups. Teething problems aside, we should not lose sight of the monumental achievement that the diploma programme represents in terms of enhancing the pre-registration education and training of nurses, and in linking it to third level. It is almost difficult to believe that the complete transition to the revised model in all schools of nursing has been achieved in the space of little more than four years. I pay tribute to all those involved in the health and educational sectors for their tremendous efforts in developing and extending the programme.

Misinformation emerged in earlier contributions, which I am sure were made in good faith. Deputy Naughten suggested there were only 800 places this year compared to 1100 last year. A total of 1,155 training places are available this year — 781 for general nursing, 201 for psychiatric nursing and 173 for mental handicap nursing. Last year, the figures were 734 for general nursing, 121 for psychiatric nursing and 40 for mental handicap nursing. That was a total of 895 places and they were not successfully filled.

Deputy Shatter's motion includes a call for full payment to meet the expenditure incurred in the new fourth year degree programme. I presume he is referring to the one year full time Bachelor of Science Degree in Nursing Studies course being provided by the National University of Ireland, Galway, for students who completed the first general nursing registration-diploma programme which commenced in 1994. Successful completion of the three-year registration-diploma programme by a student nurse leads to the award of a diploma in nursing from the associated third level institution and registration as a nurse with An Bord Altranais. Upon registration the student becomes eligible for employment as a nurse.

Since a degree in nursing studies is not a requirement for registration with An Bord Altranais and subsequent employment as a nurse, such a qualification must be regarded as an optional post-registration qualification. Registered nurses wishing to undertake a course of study leading to the award of a degree in nursing studies are, accordingly, responsible for making their own arrangements for admission to, attendance at and the costs associated with such courses.

My Department has never given an undertaking to students commencing the registration-diploma programme or to the associated third level institutions that it would provide funding for degree courses. This is reflected in the fact that the agreement into which each student commencing the programme enters with the relevant health agency specifically relates to a programme of pre-registration nursing education and training of three years' duration and one which complies with the rules of An Bord Altranais and the relevant EU directives.

The rationale behind the development by the associated third level institutions of programmes leading to the award of a Bachelor of Nursing Studies Degree is to provide those members of the nursing profession who wish to obtain a post-registration qualification at degree level with an opportunity of doing so. A primary objective is to ensure that existing registered nurses are afforded equal opportunity of access to such programmes, either immediately or on the basis of a short access course.

In moving to the new model it is important not to create a two tier system. Existing registered nurses should, on the basis of equity, be equally entitled to access to the degree course as people fortunate enough to start their nursing career under the new model. I reiterate it was never the intention that the possession of a diploma in nursing would be a requirement for admission to such programmes. Such an approach would be totally unacceptable since it would lead to a two tier nursing structure. I regard it as a fundamental principle of equity that nurses who have qualified, or who will qualify through the traditional system of education and training, should not be in any way disadvantaged in obtaining posts, securing promotion or gaining access to higher education programmes as against anyone coming in under the new system. I remind Deputy Shatter that his party colleague and my immediate predecessor as Minister, Deputy Noonan, also supported this principle.

Dublin City University and Trinity College have developed part-time degree programmes. As far as I am aware, the National University of Ireland, Galway, is the only third level institution offering a full-time course specifically for diploma holders. It would be wholly inequitable to provide funding for nurses undertaking a degree course in one third level institution but not to those pursuing a course of study leading to what is essentially the same qualification in other universities. In any event, the current system of pre-registration nursing education and training is currently predicated on a diploma based programme of three years' duration. Any other arrangement is outside the funding arrangements agreed with the Department of Finance.

I have outlined the position of students and the history of the changeover from the old apprenticeship model to the new third level arrangement. I have given the House an indication of what I have done since coming into office a little over a year ago, which is in marked contrast to the inaction of the previous three years. I have made a significant contribution to the funding arrangements for the students, which is reflected in the substantial increase in their annual maintenance grant. I have also moved to ease their financial situation during the period of their clinical placements, through the introduction of a new external clinical placement allowance. Quality clinical experience has always been regarded as an important element of the course, especially in ensuring that the nurses who come through this new programme will be as highly regarded, not just within this country but internationally, as Irish nurses have traditionally been regarded for many years. I have put my record in office before the House and have no doubt it will be judged as being as reasonable as it can possibly be, within the financial constraints that all of us must work. I have also outlined the history of the change from the old model to the new one.

Within the next number of weeks one of the most important reports on nurses ever to be produced in Ireland will arrive on my desk. I am conscious the Commission on Nursing report will be of such significance that it will change significantly the profession as we enter the next millennium. I have already indicated to the trade unions involved and to the nurse managers at their conferences that the report of the Commission on Nursing will form the most significant part of the policy in regard to the development of the profession for the future. I am also conscious that the Commission on Nursing will make major recommendations and will have a considerable amount to say as to the professional training and development which should be provided for nurses as we move into the next century. I will examine these recommendations in the near future because I expect the Commission to report as planned within the next few weeks, certainly before the autumn. I do not intend to make any other changes in the arrangements until I see this report and know the Commission's views. I think that a reasonable and prudent position to take.

These are exciting times for nurses and students. It is important, therefore, that we build on the present considerable financial arrangements for students and continue to reframe the arrangements for professional education and training over the coming years. It would not serve nursing well if, instead of continuing to have students of nursing regarded as third level students and to seek ways of easing the burden in terms of hours and weeks worked, we almost revert to the old apprenticeship model where students were regarded as student nurses doing some nursing work and paid accordingly. It will not serve nursing in the future if efforts are made to revert to a situation where students are regarded as earning wages and being on the payroll during their period of training when they should be regarded as students off the payroll. I hope the conditions of their education and training will become more akin to other third level students. On any objective criteria, there has been a marked improvement in their present position.

We await the outcome of the Commission on Nursing and commit ourselves to deal with their recommendations within the constraints in which we must work. An Bord Altranais should come forward with further modifications to deal with the problem of two sets of examinations and the front-loading in the first year. In my opinion, this is a genuine response which shows the Government's ability to deal with issues which were totally neglected under the last Administration. It is fine for the Opposition to speak a year after being in Government, but for three years not one extra pound was given to student nurses for this purpose, over which so many crocodile tears are being shed.

Mr. C. Lenihan

I thank the Minister for giving so generously of his time to explain the facts as opposed to the rhetoric. The Government has moved an amendment to the Opposition motion, which reeks of hypocrisy. As the Minister said, the last Government had ample time to rectify the position of student nurses and nurses generally. The pay award it made was given grudgingly, without a view to the long-term or to the prudent management of the national finances.

The Minister had to take all these things into consideration. As he rightly pointed out, this is taking place while nursing is increasingly regarding itself as a profession and taking account of this by developing degree courses and providing a proper system of application for student nurses. It used to be the case that they worked and studied at the same time but that is no longer deemed to be acceptable.

An increasingly important part of the development of modern medicine is the development of new pharmaceuticals and the new technology being brought to bear on the profession. This will mean that nurses must have a broad base of knowledge to develop their work. I saw this at first hand during my father's illness and the changes in the profession were striking. Theatre nurses must grapple at the same time with drug and medicine loads and with new technology which was not dreamed of even five years ago.

It is important that the Government and this House looks positively at the development of nursing and the enhancement of its knowledge and skills base. That is what the Minister is trying to do and as an indication of his good intentions he has already given student nurses the money which the previous Minister denied them by significantly increasing their grant. Unfortunately INO members have rejected this offer in a ballot but student radicalism is not to be discouraged. I would not put them off arguing for the maximum but they are being offered a good increase which was not available previously.

In their work abroad and at home Irish nurses have reflected well on our country. The Minister's intention is to help them develop further and it is a pity that Members opposite have scored another own goal. They came here armed with various facts to fight the student nurses' cause but the Minister has clearly shown that they have made nothing stick and their charges are empty. What makes the public most cynical about politics is the instant outrage which is employed on every occasion.

The Commission on Nursing is extremely important. I am confident that the Minister, in his combative and determined way, will help the nursing profession develop to meet the challenges it will face in the future, given the development of modern medicine. In the not too distant future all nurses may hold degrees as a starting point in their profession. That is something to look forward to as it will bring increased pay and emoluments, and greater status and respect.

Ms Shortall

I wish to share my time with Deputy Wall.

An Leas-Cheann Comhairle

Is that agreed? Agreed.

Ms Shortall

I welcome the opportunity to speak on this important and timely motion tabled by Deputy Shatter. The people of this State owe an enormous debt of gratitude to the nursing profession. During last year's debate on nurses' pay, the esteem in which nurses are held by the community was made abundantly clear.

The previous Government recognised the incomparable contribution nurses make to public health care in this State and managed to fashion a system whereby nurses were adequately rewarded for their contribution. The previous Government was also eager to establish a forum where nurses' concerns would be addressed. The Commission on Nursing, which is due to report in the coming months, represents a significant industrial relations advance for the profession, which I wholeheartedly support.

When in Opposition, Fianna Fáil and the Progressive Democrats were quick to beat their chests and proclaim their solidarity with the nurses. Worthy sentiments, indeed. However, it is when a party is in Government that its real commitment on an issue is laid bare.

The Government's response to the legitimate and genuine case articulated by the student nurses has been dismissive and minimalist. The Minister and the Government have failed to comprehend and provide an adequate response to the student nurses' demands. More importantly, they have pursued this short-sighted course despite the crisis facing health boards and hospitals in recruiting nurses. It is an abysmal policy, dictated by a parsimonious and penny pinching Minister for Finance; if allowed to continue, it will seriously undermine the medium to long-term future of nursing and our public health system. It is time for the Government to realise the error of its ways and immediately put in place a programme of financial and other supports which will address the concerns of student nurses.

The shortage of nursing staff in our public health care system is reaching critical proportions. In recent weeks, newspaper reports have drawn attention to the fact that health authorities are, in desperation, advertising for staff in many countries abroad. In the Dublin area alone, it is estimated there are approximately 800 unfilled nursing positions at present.

I raised this matter with the Minister on Question Time today. His answers and his policy in relation to this matter do not inspire confidence. He has failed to recognise that a problem exists. However, if he took the trouble to speak to the authorities in any of the health boards, big hospitals or private or public nursing homes, he would realise there is a critical shortage of nursing staff. The Eastern Health Board is in negotiations with the INO with a view to setting up a nurses' bank to encourage nurses who are already working full-time to work additional hours in order to fill the huge gap. Many new developments have been delayed because of problems in recruiting nursing staff. The situation is critical and needs the Minister's urgent attention.

For too long, we have taken for granted the recruitment of nurses. In previous years, when economic circumstances were entirely different, the flow of recruits into nursing could be assumed. However, this is no longer the case and there has been a significant fall off in the number of people enrolling in the profession. Young people sitting the leaving certificate have a wide range of career choices and we cannot assume that an adequate number of them will opt to train as nurses. In these changed economic circumstances, we need a vigorous recruitment campaign which will attract young people into a career in nursing. We must be able to demonstrate to young people that nursing represents a very rewarding career.

However, recruitment campaigns cannot be expected to produce results if the conditions of student nurses are so poor and the general structure is so unattractive. The way we structure and resource student nurse training is an essential element in encouraging recruitment into the profession. The Minister has failed to see the relationship between falling student numbers and the conditions under which student nurses must work and study. He has failed to recognise the recruitment crisis facing our health services, which is why his approach to this issue has been dismal.

My party colleagues and I have tabled many parliamentary questions to the Minister for Health and Children and the Minister for Education and Science on this subject over the past few months. In each reply received, both Ministers have been at pains to point out that student nurses fare much better than other third level students in the State. The Minister tried again to make that case tonight. I am constantly amazed by the poverty of analysis which lies behind this claim. It is high time the Ministers for Health and Children and Education and Science realised that student nurses are in no way comparable to other students in this State. Student nurses form a distinct and separate student body; therefore, their concerns and legitimate claims should be treated in a distinct and separate manner.

Mr. Cowen

The Deputy did not think that 12 months ago when she was in Government.

Ms Shortall

It is apparent the Government does not appreciate the huge gulf which separates student nurses from the rest of the student body. The Minister spoke about moving from an apprenticeship system to a third level degree system of training. However, that has not been done in terms of the hours student nurses must put in. We must make up our minds on whether it is an apprenticeship or a full third level training course. Most other third level students work an approximately seven month year, with 15 to 20 hours of lectures a week. That does not compare with what student nurses must do.

Perhaps in this debate the Opposition will succeed in educating the Government to some extent on this issue. I hope the Minister will adopt a new approach.

Mr. Cowen

This is very hard to take — the Deputy has a very short memory.

Mr. C. Lenihan

Deputy Quinn was the Minister for Finance.

Ms Shortall

In stark contrast to other students, student nurses work for 48 weeks of the year.

Mr. Cowen

The Deputy must think people are fools.

Ms Shortall

They have no extended summer holiday period in which they can work to earn money for the forthcoming academic year. They must also pay accommodation costs for the full year, as distinct from the usual academic year for which other students must pay. Student nurses work a 35 hour week. This workload is unique among third level students and it prevents student nurses from taking up part-time employment to supplement their income.

On examination of practically every aspect of the work of a student nurse, it is patently obvious that their teaching, examination and studying structure is unique and cannot be compared with that of other students. The Government has attempted to seek solace in the fact that student nurses receive a higher degree of financial support than other third level students. However, when one examines the facts of the case, it is clear this is a threadbare argument which fails to stand up to any objective analysis. The conditions and financial supports provided for student nurses need to be tailored to their work and study.

It is intellectually dishonest to draw up a league table of student supports and to declare that because student nurses top the league everything is all right. By adopting this comparative approach, the Government may be providing its spin doctors with an angle to peddle to the media but it is doing little else. Most importantly, by insisting on this comparative approach the Government is insulting our student nurses and is failing to seriously address their genuine concerns.

The motion incorporates most of the demands articulated by the Irish Nurses' Organisation on behalf of student nurses. The refusal of the Government to adequately address these demands has led to lunch time stoppages and the recent protest march on the Department by student nurses. On examination, the demands of student nurses certainly seem extremely reasonable. This group of workers do not expect the whole basis of social partnership to be overturned to accommodate their demands and do not expect large financial rewards from the current economic boom. They are a group who have put up with atrocious conditions in the past number of years and who have said "enough is enough". I support them in their campaign.

The student nurses are in effect asking the Government to provide them with the means to have a minimum standard of living during their three year pre-registration course and to be able to do so without having to depend on handouts from their families. Their demands are legitimate and should be met by the Government.

The INO has requested a weekly non-means tested grant of £75 a week for all student nurses. This represents an annual grant of £3,900 per student. I repeat that student nurses work a 35 hour week for 48 weeks of the year. By refusing this relatively moderate increase in the student grant, the Minister is effectively telling student nurses that he does not believe they are worth £75 a week.

Mr. Cowen

Not true.

Ms Shortall

This is a scandal, £75 a week is equivalent to the sum most recipients of social welfare payments receive. It is approximately what most single people on community employment schemes receive, and they work 20 hours a week.

Mr. Cowen

May I make a point?

An Leas-Cheann Comhairle

The Minister is requesting the Deputy to give way for a moment.

Ms Shortall

I have to finish by 8.30, and I want to continue the points.

It is a very small amount of money that barely enables an individual to eke out an existence. It is beyond belief that at a time when Exchequer revenues are so buoyant the Government is prepared to force student nurses to survive on less than £75 a week.

Student nurses and home helps are two groups within the health care system who have been treated abysmally over many years. Now that the Government finally has the resources to make modest improvements in the standard of living of both these groups of workers, it should do so without delay. The fact that the Government stoutly refuses to do so speaks volumes about its commitment to social cohesion.

Student nurses are also asking the Government to ensure that they receive free meals for the duration of their three year pre-registration programme. It is a sad reflection of the supports we currently provide student nurses that high among their demands is a request to be fed properly. The request for free meals is one of the strongest arguments in favour of increasing the grant available to student nurses. The provision of free meals should be a straightforward administrative measure that would not involve great expenditure on behalf of the health boards or the State. It should be granted. I cannot understand why the Minister does not accede to this very modest request.

The cost of secondary accommodation on a temporary basis is also a serious issue for student nurses during their placement and one that the Government has singularly failed to deal with in any kind of adequate way. The Minister has introduced a £20 per week rent allowance for students in respect of this.

Mr. Cowen

It was nil when the Deputy's party was in office.

Ms Shortall

This pitiful allowance begs the question whether the Minister knows what his Government colleagues are doing.

Mr. Cowen

What did they live on when the Deputy's party was in Government?

Ms Shortall

Is the Minister oblivious to the current housing boom and the resultant astronomical increase in rents?

Mr. Shatter

On a point of order, I disagreed with much of what the Minister said, but I had respect for his office and did not interrupt him. He has sat muttering and jabbering through the Deputy's contribution, which is most unfair. I ask the Chair to use his office to prevent him from continuing to do so.

An Leas-Cheann Comhairle

Deputy Shortall, without interruption.

Ms Shortall

Has the Minister read Peter Bacon's excellent report on house prices? The facts as they pertain in the real world mean that £20 a week would hardly cover the rent of a letterbox, let alone a flat in the current market. How does the Minister expect student nurses to make up the rest of their rent? The answer to this question seems to be similar to the Minister's attitude to all other funding issues regarding student nurses. This Government expects student nurses to depend on parental handouts or credit union loans to see them through their three year study period. This is not good enough. Student nurses put in the same number of hours as many other workers in this State. They perform valuable work in our health service, and this must be recognised.

The other main issue of concern to student nurses concerns the fourth year degree programme. The Government's stance is that this programme is not required for a student nurse to become a registered nurse, that it is additional to the required standard and, therefore, must not be funded by the State. What message does this attitude send out to those thinking about a career in nursing? This message is that the Department of Health is not prepared to assist nurses in developing their careers. Of all the demands articulated by the INO this fourth year degree issue has the most significant impact on the long-term future of nursing. Will the Minister step back from this issue and consider his vision for the future of nursing? Surely we want to have the most professional, multiskilled nursing body possible. Central to this vision is that students who wish to proceed to degree level should be supported in doing so. At present the system that the Minister for Health and Children and the Minister for Education and Science are prepared to stand over actually prevents nurses' career development. It discriminates against nurses who are prepared to study for an extra year to improve their skills and, by extension, the skills available to our health service. It is no wonder, with such a short-sighted policy as this in operation, that a large number of student nurses who finish their three year programme do not enter the profession or that they go abroad to work. If these issues are to be tackled, and if we are serious about valuing nurses and the work they do, the State must be prepared to invest in and support nurses who wish to proceed to degree level. To fail to do so is a serious impediment to the development of nursing and the services which nurses provide to this community.

I and the Labour Party fully support the motion as, for too long, nurses were taken for granted by the State. The previous Government instituted measures that will go some way to rectifying this situation. It is now up to the Government and the Minister to show that commitment to the profession and its long-term development. It is crucial, therefore, that student nurses should no longer be forced to survive for three years on a pittance. To ensure that nursing remains an attractive career in an increasingly competitive labour market, we must support student nurses and encourage them to pursue their studies to degree level.

The demands of the student nurses are reasonable and fair. These are not outrageous demands. They are not demands that will scupper the budgetary position of this Government. It is the responsibility of the Minister for Health to fight for a health service at the Cabinet table and to secure the necessary funding to maintain standards. The Minister has so far failed to do so. He cannot convince his penny-pinching colleague in the Department of Finance to open the purse strings to ensure that student nurses get fair play from the State. It is a spectacular failure by the Minister and one that will have an immediate effect on thousands of student nurses and on the future of nursing as a whole if it is not reversed.

Debate adjourned.