Caoimhghín Ó Caoláin
Ceist:79 Caoimhghín Ó Caoláin asked the Minister for Health and Children if he will make a statement on the report on nursing staffing levels published by the Health Service Employers Agency on 17 February 2000. [5547/00]
Written Answers. - Nursing Staff.
Bernard J. Durkan
Ceist:92 Mr. Durkan asked the Minister for Health and Children the total nursing complement required to provide adequate staffing for the hospitals; the number of nurses available; the number required; the number of student nurses in training; the proposals, if any, he has to address this issue; and if he will make a statement on the matter. [5586/00]
Liz McManus
Ceist:95 Ms McManus asked the Minister for Health and Children the steps, if any, being taken to address the chronic shortage of nurses, particularly in the Dublin area, which is contributing to ward closures, theatre closures and operation cancellations; the further steps, if any, being taken to facilitate recruitment of additional personnel in view of the recent report identifying 1,100 nursing vacancies; if he will introduce an additional quality of life payment to take account of the extra costs of living and working in Dublin in view of the particular problem in Dublin; and if he will make a statement on the matter. [5486/00]
Bernard J. Durkan
Ceist:184 Mr. Durkan asked the Minister for Health and Children the initiative, if any, he will take to address the serious shortage of nursing staff in hospitals; and if he will make a statement on the matter. [5750/00]
Bernard J. Durkan
Ceist:185 Mr. Durkan asked the Minister for Health and Children the total number of State registered nurses working in hospitals; and if he will make a statement on the matter. [5751/00]
Bernard J. Durkan
Ceist:188 Mr. Durkan asked the Minister for Health and Children the reason for the shortage of nursing staff; and if he will make a statement on the matter. [5754/00]
I propose to take Questions Nos. 79, 92, 95, 184, 185 and 188 together.
The survey of nursing vacancies which the Deputies refer to was carried out by the Health Service Employers Agency, HSEA, and related to the position at 30 September 1999. This was the most comprehensive report to date and covered all agencies and nursing disciplines. The survey found that there were 1,180.46 vacancies in gross terms at 30 September. The net figure when adjustments are made for the utilisation of agency nurses and overtime working is 428.16.
The results confirmed again that there is not a nationwide problem regarding the availability of nurses and that difficulties largely relate to the greater Dublin area. Indications are that the level of applicants for nursing posts outside the Dublin area far exceeds the number of positions available.
While some nurses have always moved from Dublin to other parts of the country, investment in hospitals and the development of regional specialities over recent years have increased demand for nurses outside the Dublin area. Within Dublin, issues such as housing costs, traffic problems and lack of car parking facilities have been cited as disincentives to the recruitment and retention of nurses. However, these issues are not unique to nurses or to the health service.
It should also be noted that nurse recruitment is carried out on an ongoing basis in most hospitals, and the level of vacancies fluctuate accordingly. At any given time, significant numbers of nurses would be in the process of being appointed by employers or moving from one employment to another. This is illustrated by a telephone survey of five major voluntary hospitals in Dublin which was carried out by the Department within the last week, and which found that the up to date vacancy position in three – Beaumont, Mater and St. James's – has improved while the position has disimproved in Tallaght and St. Vincent's, Elm Park.
In response to Deputy McManus's question, it is not possible to introduce an additional quality of working life payment for nurses working in Dublin. It would not be possible to ring-fence such a payment to Dublin or indeed to nurses. The Deputy may be interested to note that the Irish Nurses Organisation rejected the concept of a "Dublin weighting" at its 1999 annual conference.
The total number of nurses employed in the public health service on 31 December 1998 was 31,266, 26,695 whole-time equivalents. This compares with 50,544 nurses on the active register of An Bord Altranais in January 2000. Some 3,100 student nurses are in training at the moment. The 2000 intake will be 1,500, an increase of 300 over 1999. This increased figure was agreed with the Nursing Alliance as part of the settlement of the recent nurses' strike. A further 20 places are available on a new direct entry midwifery programme which will be introduced on a pilot basis next June.
It is not possible to be definitive as to the total nursing complement required to provide adequate staffing for hospitals. The Commission on Nursing recommended that the Department of Health and Children, health service providers and nursing organisations examine the development of appropriate systems to determine nursing staffing levels. The need to address skill mix issues was also highlighted in the Commission on Nursing report. Both of these recommendations are included in the priority action plan agreed with the Nursing Alliance as part of the settlement of the nurses' strike. It has been agreed that these issues will be addressed by a joint committee rep resentative of nursing unions and health service employers. This committee is in the process of being established.
While the recruitment and retention of nurses is primarily a matter for individual employers, initiatives have been taken or are being progressed with a view to stabilising the situation and, where possible, improving it.
These initiatives include the following: arrangements have been agreed with the nursing unions to allow more favourable assimilation arrangements on to pay scales for nurses taking up both permanent and temporary appointments; a significantly improved regime of allowances in respect of nurses working in specialised areas such as operating theatres and intensive care units has been introduced; discussions with the nursing unions are continuing in relation to the introduction of more flexible working arrangements for nursing staff; standardised overtime working arrangements have been introduced following agreement with the nursing unions; health service employers have been asked to examine the possibilities in relation to the introduction of term time working as an option for staff with family commitments; the availability of return to working courses for qualified nurses who have been out of the workforce is being reviewed with a view to maximising uptake; my Department is engaged in discussions with health agencies in relation to the provision of specialist nursing courses at centres outside Dublin. As a result, ten students commenced a one-year higher diploma in specialist nursing in Letterkenny General Hospital last month and six students commenced a higher diploma in nursing, critical care in University College Hospital Galway. A further course is planned for Waterford Regional Hospital; an anti-bullying policy has been prepared and agreed with the nursing unions and was published in December 1999; the promotional structure within nursing, including the introduction of a clinical career pathway, is being significantly improved on foot of the recommendations of the Commission on Nursing; a study of the Nursing and Midwifery Resource by the nursing policy division of the Department of Health and Children commenced in 1998 with the primary purpose of forecasting future nursing and midwifery resource needs. Following on from this, a national study on turnover in nursing and midwifery has been commissioned by the Department through the health research board and awarded to the Department of Nursing Studies, NUI, Cork; my Department is in discussions with the relevant Departments and with An Bord Altranais regarding entry visas-work permits for nurses recruited from outside the European Union or European Economic Area. These discussions are aimed at ensuring that there are no unnecessary barriers to entry.
In this context, data maintained by An Bord Altranais indicates that in recent years there has been a net inflow of nurses to Ireland. The figures in relation to registrations are as follows:
|
Inflow |
Outflow |
|
|
1996 |
939 |
1,079 |
|
1997 |
1,219 |
983 |
|
1998 |
1,400 |
850 |
|
1999 |
3,171 (Provisional) |
n/a |
Attracting Applicants to Study Nursing: In 1999, following a national and local recruitment campaign funded by the Department, the number of applicants increased by 40% over 1998. This resulted in the largest number of direct entrants to nursing for several years, i.e. a total of 1, 215 training places were filled.
Due to the success of last year's campaign, funding totalling £400,000 has been made available to the various schools of nursing throughout the country to enable them undertake local marketing campaigns this year aimed at promoting nursing as a career. The annual maintenance grant for nursing students, which is not subject to a means test, increased from £2,500 to £3,250 between 1997 and 1999. The rate will increase again to £3,325 with effect from 1 April 2000. The grant now is almost double the maximum grant for which other third level students may qualify.
In addition, allowances for external clinical placements, books and uniforms are also being increased. The range of leaving certificate subjects that may be presented by an applicant for admission to the nursing diploma programme has been expanded.
The requirement to have a foreign language in the leaving certificate has been removed.
These initiatives represent a very significant effort on the part of my Department to improve the situation. In the longer term, it is hoped that the significant increase in the number of student places will provide enough registered nurses to fill all vacancies.