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Dáil Éireann díospóireacht -
Wednesday, 24 May 2000

Vol. 519 No. 6

Written Answers. - Health Services.

Ivor Callely

Ceist:

46 Mr. Callely asked the Minister for Health and Children the position regarding the difficulties in staffing the health services; the special measures that are being considered to overcome these difficulties; if he will give a breakdown of all grades of health personnel working in each health board area; comparison figures per head of popu lation in each area; and if he will make a statement on the matter. [14386/00]

The identification of staffing requirements and the deployment of staff within the overall financial and employment levels set by my Department is a matter for the management of each health agency.

There are particular difficulties being faced by the health services at present across a wide range of disciplines, particularly in the medical, paramedical and nursing areas. Action is being taken on a number of fronts to address these difficulties.

The medical staffing of hospitals is currently being addressed by the Medical Manpower Forum. With particular regard to non-consultant hospital doctors, the forum is seeking to redress the imbalance between career posts and training posts, the need to improve postgraduate medical training to keep more Irish medical graduates in the country and the need to look at the position of women in medicine in Ireland with a view to redressing the number who leave medicine.

The Medical Manpower Forum is due to publish its first report shortly.

In relation to paramedical grades, it is clear that the balance of supply and demand for the three therapy grades, speech and language therapists, occupational therapists and physiotherapists needs to be reviewed. As a first step, I have asked my colleague, the Minister for Education and Science, and the Higher Education Authority to investigate the possibility of increasing the number of graduates taken into the courses for speech and language therapists, physiotherapists and occupational therapists from October 2000. I am confident that progress can be made on this issue. Talks are also ongoing to ascertain if additional places can be made available to students on courses in Northern Ireland.

I have agreed the terms of reference for a workforce planning study for these three grades and this is a priority issue for my Department.

I am aware that difficulties are being experienced in other areas of the allied health professions, such as social workers, care workers and physiological measurement technicians. I intend to refer these matters to the health services skills group, established under the new Programme for Prosperity and Fairness.

Following discussions with the Academy for Medical Laboratory Science, I am pleased to say that from October 1999, the number of entrants to the three approved medical laboratory science courses in Ireland has been increased by 20 per annum. I have also funded the creation of a new student medical laboratory technician post. Entrants to this grade have completed a degree programme but lack the required clinical placement. This programme addresses that lack by providing a one year placement. The first of these new graduates will have completed their training by May 2000 and will be available for employ ment once accepted by the Academy for Medical Laboratory Science.
A service review of psychology services in the health boards is under way, with manpower planning one of the three main areas for action. It has been decided to adopt a two-pronged approach to the problem, one in the short-term, for example, over five years by increasing postgraduate places available. Discussions with the heads of the schools of psychology are ongoing with a view to increasing the numbers from October 2000.
In the nursing area, the 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 fluctuates 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.
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.
New arrangements have been introduced to give better starting pay to nurses taking up employment by giving full recognition for previous experience at home and abroad. 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. Standardised overtime working arrangements have been introduced following agreement with the nursing unions. Some 11 hospitals around the country provided 'back to nursing' courses in 1999 for nurses wishing to return to the workforce. A total of 304 places were available. The expansion of these courses is aimed at maximising the available nursing workforce. During 1999-2000, 16 new post-registration programmes have been developed. This year there will be 660 places on post-registration courses in specialised areas of clinical practice. In response to an identified need, 11 of the 16 new programmes will be located outside the Dublin area. An anti-bullying policy document, prepared by the HSEA and agreed with the nursing unions, was published in December 1999 and has been widely promoted within the service. 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.
Up to 1,250 clinical nurse-midwife specialist positions are being introduced for nurses who have recognised expertise in particular areas. These posts attract the clinical nurse manager 2 salary. Nurses are also benefiting from an agreement to upgrade 1,100 staff nurse posts to clinical nurse manager 1 grade which is being implemented at present.
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, University College Cork.
Agreement has been reached between the relevant Departments on a procedure for fast-tracking immigration clearances and work permits for non-EU nurses. Data maintained by An Bord Altranais indicate that in recent years there has been a net inflow of nurses to Ireland. Inflow figures for 1999 show a dramatic increase to 3,181 in the number of nurses seeking to register here. Employers have stepped-up their recruitment from abroad with significant success in Scandinavia and the Philippines, for example, in addition to ongoing recruitment within Ireland. Swift progress is being made on the implementation of the agenda for change mapped out by the commission on nursing. A priority action plan was agreed with the nursing alliance as part of the settlement of the nurses' strike. Additional funding of £10 million has been provided this year for initiatives in the action plan.
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. These issues are being addressed by a joint committee representative of nursing unions and health service employers. From 1 January 2001, nurses working in the public health service who want to undertake nursing and certain other undergraduate degree courses on a part-time basis will have their fees paid in full by their employing agencies. Fees will be paid in return for a commitment on the part of the nurses to continue to work in the public health service for a period of up to two years after the completion of the degree course. This fees initiative will continue until at least the year 2005.
Further funding totalling £400,000 was made available to the various schools of nursing throughout the country late last year to enable them undertake local marketing campaigns aimed at promoting nursing as a career. This year there were more than three applicants for every available training place. This is most encouraging bearing in mind that the total number of training places is being increased by 25% over last year to 1,500 and the reduction in the volume of applicants for public service positions generally. The annual maintenance grant for nursing students, which is not subject to a means test, has been increased 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 have also been increased.
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 substantial increase in the number of student places will provide enough registered nurses to fill all vacancies. The numbers employed in the public health service at 31 December 1998, are set out in the following table, wholetime equivalents. This is the latest date for which census data is available.

Health Sector

Mangt/Admin*

Medical/Dental

Nursing

Paramedical

SupportService

Mtce/Technical

Total

Health Boards

Eastern

1,646

610

3,375

1,145

3,196

238

10,210

Midland

403

223

1,420

289

1,060

91

3,485

Mid-Western

639

333

1,769

368

1,057

162

4,329

North-Eastern

680

300

1,818

330

1,316

72

4,516

North-Western

650

260

1,539

338

1,404

89

4,281

South-Eastern

726

428

2,480

427

1,593

121

5,773

Southern

911

569

3,010

579

2,034

199

7,301

Western

829

457

2,580

513

1,672

172

6,223

Total HBs

6,483

3,179

17,991

3,990

13,330

1,145

46,119

Vol/Jt Board Hosps.

2,478

1,929

6,770

2,029

3,660

389

17,256

Mental Handicap

512

45

1,934

404

3,365

92

6,352

Grand Total

9,474

5,153

26,695

6,423

20,356

1,626

69,727

*It should be noted that the category of management-administration also includes such staff as consultants' secretaries, community welfare officers, out-patient department personnel, ward clerks, medical records personnel, telephonists, and computer personnel who are engaged in front line duties.
The latest data for population in each health board area is the 1996 CSO census of population, details of which follow. It should be noted that the making of comparisons between regions and agencies based on staffing ratios per head of population may fail to take account of the fact that, even with similar populations, there are significant differences in case complexity, patient profile, facilities or equipment, the range and complexity of services provided, socio-demographic factors and health and social requirements. As such these comparisons should be treated with caution.
Population

EHB

1,295,939

MHB

205,542

MWHB

317,069

NEHB

306,155

NWHB

210,872

SEHB

391,517

SHB

546,640

WHB

352,353

Total

3,626,087

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