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Dáil Éireann díospóireacht -
Wednesday, 29 Nov 2000

Vol. 527 No. 1

Adjournment Debate. - Threatened Industrial Action by Nurses.

This threatened industrial dispute among casualty staff in Beaumont Hospital is really born out of frustration. Nurses in the accident and emergency department are at the sharp end and are bearing the brunt of the frustrations which have built up through a system which has not been adequately resourced. The reality is that Beaumont Hospital is short between 100 and 150 beds. We have seen a 50% increase in its waiting lists in the past three years, resulting in huge pressures on the accident and emergency department which is dealing with well over 1,000 patients every week. Currently, more than one in six of those patients are in the accident and emergency department for over 24 hours. Over the weekend one patient remained there for 96 hours waiting for admission.

Typically the numbers waiting for admission in October was 27, three times the number waiting for admission one year ago. We are seeing growing pressures and nursing staff are trying to cope with 150 patients coming in every day while having 27 patients on trolleys for admission, making it almost impossible to conduct the professional job the nurses and doctors are trying to deliver.

Since 1 January this year one in four nurses in the accident and emergency department have left Beaumont Hospital, which is evident throughout the hospital. The Minister kindly sent me the report on manpower nurse needs and Beaumont is struggling much more than any other hospital. It has 113 vacancies, 10% of its total staffing. It lost 156 nurses last year.

This is according to the report of the Health Service Employers' Agency, which the Minister kindly sent me.

That was in September but the vacancies are now down to 57.

The position is serious. If the Minister is looking for quick answers he must seek to provide step-down facilities and fill the two accident and emergency consultant posts. I look forward to hearing the Minister commit himself to the appointment of at least two emergency consultant posts in Beaumont. He needs to seriously look at step-down facilities to free up beds. Some 72 beds are either blocked or closed and this is creating tensions. This is a cry for help from nursing staff who are delivering a quality service. I hope the Minister can deal with this problem. They are at the sharp end.

Ten complaints are being received per month concerning conditions. They describe cases of people getting up to go to the toilet and on their return their trolley was gone due to the sheer volume of people coming through.

This is no way to deliver a professional service. I ask the Minister to give this problem his personal attention. This is not a localised matter. The accident and emergency department of the Mater Hospital is also under severe pressure due to a shortage of facilities. That hospital's waiting list is up by about 40% in three years. There are serious problems on the northside. I appeal to the Minister to develop a strategy with those professionals on the northside who are only too willing to do that. The resources are there but it needs a coherent plan to respond to the need.

I thank Deputy Bruton for giving me the opportunity to clarify the position regarding Beaumont Hospital.

News reports today refer to proposed industrial action in Beaumont Hospital accident and emergency department because of work pressures and staff shortages. I understand that the ballot was only completed yesterday evening and that both INO and SIPTU members have voted for industrial action.

I can inform the House that a special pre-arranged hospital board meeting is taking place tomorrow, 30 November. This meeting had been arranged prior to the ballot of nursing staff and with their knowledge. Hospital management had asked accident and emergency staff, including nurses, for their proposals on how to alleviate pressures in the department. These proposals are to be discussed at tomorrow's board meeting – and there is to be feedback at a staff meeting on Friday next, 1 December. It should be possible with co-operation between management, medical and nursing staff to resolve the situation at local level.

I can also inform the House that the hospital has a total of 57 nursing vacancies at present. This is a 50% improvement on the position at 30 September 2000, when there were 113.5 vacancies. That clarifies that there has been a significant improvement since September. This is proof of the success of ongoing recruitment campaigns. Thirty two beds have been opened in the last two weeks, leaving 35 beds closed. All remaining beds will be opened by January 2001.

More generally in relation to nursing shortages, the Health Service Employers' Agency carried out a national survey of the position at 30 September 2000. This found that the overall vacancy figure stood at 1,388 vacancies. However, the net vacancy position stood at 476 when account is taken of agency nurses and overtime working.

The survey found again that difficulties largely relate to the Dublin area and the major Dublin acute hospitals account for a large percentage of the vacancies in the eastern region. These hospitals have engaged in a successful international recruitment drive. However, it was noted by the HSEA that the full impact of recruitment campaigns is not reflected in the survey as many of the nurses recruited abroad had not started work at that time. The Beaumont experience as stated above is an example of nurses beginning to come on stream.

In this context, I am pleased to inform the House that earlier today I announced details of a £5 million package of incentives aimed at attracting nurses and midwives back to work, retaining nurses and midwives in the public health service, and addressing shortages in specialist areas. The initiative includes a new scheme of flexible working arrangements for nurses and midwives in the public health service which will come into operation on 1 February 2001.

The scheme is designed to introduce greater flexibility in working arrangements for nurses with family responsibilities and other commitments. Fees for "back-to-nursing" courses are being abolished with immediate effect. In addition, nurses and midwives undertaking such courses will, for the first time ever, be paid a salary. The intention behind this initiative is to remove all financial obstacles in the path of nurses and midwives who wish to return to practice. From the current academic year, all nurses studying for the post-registration higher diploma in sick children's nursing will have their fees refunded. They will also receive an enhanced salary while in training. This measure is specifically designed to ease recruitment difficulties facing the children's hospitals in particular. It follows similar initiatives taken by me earlier this year on behalf of student public health nurses and student midwives. The number of available places on specialist nursing courses, including accident and emergency, is being expanded. To encourage more nurses into specialised areas of clinical practice, including accident and emergency, nurses undertaking specific courses will now receive full pay while doing so. They will also have their course fees paid in return for a commitment to continue working in the specialist area for a specified period following completion of the course.

Funding is being provided to the HSEA to employ a nurse manager to co-ordinate the provision of supervised clinical placements for nurses recruited from abroad. Nurses from the Philippines and certain other non-EU countries are required to undertake such placements prior to registration. A major advertising campaign aimed at attracting qualified nurses and midwives back to work is being launched tomorrow. This campaign will make use of radio and print media advertising to market nursing as a career with the specific objective of encouraging nurses and midwives back into the system.

I recently announced a package of investment costing £25 million to alleviate service pressures on the acute hospital sector comprising first, the appointment of an additional 27 consultants to work in accident and emergency departments and ensure early—

Where will they go?

I will be allocating a block number to the ERHA once An Comhairle has that situation resolved. Obviously the major teaching hospitals will do well under the allocation. The contracting of over 500 additional nursing home places for patients who are being discharged from acute hospitals, thereby increase the capacity of the hospitals to address the problem of inappropriate use of beds in acute hospitals. That is available to Beaumont now and has helped improve the situation.

As part of the winter initiative, I have also provided £1.5 million this year for the purchase of medical aids and appliances for older people to facilitate the discharge of older persons from hospital and also support older people in remaining in their homes. I have also initiated a national review of bed capacity in both the acute and non-acute sectors, in line with the commitment contained in the Programme for Prosperity and Fairness—

That assessment is already done in the northside.

It is not completed. It is being carried out in consultation with the social partners. It is expected that the second phase of the review will be completed next spring. Beaumont Hospital as part of the accident and emergency initiative received in 1998 an additional £200,000 of which £170,000 was used to employ additional nurses and £30,000 for medical staff; in 1999 an additional £200,000 capital specifically for revamping the accident and emergency department – the final cost of this project was £300,000; in 2000 an additional £240,000 to replace and increase the equipment levels in the accident and emergency department.

Under the national development plan I have approved a major refurbishment and equipment replacement programme for Beaumont Hospital totalling £26.469 million over the next four years. This is the first time that Beaumont Hospital has had such a programme since it opened in 1987. The equipment programme will cover all major areas of the hospital on a priority replacement programme identified by the hospital and the refurbishment programme will include civil and mechanical works, upgrading of clinics, recladding and reroofing of the hospital and major upgrading of the reception area.

It should be possible to resolve the situation in Beaumont Hospital at local level with co-operation between management, medical and nursing staff. I appeal to all involved to resolve this issue through dialogue.

It is a matter of local—

I have been available and I am interested in resolving all these issues with the various partners. I have had an ongoing discussion in terms of the nursing package with the INO. To be frank, at no stage in the past number of weeks was the specific issue of industrial action raised with me.

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