I respond on behalf of my colleague, the Minister for Health and Children, Deputy Martin. I am happy to address the issue raised by the Deputy and thank him for raising it. I have an extensive answer, some of which deals with general matters and the rest with the detailed matters raised by the Deputy.
I would first like to outline for the House the hugely significant measures for nurses and midwives that have been implemented over the past four years. The Commission on Nursing, which produced its report in 1998, proposed a radical blueprint for the development of the professions of nursing and midwifery. The recommendations of the commission were accepted in principle by the Government and implementation of those recommendations is now well advanced.
By far the most significant of these recommendations was the proposal to transfer the education of nurses into the education sector and the introduction a four year undergraduate degree course. The new degree commenced in 13 higher education institutes this month. This development is supported by a capital development programme in the education sector involving expenditure of some €243.2 million by the end of 2004. This will be accompanied by annual revenue costs of around €90 million per annum when the programme is fully up and running.
Recruitment and retention of nurses and midwives has been an issue of concern in recent years. Developments in the education of nurses have coincided with a dramatic increase in the number of places available for nursing students. This year 1,640 nursing places are available, 58% more than the number available in 1999. In addition, there are in excess of 800 places available on specialist postgraduate courses, including accident and emergency, coronary care, oncology and so on. A comprehensive package of initiatives, including payment of fees and other financial supports, are available to nurses on these courses.
A major concern of the Commission on Nursing was the question of professional development and career pathways for nurses and midwives. The commission recommended the establishment of the National Council for the Professional Development of Nursing and Midwifery for the purpose of furthering the development of nursing as a profession with a particular emphasis on post-registration education and training. The commission also recommended changes in the grading structure and the introduction of clinical nurse/midwife specialists and advanced nurse/midwife practitioners. To date, almost 1,400 clinical nurse/midwife specialists and advanced nurse/midwife practitioner posts have been developed under the auspices of the national council.
In accordance with recommendation 4:55 of the Commission on Nursing, a national pilot programme for the formal training of health care assistants commenced in November 2001 and was successfully completed in May 2002. The deployment of health care assistants will reduce the level of non-nursing tasks being performed by nurses and midwives and will allow for the more effective utilisation of the professional skills of nurses and midwives.
The measures that have been taken will transform the profession of nursing and the high capital and ongoing investment in the profession must be acknowledged. In addition, significant pay increases have been awarded to nurses in recent years over and above those provided for in the Programme for Prosperity and Fairness. This synopsis is intended to bring to the attention to the House the serious commitment of the Government to the development of nursing as a profession.
The issues in Our Lady's Hospital, Cashel, revolve around nurse staffing levels in theatre and general wards in the hospital. The staff shortage in theatre arose as a result of two members of staff being on maternity leave. Replacements were put in place by management on 14 October 2002, the day the industrial action began. Despite this, the work to rule extends to theatre.
While nurse staffing levels in the general wards are acknowledged by the South Eastern Health Board to be lower than in other centres in the region, the board is satisfied that the existing levels are consistent with adequate patient care and safety. The health board has responded to the Irish Nurses Organisation to the effect that this issue will be given priority in the 2002 service plan.
According to information supplied to me by the South Eastern Health Board, management has made extensive efforts to engage the Irish Nurses Organisation in consultations and this has not been reciprocated by the union since the beginning of October. The health board requested and has been granted a Labour Relations Commission hearing on 6 November. Despite this, and in contravention of good industrial relations practice, the industrial action continues.
This action by the Irish Nurses Organisation has led to the cancellation of elective surgical operating lists and surgical outpatients and is disproportionate to the issues at stake. The INO should engage in discussions that will be facilitated by the Labour Relations Commission on 6 November. Users of the health service are necessarily in a vulnerable position and this type of action is ultimately to their detriment. In this and all other industrial relations issues in the health service, I call on unions to engage through the established industrial relations procedures and mechanisms.
While the right to take industrial action in furtherance of their aims is acknowledged as legitimate, professionals such as nurses must have due regard to the effects on those who depend on the health services. The taking of industrial action should be contemplated only in extremis and when all other avenues for resolution have been exhausted. This is clearly not the case in this instance.
