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Seanad Éireann díospóireacht -
Tuesday, 10 Mar 2009

Vol. 194 No. 8

Nursing Education.

I welcome the Minister of State, Deputy Wallace, to the House. I thank the Cathaoirleach for ruling in order my motion to ask the Government to address urgently the inequitable level of reduction in undergraduate nursing places in St. Angela's College. Undergraduate nursing education throughout the country has been cut by 16.5%. This has been especially savage in the north west at St. Angela's College in Sligo, the only constituent college of the National University of Ireland north of a line from Dublin to Galway. The cuts there are in excess of 31% in undergraduate intake, 25% on the general programme and an outrageous 40% on the intellectual disability programme. In the Dublin area the cut has been just 7% on average. Cuts in Trinity College and UCD have been 6.5% and 6.4%, respectively.

One would question the rationale for cutting nursing education at all and especially at a time when the health service here is going through the most major reform ever experienced. Nurses still remain the only 24-hour service providers within the system and are predominantly the face of the front line. In recent times we have needed to recruit from across the world to ensure we have had sufficient nurses at the coalface. We are now complicating this shortage further by not educating our own nurses for the future. One would question why nursing was chosen to suffer cuts while other health care professional numbers have not been affected and other undergraduate discipline numbers remain unchanged.

This further compounds the urban-rural divide given that the greatest cut in student nursing places will occur at St. Angela's in Sligo. The national average cut is 16.5% and it will be between 31% and 32% in St. Angela's, which is double the national average. It defies logic when one considers that Trinity College and UCD, among the biggest colleges in Ireland, are to experience the smallest level of cuts. The impact on student numbers will be such that the overall viability and continuance of those colleges will not be remotely affected. However, at St. Angela's College it will be very significant to have such a large cut in its numbers.

A reduction of 40% on the intellectual disability programme is simply outrageous. I am informed that the Health Service Executive director of nursing services took this decision which was then approved by the Minister, Deputy Harney. I have been reliably informed that the director of nursing took this decision on the basis of the need for more nursing in Dublin. Are more students from Dublin interested in pursuing nursing as a career? Is it from viewing hospitals in Dublin that the director of nursing services perceives that it requires more places? Are the people of the north west not as entitled as those in any other region to apply to qualify as nurses in the north west as they have consistently done there and then work wherever they choose?

It is worth noting that all the people who have qualified through the intellectual disability programme have secured employment locally through the Cloonamahon facility, Craig House and other regional or local services. This constitutes further discrimination by the HSE against the north west. We have had the ongoing debacle with the proposed removal of cancer services and now we have this. It is a further indication that the HSE as an entity is detached from the will of the people and the needs of the people in regional Ireland. More than 20% of the budget in the State is under the direct control of a third party organisation that does not respond to the direct wishes through elected representatives in the Dáil, Seanad and Government and act appropriately.

I ask the Minister of State to take to the Minister, Deputy Harney, and other members of the Government the ardent wish of the people of the north west to be treated equitably and fairly as those in other parts of the country are so that we will not need to take the lion's share of the pain once again. First we had the cancer services and now the discrimination against St. Angela's College where nursing student numbers are to be cut from 65 to 40, whereas the cuts in Trinity College and UCD are minimal and will have minimal effects on the overall viability of the workings of those colleges.

We should consider other revered Government policies such as balanced regional development, the national spatial strategy and taking care of the students of the future. If a person wants to study nursing and there are not sufficient places at St. Angela's College, he or she will need to come to Dublin where the cost of living including rent is higher. As the spatial strategy would aspire to, should we not create more capacity before demand? I believe a region such as mine with St. Angela's College acting as that education centre could take more students. The level of cuts, if any, at St. Angela's College therefore should be substantially less.

I thank the Minister of State for hearing my plea and I hope in earnest that something can be done to reduce the level of savage cuts on the undergraduate nursing places at St. Angela's College. It has experienced the highest percentage cut of the 13 nursing schools with a cut of 31% compared with a national average of 16.5%. However, our biggest universities, Trinity College and UCD, have to take least pain at between 6% and 7%. I ask the Minister of State to take that on board with a view to reducing the level of cuts on St. Angela's College.

I thank the Senator for raising this important issue for his area. By way of background I should explain that following the publication of the 2009 Estimates for public services, the Health Service Executive was tasked to deliver savings of €115 million. Among many other issues, a reduction in nurse training expenditure is needed to contribute to achieving these savings. The total cost to the health services for both undergraduate and post-registration nurse education is in excess of €117 million per annum.

Savings of €5 million in 2009 will be achieved as follows. The number of places on the undergraduate nursing degree programme will be reduced by 310 places, from 1,880 to 1,570. The reductions will take place in all 13 higher education institutions in the country which provide this programme and will relate to the areas of general nursing, 197, a reduction of 18.64%; intellectual disability nursing, 60, a reduction of 25%; and psychiatric nursing, 53, a reduction of 15.45%. The total is 310 which, as the Senator explained, equates to a reduction of 16.49%. These reductions will result in savings of approximately €1.65 million in 2009 and €3.3 million per annum from 2010 onwards and will be effected mainly in those areas not experiencing nurse shortages. There will be no reductions in the undergraduate programmes for midwifery — 140 places — and children's and general nursing, integrated — 100 places.

In the second area, nurses trained under the apprenticeship and diploma models undertaking part-time degree courses can apply to their employer to have their course fees paid in return for a service commitment to the public health service. This initiative has been in operation since 2001 and should have been completed in 2005. Its purpose was to give serving nurses and midwives the opportunity to avail of the degree course, thereby avoiding a two-tier nursing and midwifery system. It will be no longer available for new entrants from 1 January 2009, resulting in a saving of €2 million next year and about €3.8 million per annum from 2010 onwards.

In the third area of specialist practice courses, further savings of €1.35 million in 2009 will be achieved by reducing places on the various post-registration courses in specialist clinical practice. These three cost-saving measures will produce cumulative savings of €5 million in 2009 and €8.45 million per annum in future years.

By way of background, the OECD public management review, Ireland — Towards an Integrated Public Service, published in 2008, in its case study on reconfiguration of the health services noted:

One statistical characteristic of Ireland is its very large number of practising nurses (15.2 per 1,000), which is twice the OECD average, just below Norway (15.4) but much higher than UK (9.1) or France (7.7). The number of nurses graduating every year is also high (14.4), above Norway (10.1), UK (8.6) or France (5.9). This contradicts the universal perception of a "shortage" of nurses, held by health actors in Ireland who were interviewed by the OECD. Partial explanations come from the fact that some 40% of nurses in Ireland work part-time (as compared for example with 26% in France for nurses working in hospitals).

With regard to geographic and demographic concerns which are Senator MacSharry's chief concerns, the percentage reductions in undergraduate student places take account of geographic and demographic trends in nursing placements whereby it is not always possible to fill all vacancies in the eastern region, whereas outside of this region the number of graduates being produced may exceed demand. Accordingly, the estimated one third reduction on the western seaboard should go some way towards correcting this imbalance. The percentage of reductions in the 13 higher education institutes also take account of the situation whereby the removal of the full intake of the nursing degree programme, which in some cases forms the backbone of an institute, could cause great difficulties for the institute as a whole.

Against this background, it is important to note that the Minister has approved a strategic review of the nursing degree programme which will commence this year. Overall, the review is designed to provide a systematic analysis of what is being achieved by expenditure under both capital and revenue headings. It should also provide sound evidence and a critical analysis of the preparation of nurses for practice. The findings will provide a basis to inform decision makers on the future direction of pre-registration nursing education programmes in Ireland.

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