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Health Services Data

Dáil Éireann Debate, Tuesday - 29 May 2018

Tuesday, 29 May 2018

Ceisteanna (38)

Louise O'Reilly

Ceist:

38. Deputy Louise O'Reilly asked the Minister for Health if he will report on the decrease in the number of community nurses in community health organisation, CHO, areas nationally; his views on the impact this is having on the delivery of health services in the community; the steps being taken to increase these numbers; the number of nurses working in the community setting in each of the years 2007 to 2017, inclusive, and to date in 2018, by CHO area; and if he will make a statement on the matter. [23454/18]

Amharc ar fhreagra

Freagraí ó Béal (8 píosaí cainte)

I listened to the Minister and the Deputy having a wee chat about the reform of the model of care, which I assume means a shift to the community, making my question very timely. I am sure the first thing the Minister will do is thank me for it but I will dispense with the need for that.

I will do that a special courtesy to the Deputy..

Perhaps he could get to the figures on, and explain where, all the nurses will come from to provide all this marvellous service in the community that we all want to see. Unfortunately, however, the decrease in staff numbers does not bode well for any great shift to the community.

I find it unusual to have to apologise for being courteous to the Deputy but I will take her at her wish. The Deputy is correct in that if we look back to 2007 and compare the figures then to the latest figures, there has been a reduction in the number of community nurses. If the question is pitched in terms of the timelines as the Deputy has done she is correct the figure is down. This reflects the fact that the recruitment moratorium that was in place across the public service from 2007 had a real and lasting impact on staffing levels in the health service. I acknowledge that and I also acknowledge that if we are talking about new services we need to staff them. 

Nonetheless, it is important to recognise that there has been a reversal in the trend of declining numbers in more recent years. Since December 2014, there has been a year-on-year increase in community nursing numbers which have risen from 14,539 to 15,175 as of April this year. That is 636 extra nurses. The Deputy has asked for a great deal of statistical data and I will of course arrange for it to be provided in tabular format.  

Past staffing levels may have added to the pressures of delivering services but the commitment and flexibility of front-line staff, combined with innovative ways of working, have ensured the focus has always remained on patient care. There are several recruitment and retention initiatives in place to assist in further bolstering nursing capacity, including offering permanent posts to graduate nurses, continuing the process of pay restoration and offering new opportunities for career development.

Also, in recognition of the need to increase capacity in public health nursing, the number of sponsorships for post registration education will rise to 160 by 2019. This year there will be 150 sponsorships, that is, 42 additional places since 2016. This reflects the commitment to improve recruitment and retention in nursing and midwifery.

As I heard very clearly when I addressed the Irish Nurses and Midwives Organisation, INMO, conference in Cork only a few weeks ago, it is very eagerly awaiting the outcome of the Public Service Pay Commission negotiations. We have specifically asked the commission to consider issues regarding recruitment and retention of healthcare staff, including nurses as a new tranche of their work. We will be guided by their recommendations on how we assist with the Deputy’s question about recruitment and retention.

Let us be honest that more of the same will not work because it is not working. The Minister is offering nurses a permanent contract in a health service that has become an unattractive place to work. I am sure the INMO members told him that at their conference - in fact, I am certain they told him that. I acknowledge the damage caused by the recruitment moratorium introduced by Fianna Fáil in the health service two years ahead of everywhere else. I campaigned against it at the time. We warned about the impact but notwithstanding that we need to face the fact that in my area, in community health organisation, CHO, 9, the nursing numbers are down by 175 since 2007. That is in the area with the fastest growing population in this State. If we are to see the shift to primary care and if it is to become a reality we will need to see an absolute increase in the numbers and we are not seeing that increase. We are not seeing a year-on-year increase in anything like the numbers we will need. It calls into question the Government's commitment to the Sláintecare report because the staff will not be there to effect the necessary change.

We are not proposing doing more of the same, hence specifically as part of the public sector pay agreement, the stability agreement, there was another agreement with the INMO that issues relating to recruitment and retention of health care professionals would be the first thing to be considered by the second phase of the Public Service Pay Commission’s work. That work is under way. It is nearly concluded and we will be guided as a Government by its findings. The unions have had an opportunity to put their views on what could help with recruitment and retention issues as well. I accept that we have a way to go to get back to pre-crisis figures for people working in nursing and community nursing. The Deputy is correct in the data she gave in that regard.

In December 2014, there were 14,539 community nurses; in December 2015, there were 14,789; in December 2016, there were 14,826; in December 2017, there were 14,874; and in April 2018, there were 15,175. I will circulate these figures. We are seeing an increase and we need to see a further increase. When I talk about offering permanent jobs to graduates, the HSE has appointed 861 which is 80% of the 2017 nurse graduates. I take the point that when we appoint them, we need to keep them in the country. It is not just a question of recruitment but also of retention.

When I said more of the same, the Minister read out statistics. I asked for them so I am not criticising him for that. They showed a rate of increase, and I am not brilliant at hard sums, such that by my reckoning it will probably take a decade or more to get back up to the level we were at before the crisis. That is before taking account of the fact that we are moving away from a hospital-centred model, supposedly, although we obviously are not because we do not have the staff to do it. We are also dealing with an increased population. My area of north Dublin is an example. It has the fastest growing population in the State and the number of nurses has declined. At the rate of increase many of those people who are living in my constituency will be shuffling around looking for their pensions before they will see anything even approaching adequate community services. Meanwhile the pressures on the acute hospital sector will not be alleviated because we do not have the staff in the community.

My mathematics are not brilliant either but the Deputy said she is in the CHO 9 area and I have done a rough calculation. There were 1,971 community nurses there in December 2017 and that had risen to 2,074 in April 2018, which I think is an increase of 103 nurses. I accept the point and am not contesting that we need to continue to do more to get back to where we want to be in respect of people working on the front line of our health service. We also need to make sure that we provide more attractive working opportunities for nurses in the community. We have a draft policy for community nursing and midwifery which is a response to an integrated model of care. This model of care proposes one that offers the individual family and community a range of choices and will be facilitated through a variety of changes to the model so that we can have a proactive rather than reactive model of care. The policy proposes to meet service users choice and needs as close to home as possible.

In addition to dealing with the traditional ways of recruitment and retention, we are considering the career opportunities and satisfaction for community nursing. I accept we have more to do in this area and a significant amount more to do to get back to where we were in 2007 but I contend we are beginning to make slow progress on this. There has been an increase in recent years. I read out the figures for the Deputy and I will circulate the table to her. I look forward to the outcome of the Public Service Pay Commission negotiations and being guided by its recommendations.

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