Speech
Statement from Minister for Health to INMO’s Annual Delegate Conference
From Department of Health
By: Stephen Donnelly
Published on
Last updated on
From Department of Health
By: Stephen Donnelly
Published on
Last updated on
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President Karen McGowan, general secretary Phil Ní Sheaghdha, staff of the INMO, members, colleagues, distinguished guests.
I’m delighted to be here at your Annual Delegate Conference again, and for the first time, in person – at last! Thank you, President, for inviting me to speak with you all this morning.
Although the pandemic isn’t yet fully behind us, we have moved into a different phase. Notwithstanding the very real challenges which remain for all of you on the frontline, it’s great to be able to meet up to talk about our health services, current and future developments, and the critical role of nurses and midwives.
Since I last spoke at your conference, nurses and midwives have continued in their extraordinary efforts on the front line of Ireland’s response to the COVID-19 pandemic. Your efforts have prevented and reduced the spread of the virus.
Covid has brought great uncertainty and suffering. But through it all, nurses and midwives have remained dedicated in their work for their patients. Ireland’s vaccine programme has been one of the most successful anywhere in the world. Much of that is down to you. Your work in coordinating, planning, and rolling out the vaccination programme has been instrumental in our efforts against Covid.
But you have done so much more. A recent study published in the Lancet shows that when it comes to the additional number of deaths seen in countries during Covid, Ireland has one of the lowest rates globally. In fact, our excess mortality rate is just one tenth of that in the UK. Much of the credit for that goes to you. While dealing with Covid, you also continued to deliver non-Covid care. You kept innovating and improving how that care was delivered. You have shown compassion for those in most need, for their families and loved ones.
In the face of the many challenges posed during this time, the INMO continued to support optimal care delivery through constructive engagement, both by the organisation and its leadership, and I would like to acknowledge these efforts.
None of this has been easy. A number of healthcare workers lost their lives to Covid. Many of you, or your colleagues, became sick. You worked longer hours, under more stressful conditions. You made personal sacrifices. Ireland’s healthcare workers have represented the very best of our nation. For your extraordinary contribution, both I, as Minister for Health, the government and the whole country, sincerely thank you.
As a token of appreciation, the government has announced an additional public holiday for all workers, and a special payment for frontline healthcare workers. My department has been liaising with the HSE who have been working hard to roll out this measure. I have made it very clear that I want all eligible nurses and midwives to receive this payment without delay.
The Department of Public Expenditure and Reform introduced COVID-19 Special Leave With Pay for all Public sector employees at the start of the pandemic, as a temporary measure to assist in preventing the spread of the virus in work premises.
I am aware that long COVID is an issue for a number of healthcare staff, including some nurses and midwives who have remained absent on Special Leave With Pay in respect of Long Covid. Officials in my department and the Department of Public Expenditure and Reform will engage on this issue in advance of the cessation of Special Leave With Pay.
As you know, the reform of our health services is vital to the future of our health and social care services. Nursing and midwifery are playing an important role in this. Our goal is universal healthcare – a public health service which provides the best possible care when it’s needed.
Sláintecare is an important part of this. The plan has 228 deliverables. In spite of the enormous challenges of Covid, 4 in every 5 of these had been significantly progressed by the end of last year.
Over the past 2 years, record numbers of healthcare workers have been hired. Record numbers of beds have been added. There has been an unprecedented expansion of community care. Regional Health Areas are being set up. New hospitals are being progressed. Costs to patients are being reduced. For the first time the clinical strategies are being fully funded – in maternity, trauma, cancer, mental health and many more.
Also for the first time, Women’s healthcare has been put front and centre. The Women’s Health Action Plan is radical and ambitious. It includes new services in endometriosis, menopause, perinatal mental health, eating disorders, fertility, gynaecology, breast feeding and more. Free contraception is being introduced for women, starting this year with 17 to 25 year olds. Two years ago the funding for new measures in women’s health was €4m. The full year funding requirement for this year is nearly €50m. Critically, the plan was developed over the past 2 years by listening to women and clinicians and what they said was needed.
Last year saw the completion of the Community Virtual Ward proof-of-concept test and this report demonstrated the very positive improvements in integration of care. A Community Virtual Ward national steering group is being established to oversee implementation.
We now have national coverage of Community Intervention Teams. These specialist teams offer an extended service over seven days, enabling a fast-tracked provision of health care in the community or home setting, preventing unnecessary hospital attendance.
The Enhanced Community Care Programme continues to be rolled out. It’s reducing dependence on the acute hospital system, through initiatives that see healthcare reoriented towards general practice and community services. We now have 49 Community Healthcare Networks with 15 specialist teams for Older Persons and 2 community-based Chronic Disease Management teams.
For the acute hospital sector there has been an additional 42 critical care, 813 acute and 73 sub-acute beds. Many more are being opened this year.
Nurses and midwives are playing an essential roll in all of this, including in the context of enhanced, specialist and advanced practice.
It has never been more evident than during this pandemic, how critical the nursing and midwifery workforce is to delivering safe, effective and quality healthcare.
Recruitment, retention and the wellbeing of the nursing and midwifery workforce are priorities in the coming years. Enhancing the wellbeing of staff includes strategies to ensure safe staffing and safe environments to do complex jobs. The Safe Staffing Framework goes a long way towards this and has given us evidence of the positive impact on patients, staff and organisations.
I am aware that both INMO members and its leadership, are committed to and are an integral part of the Framework’s development. I also fully committed to supporting this with the work of the Chief Nursing Office. I am also aware that implementation has been slow to date. However, the HSE now has the highest ever numbers of nurses and midwives. By the end of February we had over 42,300 Whole Time Equivalent nurses and midwives. Over 1,400 were added in the past twelve months alone. This has been vital in supporting the delivery of care during the pandemic. I am keen to sustain this progress in meeting the safe staffing targets right across our public health system.
I have supported an investment of €25 million to date to for Phase 1, to deliver safe nurse staffing and skill mix in General and Specialist Medical and Surgical Care Settings.
I’m also pleased to be able to share that I have recently approved Phase 2, a Framework for Safe Nurse Staffing and Skill Mix in Adult Emergency Care Settings, developed by the Chief Nursing Office. Nearly €3m has been allocated to this as part of the imminent national rollout.
I would like to take this opportunity to extend my thanks to the staff in the four pilot sites for their commitment to this pilot during such unprecedented times for emergency services during the pandemic. The sites are Ennis Hospital Injury Unit, Cork University Hospital, South Tipperary University Hospital and the Mater University Hospital.
Phase 3 of the Safe Staffing Framework sees the work move to the community. This focuses initially on long term residential care settings, as recommended by the Nursing Home Expert Panal, due to the significant impact of the pandemic in these areas. The pilot testing across nine sites is well underway.
Safe staffing is fundamental to safe care delivery. I have heard this in every hospital I visit. Nurses and midwives have spoken about the improvements in patient outcomes and better and safer working environments, supporting them to do their jobs.
The rollout of the Enhanced Nursing and Midwifery Practice contract has progressed to a very advanced stage. I expect that along with its improved payscale for staff, the flexibilities and reform services for patients well into the future. The contract establishes the role as part of the career pathway.
I have seen first hand the impact that Advanced Nursing and Midwifery practitioners are having across so many care areas, particularly in addressing timely access to care, waiting lists and patient experiences. This year I asked for an increase of Advanced Nurse and Midwifery Practitioners in the workforce from 2% to 3%. Nearly €12m has been provided for this year to start this increase. This will provide around 160 additional Advanced Nursing/Midwifery Practitioners in the first phase.
The Chief Nurse is working with the HSE on the Clinical Nurse Specialist element of the workforce with a view to determining the optimum specialist workforce requirement. Initial and important steps to bring the eligibility criteria for Clinical Nurse and Midwife specialists posts in line with the policy are well underway.
In March we saw the publication of the Expert Review Body on Nursing and Midwifery’s report. I would like to acknowledge your contribution and those of your colleagues to the Report. It sets out a number of important recommendations which, with the INMO, other unions and key stakeholders’ engagement and collaboration, will lead to important reform of the professions and our health services.
The Report conducted a general review of the professions and addressed the specific issues related to management grades. The 47 recommendations provide a framework for improvements across the areas of digital health, workforce, education, leadership and governance. The Report recognises the continued importance of the role of nurses and midwives and acknowledges the importance of recruitment, retention and progression.
The department and stakeholders are finalising plans for implementation of the recommendations. I can confirm that the INMO and other nursing unions will be part of this implementation process.
There are a number of recommendations that have specific public pay implications, which require further negotiation. I know that these are a priority for the INMO and have asked the department to prioritise these negotiations.
In relation to the pay differential arising from the implementation of the enhanced nurse contract, significant engagement is underway under the sectoral bargaining process in this years pay agreement.
As provided for in the Building Momentum pay agreement, the government recently received the report of the Independent Hours Body. This report recommended that contractual working time commitments be reduced for public servants, including nurses and midwives, from 1 July 2022.
Engagements are well underway and the INMO will be a key part of this process.
Late last year I received the Longer-Term Review on matters relating to student nurses and midwives, which was conducted by Mr Sean McHugh. The independent review set out recommendations to enhance the current Travel and Subsistence scheme for students in attending their supernumerary clinical placements. Proposals to enhance this scheme are due shortly. I look forward to receiving these so that a permanent enhanced scheme can be developed. We need a scheme that provides a targeted and more equitable approach to supporting students from this September.
In the meantime, I secured government approval to provide significant additional supports, worth €12 million, for student nurses and midwives while attending their clinical placements. This included doubling the accommodation allowance to €100 per week and extending the Pandemic Placement Grant for supernumerary students.
Another important recommendation of the Report is to consolidate the salary of fourth year student interns. Work is under way to develop detailed proposals to give effect to this recommendation in the longer term. In the interim, all student nurses and midwives on paid internship placement receive additional financial support worth 50% of the Pandemic Placement Grant.
I’d like to conclude by again thanking you all. Due to your dedication services are emerging from the pandemic. As new challenges emerge, not least those caused by the situation in Ukraine, I know that nurses and midwives will continue to help those most in need. I, along with my government colleagues, will continue to support you in this work.