President, Vice-Presidents, office-holders, members of staff of the INMO, members, colleagues, distinguished guests.
First of all, I want to thank you for inviting me to speak at your 98th Annual Delegate Conference here in the Clayton Whites Hotel, Wexford. I know that the theme of this year’s conference is “Nurses and Midwives – Together Shaping Healthcare”. It’s a theme I wholeheartedly support and, with nursing and midwifery encompassing almost one third of the public health workforce, it’s a theme that’s indisputably true.
I’d like to begin by acknowledging the incredibly difficult number of years that nurses and midwives have gone through, the extraordinary challenges you have faced and the huge contribution you make to the health service. Wherever I go, the people I meet tell me about the difficulties we all know exist, particularly with accessing services, but they never fail to mention and praise the great care they receive once they do access them.
I have seen for myself the dedication, care and commitment that nurses and midwives demonstrate every day. You are the glue that holds our health service together in your day-to-day professionalism and hard work in our wards, clinics and practices around the country.
International Midwives Day
Today is a particularly important day for all our midwifery colleagues as the 5th of May marks the International Day of the Midwife 2017.
Such a day is a great opportunity to raise awareness of the vital work of midwives. I know that the main theme of the day is to highlight the importance of partnership between midwives, mothers and families. If I could borrow this theme, I would also say that partnership is a theme which is of great importance to all of us - whether you're a nurse, a midwife, a mother, a member of the INMO or even a Minister. We all need to continue to work together and to build a better health service.
It is one year now since I became Minister for Health and, while we continue to face significant challenges, I have witnessed the extraordinary resolve of nurses in caring for their patients despite those challenges and this only strengthens my resolve to keep focussed on the big picture.
When we deliver for people and patients – improving their lives in different ways – it makes it all worthwhile. Looking back over the past year or so at my tenure as Minister for Health, I can cite some examples of progress we have made:
- Developing our new National Cancer Strategy for the next decade.
- Publishing the National Standards for Bereavement Care following pregnancy loss and perinatal death and the first ever HIQA Standards for maternity services.
- Extending the vaccine immunisation programme
- Making Orkambi and Kalydeco available for adults and children with Cystic Fibrosis from 1st May.
- Negotiating a very good deal with IPHA on the cost of medicines, leading to savings of hundreds of millions of euro which will be reinvested in health and specifically in new and innovative drugs.
- Making things a little bit easier for parents of children with a disability, by providing children in receipt of the Domiciliary Care Allowance with full medical cards.
- Making sure that prescription charges for 390,000 people over 70 and their dependants were reduced.
- Publishing and implementing our first ever National Obesity Strategy.
Future of Healthcare Committee
Looking ahead, one of my key objectives on becoming Minister for Health was to develop a long term vision for the Irish health service supported by political consensus, which I believe is essential. I believe the current problems being experienced in our emergency departments and with waiting list numbers are the result of underlying, systemic issues within our health service.
The cross-party Oireachtas Committee on the Future of Healthcare was established in recognition of the growing need for the development of that political, and indeed societal, consensus around this long-term vision. I want to thank the INMO for your contribution to this process.
I recognise that capacity in the broadest sense encompassing the workforce and physical structures must be addressed. We need to resolve the problems we face in a planned, realistic, achievable and sustainable way, one that won’t deviate with every election, to the detriment of the health service and the patients.
For my part, when I had the opportunity to address the Committee I outlined the areas where I believe the focus needs to be. You’ll be relieved to hear I’m not planning to repeat the presentation I made then here today but, to summarise, paring back bureaucracy, more beds and more staff have to be a priority.
Industrial Relations
After long and difficult years of cuts, we can now begin to plan for the opposite. We can begin to put in place that increased capacity I have talked about. So how are we going to get there? I believe at least part of the answer lies in the very good dialogue we have had with your union and the set of proposals that resulted.
I very much welcome your members’ majority acceptance of those proposals and I know you had a detailed, deliberative process to arrive at that result. In my view, these measures can make a real difference to recruitment and retention, which I agree is absolutely vital to rebuilding our capacity.
Recruitment and Retention WRC Agreement
The issue of pay and staffing has of course been a significant part of the discussion during your conference and it’s an issue which has been given considerable attention by me and my Department, in conjunction with you, in coming to the WRC agreement.
I wish to reaffirm once again my absolute commitment to the implementation of this agreement. I have heard loud and clear from your union that we are only going to succeed if we attach the kind of priority to recruitment and retention that has never been seen before and that is exactly what we are doing. These are not just soothing political words. My statement of commitment is matched by an unprecedented direction to the HSE.
Today, I have with me a written direction from me as Minister to the HSE under Section 10 of the Health Act 2004 regarding implementation of the 2017 Nursing and Midwifery Funded Workforce Plan. This is a rarely used legal provision whereby the Minister of the day can issue a direction with which the HSE must comply. This Section 10 direction will be laid before the Houses of the Oireachtas and will be lodged with the WRC.
Furthermore, this afternoon, I wish to confirm that a circular outlining the provisions of this agreement, including confirmation of the delegation of recruitment to Directors of Nursing has been issued by the HSE.
Under the direction I have issued, the HSE must report to me on the performance and implementation of these arrangements as part of the 2017 National Service Plan. The HSE will also have to provide special reports by June, September and December 2017 on the recruitment of the posts provided in the workforce plan. These quarterly reports will also be shared with the INMO and lodged with the WRC.
Arrangements are firmly in train for the establishment of the High Level Group to oversee the implementation of the agreement – senior officials within the HSE and Department of Health will be represented at this Group along with your chosen representatives – and we have proposed the first meeting of the group will take place this month.
Let me send a very clear message today: delivering on the implementation of this agreement and these recruitment plans is not an optional extra but an absolutely essential priority for the health service this year. I cannot be clearer than that.
We are committed to:
- The funded workforce plan increasing the nursing and midwifery workforce in 2017, delivering 1,208 additional permanent posts;
- Conversion of agency employed staff into HSE direct employees;
- Offering all graduating nurses and midwives full time contracts – and this afternoon I wish to announce that the health service will be writing directly to each of those student nurses in the coming days to tell them this and outline the next steps.
The Irish health service needs these graduate nurses and this letter will tell them that.
Other key measures include:
- Maternity leave cover;
- A career break scheme;
- 130 additional undergraduate places in 2017;
- And offering nurses and midwives improved educational opportunities and career pathways.
Task Transfer (Restoration of Time and 1/6th )
Delegates, other important developments include the transfer of tasks which has been implemented in the Acute hospital sector. Earlier this year, admittedly after some delay, the restoration of time and 1/6th was paid to those working twilight hours in this sector.
This will see patients benefit from fewer delays when it comes to getting their IV antibiotics, their bloods taken or discharge papers and there will be fewer delays for patients in the clinic waiting rooms as doctors won't be expected to be on the wards and in a clinic at the same time as frequently as they are now.
I was pleased to hear this week that agreement has been reached to extend this to the Social Care and Intellectual Disability sector. The tasks appropriate to these sectors have been agreed and Local Implementation Groups are being established with the appropriate protocols.
I see great benefits to the patients in these settings arising from nurses undertaking key tasks. If the administration of IV antibiotics or IV fluids hydration to the elderly or patients with dementia in their own environment prevents an ambulance trip to an emergency department then we know it has been worth the journey to get to the implementation of the Task Transfer.
Incremental credit for 36 week student placement
I was delighted that I was able to address the anomaly to provide incremental credit for the fourth year student placement for those who graduated between 2011 and 2015.
This decision came into effect from 1st January 2017, approximately 4,000 nurses who graduated between 2011 and 2015 are eligible and it could add over €1,000 to their salaries.
I am pleased that this restoration will also apply to nurses who graduated during these years but may have left the country and might be thinking about coming home.
Approved Group DON Salary
I was also glad to get approval from the Department of Public Expenditure and Reform to award an appropriate salary for the Group Directors of Nursing commensurate with their Acute Hospital Group counterparts.
Recruitment initiatives
We are pursuing a number of recruitment initiatives to attract nurses and midwives to the public health system. There have been a number of events with the first held at Christmas in Dr Steeven’s, this attracted over 200 nurses and midwives over the 3 days, with further events in the RDS and again in Dr Steeven’s Hospital. This provided an opportunity for professional engagement with the Chief Nursing Office, the Office of the Nursing and Midwifery Services Directorate in the HSE and the Nursing and Midwifery Board of Ireland.
It provided an opportunity for attendees to acquire information on return to practice, adaptation, competency assessment and the many education opportunities available.
On the 7th April a delegation travelled to London to attend a recruitment fair and this will be followed by other recruitment fairs in Cardiff, Birmingham and Scotland in the coming months. I would like to acknowledge too the support of the INMO for this.
The HSE are offering an enhanced relocation package and devolvement of recruitment to Directors of Nursing and Midwifery and Directors of Public Health Nursing. Interview processes have adapted to enable Skype interviews for those applying for posts from overseas.
Retention initiatives
There are also a number of retention initiatives in train. To name a few:
Leadership, Education & Professional Development - In the context of implementing the Health Service People Strategy management commits to ensuring all Nurses and Midwives will have a Personal Professional Development Plan. This process will commence prior to December 2017. Plans will be reviewed and developed on an annual basis.
Management will undertake a review of education and development supports for Nursing and Midwifery in consultation with yourselves with a view to prioritising education initiatives in 2018.
Pre-Retirement Initiative – this will be operated on pilot basis for 2 years commencing 1st July, 2017. Eligibility will be confined each year to 250 nurses and midwives aged 55 and over who have 20 years public service or more whole-time service and do not have enhanced superannuation benefits.
Career Break Scheme - All newly recruited nurse and midwife graduates, after one full year of service, will have a career break option.
I wanted to give particular mention here to the work of our Chief Nursing Officer, Siobhan O’Halloran and her team, and the fresh thinking they are bringing to the challenge of sustaining the nursing and midwifery workforce.
To name but a few of their initiatives, that office set itself five priority actions, to be achieved by the end of 2017, and I am delighted that all five have been completed and I would like to briefly mention them here.
An initiative on Nursing and Midwifery Values was led by the CNO’s office to identify the core values that underpin nursing and midwifery practice, and support behaviours associated with care, compassion, and commitment and to ensure that they are reinforced in nursing and midwifery practice and culture across all settings. In June last year, I launched a position paper on the values that outlines a framework for supporting nurses and midwives to sustain and renew the values and on the 16th May a conference on nursing and midwifery values in practice will take place in Dublin Castle to build on the momentum of this very important initiative.
The Taskforce on Staffing and Skill Mix for Nursing has been established to contribute to the stabilisation of the nursing resource and to help us develop safe nurse staffing, that provides safe patient care and outcomes, along with a healthy work environment that attracts and retains our vital nursing resource.
We have a draft policy on the future development of advanced and specialist nursing and midwifery practice. This policy presents a framework for graduate, specialist and advanced practice that is capable of developing a critical mass of nurses and midwives and I understand that we will be recruiting 120 Advanced Nurse Practitioners, to commence an education programme, very shortly.
Furthermore, we now have a new draft policy on nursing and midwifery models in the community that will develop genuine integration between our community and our hospital services.
I launched consultations on both of these draft policies on the 27th of March and they have recently concluded. I was delighted to learn that around 600 of you attended consultations throughout the country.
I am today announcing the establishment of two steering committees for the implementation of both policies to ensure the vision becomes a reality. The first meeting of each group will take place in the week commencing the 15th of May and I’m delighted that the INMO has agreed to participate.
Finally, we have developed a framework for national performance indicators for nursing and midwifery to ensure that their development, prioritisation, endorsement, and monitoring is standardised.
The five initiatives I’ve just outlined aim to embed the values of nursing and midwifery, stabilise the nursing and midwifery resource, maximise nursing and midwifery outcomes and measure the impact of nursing and midwifery. They are fully integrated and, I believe that once implemented, they have the potential to revolutionise the delivery of nursing and midwifery services.
Pay Talks
I am conscious that you have emphasised the need for increasing pay to address recruitment and retention. I agree that pay is important, especially the restoration of your pay. I also want to see all nurses being able to have a better work life balance. We must ensure that we can provide an environment that is beneficial for the nurse or midwife through appropriate management structures to support you, the right skills mix based on patient acuity level, the right equipment, improved capacity and suitable physical infrastructure. Of course all of these factors will also benefit the patient.
Public sector pay talks lie shortly ahead and your organisation will be pursuing pay claims for all members beyond the restoration of the FEMPI cuts. I know there are outstanding issues you and your members wish to discuss and I look forward to that process. The work of the Pay Commission will be important in informing the engagement in relation to the appropriate pay levels for key health care providers including nurses and midwives and dealing with pay issues in a structured way. No doubt, following the publication of the Commission Report the INMO will play an important role in the discussions and negotiations.
Conclusion
As I draw to a conclusion I want to again acknowledge the contribution you make to the delivery of care in circumstances that can be challenging given the current capacity deficits. I would like to acknowledge the determination your President Martina Harkin-Kelly has demonstrated in our meetings to get the best for you. I would like to thank you once again for the opportunity to speak to you.
And last but by no means least, I would like to acknowledge the significant and positive contribution made by Liam Doran, during his time as General Secretary of the INMO.
Liam is well known as a worthy adversary and, while he didn’t shy away from the rough and tumble of industrial relations negotiations, he was instrumental in facilitating some of the most transformational nursing and midwifery initiatives. Work fills a large part of our lives, and the only way to be truly satisfied is to do what you believe is great work. I have always been struck by Liam’s passion for nursing which is, quite simply, extraordinary.
I think Liam’s legacy will be that he had the foresight to appreciate the merit in the longer-term policies that will really make a difference for nurses and midwives and, indeed their patients, in the years to come. I am reminded of O’Casey’s comment ‘Every action of our lives touches on some chord that will vibrate in eternity’.
I wish Liam a very happy retirement and I hope he enjoys the many opportunities that the future will bring. And, of course, I wish you all well with the rest of your conference and thank you again for inviting me to be with you here today.