Dáil Éireann - Volume 508 - 30 September, 1999

Adjournment Debate. - Nursing Staff.

Mr. Shatter: While the House was in recess difficulties arose in a number of hospitals resulting in theatres and beds being closed, deriving directly from nursing shortages which are particularly acute in the Eastern Health Board area, particularly in Dublin hospitals. In April this year the Mater Hospital had a shortfall of 67 nurses while Beaumont Hospital had a shortfall of 60 nurses. Currently the Mater Hospital has 3,759 patients on its in-patient hospital waiting list, many awaiting treatment for in excess of 12 months and far too many awaiting treatment for in excess of two years. Beaumont Hospital is in the same position. In the context of the Mater Hospital there are 1,359 cardiac patients awaiting in-patient hospital treatment, hundreds of whom are awaiting major heart surgery.

Yesterday I tabled a Dáil question to be answ[712] ered by the Minister to ascertain whether the level of nursing shortages had further deteriorated and whether there were fewer nurses now available in some hospitals than was the case last April. I would have expected, due to the problems of 34,000 people on waiting lists and the ongoing waiting list crisis and the publicity during the summer months which indicated theatres and beds were closing due to nursing shortages that this issue would have had the personal attention of the Minister.

In the context of the threatened nursing strike, part of the problem in this area derives from the fact that nurses are over worked and feel they are working under far too great a pressure, particularly in the Dublin and Eastern Health Board areas, because of staff shortages. I would have expected the Minister to know where we stand in the context of nursing shortages and to have in place some form of strategy to tackle the problem. In reply to my Dáil question I was told by the Minister that the most recent survey of nursing vacancies was that carried out last April to which I referred and that he has no up to date information of any nature. In the context of his response to the question he said he would ask the health service employers' agency to carry out a further study of the position as of 30 September.

This is indicative of the Minister's neglect of our health service. I would have expected that a Minister half involved in his Department, in the context of discovering that theatres were closing in major hospitals with responsibility for national specialities, would have ensured that he had the most up to date information at his fingertips. I would have expected the Minister to be taking initiatives to ensure we made good the nursing shortfall where necessary in particular hospitals. I would have expected him to be liaising with the voluntary hospitals and indeed the health board hospitals and the health boards where these difficulties are being experienced.

I believe the Minister yet again is not taking seriously the problems and difficulties of nurses or the waiting list crisis. Apparently he believes that when theatres and beds close there is no particular need for him to even find out information, let alone intervene. I call on the Minister to take a far more active interest in this area, to actually do his job because I believe he is failing to do his job properly, is exacerbating the nursing crisis and the waiting list crisis and is directly responsible through his neglect of the difficulties in this area for the hospital beds and theatres which have closed and for people awaiting vital in-patient hospital treatment being deprived of the treatment to which they are entitled.

Dr. Moffatt: I am grateful to the Deputy for giving me this opportunity to clarify the situation regarding nurse shortages.

First, I would like to point out to the Deputy [713] that my colleague, the Minister for Health and Children, Deputy Cowen, inherited the nurse shortage situation. Deputy Shatter's party, and before that the Labour Party, had control of the Department of Health and the manpower requirements for nursing. The numbers coming out of the nursing schools now were not agreed by Minister Cowen—

Mr. Shatter: The Minister has been in Government for two and a half years and the Minister of State is still engaging in historical treatises.

Dr. Moffatt: It takes three or four years for nurses to come on stream, if the Deputy knows what he is talking about.

An Leas-Cheann Comhairle: I ask Deputy Shatter to allow the Minister continue without interruption.

Dr. Moffatt: If the supply is inadequate the blame need not be laid at Minister Cowen's door. I would point out that Minister Cowen increased the number of nursing training places last year and again this year. In 1998 a new school of general nursing was established in the Midland Health Board area with an annual intake of 20 places. The combined intake of the two schools attached to Tallaght hospital was also increased by 33 places in 1998. This year Minister Cowen made available funding for 100 extra training places in general and psychiatric nursing and these have been offered to applicants who successfully came through the competition.

I am glad to take this opportunity to refer to the highly successful outcome to this year's competitions for training places on the nursing diploma programme. As the Minister for Health and Children announced yesterday, a total of 1,217 training places have been filled – 819 in general nursing, 242 in psychiatric nursing and 156 in mental handicap nursing.

I am particularly pleased that the promotional campaigns have raised the profile of both psychiatric nursing and mental handicap nursing. This year we succeeded in filling a record 242 training places in psychiatric nursing compared with only 92 in 1998, and a record 156 places in mental handicap nursing compared with 117 last year. It is true that the Deputy asked for comparative figures on nursing shortages for September 1998 and September 1999 and these are not available in the Department. The most recent survey of nursing vacancies carried out by the Health Service Employers' Agency related to the position at the end of April 1999 and found that of the 566 staff nurse vacancies nationwide, all but 30 were in the Dublin area.

Deputy Cowen has asked the HSEA to carry out a further study on the position at 30 September 1999. He will also consider whether such statistics should be collected on a monthly basis. He is somewhat concerned, however, that doing so simply places further administrative burdens on health agencies, particularly the nursing and [714] personnel departments, where time might be better spent on efforts to recruit nurses.

Mr. Shatter: There should be a proper information system.

Dr. Moffatt: The House will be aware that employment of nurses is at an all time high. The whole time equivalent number of nursing staff in the public health service at the end of December 1998 was 27,586, an 11 per cent increase since 1990. Within this upward trend there has been a significant change in that more qualified nurses have been engaged to replace the traditional student nurses whose education has changed from an apprenticeship model to a third level supernumerary basis.

OECD health data for 1998 also show that Ireland is significantly out of line with other European countries in relation to the very high ratio of nurses per hospital bed employed here. We have 1.26 nurses per hospital bed while France has 0.42.

The principal difficulties relating to the recruitment and retention of nurses are concentrated in the Dublin area. While some nurses have always moved from Dublin to other parts of the State, investment in hospitals and development of regional specialities over recent years have increased demand for nurses outside the Dublin area. Within Dublin, issues such as housing costs, traffic problems and lack of car parking facilities have been cited as disincentives to the recruitment and retention of nurses. However, these issues are not unique to the health service.

Nurse recruitment is carried out on an ongoing basis in most hospitals, and the level of vacancies fluctuates accordingly. At any given time, significant numbers of nurses would be in the process of being appointed by employers and moving from one employment to another. I understand that a number of newly qualified nurses have started or will start work in some of the major Dublin hospitals this week.

While the recruitment of nurses is primarily a matter for individual employers, who take their own initiatives in this regard, a range of initiatives has been taken or is being processed with a view to stabilising the situation and, where possible, to improving it, as requested by the Deputy. These initiatives include the following: arrangements have been agreed with the nursing unions to allow more favourable assimilation arrangements on to pay scales for nurses taking up both permanent and temporary employment and there has been a significant improvement regime of allowances in respect of nurses working in specialist areas, such as operating theatres and intensive care units is being introduced. Implementation of these increased allowances is subject to a—

Mr. Shatter: The Minister is forgetting about the summer closures.

Dr. Moffatt: The Deputy does not want to hear [715] what is being done in relation to increasing numbers.

An Leas-Cheann Comhairle: We have exceeded the allotted time. I ask the Minister to conclude his remarks so we can move on to item 4.