Dáil Éireann - Volume 517 - 05 April, 2000
Written Answers. - Nursing Staff.
Ms McManus Ms McManus
71. Ms McManus asked the Minister for Health and Children the steps, if any, being taken to address the chronic shortage of nurses, particularly in the Dublin area, which is contributing to ward closures, theatre closures and operation cancellations; the further steps being taken to facilitate recruitment of additional personnel; if he will consider the introduction of an additional quality of life payment to take account of the extra costs of living and working in Dublin in view of the recent report of his Department which identified 1,100 nursing vacancies and the disclosure by the Nursing Career Centre that the numbers seeking to pursue a career in nursing had declined by 1,000; and if he will make a statement on the matter. [9896/00]
Mr. Durkan Mr. Durkan
191. Mr. Durkan asked the Minister for Health and Children if his attention has been drawn to the reasons for the increased use of agency nurses in the health services generally; the action, if any, he has taken or intends to take to address this issue; and if he will make a statement on the matter. [10154/00]
Mr. Durkan Mr. Durkan
192. Mr. Durkan asked the Minister for Health and Children if he has received any indication of a crisis or potential crisis in respect of nursing and medical staff in the various hospitals; the plans, if any, he has to improve this situation; and if he will make a statement on the matter. [10155/00]
Mr. Durkan Mr. Durkan
194. Mr. Durkan asked the Minister for Health and Children the total number of nurses required to maintain an adequate service to the various public hospitals throughout the greater Dublin area and Kildare; the number of nurses currently available; and if he will make a statement on the matter. [10157/00]
Mr. Martin Mr. Martin
Minister for Health and Children (Mr. Martin): I propose to take Questions Nos. 71, 191, 192 and 194 together.
The most comprehensive survey on nursing vacancies was carried out by the health service employers agency (HSEA) and related to thepos ition at 30 September, 1999. It found there were 1,180.46 vacancies in gross terms but, when adjustments are made for the utilisation of agency nurses and overtime working, the net figure is 428.16.
The results confirmed again that there is not a nation-wide problem regarding the availability of nurses and that difficulties largely relate to the greater Dublin area. Indications are that the level of applicants for nursing posts outside the Dublin area far exceeds the number of positions available.
While some nurses have always moved from Dublin to other parts of the country, investment in hospitals and the 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 nurses or to the health service.
It should also be noted that 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 or moving from one employment to another. This has been borne out in a recent survey carried out by the HSEA of nursing vacancies in the Dublin area, at March 2000, which indicates that while the overall number of vacancies has increased, St. James's Hospital, Beaumont Hospital and the Mater Hospital reported improvements in their nursing levels.
I have no plans to introduce an additional quality of working life payment for nurses working in Dublin. It would not be possible to ring-fence such a payment to nurses. The Irish Nurses Organisation rejected the concept of a “Dublin weighting” at its 1999 annual conference.
While the recruitment and retention of nurses is primarily a matter for individual employers, initiatives have been taken or are being progressed with a view to stabilising the situation and, where possible, improving it. These initiatives include the following:
(1) New arrangements have been introduced to give better starting pay to nurses taking up employment by giving full recognition for previous experience at home and abroad.
(2) A significantly improved regime of allowances in respect of nurses working in specialised areas such as operating theatres and intensive care units has been introduced.
(3) Discussions with the nursing unions are continuing in relation to the introduction of more flexible working arrangements for nursing staff.
(4) Standardised overtime working arrangements have been introduced following agreement with the nursing unions.
(5) Health service employers have been asked to examine the possibilities in relation to the  introduction of term time working as an option for staff with family commitments.
(6) Some 11 hospitals around the country provided “back to nursing” courses in 1999 for nurses wishing to return to the workforce. Some 304 places were available. The expansion of these courses is another factor in maximising the available nursing workforce.
(7) During 1999/2000 sixteen new post-registration programmes have been developed. This year there will be 660 places on post-registration courses in specialised areas of clinical practice. In response to an identified need, eleven of the sixteen new programmes will be located outside the Dublin area.
(8) An anti-bullying policy document, prepared by the HSEA and agreed with the nursing unions, was published in December 1999 and has been widely promoted within the service.
(9) The promotional structure within nursing, including the introduction of a clinical career pathway, is being significantly improved on foot of the recommendations of the Commission on Nursing.
(10) A “Study of the Nursing and Midwifery Resource” by the Nursing Policy Division of the Department of Health and Children commenced in 1998 with the primary purpose of forecasting future nursing and midwifery resource needs. Following on from this, a national study on turnover in nursing and midwifery has been commissioned by the Department through the Health Research Board and awarded to the Department of Nursing Studies, NUI, Cork;
(11) On-going discussions continue with the relevant Departments and with An Bord Altranais regarding entry visas/work permits for nurses recruited from outside the European Union or European economic area. These discussions are aimed at ensuring that there are no unnecessary barriers to entry. I am pleased to report that agreement has been reached on a procedure for fast-tracking immigration clearances and work permits for non-E.U. nurses.
In this context, data maintained by An Bord Altranais indicates that in recent years there has been a net inflow of nurses to Ireland. Provisional inflow figures for 1999 show a dramatic increase to 3,171 in the number of nurses seeking to register here. This pattern has continued during the first three months of this year.
Employers have stepped-up their recruitment from abroad with significant success. For example, the Mater Hospital, Dublin has just finalised arrangements for the recruitment of 75 qualified nurses from the Philippines in addition to on-going recruitment within Ireland.
Further funding totalling £400,000 has been made available to the various schools of nursing throughout the country to enable them undertake local marketing campaigns aimed at promoting nursing as a career.
The number of applicants for nurse training places this year has not declined by 1,000 over last  year. The newspaper which published a report to that effect subsequently published a retraction. More than 5,000 applications have been received by the Nursing Career Centre this year. This means that there are more than three applicants for every available training place. This is most encouraging bearing in mind that the total number of training places is being increased by 25% over last year and the reduction in the volume of applicants for public service positions generally.
(13) The annual maintenance grant for nursing students, which is not subject to a means test, has been increased to £3,325 with effect from 1 April 2000. The grant now is almost double the maximum grant for which other third level students may qualify.
In addition, allowances for external clinical placements, books and uniforms are also being increased.
(14) The range of Leaving Certificate subjects that may be presented by an applicant for admission to the Nursing Diploma Programme has been expanded.
(15) The requirement to have a foreign language in the leaving certificate has been removed.
These initiatives represent a very significant effort on the part of my Department to improve the situation. In the longer term, it is hoped that the substantial increase in the number of student places will provide enough registered nurses to fill all vacancies.
In response to Deputy Durkan's questions, the total number of nurses employed in the public health service on 31 December, 1998 was 31,266, 26,695 whole-time equivalents. This compares with 51,212 nurses on the active register of An Bord Altranais in March, 2000. The Department's annual personnel census is the principal source of data on employment levels among nurses. The most recent census available is 31 December, 1998 and shows the number of nurses employed in the greater Dublin area and Kildare is 10,366.72 whole time equivalents.
It is not possible to be definitive as to the total nursing complement required to provide adequate staffing for hospitals. The Commission on Nursing recommended that the Department of Health and Children, health service providers and nursing organisations examine the development of appropriate systems to determine nursing staffing levels. The need to address skill mix issues was also highlighted in the Commission on Nursing report. Both of these recommendations are included in the priority action plan agreed with the Nursing Alliance as part of the settlement of the nurses' strike. It has been agreed that these issues will be addressed by a joint committee representative of nursing unions and health service employers. This committee is in the process of being established.
The medical staffing of hospitals is currently being addressed by the Medical Manpower Forum. With particular regard to non-consultant hospital doctors the forum is seeking to redress the imbalance between career posts and training  posts, the need to improve postgraduate medical training to keep more Irish medical graduates in the country, and the need to look at the position of women in medicine in Ireland with a view to redressing the number who leave medicine.
The Medical Manpower Forum is due to publish its first report shortly.
Dáil Éireann 517 Written Answers. Nursing Staff.