Dáil Éireann - Volume 602 - 11 May, 2005

Priority Questions. - Hospital Staff.

  60. Ms McManus asked the Tánaiste and Minister for Health and Children the number of nursing posts unfilled at the latest date for which figures are available; the number of qualified nurses who were offered permanent posts in the acute hospital service during 2004; if her attention has been drawn to warnings from the INO that the number of vacancies would rise to 2,000 over the next 18 months; the steps being taken to deal with the shortage of nurses; if her attention has further been drawn to concerns expressed that further hospital beds may have to be closed later in 2005 due to the shortage of nurses; and if she will make a statement on the matter. [15481/05]

  Ms Harney: According to the most recent Health Service Executive, employer representative division survey of nurse resources, recruitment remains well ahead of resignations and retirements. Employers reported that 765 vacancies existed at 31 December 2004. The vacancy rate now stands at 2.25%. This could be considered to be a normal frictional rate, given that [400] there will always be some level of movement due to resignations, retirements and nurses availing of opportunities to change employment and locations.

Data on the number of nurses offered permanent contracts in acute hospitals are not available. However, the survey found that in the year ending 31 December 2004, a total of 3,949 staff nurses were recruited by the Health Service Executive, voluntary hospitals and intellectual disability agencies. During the same year, 3,131 staff nurses resigned, retired or moved to another employer. An extra 819 nurses were, therefore, employed in the health service in the year ending 31 December 2004.

The recruitment and retention of adequate numbers of nursing staff have been a concern of the Government for some time. A number of substantial measures have been introduced in recent years. The number of nurse training places has been increased by 70% since 1998 to 1,640 places per year. In excess of €90 million revenue funding is being provided in 2005 for undergraduate nurse training. This is in addition to a capital investment programme of €240 million for the establishment of state-of-the-art purpose-built nursing education facilities on the campuses of 13 higher education institutions. Nursing continues to be regarded as an attractive career. CAO applications for 2005 indicate that 8,155 people applied for nursing, 4,869 of whom gave nursing as their first preference, an increase of 3.5% over last year.

A comprehensive range of financial supports has also been introduced to support nurses in pursuing part-time degrees and specialist courses, including “back to practice” courses. The cost of this in a full year is €10 million. The Department of Health and Children introduced a scheme of flexible working arrangements for nurses and midwives in February 2001. Under the scheme, individual nurses and midwives may apply to work between eight and 39 hours per week on a permanent, part-time basis. Almost a quarter of all nurses now job share or work part-time hours.

Additional information not given on the floor of the House.

There have been substantial salary increases for nurses over recent years. Between 1997 and 2004 the basic salary of a staff nurse increased by 57.5%. In the same period, the salaries of clinical nurse managers increased by between 73% and 89%. The promotional structure within nursing, including the introduction of a clinical career pathway, has been substantially improved on foot of the recommendations of the Commission on Nursing and the 1999 nurses’ pay settlement. The National Council for the Professional Development of Nursing and Midwifery has been especially active in this area and, to date, more than 1,650 clinical nurse specialists and 24 advanced nurse practitioner posts have been created.

[401] The measures I have outlined have produced very positive results. Since 1997 there has been a net increase of 7,000 nurses. This represents a 25% increase in the nursing and midwifery workforce in the public health service. Turnover of nursing staff has also declined. The most recent turnover study covered the years 1999 to 2003. The results of this study showed that nationally turnover had decreased by 40% over the five-year period. Ireland now has 12.2 nurses per 1,000 people, about 50% more than the EU average of 8.5 nurses per 1,000 people.

Ensuring that there are sufficient nursing resources in 2005 and 2006, particularly within acute hospital services, is a priority for the Health Service Executive. This will be the transition period between the diploma and the degree programmes. The final group of diploma students graduated in late 2004 and the first group of degree students will graduate in autumn 2006. A national steering group, inclusive of nurse managers and HR specialists, has been established by the HSE to examine and address the issues involved in ensuring there are adequate numbers of nurses in 2005 and 2006. The group is overseeing the work of a project office tasked with running local and overseas recruitment campaigns. Additional funding has been provided for the HSE for nursing recruitment in 2005. Work is well under way on the tender process for overseas recruitment. Registered nurses in Ireland, who are not practising, are being invited to apply and nurses working flexible/part-time hours are being asked to increase their hours. Improved skill mix will also assist in addressing the problem.

  Ms McManus: That is the exact same reply that was given to another Deputy a couple of months ago. The question I asked has not been answered. I ask the Minister to expand on whether we have a real problem this year, which is unique, because there will be no nurse graduates coming on stream. What precisely will be done about this? Why is she not aware that just one in four nurses from last year got permanent posts? I am amazed that the data are not included in her answer. Does she accept it is very cost ineffective to be so reliant on overtime and agency nurses? Is she aware that it is currently much more attractive for a young nurse to become an agency nurse? There is no incentive to become permanent, which is very expensive and not cost effective.

Does the Tánaiste accept that the shortage of hundreds of nurses has a particular impact in the Dublin region and that some of the problems that arise can be sourced back to the shortage of nurses in the Dublin region? Is she aware that as far back as 2001 the DATs management report indicated that there should be special arrangements, such as Dublin weighting or acuity payment, to deal with the problem?

  Ms Harney: Some 819 additional nurses were employed last year, many of whom replaced people who retired. CSO statistics indicate that [402] there are 12.2 nurses per 1,000 people in this country. Bord Altranais registration figures indicate that there are more than 15 nurses per 1,000 people. In the EU, the ratio is 8.5 nurses per 1,000 people and in Britain the figure is nine nurses per 1,000 of the population. Nurses represent more than half of all the professionals working in health care in Ireland. In Britain, they represent 28% of professionals and in France, 22.5%. I accept there are issues this year because of moving from the apprenticeship programme to the graduate programme. That is why €2 million was allocated towards recruitment policies, essentially going overseas. To put it in context, 91% of nurses working in Ireland are Irish and just under 2% are from the UK. Contrary to the impression which is often created, approximately 6% are from outside Ireland and the UK.

The Dublin allowance was examined by both the Labour Court and the benchmarking body. There is merit in that and it is used in other countries, but it cannot be ring-fenced around nurses. It would have to apply to other public servants. The cost of that in a full year, at the rate suggested, would amount to approximately €258 million. I said to the INO on Friday, and at the SIPTU conference on Monday evening, that if we could deal with some of the practicalities around individual hospitals, we might be able to have more innovative solutions. The Mater Hospital has 1,000 nurses, as has Tallaght, yet there is no flexibility at hospital level to put in place innovative approaches to try to attract people or retain them. Even though the retention rate in Dublin is higher than in the rest of the country, the turnover rate in nursing has declined from 17% per annum to approximately 10% per annum over recent years. At least we are moving in the right direction.

Many young people, including nurses, are taking the opportunity to travel abroad, some of them to practice nursing and more to travel the world. According to An Bord Altranais, relatively few — approximately 400 — practise nursing because they must register. Many of them travel the world, as do many young people. This is a factor in nursing as it is in many other areas.