Nurses and midwives have never been held more accountable, yet simultaneously denied policy input, says Ray Kinsella. Gillian Tsoi reports

Ray Kinsella began his keynote speech at the recent ADC in Letterkenny on a positive note: “There are good things happening”, he said of the Irish health service.

The renowned economist, who is also a senior lecturer at UCD’s Michael Smurfit Graduate Business School, spoke about the progress being made in technologies, such as diagnostics, and told the delegation: “There are other positive developments which are more evident at the micro-level within hospitals and specific specialties and teams.”

But according to Mr Kinsella, many of these positive developments are happening in spite of, and not because of, the present healthcare policy regime adopted by the Irish government.

He said: “The leadership shown by the professions within the hospitals, and the commitment of nursing and midwifery staff, is keeping the lid on the consequences of the most difficult years in modern Irish history.”

In his address, Mr Kinsella spoke about why the healthcare service is in its current dire situation, and the importance of maintaining the integrity of the nursing and midwifery professions.

According to Mr Kinsella, whose wife and three daughters are nurses, the nursing and midwifery professions share common values and objectives.

Emasculation of the health system
Mr Kinsella argued that the global economic crisis, and especially the policy responses within the Eurozone, have compromised the autonomy and integrity of the Ireland’s budgetary policy.

“Our macro-economic policy including the level and composition of expenditure and investment in health is now determined by the Troika and is, essentially, benchmarked against costs and expenditures in Germany, ” he said. “ The government, no longer in the driving-seat of the healthcare budget, has committed to uncritically implementing the terms of the ‘bailout’ programme.”

It is because of this that staffing and systems have been put in the untenable position of having to ”do more with less”. Meanwhile, the nursing and midwifery professions have never before been held more ‘accountable’, and at the same time, have never had less respect in terms of input into policy.

Nursing and midwifery: the present environment
Mr Kinsella highlighted the fact that the HSE’s budget has been cut by over €3 billion since 2008. This year, a further reduction in the gross pay bill of €286 million has been targeted, with €69 million linked to staff reductions.

He asked delegates to bear in mind what the 2001 Health Strategy said about healthcare expenditure: that it is an investment rather than a cost – an investment with measurable economic benefits.

Mr Kinsella also raised the point that the Service Plan 2013 provides for €10 million to be “set against the recruitment of graduate nurses to directly off-set the amount spent on agency and overtime”.

He said: “I would suggest that tells us precisely where so called ‘strategy’ is coming from. It is nothing to do with beneficently offering training places to our nurses. It has everything to do with ‘budget price nursing’, which sells short the capability of the nurse and the enormous commitment of the profession to education and training (including placements) over recent decades.”

Responding to the crisis
According to Mr Kinsella, the Troika and the State are approaching healthcare from an entirely different perspective than the nurses and midwives of Ireland. The former are concerned with healthcare from a contractual basis, ie. hours worked, head count, terms and conditions etc, whereas the latter are coming at it from a vocational perspective.

This vocational perspective is what drives nurses and midwives to provide patient-centred care long after healthcare ‘resources’ have run out.

Mr Kinsella said: “If one reflects on it, it’s very clear that the professions deliver, over and above and beyond contractual responsibilities. A decision to stick solely to contractual obligations on the part of the professions would make it near impossible to deliver on the objectives of the Service Plan.

“So, here is the paradox: The State is attempting to navigate the healthcare system through this crisis from a purely contractual basis. Yet it presumes that the professions will respond from their vocational values.”

According to Mr Kinsella, if the State were to meet the nurses and midwives on the common ground of vocationalism, then the outcomes, in terms of costs and services, would be much greater. He argued that real change can be brought about by putting vocationalism rather than contractualism at the heart of the Irish healthcare system.

“That changes everything. It turns the lights on,” he explained. “Really it’s about the common sense approach of working together and creating a ‘community’ in teams across different specialties and settings within which you can make a real difference.”

He told the conference: “Nursing and midwifery is, of course, a job; it’s a profession; it’s a career; but above all else, it is for many of you here today a ‘calling’. It makes enormous demands. But, if it is your calling, then as some of your colleagues who know more about these things than I do have assured me, it is the only path to happiness and fulfilment.”

Mr Kinsella made the point that, although nursing is a ‘calling’: it does not put bread on the table: it does not mitigate the effects of wrongheaded policies or the fundamental unfairness of salary scales; and it does not prevent graduates emigrating to where their talents and education are respected and valued at every level.

He continued: “I would be the first to acknowledge the difficulties, and constraints, that the present economic environment make for the delivery of safe and high quality care in all of the settings represented here today. But it is precisely because of these difficulties and constraints that you, and your professions, make such an enormous difference to your patients and to your country. That is not rhetoric.”

Ray Kinsella at the ADC: “Nursing and midwifery is, of course, a job. It’s a profession. It’s a career, but, above all else, it is for many of you here today – a ‘calling’.”

New opportunities
Mr Kinsella said that INMO members have been presented with various new opportunities such as the relatively new clinical directorates. “

Clinical nurse specialists have already made enormous contributions to the success of the national cancer care programme,” he said. “The new regional networks, which are imminent, provide a really substantial role for the directors of nursing, which includes not alone the direction of nursing care, but also a strategic role including a place at the corporate table,” he said.

However, Mr Kinsella stressed that there is still more work that could be done, some of which can only be done at a national level “where common sense needs to be turned into standard practice”.

For example, in ensuring that across the whole system directors of nursing have access to all of the management information necessary for their healthcare facility to operate safely and effectively. Equally, by ensuring that directors of nursing sit on all panels which recruit their staff.

He said that some of the most important contributions can only be carried out in individual institutions and care settings because they are driven by the values, vision and insights of the director of nursing and senior clinical nurse managers.

Mr Kinsella highlighted the importance of recognising the contributions of nurses and midwives in the workplace. “Recognition can take the form of encouragement to young nurses and midwives to undertake further training or study visits,” he said.

“Really it’s about feeling valued. I don’t say that it’s a substitute for salaries that have been slashed. It’s coming from a different place and it does make a real contribution to personal and professional development.

“When you are valued; your capacity to give is so much greater. And the more you give of yourself, the greater is your capacity,” he added.

According to Mr Kinsella, in a care setting where people are valued, there is a much greater sense of ownership, and an incentive to work in partnership.

He told delegates that the right culture in an organisation can be transformational.

“The start and the finish of the profession of nursing and midwifery, has to do with the mission of the institution, and the values through which this mission is delivered.”

“The mission may be specific to the care of the person in a particular setting. The focus is still on the person,” he said. “The values are universal. These values are embedded in the core values of your profession whose integrity is I believe under threat in the days that are in it. These values translate into: best practice; advocacy; justice; compassion; and empathy,” he said.

Mr Kinsella’s final message came from his daughter, who is a CNM in St Michael’s Hospital in Dublin: “I asked her what message I could possibly leave with all of you here this evening. She said ‘a message of hope, appreciation, and admiration’.

“In the way of daughters, she was entirely right,” he said.

ADC - Keynote speaker - The call of duty