Health Minister James Reilly told delegates that they had a vital role to play in the reform of the Irish health service. Alison Moore reports

“Your profession is synonymous with commitment to excellence and dedication to providing quality safe care. But it’s also synonymous with resilient response to new demands. It always has been.”

These were Health Minister Dr James Reilly’s opening words at last month’s annual delegate conference in Letterkenny. In light of recent events his reception was always likely to be the stony silence that eventuated and the conciliatory nature of his opening was most likely in recognition of this.

Minister Reilly described the demands being made on nurses and midwives as a result of economic circumstances and the demands of reform as being “enormous” “Either, on its own, would have been tough for you at the front line. Together, they’re unprecedented – and have met with unprecedented response at the front line. Nurses and midwives, all day and all night, 365 days of the last couple of years, have demonstrated ongoing commitment to quality patient care and effective service delivery. The flexibility and dedication of health professionals means we’re still delivering the same, and in many cases an enhanced, level of service. Despite reduced financial resources and staff numbers,” he said.

Heath service funding
Dr Reilly presented the government case that despite progress made in addressing the financial position of the State, the budgetary position remains challenging.

“This year we are receiving €12 billion from the Troika. We have to continue to narrow the gap between the State’s income and expenditures so that we can successfully exit the present bailout. For the public service, this means that government must pursue measures that are difficult more than difficult for those who work there,” he said.

“For the HSE, pay savings of €150 million have to be achieved in 2013. On top of the many reforms and efficiencies designed to improve services and live within budget, pay savings must be made. Frankly, we’re between a rock and a hard place,” the Minister added.

With reference to the talks with the health unions and the Labour Relations Commission that were ongoing at the time of the ADC, Dr Reilly commented that agreement would be much better than an imposed solution. “Those who depend on our health services must be able to rely on them, especially in times of great difficulty or personal crisis. I would ask your Organisation to keep this imperative to the forefront in its deliberations,” he said.

Reform
The next major step in healthcare reform is the re-organising of hospitals into a number of groups that will be geared to integrate the delivery of services.

“A key feature of these new arrangements will be the appointment of a chief finance officer to establish robust financial governance structures and controls. The new governance legislation, creating a directorate structure in place of the Board, should be enacted in the coming weeks.

“These changes will pave the way for the eventual abolition of the HSE and its replacement by new structures that will bring universal health insurance into being,” said the Minister.

Dr Reilly explained that it was a priori ty for the government to deliver “faster, more equitable access” to hospital services for patients. He pointed to the improvements in waiting times for unscheduled care, gained against a background of reduced funding and significant demographic pressures, and gave credit to nurses and midwives in this achievement.

“By the end of 2012, for instance, there had been 20,000 fewer people on trolleys in Irish hospitals compared to the end of 2011 an improvement of almost 24%. And in 2013 despite the extended period of winter weather and a 3.5% increase in admissions from ED which included a 17% increase in the number of older patients admitted up to 19 April we had 7.7% fewer patients on trolleys compared to the same period last year,” said Dr Reilly.

These figures however were met with some scepticism from delegates.

Dr Reilly then quoted the INMO’s figures comparing the first quarter of 2011 with the first quarter of 2013, these showed a 29% reduction in the number of patients enduring long trolley waits. “These figures are a testament to the commitment and care you have delivered to patients in our hospitals and I want to acknowledge and thank you for that,” said the Minister.

“We have also addressed waiting lists for elective care. By the end of 2012, 98% fewer adults were waiting over nine months than at the same time in 2011. For the first time we have quantified to the full extent waiting times for outpatients and we will deal with that change in the same way as we have dealt with inpatient waiting times. Once the urgent cases have been dealt with, the longest waiters will be seen first,” he added.

Leadership
Dr Reilly spoke about the HSE’s national clinical programmes and referred to the key role played by nursing and midwifery in their implementation. To date, there are 35 lead clinical nurses and midwives for 25 programmes who, according to the Minister, are critical to the design, implementation and evaluation of these initiatives.

He said that the establishment of primary care teams, of which PHNs and community RGNs were key members, provided the “basis for the delivery of integrated and more comprehensive health and personal care services in the community”.

He said that the government remained committed to the strategy to roll out universal primary care in Ireland, including access to GP care without fees.

Citing the importance of nurses working in the community, the Minister spoke about work underway to develop diabetes services through the appointment of 17 clinical nurse specialists who would “play a key role in the development of clinically sound collaborative links between primary and secondary care and will be an essential resource in empowering patients to achieve optimum diabetes control”.

Dr Reilly stressed that nursing and midwifery must take on the leadership in organising and managing healthcare provision and challenged delegates to take on these roles.

“Sometimes this can involve leading out on less than popular measures and challenging the orthodox analysis of issues, in one’s own and other groups. This is not a comfortable space to occupy but these are the challenges that go with taking on real leadership roles,” he said.

He said that a number of important leadership development initiatives had commenced, including the ‘Future Nurse Leaders Programme’ for directors of nursing and midwifery and the ‘Leading in Uncertain Times Programme’ to support and strengthen the leadership contribution of staff nurses and midwives and clinical nurse and midwife managers.

“As clinical leaders, I would encourage you to nurture and grow the leadership and innovation capacity of yourself and of your teams. Capacity and enhancing capacity is crucial,” said the Minister.

To this end, he argued that continuing professional development had a significant role to play, citing the introduction of prescriptive authority and x-ray prescribing for nurses and midwives as examples of how nurses, with ongoing education, training and development, can really bring added value to our health services.

Graduate pay
The topic of nurse and midwife education has become contentious due to both the shortage of employment opportunities and the emergence of the HSE’s graduate employment programme that offers only 80% of a staff nurse salary but the Minister told delegates that his department would listen to what the INMO had to say on these issues. He said that nurse education in Ireland had a long tradition and was highly regarded, with an excellent reputation both nationally and internationally.

The recent review of the undergraduate degree programme for nursing and midwifery identified that the nursing education programmes in Ireland provide for highly qualified, competent and motivated nurses and midwives and Dr Reilly told delegates that the Department of Health has set up an oversight group to ensure that the report’s recommendations are implemented in full and would be working with the Nursing and Midwifery Board of Ireland to this end.

Mental health services
Dr Reilly said that this government was strongly committed to reforming mental health services. “I am working hard with Minister Lynch to ensure that services are being re-focused around the service user, mainly through more in-patient and community based care, while enhancing quality of services and patient safety. The government’s commitment has been underlined by the special allocation totalling €70 million for mental health in this year, comprising €35 million from 2012 and a further €35 million this year, to recruit up to 900 additional staff by the end of 2013. The allocation will be used largely to strengthen services such as community mental health teams, across the full range of adult and child services,” he said.

He told delegates that the issue of suicide was being prioritised with a range of prevention and support measures aimed at individual, family and community level. He said that the government has increased the annual budget for suicide prevention this year to more than €13 million.

Safe care
Maintaining safe standards of care is at the centre of our approach to delivery of services. Managing clinical risk within constrained resources is challenging for all health professionals, but in particular for nurses and midwives.

Dr Reilly stressed that excellence in nursing and midwifery would continue to be a central pillar of our health system and he said that enhancing nursing and midwifery roles would help to achieve the central objectives to put patients first and ensure better outcomes for them, to provide quality safe patient care and aftercare, and to empower frontline staff.

New chief nursing officer role
Announcing the establishment of a new chief nursing officer role within the Department of Health, at assistant secretary level, that will have executive authority to lead the nursing profession in Ireland and represent its perspective both to government and internationally, Dr Reilly said: “Strong nursing and midwifery leadership must be at the heart of corporate and clinical governance structures in services. You must be centrally involved in service planning, budget control, management and clinical decision making.”

This development had been lobbied for by the INMO, which made a compelling case for a higher status and greater authority for nursing and midwifery within the Department of Health.

“ In short the voice of nursing will be heard and listened to at the highest level of planning as the future of our health service evolves,” promised the Minister. This announcement was warmly welcomed by delegates.

Speaking on the newly announced hospital groups, Dr Reilly added that each would require a chief director of nursing as a full executive on the management team with the clinical director and chief executive.

“This will provide strong national leadership for the profession, give a clear voice to the nursing and midwifery perspective as policy and strategy are being formed and lead essential national programmes on strategic workforce planning and a review of the present skill mix in hospital, community and primary care settings.

He said that nurses and midwives were the “bedrock” of the health service, without whom services could not be provided.

“I greatly appreciate the commitment and hard work that you bring to your role and that the challenges that we all face in recent years are without precedent in the recent history of the State.

“I hope that together we can successfully deliver the sort of care we all believe as nurses and doctors our patients deserve.

“I want to genuinely thank you all for the wonderful ethos of care and compassion that you bring every day to some of the most vulnerable in our society,” concluded the Minister.

Claire Mahon, INMO president, speaking after the Minister, welcomed his acknowledgement that nurses and midwives were “under pressure every day they go to work” and said that the Organisation was always open to working with the Department of Health.

“We have no problem with a collaborative approach to solving issues. We definitely have no problem with improvement in staff satisfaction and we do hope that we will engage in discussions on these issues,” said Ms Mahon.

So, some nice words on the nursing and midwifery professions from the Minister but delegates will be waiting to see if they are backed up with action over the coming weeks.

Minister’s comment leads to row at ADC

Health Minister James Reilly became embroiled in a row following remarks he made to a delegate as he was departing from the annual conference .

Ms Bolatito Aderemi, Dublin South West Branch, who was subject to the Minister’s parting shot

Having delivered his address to the nurses and midwives assembled, Minister Reilly, on walking from the podium to chants of ‘no more cuts’, told one of the delegates, Bolatito Aderemi from the Dublin South West branch, who had started to sing in protest, to “stick to the day job’”.

The comment caused much consternation among those delegates who heard it, with one nurse calling on the press to report on the incident and for the top table to seek a public apology from the Minister.

Geraldine Talty, first vice-president of the INMO called for delegates to rise above the situation and continue with the work of conference.

The Minister had been met with silence when he arrived at the conference hall, however, the atmosphere had thawed a little when he announced the new chief nursing officer post. His comment immediately reversed whatever ground he had made with delegates.

The Minister later met with Ms Aderemi privately and apologised. He explained that he had simply made a “quip” as he left the hall and he had not intended to offend anyone.

Ms Aderemi told the press that the Minister had shaken her hand, tried to give her a hug and told her he was sorry and that he had not intended to embarrass her. She said that she accepted his apology.

ADC - Health Minister’s address - Differing views remain after Minister’s address