Due to illness, the Minister’s address was given by Ambrose McLoughlin, secretary general at the Department of Health. Alison Moore reports

“All of us here today share a common goal. We want to provide the best possible care for every member of the Irish population. As we navigate our way through all the challenges we face in reaching that goal it’s vitally important that we work together. “

The opening words of Ambrose McLoughlin, secretary general of the department of health, who was delivering Health Minister James Reilly’s speech to the ADC on his behalf due to the Minister’s ill health. The speech delivered to delegates was, in contrast to recent years, very focused on nursing and midwifery issues, perhaps showing the early influence of the new chief nursing officer, Dr Siobhan O’Halloran, at the Department.

Dr McLoughlin made reference to this appointment, stating: “I [The Minister] believe that it is critical that nursing and midwifery plays a central role realising health reform. The appointment of Dr O’Halloran as the first chief nursing officer (CNO) at this level in the Department of Health ensures that the voice of nurses and midwives is represented at the highest levels of policy making in the health service. This appointment greatly strengthens policy deliberations and ensures that dialogue and collaboration between nurses and midwives and policy makers can be sustained over time.“

Dr McLoughlin then went on to announce the recruitment of three deputy CNOs is underway. He explained that the three general areas for which the deputy CNOs will have respective responsibility were: Patient care and systems; women’s health and primary care services; and nursing and midwifery policy and legislation.

“The programme of reform currently underway represents the most radical overhaul of the Irish health service since its inception and the CNO and her deputies will have a critically important role to play,” he said.

Austerity
Speaking on the financial issues facing the health service, Dr McLoughlin said it was necessary to “find ways to maintain the highest possible quality of service while operating within a very constrained fiscal environment”. In reference to the recruitment moratorium and the INMO’s call for minimum ratios to be applied the Department’s position was that “deciding on an optimal number of nurses is not easy”

“There is a delicate and important balance to be struck to meet both economic efficiency and patient safety requirements. It is imperative that patient safety continues to be maintained in the context of these reductions, and achieving this requires that relevant expertise is applied to the decision making process.”

Dr McLoughlin revealed that the Minister had approved the establishment of a taskforce to develop a framework to determine staffing and skill mix requirements for the nursing workforce, with focus on the development of staffing and skill-mix ranges that take account of influencing factors.

Phase I of the project will focus on developing a staffing and skill mix framework for general and specialist adult hospital medical and surgical care settings. The taskforce is set to be chaired by the CNO and will comprise relevant experts, including representatives from the INMO.

Dr McLoughlin, on the Minister’s behalf, acknowledged that nurses and midwives, have made many sacrifices over the course of the past five years.

“I can’t stress strongly enough how aware I am of the huge contribution each and every one of you makes to the health service on a daily basis, and how grateful I am for your continued commitment and professionalism through these extremely difficult economic times’” he said.

“Your devotion to providing your patients with the best possible care when you are often under these considerable pressures is exemplary,” he added.

However, he said that these measures were “unavoidable as we must operate within the financial limits of the present economic environment. But there is no denying they have made many tough demands on you, particularly given the reductions in the numbers employed in the health service”

He went on to note that the Haddington Road negotiations also resulted in “positive outcomes” mentioning the regularisation of acting-up posts and the restoration of the senior staff nurse scale as well as citing the graduate programme as, despite the criticism, leading to 500 nurses and midwives taking up employment.

Safety
In reference to some safety issues faced by the health service, Dr McLoughlin said that the recommendations of the HIQA Report into the care and treatment provided to Savita Halappanavar and the Report of the chief medical officer (CMO) into Portlaoise Hospital are currently being implemented. Referencing the reports Dr McLoughlin said: “I am confident they will ensure that patient safety is everyone’s priority and reassure patients that our health services are of the highest quality in terms of care and safety.”

One of the key recommendations arising from the CMO report on Portlaoise Hospital was that the health service should develop evidence-based workforce planning tools and data systems for midwives and maternity care assistants, using ‘Birthrate Plus’ - a tool championed by the INMO in its call for minimum ratios.

Speaking on this, Dr McLoughlin said that progress was being made in this area with data gathering beginning shortly and that it was anticipated that a report will be available in the autumn.

“My Department is continuing to develop proposals on the organisational structures needed to improve patient safety in our health system. We are working with the HSE to establish a new Patient Safety Agency (PSA) at the earliest opportunity,” he said.

Trolleys
Dr McLoughlin cited figures from the Minister showing that since this government came to power in 2011, the number of patients waiting on trolleys had fallen significantly.

“International evidence tells us that where patients spend lengthy periods of time on trolleys in overcrowded EDs, they have poorer experiences and poorer outcomes. Addressing this problem by moving patients to other areas within the hospital is preferable to the risk of severe overcrowding, but it is not a real solution.

The introduction of Ward Watch has been important in bringing a meaningful focus on this issue and in working to find a real resolution. It is welcomed by my Department and the Special Delivery Unit and I hope that the INMO will continue to work with the SDU on finding ways to minimise the use of non-designated bed spaces to accommodate patients,” Dr McLoughlin said.

He explained that tackling these problems has required a ‘systems’ response and that we need to focus on improving the patient experience in ED. The national Patient Experience Time (PET) standard is that all patients will complete their care in less than nine hours, and that 95% of patients will complete their care in under six hours.

“Achieving and maintaining these standards is undoubtedly a challenge. However, with the introduction of medical assessment units, minor injury units and other streams to manage patient pathways, and by ensuring that low acuity patients, who generally do not require admission, are focused on, I think we will begin to see the same significant beneficial changes we have witnessed in terms of trolley reductions,” he said.

Standards
Since commencing the Nurses and Midwives Act 2011 in October 2012, Dr McLoughlin told delegates that the Department has been working with the Nursing and Midwifery Board of Ireland to give full effect to the new legislation.

“I [the Minister] made provision in the Nurses and Midwives Act for a statutory Midwives Committee in NMBI and am pleased that work has commenced within this structure to revise and update the Practice Standards for Midwives (2010)”

He said that this would address the skills required by a midwife to maintain their professional competence to the satisfaction of the NMBI. He said that midwifery education was also being examined to ensure that future midwives would be prepared to meet evolving health needs.

Dr McLoughlin said that developing the role of nurses and midwives to support safe access to efficient health services was one of Dr Reilly’s core priorities and told conference that the NMBI now has six AMP and 134 ANPs registered, and that a project to review and support the development of these roles was at an advanced stage.

Leadership
According to the Minister, building the leadership capacity and capability of nurses and midwives is essential in delivering a reformed health service.

Since the establishment of the National Leadership and Innovation Centre for Nursing and Midwifery (NLIC) in 2011, 1,417 nurses and midwives have engaged in various programmes and workshops, including key initiatives such as the recent ‘Future Nurse Leaders’ programme for 74 assistant directors and directors of nursing and midwifery. In response to service needs, Dr McLoughlin told delegates that the NLIC would be facilitating the Midwifery Leadership to support 60 senior midwives, commencing in September 2014.

According to Dr McLoughlin, programmes like these are much needed as the role of the nurse and midwife becomes ever more developed. He said that the Nurse and Midwife Medicinal Product Prescribing Initiative continues to go from “strength to strength” as there are approximately 660 registered nurse prescribers in the country.

“This role enhancement, across diverse clinical specialties, contributes to more timely patient and service user care. This is a truly collaborative, innovative and successful initiative and I am committed to seeing nurses and midwives taking on enhanced roles throughout the health service,” he said.

Dr McLoughlin also announced that 107 public health nursing sponsorships had been approved for 2014 – the highest number since 2008.

Typhoon Haiyan aftermath
The speech concluded with an announcement that the Minister had approved an initiative that would allow six Filipino nurses who had volunteered to return home to undertake frontline relief work in the wake of Typhoon Haiyan to do so on full pay.

Fundraising by the INMO has ensured that all travel, hotel and living expenses for the volunteers will be covered during their stay. The volunteers’ posts will also be filled for the four weeks of their absence.

ADC - Government address - A critically important role