Dr. Maura Pidgeon:

Good morning, I thank the Chairman and committee members for inviting my colleague and me to speak and for their interest in this matter.

I am accompanied by my colleague, Ms Ursula Byrne, who is acting deputy chief executive officer in the Nursing and Midwifery Board of Ireland. I will read an extract from my opening statement in order to keep within the time allocated.

We are acutely aware of the impact that delays in the registration of overseas nurses is having on the recruitment of nursing staff in the health services across all of the sectors. The extent of the problem is that there are currently 2,016 applications being processed, 70% of which cannot progress due to incomplete documentation having been received by the Nursing and Midwifery Board of Ireland from all of the applicants. All of the applicants who did not send complete documentation have been notified and are notified and updated on a regular basis. Some 35% or 698 applications have been in the system for more than 12 months.

Reflecting the lift in the economy, some 974 applications were received between January and June of this year, which compares to 302 applications received in the same period last year. Notable contributory factors to the delay include staffing levels and funding at NMBI, with revenue being significantly less than expected for 2015, due to a lower than expected annual retention fee for the year. This funding crisis has created uncertainty and insecurity among staff in the organisation with the subsequent increase in staff turnover for the first half of this year. Eleven staff have left between January and June 2015. This has added to the challenges of processing applications.

To get on the NMBI register, which is a legal requirement for anybody wishing to work as a nurse or a midwife in Ireland, the individual must demonstrate that he or she has met and achieved a level of competence in practice, educational preparation and would be prepared to work in accordance with the NMBI code of professional conduct and ethics. This standard applies to all applicants, regardless of whether they are students graduating from Irish nursing undergraduate programmes or from overseas. It is in the interest of patient safety that the process of registration must be rigorous and therefore cannot be compromised or undermined in any way.

There are two major streams to registration. Irish registration is about first-time registration for nurses and midwives following successful completion of their undergraduate programme and the annual renewal of registration of individual nurses and midwives. The annual renewal process allows for restoration of nurses and midwives to the register if an individual has been removed for non-payment of fees. If a nurse or midwife requires verification of their registration for the purposes of working overseas, a certificate of current professional status is issued. Issuing of these certificates does not mean that the individual has actually gone to work abroad.

Students of nursing and midwifery in Irish universities and institutes of technology on successfully completing their education programme must apply to get on the register by submitting an application for initial registration in the Register of Nurses and Midwives, which is signed by the head of the nursing department in their educational institution and the director of nursing of the partner hospital. This process takes place throughout September and October each year and the average time from receipt of application to confirmation of registration for students is seven days. The number of students graduating each year is 1,500 in total. Of that number, 860 are general nursing students, 290 psychiatric nursing students, 180 intellectually disability students, 100 children's general integrated students and 140 midwives. These are all registered within 15 working days. There is no delay in this part of the system.

For nurses and midwives who have trained outside of Ireland and wish to practice in Ireland, the registration process is best described in four steps. The first step involves the completion of a request for application and a payment. This is followed by the issue of a personalised application pack to the applicant containing a formal application form and a full suite of supporting documentation, setting out all of our requirements together with full instructions. The third step is the validation and verification of the application. This stage requires a thorough visual check and validation of all documentation provided by the applicant. The next step is that the application goes through an educational assessment for recognition of their qualifications and finally the application is assessed for determination of registration. The decision can be one of three outcomes, namely registration, refusal, or successful completion of a period of adaptation and assessment, during which the individual's competence to practise is assessed.

The period of adaptation and assessment can be undertaken in any health care facility that has been approved by the Nursing and Midwifery Board of Ireland, having met the standards for overseas adaptation. These standards are available on the website. On successful completion of this adaptation period, the applicant will have his or her registration confirmed by the board and his or her personal identity pin number is issued. All applications from EU member states are processed within 90 days, as set out in the EU Directive 2005/36/EC, providing all documents are in order.

In regard to the current situation, the number of applications in January to June this year is 974 compared to 302 for the same period last year. At the same time the budgeted revenue for the organisation was reduced by 33% as a consequence of lower than expected annual retention fee.

In addition, natural attrition of staff from the organisation was in the region of 23% of the organisation’s complement.

Delays are also being experienced in Irish registration in respect of issuing certificates following restoration to the register for non-payment of fees. The removal of nurses and midwives from the register for non-payment of fees and subsequent requests to be restored to the register is an annual event. This year the numbers requesting restoration increased from 159 in 2014 to 1,472, with approximately 300 requesting a waiver of the restoration fee. This volume of requests, against the backdrop of the resourcing issue outlined above, has given rise to delays in this process, which are currently being addressed. These delays have not prevented the individuals concerned from practising. Once an individual can produce evidence to his or her employer of completion of the restoration application and payment of fees, the registration is restored and the individual is able to practise, with the certificate being issued subsequently. We are introducing an internal mechanism to allow staff to track individual applications online, thus enabling a more efficient response to queries. Furthermore, the new restructured website will provide some online functionality, including the ability for individuals to track their own applications and payment options for applicants by the end of this year.

We have engaged in a collaborative process with key stakeholders so that we can further improve the process while maintaining the integrity of registration. Those involved in the process include representatives from the HSE, Nursing Homes Ireland, independent private hospitals, directors of nursing and midwifery, human resources experts, systems analysts and NMBI registration staff. Moreover, our revised spending plan has been approved by our board, and the Department of Health has recently authorised additional resources to assist us in respect of the overseas registration delay backlog. To clear the current backlog and ensure sustainability into the future as the demand on our organisation increases, we now require three additional full-time positions and funding for a web-based integrated case management system and register.

To sum up, while there are indeed delays in the registration of overseas nurses and midwives, these delays have come about as a result of a combination of exceptional and unforeseen circumstances, all of which have been or are in the process of being addressed urgently. We are making progress, but much remains to be done. In 2015 to date we have registered 253 nurse applicants from within the EU and 158 from non-EU countries, to a total of 411 nurses. In 2014 we registered 344 nurses from within the EU and 161 from non-EU countries. In the past 18 months, therefore, a total of 916 nurses registered with us. A total of 2,016 applications are currently in the system, of which 818 are from EU member states and 1,198 from non-EU countries. The number of applications received between January and June this year was 974, compared to 302 during the same period in 2014. The number of applications in process for more than 12 months is 698, and the number of applicants with incomplete documentation is 1,398. Of the 473 applicants who have received decisions, 330 were deemed to require adaptation, 43 have had their registrations refused, 55 were deemed to require further information following the initial assessment and 45 were recommended for registration. Progress is being made but it is not quick enough, and this gives rise to the need for additional resources. We welcome the support provided by the Department of Health and the HSE.