John Crown (Independent) | Oireachtas source

I welcome the witnesses and acknowledge the important work done by the board. This is obviously a much more challenging time than in the days when six or seven Irish nursing schools provided all the graduates that were needed. Circumstances are now very different.

Having had extensive representations made to me by individual nurses and their representatives at the time of the proposed increase in the retention fee, I learned they have a number of concerns that need to be addressed. There was a sense that increasing the fee by 80% over two fee cycles in two years seemed hard to justify. The nurses asked repeatedly what extra they were getting for the 80% increase in the retention fee over the cycle. It is important that the delegates and members know that a consistent refrain I heard from many nurses - I am not saying I agree with their perspective - was that the board appeared to have two functions, the first of which was to take nurses' money and the second of which was to discipline them. This was certainly a widespread opinion among registrants.

Nurses felt they had suffered disproportionately the effects of personal circumstances cutbacks during the recession. Like everyone else, they were subject to the universal social charge. Since they were mostly public servants, they sometimes had very substantial decreases in pay. Many of them had depended on what had been non-discretionary overtime, which disappeared. More important, many of them felt they were working much harder. They were working harder because there were fewer replacement posts being filled and people were being allowed to retire. The increased attention paid to the capping of staff numbers within publicly funded institutions meant retiring colleagues were not being replaced. These were all concerns of the nurses. Many of them asked where the board was when these issues were arising. They wanted to know what position of public advocacy it was taking.

I have a few specific questions. The board tells us it is understaffed, which I accept. We are well used to hearing that a body run by the public service is likely to be either understaffed or "malstaffed". By how many is the board understaffed? What is the budgetary shortfall required to refill the positions? I am not trying to be provocative but feel this is an opportunity to bring points to the attention of the board that were brought to my attention. Nursing members had concerns about how the board's money was spent. They wanted to learn how much was being spent on public relations, travel and other items. I am sure all these expenses were legitimate but the nurses questioned whether there were opportunities for cost savings. At the time, they were wondering whether the cost savings could have been passed on with smaller retention fees. Could the cost savings be passed on by hiring extra staff to do what is required?

Many Irish graduate nurses train in medical schools with which the board is very familiar. The board knows all about these schools and the individuals concerned, who have been with the board for many years. Re-registration of somebody with this background should be very simple by comparison with the registration of somebody who may have come from a medical school on a different continent, bearing in mind the interrogation of credentials. A foreign nursing school may be a very fine one, but the board may not be familiar with it. Is there any degree of cross-subsidisation of the current expenses? Are the relatively simple registration requirements of Irish and EU-trained nurses being used to subsidise the appropriate interrogation of the credentials of nurses coming from schools that are less well known?

I have raised the question of fees on several occasions when it looked like we were facing a shutdown in the health service on this issue. Many nurses said they would not pay the increased fee. I am thankful that there was an outbreak of compromise and common sense. The then Minister gently reproached me and said I misunderstood the function of the board. I was told there was one function only, namely, to protect the public. I kind of get that. There is a need to protect the public but if one is entirely protecting the public, the public should pay for it. If one is protecting the public and also defending the standards of the profession and individuals in the profession, then it is appropriate that those in the profession should pay some component of the fee.

We have in Ireland a tendency to follow the tombstone principle, which is the principle enunciated in the world of air safety. Rather than trying to prevent crashes, most of the great air safety organisations wait until a crash has occurred and then investigate what happened. In air traffic circles, prevention would involve advocacy of telemetry and real-time monitoring of cockpit management, etc. I get the sense we do in our health service what is being done in the world of air safety. We have a very unsafe health service. We have a health service which, in all the critical front-line areas, is grotesquely understaffed. Staff are overworked and expected to do jobs they are sometimes not trained to do at all. In these circumstances, there is a higher frequency of adverse outcomes, lawsuits and general quality queries than in other equivalently sophisticated health systems. I have made the point to HIQA, and now make the point to the board, that it is important that those concerned prospectively rap the knuckles of the people who hire the nurses and make decisions. It is important that they tell them there are problems they need to fix and that they should not be depending on the board to come in as the police force afterwards to investigate people who, sometimes in difficult circumstances, produce outcomes that are not as good as they should be.