Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I very much welcome the opportunity to address the House on the important motion brought forward by my constituency colleague, Deputy Cullinane, on nurses and midwives. I would like to thank all Deputies who have contributed to this debate.

I would also like to take this opportunity to thank all nurses and midwives, including students, and all healthcare workers for their unwavering dedication and commitment as we continue to deal with the Covid-19 pandemic. There is no doubt healthcare workers have made enormous sacrifices during what has been an extraordinarily challenging and difficult time. In the past couple of months, before there was a spike in Covid cases, I managed to visit quite a few community hospitals in Thurles, Kerry, Galway and Waterford, among other areas, and was able to speak to nurses who have worked extremely hard over the past 18 to 20 months and beyond. I heard from them first hand about how challenging it has been, especially in regard to older people and Covid prevention and control measures. It has been difficult.

I note the Minister, Deputy Donnelly, advised the House that the Government is committed to recognising the great dedication front-line healthcare workers have shown during the pandemic, and work is ongoing to determine how best we can do that. This matter is important but complex because the pandemic is still ongoing, and workers in areas beyond the health service and public service, such as those in private nursing homes, have also made a significant contribution to the national effort to tackle the pandemic.

As Minister of State with responsibility for mental health and older people, I fully recognise the importance of having strong mental health supports for healthcare workers. A range of expertise, advice and other supports are in place for the staff of our health services. They are provided by the HSE's workplace health and well-being unit, a division of HSE national human resources, and through the national health and safety function.

The HSE's occupational health service provides specialised medical advice and guidance to employees. It assists managers in the health service in securing supports for their staff where needed and provides information to employees on other supports available to them, such as the HSE employee assistance programme. This is a free confidential support service that provides well-being supports and interventions for staff and service managers when they are needed, including counselling and consultations on staff well-being issues. This programme has been an increased level of support throughout the pandemic. Additional psychosocial supports, including those specifically tailored to healthcare staff, have continued to be delivered in response to Covid-19. These include free online counselling supports for healthcare workers nationwide. These are not only healthcare workers in the HSE but also healthcare workers who work for private and voluntary bodies. MyMind, for example, is an organisation that provides online counselling free of charge - 4,000 hours a month in 17 different languages - to support nurses who may not originally have come from Ireland. It is important to acknowledge that that support is there.

As part of budget 2022, mental health services will continue to be developed, with funding of €1.149 billion. This funding will provide for 350 new mental health staff across our services. I also welcome the decision of the Minister, Deputy Stephen Donnelly, to extend the booster vaccine programme to all healthcare workers, including those in nursing homes. I chaired an inter-agency meeting recently with HIQA, the HSE, public health, the HPSC and the Department to discuss ongoing nursing home preparedness, and this was one of the key issues considered. I also wish to clarify that all mental health service staff and all healthcare workers working in the home will also be offered the booster vaccine. This decision, along with the progress made to date on boosters, will add further to the protections afforded to front-line health staff and the people under their care. Preparations are being made to commence the roll-out as soon as possible, and the Department will continue to engage with the HSE to ensure timely roll-out. I believe everyone will be in agreement that this cannot come soon enough.

Nurses and midwives play a vital role in health promotion and in the prevention and management of communicable and non-communicable diseases. Their contribution is key to enabling the full economic value of healthcare provision across multiple care settings. For the purpose of enhancing the nursing and midwifery workforce, many new initiatives and advance roles are being progressed. Nurse-led community virtual wards are being developed to provide a single point of contact for patients living with chronic diseases such as chronic obstructive pulmonary disease, COPD, and heart failure. Care is delivered in the community, in the person's home, through enhanced co-ordination and shared pathways of care.

I recognise that this winter will be a difficult one for our healthcare workers. The Government has funded significant initiatives through the 2021 winter plan and budgets 2021 and 2022, across the health service, in the acute, community care and primary care sectors, to reduce demand on emergency care by providing alternative care pathways outside the acute sector in line with Sláintecare. The 2021-22 winter plan will provide for appropriate, safe and timely care for patients by ensuring insofar as possible that effective levels of capacity and resources are in place to meet the expected growth in activity levels. The 2021-22 influenza vaccination programme, which is an important part of winter preparation, was launched on 4 October 2021. Vaccinations have been made available free of charge to adults in specified at-risk groups and children aged from two to 17 years of age, and I encourage all those to avail of this vaccine if they so wish.

It is recognised that waiting times for scheduled appointments and procedures have been impacted in the past 19 months as a direct result of the pandemic and, more recently, as a result of the ransomware attack. The Department of Health, the HSE and the National Treatment Purchase Fund are focusing on improving access to elective care in order to reduce waiting times for patients. These plans include increased use of private hospitals; funding weekend and evening work in public hospitals; funding see-and-treat services, whereby minor procedures are provided at the same time as outpatient consultations; providing virtual clinics; and increasing capacity in the public hospital system.

For 2022 an additional allocation of €250 million, comprising €200 million to the HSE and €50 million to the National Treatment Purchase Fund, has been provided to reduce hospital and community waiting lists. As part of this initiative, I expect there will be an opportunity to consider whether available funding could support the development of a more sustainable primary care psychology service through the recruitment of additional permanent staff. This follows the announcement of €4 million in August to reduce the number of children and young people under 18 waiting more than 12 months to be seen by primary care psychology for the remainder of this year.

Building on the significant growth in the number of healthcare staff, with an additional 4,462 staff this year, initiatives to enhance graduate to specialist and advanced nursing and midwifery practice will maximise nursing responses at senior level. The policy on graduate to specialist and advanced nursing and midwifery practice provides a framework that enables the development of a critical mass of advanced nurse and midwife practitioners. Creating a critical mass of advanced practitioners has demonstrated effective and efficient patient care and can target care across a range of population health needs. The evidence demonstrates high levels of positive patient outcomes, including patient satisfaction, patient education, care continuity, admission avoidance and reduction in the development of condition-related complications. The impacts also include a reduction in waiting lists across a range of specialties and a reduction in the number of hospital admissions. I understand that the Minister, Deputy Stephen Donnelly, has asked the Department to work with the HSE on this proposal to increase the numbers of advanced practitioners across the nursing and midwifery workforce by adjusting the target from 2% to 3% over the next three years. This will provide a total of 1,200 advanced practitioners. Currently, there are only 500 in post.

Nurses and midwives, including students, have made an exceptional contribution to the Covid pandemic response. There are about 7,000 student nurses and midwives at present and half of these students are on placement at any given time. The Minister for Health has implemented a number of measures to support student nurses and midwives, including provision of the pandemic unemployment payment in addition to payment of a pandemic placement grant. As the Minister has already stated, he agrees with the recommendation that the pay of interns be increased and will request approval from the Cabinet to make provision for increased financial supports for 2022. He also intends to extend payment of the pandemic placement grant.

I do not underestimate the huge challenges nurses and midwives have experienced throughout the course of the pandemic. Without question, it has been an extraordinarily difficult time. In conjunction with the HSE, the higher education institutes, the Nursing and Midwifery Board of Ireland and clinical partners, the Department will continue to focus on providing the necessary supports to ensure a sustainable nursing and midwifery workforce.

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