Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I welcome the opportunity today to contribute to Dáil statements on safe staffing in our hospitals. Safe, in hospital terms, means much more than numbers of staff - it refers to safety for both patients and staff. It refers to the environment in which patients are treated and where staff deliver care.

Of course, maintaining adequate staffing levels is an important factor in making sure we have safe staffing in our hospitals. Safely staffing our hospitals is a top priority for the Government and for me. The Government has fully supported the continued expansion of staff numbers working in our health service, including working in our hospitals. This expansion has been made possible by successive, large increases in the health budgets, which Governments have proposed and the Oireachtas has voted through.

I will give an overview of the increases in staffing in our healthcare service over recent years and outline where improvements have been made. I will also talk about other important aspects of safety. There are almost 18,500 more people working in our public health service than there were when Covid arrived. It is an expansion of 15%, which is the largest increase in the workforce since the establishment of the HSE. We now have almost 5,700 more nurses and midwives and 3,000 more health and social care professionals. We have 1,800 more doctors and dentists. We have more to do, but this level of hiring during a pandemic is something of which we should be proud.

In order to maintain and increase these staffing levels we need, amongst other things, to make sure a sufficient number of graduates is entering the workforce. Since 2014, the number of students graduating from healthcare courses such as medicine, pharmacy, nursing, midwifery and others, has increased by nearly a third, that is, 30%. Back in 2014, there were approximately 4,800 graduates from healthcare courses. By last year, the figure had gone from 4,800 to 6,200, which is a significant increase. We are continuing with this work. We have additional places coming this September.

In addition, the Minister, Deputy Harris, and I, with our Departments, are engaged in a plan to increase radically college places in the coming years. Colleagues will have heard me say previously that we need to double the number of healthcare college places in our country. We need more doctors, nurses, midwives and health and social care professionals, including dentists, pharmacists, medical scientists and many other people across the system. We have to set Ireland up, not just for the next two or three years, but for the next ten, 20 or 30 years. In doubling the number of healthcare college places, that is exactly what we intend to do. I have had the opportunity to meet with senior academics within some of the universities and colleges who are running some of these healthcare schools, be it in medicine, nursing or other areas. I have to say the level of enthusiasm and the positive engagement I have found has been very encouraging. All of the universities and colleges I have met have been very keen to engage with the Government about a significant, radical increase in college places.

The nursing and midwifery workforce accounts for approximately a third of the overall workforce in the HSE. Ireland has the second highest number of nurses per capitain the EU. We are second only to Finland, according to official figures from the OECD. We have 12.8 nurses per 1,000 population. The EU average is much lower than that, at 8.3. Our nursing and midwifery workforce is highly skilled, educated, motivated and professional. While nurses and midwives demonstrate their professionalism and skill as clinicians, at all times, we all appreciate the extraordinary additional work, skill and professionalism shown by these healthcare professionals throughout Covid.

The development and implementation of the framework for safe nurse staffing and skill mix accounts for a significant portion of our investment in the workforce. Two related policy documents have been published. Phase 1 focused on general and specialist medical and surgical care settings. Phase 2 focused on emergency care, that is, ensuring there are sufficient numbers within emergency departments. The framework provides us with an evidence-based approach to ensure we have the right safe staffing levels and skill mix levels for nursing and healthcare assistants. The framework determines nurse staffing levels based on care requirements, rather than ratios. This is an important innovation in Ireland, whereby the level of nursing staff we deploy on a ward in an emergency department is not based on a national ratio. It is based on the level of care required by the patients in the ward at that time. It has been a positive innovation.

Since the start of Covid, more than €31 million has been allocated to the framework, with €25 million of this investment allocated to implementing phase 1, with regard to hospital wards. This funding provides for an additional 470 whole-time equivalent registered nurses and healthcare assistants across large hospitals. I am pleased to be able to share with colleagues that 85% of those posts have been filled. The balance of €6 million is providing for an additional 101 nurses as part of phase 2, that is, increased staffing within the emergency departments. Positions are being filled for this, as well.

The framework is an agreed part of the overall strategic workforce approach. The budget for this year provides an additional €24 million for workforce measures, including the continued implementation of phase 1 to model 3 and model 2 hospitals, as well as an additional 80 advanced nurse and midwife practitioners. This is very important, because the largest hospitals were targeted at the start of phase 1. The Irish Nurses and Midwives Organisation, INMO, and others said that was great and they fully support it, but they wish to see the same framework rolled out in the smaller hospitals, that is, the model 3 and 2 hospitals. They are absolutely right in calling for that. It is being funded and rolled out.

The framework is positive and continues to demonstrate real impact for patients, staff and the organisations where it is in place. We see reduced length of stay for patients, increased overall job satisfaction for our healthcare workers, a reduction in staff intentions to leave and efficiency gains through reduced agency usage, which I think we would all support. As part of my commitment and the Government's commitment to full implementation of this framework, a national safe staffing unit has been established in the HSE. It is responsible for oversight of the national implementation of the safe nurse staffing and skill mix framework and is led by a director of nursing.

Deputies will be aware that I established a national taskforce to look at the situation for non-consultant hospital doctors, NCHDs, last year. We have had positive feedback on it from front-line clinicians who have been engaged with the taskforce and are looking at what is being rolled out. The purpose of the taskforce is to put in place sustainable workforce planning strategies and policies to improve the NCHD experience, work-life balance and training opportunities. Our aims are to develop and foster an even stronger culture of education and training for NCHDs. It is worth saying that Ireland has a very strong reputation globally for the training of our NCHDs and the quality of the consultants coming out of Ireland. They train longer and, in many cases, harder and more intensely than in some other countries. This is recognised around the world. However, I know, and colleagues will be aware from their own conversations with NCHDs, that in far too many hospitals, this is simply not sustainable. NCHDs are being asked to work unsustainable work patterns and have not traditionally been supported in moving around the country. They have been dealing with a nightmare of repeated emergency tax and many other issues. There are basic facilities that they should have in hospitals and have not had. I have spent considerable time engaging with NCHDs and this taskforce is focused on making sure we deal with those issues.

I thank colleagues for their support for the new public-only consultant contract. It was launched recently, following intensive negotiations. We wish to remove private practice from public hospitals and make sure patients in our public hospitals are treated on one basis, that is, the basis of clinical need. I recognised the importance of making this contract as attractive as possible to both future and currently serving consultants. The contract involves a significant expansion in consultant availability and the provision of consultant-delivered care and consultant decision-making over an extended day, from Monday to Friday, and on Saturdays. The contract also facilitates more flexibility for consultants who wish to opt for different work patterns.

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The Government is committed to continuing to build our consultant numbers to provide a better service and faster access for patients while also improving the work-life balance of consultants. Colleagues will be aware that many consultants quite rightly say we need to have more. Our ratio of consultants per capitais far too low. We have a little under 4,000 whole-time equivalent consultants in the country and we need approximately 6,000. That is something we are absolutely determined to fund. We are determined to make sure that the consultants are put into the right places, that the non-consultant hospital doctors, NCHDs, coming up through their training want to take these posts and that a lot of consultants around the world, many of whom are Irish trained, see Ireland as a very attractive place to come to work. As we expand those consultant numbers from a little under 4,000 to closer to 6,000, we really are going to see a big difference, first and foremost, for patients but, second, in the consultants' workload, their ability to treat their patients, their ability to spend the kind of time they want with their patients, and their ability to engage in research, clinical trials and local innovation on behalf of patients.

The contract does not result in an increase in working hours for consultants. For most consultants, including on-call, it will be approximately €300,000 for a 37-hour week. I acknowledge that many consultants work much longer than that on a voluntary basis anyway but the rostered week is a 37-hour week. The rostered hours are more flexible but the actual hours worked do not change. What does this do? It helps us have a health service that can manage timely and effective patient flow in the evenings and on the weekends, enhance senior decision-making presence on site and rosters, reduce waiting times and waiting lists for patients, and reduce the number of patients on trolleys. It was very evident in January when there were three particularly bad days. The issues went on for longer than three days but three days were very bad. The HSE implemented a much more flexible rostering approach and within a matter of days the number of patients on trolleys fell by approximately half. We know how effective it is but we cannot ask the same doctors to keep working more and more hours. We have to build the workforce to make sure we can roster that on a sustainable basis. We have to make sure that the other facilities they need, including access to diagnostics, outpatient clinics, other consultants, discharge teams and health and social care professionals, are available as well.

Last night we debated universal healthcare in the context of the Bill to remove hospital charges for adults. Ultimately, universal healthcare is about putting people at the centre of our health service. W are all working towards a health service people can access when they need it, in which there is always high-quality care that is either free or affordable. Despite significant challenges, important reform and innovation is being delivered through increasing beds and critical care capacity, improving primary and community care, developing new models of care designed to work for the patient as opposed to being designed to work for the system with the patient having to navigate their way through it. It has been supported by unprecedented investment and funding for our national clinical strategies, including the national cancer strategy, trauma strategy, maternity strategy, mental health, stroke, dementia, women's health services and many more. I want to acknowledge the work of healthcare professionals throughout the system who are rolling these services out and who are putting really important new models of care and services in place for patients. I was talking this morning with some clinicians about the impact that the oncology bypass nurses are having. Up until very recently, for anyone going through treatment, if they crashed during treatment a lot of the time they had to sit in an emergency department. It is completely inappropriate, particularly for somebody who might be very sick and might be immunosuppressed. That is now being changed in all of the hospitals. There are bypass nurses who will bring those patients directly to the oncology services, bypassing the emergency department. It is not 24-7 yet but that is what we are staffing up to do. There are improvements like that, the see -and-treat gynaecology clinics and the new specialist menopause and endometriosis clinics. There are new services like that being rolled out in all of our constituencies that are beginning to make a difference to patient care and to families.

Waiting times for scheduled care were far too long for patients before Covid and we know they got a lot worse during Covid. We are working with the HSE and the National Treatment Purchase Fund, NTPF, to find ways to cut these waiting lists and, critically, progress is being made. As we discussed last night, last year saw the first fall in patient waiting lists since 2015. This year is going to be the second year. From the Covid peak, there are 150,000 fewer men, women and children waiting beyond the agreed ten- and 12-week targets than there were at the end of last year. Hundreds of thousands are still waiting. The goal is to bring it down to no one waiting longer than the ten- or 12-week agreed times but a reduction of 150,000 is a good start. The number of patients waiting longer than the 12-week target for inpatient and day cases fell by about a third from the pandemic peak, which is very welcome as well. Colleagues will be aware that we published the waiting list action plan recently. Some €363 million is being allocated across the HSE and to the NTPF as well, into hospital waiting lists, community waiting lists and diagnostic waiting lists to increase the speed at which patients are getting care. As I said, last year for the first time in a long time we saw the waiting lists fall. We are going to see them fall again this year. We are taking a multi-annual approach, something colleagues here have rightly called for many times.

I would like to turn in the last few minutes I have to recruitment and retention. The HSE has increased retention efforts right across our health service. It has contributed to record staff increases in recent years, which I referenced a few minutes ago. We are heavily invested in the ongoing education of healthcare staff to support recruitment and retention. My Department and myself are engaged on an ongoing basis with the HSE to make sure there is sufficient professional development, mentorship programmes and opportunities for our healthcare professionals. The HSE has commenced a recruitment reform and resourcing programme to lead out on the development of a resourcing strategy, which is an important innovation. A core element of this will be enhancing the HSE's ability to attract, develop, retain and engage with the workforce on an ongoing basis.

We have all spent quite a bit of time in this Chamber over recent weeks and months discussing patient safety legislation and other policies to improve patient safety. Patient safety initiatives enable the support of safe, high-quality care and incorporating patient safety within health professional undergraduate and postgraduate education with an emphasis on inter-professional learning is a vital tool to supporting the ongoing improvements in patient safety. Retaining experienced staff in our healthcare system, providing strong leadership, governance and regulations are other ways we can improve and maintain patient safety as well.

Significant evidence on safety in our system stems from nursing and midwifery. Throughout the system, every patient interfaces with a nurse but it is no longer one profession that defines or delivers patient safety. The WHO's global patient safety action plan 2021-2030 identifies healthcare worker education, skills and safety as an important strategic objective. The plan recognises the need to inspire, educate, skill and protect nurses and all healthcare workers to contribute to the design and delivery of safe patient-focussed healthcare services.

The HSE's national health and safety function has reported that incidents of assault across the public service, that is, the HSE and section 38 organisations, have reduced from approximately 11,700 five years ago to 9,100 last year. The reduction is welcome but I know we will speak with one voice in saying there is not a single assault or abuse on any healthcare worker that is ever acceptable under any circumstances. It is important that we are seeing a reduction from nearly 12,000 down to a little over 9,000. It is very positive and encouraging to see but it is still 9,000 too many. Ensuring the safety of employees and services users is a priority for me, the Department, the HSE, the Government and all of us here in the Oireachtas. I am advised that the HSE is now prioritising a review of the policy on managing violence and aggression in the workforce.

I am fully committed to putting in place sustainable workforce planning strategies and policies, improving the NCHD experience, continuing to deliver reform and innovation towards universal healthcare, focusing on waiting lists, staff safety and continuing to roll out and complete the nursing and midwifery safe staffing framework.

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