John Perry (Sligo-North Leitrim, Fine Gael)
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This issue is of national importance and is critical to St. Angela's College in Sligo. I have great admiration for those who choose a career in the medical and caring professions. It is a most noble and worthy career path and marks these individuals out as true custodians of our health and well-being. Graduates from the general nursing programme in St. Angela's College are employed locally, regionally and nationally in both private hospitals and the HSE. In addition, all the graduates of the intellectual disability nursing programme have secured employment in local and regional services. I have no doubt every nursing graduate from St. Angela's College becomes an outstanding health care professional.

The proposed cuts in nursing places will lead to a reduction in the number of graduates available to the health service in the region and nationwide. The Minister's proposed cuts will mean the number of places on the bachelor of nursing science degree programme will be reduced by 310 from 1,880 to 1,570 in the forthcoming year. The intake to St. Angela's College will be reduced from 65 to 40 places annually, a 31% reduction in nursing places offered by the college. This reduction is one of the highest in the country, with the intellectual disability nursing programme being particularly hard hit, with a 40% reduction in places. General nursing will suffer a 25% reduction in places and the western region, particularly St. Angela's College, is being severely hit by these cuts.

Cutting the number of nurse training and education places is a short-sighted proposal. A shortage of nurses exists at European and global level. Cuts to undergraduate nursing numbers will make this problem worse and will have a long-term negative impact on the Irish health care system. From recent history we know that if we cut the number of nurses in training, within a few years there will be a shortage of qualified nurses. In response, international recruitment will be required to meet the needs of the Irish health service. This is a more expensive solution than continuing to educate nurses and maintaining a steady nursing work-force.

Education and training of nurses is an important investment in the capabilities and skills of our most valuable resource, our people. A nursing qualification represents a practical and durable skill, and is one of the most marketable qualifications internationally. Qualified nurses have a passport to a job anywhere in the world. From past experience, we know that if there is a short-term surplus of nurses they can find work abroad and when demand picks up at home, many of them will come back to work in our health system. Thus, the investment we made in the education and training of nurses reverts to us. As we head into a period of rapidly rising unemployment, we must strive to give maximum investment to job-related education and training. Our number one priority must be education and training for people coming out of second level this year and next.

A reduction in the number of nursing places will also have a significant impact on the number of mature students entering the profession. This will deny the health service access to a group of graduates that offers considerable practical experience to patients, service users and the nursing profession. This is a significant factor in the current economic crisis with the increase in job losses among those with practical work experience.

Do the Minister for Education and Science and the Minister for Health and Children really believe that slashing nursing education places is good for the economy, our children and our future? If they do not believe that education and training is the way to a better economy, then it is time for them to quit as Ministers. The country has a great opportunity to educate and train people for real jobs anywhere in the world. The education staff, facilities and training skills are all available. All that is needed is a student intake. I ask the Government urgently to review and reverse the proposed reduction in the numbers of nursing places being made available nationally, and in particular at St. Angela's College, Sligo. Given the scale of the job losses now sweeping across the country, we should be expanding the number of nursing education programmes, not reducing them.

Seán Haughey (Dublin North Central, Fianna Fail)
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I thank the Deputy for raising this matter on the Adjournment, which I am taking on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

By way of background I should explain that, following the publication of the 2009 Estimates for public services, the Health Service Executive was tasked to deliver economy savings of €115 million. Among many other issues, a reduction in nurse training expenditure is needed to contribute to achieving these savings. The total cost to the health services both for undergraduate and post-registration nurse education is currently in excess of €117 million per annum.

Savings of €5 million in 2009 will be achieved as follows. First, the number of places on the undergraduate degree programme will be reduced by 310 places, from a total of 1,880 to 1,570. The reductions will take place in all 13 higher education institutions across the country which provide this programme and will relate to general nursing, 197 places; intellectual disability nursing, 60 places; and psychiatric nursing, 53 places making a total of 310 places. These reductions will result in savings of €1.65 million approximately in 2009 and €3.3 million per annum from 2010 onwards. They will be effected mainly in those areas that are not experiencing nurse shortages. The Deputy should note that while the reduction in intellectual disability places in St. Angela's College, Sligo, is 40%, the reduction for this programme nationally is25%, as I have outlined. There will be no reductions in places on the undergraduate programmes for midwifery, 140 places, and children's and general nursing, integrated, 100 places.

Second, nurses trained under the apprenticeship and diploma models undertaking part-time degree courses can apply to their employer to have their course fees paid in return for a service commitment to the public health service. This initiative has been in operation since 2001 and should have been completed in 2005. Its purpose was to afford serving nurses and midwives the opportunity to avail of the degree course, thereby avoiding a two-tier nursing and midwifery system. It will no longer be available for new entrants from 1 January 2009, resulting in a saving of €2 million next year and about €3.8 million per annum from 2010 onwards.

Third, further savings of €1.35 million in 2009 will be achieved by reducing places on the various post-registration courses in specialist clinical practice.

These three cost saving measures will produce savings of €5 million in 2009 and €8.45 million per annum in future years.

The OECD's 2008 public management review, entitled Ireland — Towards an Integrated Public Service, noted in its case study "Reconfiguration of the Health Services":

One statistical characteristic of Ireland is its very large number of practising nurses (15.2 per 1,000), which is twice the OECD average, just below Norway (15.4) but much higher than UK (9.1) or France (7.7). The number of nurses graduating every year is also high (14.4), above Norway (10.1), UK (8.6) or France (5.9). This contradicts the universal perception of a "shortage" of nurses, held by health actors in Ireland who were interviewed by the OECD. Partial explanations come from the fact that some 40% of nurses in Ireland work part-time (as compared for example with 26% in France for nurses working in hospitals).

The percentage reductions in undergraduate student places take account of geographic and demographic trends in nursing placements whereby it is not always possible to fill all vacancies in the eastern region, whereas outside this region the number of graduates being produced may exceed demand. Accordingly, the estimated one third reduction on the western seaboard should go some way towards correcting this imbalance.

The percentage reductions in the 13 higher education institutes also take account of the situation whereby the removal of the full intake of the nursing degree programme — which, in some cases, forms the backbone of an institute — could cause great difficulties for the institute as a whole.

Against this background it is important to note that the Minister has approved a strategic review of the nursing degree programme, which will commence this year. Overall, the review is designed to provide a systematic analysis of what is actually being achieved by expenditure under both capital and revenue headings. It should also provide sound evidence and a critical analysis of the preparation of nurses for practice. The findings will provide a basis to inform decision makers on the future direction of pre-registration nursing education programmes in Ireland.