Mary Wallace (Meath East, Fianna Fail)

I thank the Senator for raising this important issue for his area. 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 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 for both undergraduate and post-registration nurse education is in excess of €117 million per annum.

Savings of €5 million in 2009 will be achieved as follows. The number of places on the undergraduate nursing degree programme will be reduced by 310 places, from 1,880 to 1,570. The reductions will take place in all 13 higher education institutions in the country which provide this programme and will relate to the areas of general nursing, 197, a reduction of 18.64%; intellectual disability nursing, 60, a reduction of 25%; and psychiatric nursing, 53 a reduction of 15.45%. The total is 310 which, as the Senator explained, equates to a reduction of 16.49%. These reductions will result in savings of approximately €1.65 million in 2009 and €3.3 million per annum from 2010 onwards and will be effected mainly in those areas not experiencing nurse shortages. There will be no reductions in the undergraduate programmes for midwifery — 140 places — and children's and general nursing, integrated — 100 places.

In the second area, 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 give serving nurses and midwives the opportunity to avail of the degree course, thereby avoiding a two-tier nursing and midwifery system. It will be no longer 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.

In the third area of specialist practice courses, 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 cumulative savings of €5 million in 2009 and €8.45 million per annum in future years.

By way of background, the OECD public management review, Ireland — Towards an Integrated Public Service, published in 2008, in its case study on reconfiguration of the health services noted:

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).

With regard to geographic and demographic concerns which are Senator MacSharry's chief concerns, 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 of 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 of 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 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.