Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I very much welcome the opportunity to address the Seanad on the Private Members' Bill, and the interest of colleagues in the health service and the nursing and midwifery professions. I thank the Labour Party Senators for tabling the Bill which initiated this evening's debate. I recognise in particular the ongoing, important work of Senator Hoey and her colleagues on issues pertaining to students.

Like many Members of the House, I take the opportunity to acknowledge the real commitment of all nursing and midwifery students to healthcare and to their education. I also thank all nurses and midwives and all healthcare workers for their dedication and commitment as we continue to deal with the Covid-19 pandemic. As we all know, it has been a very tough year right across the country. It has been a very tough year in particular for all those in healthcare, be they students or qualified staff - doctors, nurses, hospital porters, cleaners, receptionists or managers. Like many colleagues here, I have spoken directly with a lot of healthcare workers. What they have experienced is really tough. They are working long hours. They have been under huge pressure. They have seen awful situations within the hospitals. The recent "Prime Time Investigates" report from Tallaght University Hospital really brought home both the level of pressure that our healthcare workers have been under and the extraordinary commitment they have and just how fortunate we all are to have them. They continue to step up week after week to make sure the healthcare system in this country continues.

Student nurses and midwives are in educational placements and while they are on the supernumerary clinical placements, they are in addition to the rostered staff. That has been agreed between the colleges and the HSE. The education is carried out under supervision on the front line in accordance with the relevant EU directive, as part of a team across a wide variety of care settings. The supervision is provided by qualified, experienced nurses and midwives.

If they wish to do so, students may undertake paid work in healthcare settings while adhering to the public health advice, while maintaining their nursing and midwifery programme, which many do. Students obtain a high level of competency over the training programme and by the internship year this is at a level where they can work under what is called distant supervision. Up until then, they are building that competency and in line with education programmes, paid work is not counted towards regulated clinical learning hours and experience.That is an important part of this issue. In order to qualify, very specific hours are required in terms of learning and competencies. It is highly structured. According to the directives laid down at European level, paid hours do not count toward that.

I note that the Bill refers to the setting of specific pay levels by the HSE for particular work; in this case, for healthcare assistants. Although I understand the desire to prescribe such pay in the Bill, it is important to note that pay determination is a matter for the HSE under section 22 of the Health Act. It is not a political act; it is a matter for the HSE under the 2004 Act. Such determination is given effect with the approval of the Minister for Health and the consent of the Minister for Public Expenditure and Reform. In that context, it is not a matter for the Oireachtas to deal with a specific pay issue such as this other than by way of amending legislation to the Health Act to determine pay.

That said, as I stated earlier, the Government is not opposing the Bill as it generally refers to pay for work. The Government fully supports the paid work internship programme, for example, that is in place for fourth year student nurses and midwives. It also fully supports the continued protection of the nursery and midwifery supernumerary clinical placements programme. Changing the supernumerary status of those placements, which is essentially what we are debating, to that of an employee would remove the educational protections that are so important to the learning experience. Those protections mean the students are unencumbered by an employment contract. In other words, what they are there to do is to learn, which is the most important thing.

That is not to dismiss what has been a very difficult year in which students and, indeed, all those involved the healthcare system, have stepped up. As colleagues will be aware, nursing and midwifery has been a graduate profession in Ireland since 2004. Research has demonstrated that positive patient outcomes, including lower mortality rates and fewer medication errors, are linked to having a nursing and midwifery workforce that is educated to degree level. It is a very important component of the healthcare system for nurses and midwives themselves, but also very much for patients. It is important to focus on the benefits of the undergraduate nursing and midwifery programmes, which, as colleagues noted, are second to none. As the chief nurse told me one evening when we were discussing the details of these placements, the degree training in nursing and midwifery in this country is the envy of the professions globally. We are recognised as having one of the best educational programmes anywhere in the world for nurses and midwives. It is one of the reasons they are so highly sought after when they graduate. They are actively pursued by other countries because they are so well trained. The reason they are well trained is partly down to the hard work they put in during the programme, but it also stems from the four-year programme which was modelled on medical doctor training when it was introduced in 2004. The final year internship programme is very unusual. It is a valuable part of the programme.

We may agree or disagree on various matters, but I assure colleagues that I spent a lot of time on this issue in recent months. I spent a lot of time with the chief nurse and departmental officials. I spent time listening to senior nurses and the higher education institutes. Each of those conversations started and ended with a passion from those people for education for the students. We can debate issues around pay for work and so forth, but I can tell the House with absolute certainty that I am confident that among the people whom we charge to make sure these students get the best education possible within the HSE - the preceptors, the nursing supervisors, the qualified senior nurses who work with the students, the professors, assistant professors and other staff in the colleges and higher education institutes, the officials in the Department of Health, the chief nurse and the NMBI team - there is an overwhelming commitment to ensure the students are safe, cared for and listened to and that they get the best possible education to make them the best nurses and midwives they can be.It is important to reflect that, although we can obviously disagree on many of the issues raised today. I have seen that commitment at the core of everything in my interactions since becoming the Minister for Health.

Student nurses and midwives undertake an honours degree level programme over four years. Unlike in the UK and in other international degree programmes, our graduate programme includes a contractual internship with a salary for the final 36 weeks. The programme supports the optimal learning environment, where students actively take part in patient care and learn through supervision. Over the four years of the programme, the payment to the students is approximately €17,400. Additional expenses can also be claimed in some cases for travel and accommodation.

I am sure that every Member of this House will agree that our nurses and midwives are internationally sought after. As some colleagues said, we want to recruit more and we have put significant investment in place for the coming year both to scale up the nursing and midwifery workforces and, critically, to do so according to the agreed safe staffing levels. That is really important. We need the HSE and public healthcare in Ireland to be the place where our graduates want to work. That is important. The graduate programme has created exciting career opportunities. It has extended practice and has allowed for advanced practice routes, which were not possible previously and which are being seized upon by our qualified workforce.

There are many opportunities for graduate nurses and midwives by way of further education, for example. The policy for the development of a graduate to advanced nursing and midwifery practice provides a framework for graduates to draw upon their undergraduate programme. Additional funding of €2.2 million has been recently provided for the advanced nurse practitioner and advanced midwife practitioner roles. The numbers employed in these grades continue to increase, which is important. Today's graduate nursing and midwifery students can apply for the enhanced nurse midwife role after one year and 16 weeks of suitable experience, and that role has a starting salary of a little over €37,000. There are also various allowances and pay premiums in certain roles.

The expert review on nursing and midwifery is also a really exciting development. It is expected to report to me with recommendations in the coming months and it is going to be an important milestone in the evolution of the professions in Ireland. It is exciting work. This work on the future of nursing and midwifery is being undertaken in the context of significant planned reform within our health service. Student placements in our hospitals are a vital part of the clinical learning programmes. Clinical placements make up 50% of those programmes. As students rather than employees, supernumerary clinical student placements ensure that learning takes place on the front line, while being supervised. This enables students to develop the practical knowledge, clinical skills and professional behaviours required for competence to qualify and be eligible to join the professional register, which of course is what we all want them to be able to do.

The Government wants to protect the status of participants in these programmes as students and to protect the graduate programme, which has so many benefits. The supernumerary clinical placements afford students the opportunity to learn in the optimal clinical learning environment. That is the view of the Higher Education Authority, the preceptors, the directors of nursing and of Professor Collins. We will also have another review of those placements later.

The placements were disrupted several times during Covid-19, as colleagues have stated. In April 2020, all clinical placements were cancelled nationally to free up for full-time patient care the qualified nurses and midwives who would normally have been supervising students during their placements. An impression may have been given that the nurses while on placement were then simply paid as healthcare assistants and that there was a simple transition. Clarification of this point is important. That is not what happened.All student places were cancelled. The hospitals then offered HCA roles, essentially, and approximately one in three students applied for those. The student places did not transition into HCA roles at all; they stopped. Much work was then done to make sure that learning time was made up. As I said earlier, the time in paid employment cannot and does not count towards their qualifications.

Significant recruitment across the system last year of more than 6,000 staff, which included approximately 1,700 nurses and midwives, enabled the placements to resume for this academic year, which obviously was very important. Then, of course, we had the third wave, of which Senators are aware. The HSE contacted the Department and asked again that the student placements be suspended for first, second and third years. Again, that was done because it freed up several hundred qualified nurses, and in some cases, senior nurses who would normally be supervising the students, to go where the HSE needed them for full-time patient care. That lasted approximately three weeks. As the pressure has eased somewhat, although they are obviously still under huge pressure, the HSE was able to put the placement infrastructure back in place. A phased return of those placements is now happening.

I want to acknowledge the efforts to maintain placements. There is, however, no doubt that the education of healthcare students during a pandemic is challenging, as evidenced today by the very powerful, personal and important testimonies that have been read out by many Senators. We need to listen to the students very carefully. It has been a tough year. Neither I nor anybody else is going to try to dismiss that. It has been tough and we need to recognise this.

I will clarify that the student nurses were vaccinated. I double-checked that they were vaccinated as part of cohort 2. If the Senator, or indeed, any colleagues have examples where that has not happened, they should feel free to contact me directly and I will raise it with the HSE immediately because they are most definitely included in cohort 2.

To further assist student nurses and midwives on clinical placements, I appointed Professor Tom Collins to carry out an independent review of the clinical placement allowance specifically during Covid-19, a more stressful time of which we are all aware. Professor Collins reported back to me on 31 December and made several recommendations. The one of focus is his recommendation to implement a pandemic placement grant, which is the non-taxable €100 per week for each supernumerary placement week during the pandemic. He provided an option for me to backdate that to the start of September. Therefore, the recommendation is that the 12 weeks of placement essentially would be subject to a non-taxable payment of €1,200. I would very much like to pay this and implement Professor Collins's recommendation. We have had good conversations with the representative bodies and will continue to have those. If we can get to a point where there is agreement with Professor Collins's report as a balanced response to the placements during Covid-19, we can implement his recommendations straightaway.

I have also asked for a long-term review of the placements and allowances to be carried out. I believe this is very important. This will go some way to addressing some of the issues that have been raised here by colleagues around students being able to afford to be students. My view is that financial barriers should never prevent someone from being a student. We are all aware that they do at times. There is no question about it. Graduate training for student nurses and midwives should not be down to, for example, how much family income might be available.That is one of the points that is going to be examined in the long-term review. The work has commenced and I have asked that I receive a report in June. That will give us some time to work with the students themselves, the representative bodies, the educators and all the stakeholders to determine whether we can reach agreement and implement the plan from the start of the academic year this coming September.

I do not underestimate the difficulties that student nurses and midwives have had over the past year. Without question, it continues to be a difficult time. The Department of Health and I, in conjunction with the HSE, higher education institutes, the Nursing and Midwifery Board of Ireland, our clinical partners and representative organisations, will continue to focus on supporting our students, keeping them safe and ensuring they have the best possible education that they can have.