Paddy Burke (Fine Gael)
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I welcome the Minister of State, Deputy Gerald Nash, to the House.

Colm Burke (Fine Gael)
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I, too, welcome the Minister of State and thank him for coming to the House to deal with this matter. My understanding is that more than 700 applications for registration with the Nursing and Midwifery Board of Ireland are pending. Earlier in the year I received representations from an Irish person who, following completion of her training in England, had returned to Ireland to take up a job but was unable to do so for 14 weeks even though the hospital needed somebody urgently. The Minister of State, Deputy Lynch, is reported in today's Irish Examineras saying that a unit in Cork cannot be opened because the 40 nurses required are not available. Much of the funding for this unit was raised voluntarily. However, because of a lack of nursing staff, it cannot open. I am not suggesting that this is connected to the delays in registration with the Nursing and Midwifery Board but it must be a contributory factor.

I understand from Nursing Homes Ireland that the HSE is recruiting nurses currently working in private nursing homes and that this is resulting in a significant shortage of nurses in the private nursing home sector. The private nursing home sector proposes to recruit an additional 300 nurses over the next couple of months, some of whom may be Irish nurses working abroad wishing to return home, which will result in the number of nurses awaiting registration with the Nursing and Midwifery Board increasing to 1,000. The registration body has cited the cost of employing staff as the reason for the delays. This issue needs to be addressed. We need front-line staff and competent nurses. If we cannot register these staff within a reasonable period, they will continue to go to other jurisdictions such as Canada, the US, the UK, New Zealand, Australia and so on. People will look to other alternatives if there is undue delay in the process here.

My understanding is that for people coming here from outside Europe, registration takes six to eight months. It is horrendous that people have to wait that length of time to be registered and as a result are looking to other jurisdictions. I am asking that the Minister engage with the board to see if a solution to this problem can be found such that anybody who applies for registration can be registered in a timely manner.

Gerald Nash (Louth, Labour)
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I thank Senator Burke for raising this issue. I am taking this matter on behalf of my colleague, the Minister for Health, Deputy Leo Varadkar, who is not available this afternoon due to Government business.

I wish to advise the Senator that Department of Health officials met with the president and chief executive of the Nursing and Midwifery Board of Ireland, NMBI, last week to discuss a range of operational issues, including the current delays in registration. The NMBI is keeping the current situation under review. The Senator may wish to know that the NMBI has been allocated additional resources to address the issues which he outlined. Delays in processing nurse registration applications are directly connected to the volume of requests arising from current initiatives to attract and retain nurses in the health services. The Department of Health and the Health Service Executive are collaborating to find solutions to meet the issues arising in regard to nurse recruitment and retention. The background to this issue is that nurses who trained in a country outside of Ireland and wish to work in Ireland are required to apply to register as a nurse with the Nursing and Midwifery Board of Ireland, NMBI. In assessing an applicant for registration and in order to protect the public, the NMBI seeks evidence from applicants of comparable standards of education and practice.

According to the NMBI, the timeframe for completion of the assessment of qualifications for registration is up to a maximum of 90 days provided all necessary documentation has been supplied by the applicant. The main difficulty in expediting timely applications, as reported by the NMBI, is the failure by the applicant or third parties to furnish the documentation required to assess eligibility for registration, or the delay in so doing. The board, following assessment of qualifications by an applicant, may require him or her to undertake a six to 12- week period of adaptation and assessment. This period of adaptation is designed to make up for differences in education and ensure competence to work in the Irish health service. If such adaptation is required, it must be successfully completed as a prerequisite to registration.

There are two remaining HSE adaptation courses available this year, in June and August. These courses are six to 12 weeks in duration and facilitate the integration of global nurses to nursing in an Irish context. Since the nationally co-ordinated pilot adaptation programme commenced in June 2014, 151 candidates have completed the programme, 58 are currently undergoing assessment, and 126 are due for assessment up to the final programme in August 2015. Outside of the current provision for placements in 2015, there are 293 requests for placements by employers. These numbers are not reflective of a national total as some hospital sites run independent adaptation programmes.

A collaborative group, including the Department of Health, the HSE and Nursing Homes Ireland, NHI, representatives, continues to explore options to facilitate adaptation. In this regard, some hospitals will respond to local need from local nursing homes, and this has been encouraged within the hospital group structures. Other hospitals will continue to support placements pending funding from NHI, although not at peak undergraduate student times. In addition, some hospitals are withdrawing from the provision of clinical placements to facilitate their own internal international recruitment initiatives.

It is important to note that the NMBI is dealing with very significant volumes of applications at present. It is processing all applications as quickly as possible, while ensuring appropriate procedures and checks are adhered to with a view to ensuring protection for the public. As I said at the outset, the chief executive officer of the board met with departmental officials last week to discuss a range of operational issues, including the current delays in the registration process. The NMBI is keeping the situation under review and has been allocated additional resources to address the issues the Senator outlined.

Colm Burke (Fine Gael)
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I thank the Minister of State for his comprehensive reply. He indicated that registration takes up to a maximum of 90 days provided all necessary documentation is supplied. The complaint I have had from applicants is that it is six to eight weeks after submission that they are being told their documentation is not in order. That leads to a delay in the process. I am proposing that all applications be assessed within a very short timeframe, preferably within a week of their being submitted, and if any documentation is missing, the candidate should be notified immediately rather than having to wait six to eight weeks for such notification.

In regard to the adaptation courses, my understanding is that Nursing Homes Ireland intends to seek to expedite the provision of those courses by putting its own funding in place, with the co-operation of hospitals. It has no choice in the matter, and the Department needs to understand the urgency of this situation.More than 23,500 people are accommodated in private nursing homes. While these homes are well run by competent staff, when staff shortages occur, the downside is that patients suffer. This is the reason I seek to have this matter prioritised.

Gerald Nash (Louth, Labour)
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I thank Senator Colm Burke for his remarks on this important issue which all of us have encountered locally or in our constituencies, especially in areas that are coming under significant pressure in terms of demographic demand and access to health care facilities. The Senator is correct that the private nursing homes industry plays an important role, alongside the public service, in providing top-class health care for older people in residential settings. I am familiar with the needs of private health care providers of nursing home care in my constituency. I am also aware that in recent years some leading providers of private health care have had to go as far afield as India to try to access appropriately qualified nurses to work in their homes and provide the type of health care we expect.

There is good reason for the standards we have put in place through the Nursing and Midwifery Board of Ireland and State agencies to ensure health care is provided to those who need it in a safe and effective manner. However, I accept Senator Burke's point on the validation of documentation which, in the normal course of events, is provided to the Nursing and Midwifery Board of Ireland. As I indicated, it takes a maximum of 90 days to have the application process completed, provided all necessary documentation has been supplied by the applicant. While 90 days appears to be a reasonable period, it can be frustrating if an applicant learns further down the line, having submitted documentation, that there is a problem. We expect all State agencies and other relevant actors engaged in this sector and other areas to ensure the first step in such application processes is to ensure key paperwork and documentation is validated and checked and early engagement takes place with applicants to ensure the system is as streamlined as possible.

We should always be mindful that the health service is under extreme pressure. If there are obstacles or roadblocks that can be removed early in the process, it is a matter for the relevant agencies to ensure this is done. I will communicate the Senator's concerns to the Minister for Health and ask him to ensure the issues he raises are addressed.