Ruairi Quinn (Dublin South East, Labour)
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Question 212: To ask the Minister for Health and Children if she will explain her decision to cut undergraduate nurse training places by 17% in budget 2009; the amount she estimates will be saved by this measure; her reasoning behind the curtailment of specialist practice courses and the add-on conversion programme as a consequence of these cutbacks; if her attention has been drawn to the fact that this cutback will impair the quality of front-line services in the health system here and will lead to higher overtime bills due to a shortage of fully qualified nurses; and if she will make a statement on the matter. [38663/08]

Mary Harney (Dublin Mid West, Progressive Democrats)
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The O.E.C.D. Public Management Reviews: Ireland — Towards an Integrated Public Service (2008) in its case study "Reconfiguration of the Health Services" notes:

"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)."

In outlining the detail of the 2009 Estimates for the health services, I announced that the H.S.E. is to deliver economy savings of €115m as part of Budget 2008. Among other issues this includes a reduction in nurse training expenditure in 2009. The total cost of nurse education to the Health Services, both undergraduate and post-registration, is currently in excess of €117 million per annum.

The number of places on the undergraduate degree programme will be reduced by 310 places. This means that from next year we will be providing 1,570 undergraduate places in the following courses:

General Nursing, 860 places

Intellectual Disability Nursing, 180 places

Psychiatric Nursing, 290 places

Midwifery, 140 places (no reduction.)

Children's and General Nursing Integrated 100 places (no reduction.)

Total, 1570 places

The reduction in places which will result in savings of €1.65 million approximately in 2009 and €3.3 million from 2010 onwards will be effected mainly in those areas that are not experiencing nurse shortages.

Nurses trained under the apprenticeship and diploma models undertaking part-time degree courses have been able to 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 was due for completion before now. It will be no longer be available for new entrants from 1 January 2009, resulting in a saving of €2m next year and about €3.8m per annum from 2010 onwards.

Further savings of €1.35m 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 €5m in 2009 and €8.45m in future years.

The investment in the undergraduate degree programme is a substantial and significant element of health service expenditure. My Department in cooperation with the HSE is initiating a study to review the clinical, educational, contractual and financial arrangements in place for General, Psychiatric and Intellectual Disability pre-registration nursing programmes established in 2002. (The undergraduate Midwifery and Integrated Children's and General nursing programmes are outside the terms of the review as they are relatively new programmes.)

The Review will assess the VFM achieved from monies allocated and utilised in the degree programme and will inform the scope for alternative approaches to nurse education.

The Review will also provide a systematic analysis of what is actually being achieved by expenditure under both capital and revenue headings and will 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.

The Review will be carried out in the context of nursing recruitment and retention patterns, future workforce projections and the overarching health service reform agenda.

There is no evidence that these savings, which represent less than 5% of overall nursing education expenditure, will impair the quality of front-line services in the health system here or that they will lead to higher overtime bills due to a shortage of fully qualified nurses.