REPORT OF THE COMMISSION ON NURSING HOURS SHOWS HOW AND WHEN 35 HOURS CAN BE INTRODUCED
The Commission on Nursing Hours, which was established as a direct result of the seven week work to rule, between March and May 2007, has now completed its work and furnished its final report to Ms. Mary Harney TD, Minister for Health and Children.
In its final report, the INO is very pleased to learn that the Commission, following its independent assessment, has found that a 35 hour week should be introduced for nurses and midwives, and can be introduced, in a manner fully consistent with the development of nursing and midwifery, the HSE’s transformation programme and the changed economic environment now being experienced by this country.
In its final report, the Commission has not only confirmed the 35 hour week can be introduced, but also how it should be done through the form of an initial planning stage, followed up by a pilot stage, leading to nationwide implementation, after this 18 month lead-in period.
The INO warmly welcomes the final report of the Commission and, in particular, its vindication that a 35 hour week, for nurses and midwives, is not only possible, but is desirable in the context of the changed role, envisaged for nurses and midwives, within the HSE’s transformation programme, with its emphasis upon integrated care.
The INO is disappointed that, notwithstanding the total independence of the Commission, the Minister for Health and Children has not yet brought the report to Cabinet and/or published it for wider public consideration.
Notwithstanding these delays the following is a brief overall summary of the Commission’s final report and findings:
Section 1:
In Section 1, the Commission details its terms of reference, its membership, its method of work, including its very comprehensive consultation/communication exercise with nurses and midwives nationwide, how the Commission worked and the financial model upon which it built its final set of findings.
Section 2:
In Section 2, the Commission outlines the context of the claim, by the INO, for a 35 hour week, quoting from Labour Court Recommendation 18763, in November 2006, the nursing and midwifery dispute, in April/May 2007 and the National Implementation Body’s statement, which was, ultimately, accepted by INO members.
The Commission also notes that the move to a 35 hour week was to be achieved in two phases with the first phase being the implementation of the 37.5 hour week.
Crucially, the Commission states:
“The 37.5 hour week is now accepted as the national norm for the working hours of nurses and midwives. “
The Commission then details the policy context of its deliberations, focussing upon health service reform, the transformation programme for 2007-2010, the Towards 2016, Social Partnership Agreement and the European Working Time Directive.
Finally, in Section 2, the Commission details the pathways followed, for entry into the profession, and focuses, in particular, upon the continued expansion in the individual nurses/midwives scope of practice and how this must continue in order to complement health service developments.
Section 3:
In Section 3, the Commission profiles, in great detail, the current nursing and midwifery workforce in Ireland.
In particular, it focuses upon the number of nurses and midwives registered with An Bord Altranais, the number of nurses and midwives employed by the HSE, the number of nursing and midwifery support staff and the many, and varied, work patterns of nursing and midwifery staff employed in HSE organisations.
Also, in Section 3, the Commission considers in some detail, the actual nursing/midwifery staffing levels in Ireland, as compared to other OECD countries, in the context of the much quoted OECD finding that Ireland has one of the highest ratios of practising nurses per head of population, at 15.4 per 1000.
In commenting on these figures, the Commission notes the views of various parties, including the York Consortium and Howarth Study, both of which effectively question the accuracy of the OECD data, suggesting, quite strongly, that it did not present a fully accurate outcome.
In particular, the Commission quotes from the Department of Health and Children’s own report, “Towards Workforce Planning 2002”, which concluded that the more accurate ratio, for the public and private sector, was a nurse population of 10.8 per 1000 of the population, which is at the mid level of OECD countries.
In the remaining parts, of Section 3, the Commission carries out a very detailed international literature review, looking at such things as staffing, skill mix and patient outcome, scope of practice initiative, the influence of organisational and environmental factors, activity analysis, other staffing and workforce issues, absenteeism, efficiency measures and information technology.
Section 4:
In Section 4, the Commission analyses the submissions made, by various parties, again under such headings as skill mix, scope of practice, rosters, professional autonomy, environmental issues and information technology.
Section 5:
In Section 5, the Commission, having examined the range of possible models, which could lead to the introduction of a 35 hour working week, proposes a specific model, which provides for the implementation of the reduced working week, fully cognisant of the following:
- the quality of patient care and patient safety be improved by directing the nursing resource to patient activity and by increasing continuity of patient care;
- any change introduced should support overall health policy;
- there would be no diminution of service from the 37.5 hour context to the 35 hour context; and
- the introduction of the 35 hour week should incur no additional exchequer cost.
While the detail of this recommendation, requires comprehensive consideration, in essence the Commission has said that the 35 hour week can, and should, be introduced through a model which provides for:
- a once off reduction of 2,500 nursing and midwifery posts which are not replaced following resignation and retirement;
- the introduction of a two year graduate nursing programme, to be given to all graduate nurses immediately upon registering as a nurse, which would see them being guaranteed two year employment and consolidate their clinical skill. This would mean a rolling 3,000 new nurse/midwife graduates would be on this programme at all times.
- the introduction of a new, lower, salary, for the two year duration of this graduate nursing programme (85% of the minimum of the current staff nurse scale);
- the recruitment of 400 additional healthcare assistants/clerical staff;
- the introduction of more efficient rostering based upon a core six hour module, with a maximum of 12 hours.
This model, which is innovative, fully consistent with the utilisation of the nursing/midwifery resource in the most effective way possible, and is cognisant of the changed economic situation, allows for the introduction of a 35 hour week in a manner which is cost neutral.
Implementation Phase:
The Commission then goes on, in Section 5, to recommend a planning and piloting phase, spread over 18 months, during which any problems associated with the model, can be isolated and addressed, thus providing for nationwide roll out 18 months after the implementation phase begins.
Current Position:
As previously stated, the Commission on Nurses/Midwifery Working Hours has now furnished its final report to the Minister for Health and Children.
The INO has written to the Minister for Health and Children calling upon her to publish the report and bring it to Cabinet for formal approval. It may be recalled that the Minister, at our Annual Conference in May, indicated that she was still examining the report and will be bringing it to Cabinet in due course.
The INO has referred the implementation of the Commission’s findings to the Labour Court which has, in the first instance, recommended direct talks between the INO, HSE and the Department of Health and Children on this key issue. In the event that these discussions fail to yield a satisfactory outcome the Court has said it is available to assist the parties by receiving submissions and issuing a recommendation under the IR Act of 1990.
INO General Secretary, Liam Doran, commenting on the current situation said:
“The INO wishes again to publically thank Professor Tom Collins and all members of the Commission, for their commitment and diligence to the work of the Commission, and in finalising a report which manages, in these very difficult times, to strike an equal balance between the legitimate expectations of nurses and midwives and the overall economic situation facing the Health Service.
The Commission was phase 2 of the agreement, put forward in May 2007 by the National Implementation Body, and narrowly accepted by our members, at that time. It is, therefore, imperative that the Commission’s Report, which is an independent assessment of how the 35 hour week can be introduced, is now accepted, by all parties, and we move, without delay, to the planning and implementation stage.
The Report is also innovative insofar as it guarantees employment for two years for all graduating nurses, who, while working a 35 hour week, will consolidate their education and, in particular, prioritise their clinical skills.
There are no reasons, financial or strategic, why this Commission’s Report and key recommendations, cannot be accepted and rolled out immediately. In this context, and consistent with the reply from the Labour Court, the INO is now seeking early discussions with the HSE and the Department of Health and Children, to agree the roll out of the Commission’s findings”.
In the coming weeks the INO will formulate a detailed summary of the Commission’s recommendations and will circulate these to branch officers/nurse representatives. In addition, at the appropriate time, the INO will hold meetings, at local level to outline the Commissions proposals, in detail, to all members.