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Editorial - Are ratios the bottom line?

In response to continuing, misleading and illogical attacks from certain sections of the media and other ill-informed commentators, the government has said that the Croke Park Agreement must deliver even more savings – ie. healthcare workers must do even more with even less!

As a result, health service management recently tabled renewed demands for change, reform and re-configuration in the context of a further €750 million cut in the healthcare budget in 2013, and a loss of 5,000 more staff over the next three years. As we know, this is not possible.

In making these demands, ministers and health service management mentioned, without sincerity, that any changes must maintain high-quality care and prioritise patient needs. However, the reality is that patient safety is being ignored, patient care is being compromised and the ability of nurses and midwives to practice safely is constantly under threat.

In recent days, the INMO was visited by Judith Kiejda, from the New South Wales Nursing Association, to learn first-hand about its recent campaign to secure mandatory nurse/midwife patient ratios within the public health service in that province of Australia.

Judith gave us a clear account of her association’s campaign, which had public, political and internal dimensions, and was designed to secure safer working environments for its nurse/midwife members.

The campaign – which had the core slogan ‘1 to 4’ – culminated in negotiations with the provincial government and resulted in the introduction of mandated ratios in New South Wales in 2011.

The campaign did not secure the desired ratios in every area of the health service, but it did secure 1,400 additional nursing posts in its province. This has undoubtedly, eased the workload of frontline members.

But now, the NSW Nursing Association is preparing for a second set of negotiations with a new provincial government, which is seeking to renege upon the original agreement. In addition, they are seeking to make it more difficult for trade unions to function and minimise the entitlements of all workers in the workplace. This sounds familiar.

I am struck by the relevance of the NSW campaign to our own situation. It is a simple fact that Ireland’s health managers do not have a ‘bottom line’ with regard to staffing levels, they do not have a ‘bottom line’ with regard to what is acceptable in terms of quality, and they do not have a ‘bottom line’ with regard to the number of frontline staff they can remove from rosters, wards and departments in hospitals and community services nationwide.

However, management’s renewed proposals do offer the INMO an opportunity to explore the introduction of mandatory nurse/midwife patient ratios within the health service. Considering our experience in recent years of the government’s insatiable demand for more cuts, a cogent argument can be made that the only way we will find a bottom line is to have mandatory ratios.

Like our NSW colleagues, the first step on this journey will be to consult INMO members as to what they feel should be the priority agenda of the Organisation in the coming years, against the backdrop of government policy, Troika statements and the Croke Park Agreement then we must impose our agenda, which will be focused entirely on safe practice and safe care, on the service.

Ratios may not be the answer to all of our problems. However, faced with a government and management who do not appear to have a ‘bottom line’, there is undoubted merit in considering whether campaigning for mandatory ratios should be part of our response to the scalpel that continues to cut to the very bone of our public health service. What do you think?

Liam Doran
General Secretary, INMO

Editorial - Are ratios the bottom line?
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