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Speech by INMO President, Karen McGowan in response to Minister Stephen Donnelly
Reply Speech by Karen McGowan, INMO President at 6th May 2022 ADC 2022 to Minister for Health - Stephen Donnelly
1. Introduction
Thank you for joining us Minister and for your remarks. 
Before I respond to the Minister’s speech, I want to thank members of the Executive Council who go above and beyond to ensure that the voice of our members is at the centre of all of the Irish Nurses and Midwives Organisation campaigns and advocates for. 
The unknown unknowns of COVID-19 have thrown many curve balls our way in the last two years but INMO members have continued to showcase the very best of our profession. 
2. Tribute to members
It would be remiss to not pay tribute today to the thousands of nurses and midwives around the country who have held our health service together, particularly over the last twelve months. Nurses and midwives have played and extraordinary part in the fight against COVID-19. 
It was an honour as President of our union to launch a permanent reminder to those who lost their lives because of COVID at the Richmond Education and Event Centre. We want to thank the Taoiseach and you Minister for attending our commemorative event. Our commemorative benches are open for you to visit if you find yourself in Dublin and want to have a moment to reflect. 
The State has also held a National Day of Commemoration for frontline workers, which was a privilege to attend. It is welcome that we will be able to reflect on the impact COVID had and continues to have on our nation on the 1st of February every year from here on out. 
While we appreciate the sentiment of events like the State commemoration, valuing our nursing workforce must go beyond commemoration. 
The measurement of success will be working on retention measures, working with us on implementing past agreements, funding and implementation instruments for the framework of safe staffing.  It annual requires investment in the nursing and midwifery workforce, fair pay, training and development.
3. We are experts in nursing and midwifery care 
Minister, we want to thank you for coming here for attending our conference, we know from your public comments that you do understand the added value expert nursing care brings to patient care. We need you to listen to how you, your Government, your Department and how the HSE can engage better with us as nurses and midwives, as there have been many times over the last twelve months since we met virtually where we feel the role of the nurse and midwife has been taken for granted. 
We are currently once again tasked with seeking to justify what enhanced nurses have brought to the health service over the past two years. Implementation processes of all agreements are too long and too cumbersome and work against the benefits of the original agreement. Pay nurses better for skills that are competitive, we have the agreements but implementation is being dragged through a ditch to see what falls off. As Minister for Health you should not stand over that.
4. Issues that must be addressed under Building Momentum and beyond
The recommendation that working hours in the public service should be restored to pre-Haddington Road Agreement levels from July 1st 2022 has been agreed by Government. Minister, I need to remind you in no uncertain terms that one of the main reasons why our members endorsed the latest public sector pay agreement, Building Momentum, was because of the commitment to reverse the Haddington Road hours. Nothing short of full implementation of the reversal will be acceptable. 
Minister, nurse managers have proven their work. It has been independently verified that the differential in salary owed to them is 3.28%. Yet there is a real reluctance somewhere to make sure this is realised. We were expecting a strong commitment from you here today and I have to say we are disappointed. 
Likewise Minister, I’ll describe what the last few years have been like for our students in training later in my address but we have had two independent reports, a lot of talking and the current students are waiting for you to deliver on the full consolidation of he 80% salary for the 4th year interns as recommended in the Seán McHugh report. 
What should have been a good news story in the announcement of a Pandemic Recognition Payment has turned into a protracted process and has taken the good news out of the announcement. Minister, we are asking that you extend the eligibility of those who can receive the payment, it is not good enough that only those who worked until June 2021 are eligible for payment. We have all worked through significant COVID waves since then, those who have joined the health service and the fight against this virus since then should be recognised for it. Minister, you cannot forget those who worked in GP practices or our private hospitals. Government must come up with some mechanism for those workers to be paid. 
Minister, these are matters that are about making nursing attractive, but they also have to be safe.  
We should not have to take to the national airwaves to get movement on issues such as ensuring nurses and midwives get timely access to booster vaccines in the middle of a pandemic. 
Yesterday, we heard harrowing stories of nurses who have been assaulted while going about their job. It isn’t acceptable that nurses are bearing the brunt of aggression levelled towards healthcare workers. It isn’t acceptable that nurses and midwives are suffering career ending injuries in their place of work. 
Minister, there are actions that can be taken by your Department and arms of the State to ensure the safety of nurses and midwives in their place of work
The health service is a place of work, it has become a more dangerous place than the construction. There is no scaffolding to protect us. A fully resourced and staffed division of the Health and Safety Authority must be established that is dedicated to healthcare workers. The fines imposed for in this legislation must be substantially increased. 
Minister, the safe staffing framework must be underpinned by legislation for implementation. Very good policy that has come from the office of the Chief Nurse. We are asking that you work with us on legislation and ensure that it is included in your Government’s legislative programme for the Autumn session of the Oireachtas. 
5. Cost of Living
Minister, as you arrived here this morning you would have heard first hand experiences of nurses talking about how sharp rises in the cost of living is impacting our members. 
Minister, we envy our colleagues who get a national press conference to launch their new uniforms which are provided to them by the State.  
There is a cost to being a nurse or a midwife before we even cross the threshold of our places of work – we do not have an option to work from home one or two days a week, when we are rostered in, we are expected to show up. There is a significant cost when you have to drive to and from work for every shift. We are driving lengthy distances because it is becoming impossible to afford a home to buy or rent near our places of work. This is not just an urban phenomenon. When we are building new hospitals, we need to factor in where these nurses are going to live. Zoning of land must include affordable housing for frontline workers. Affordable housing is a problem that persists in rural areas, particularly tourist areas, where nurses and midwives are priced out of living near their places of work.   
Young nurses and midwives who are starting out on no wages or the first point of the scales are telling us they are forced to factor in taxi costs because of poor public transport services if they start or finish a shift late at night because they don’t feel it is safe to walk home alone. The costs associated with getting to work are not just hitting our pockets, they are hitting us mentally too.  
Nurses caring for patients in their own homes and in the community predominantly drive to and from visits in personal vehicles, with some driving hundreds of kilometres per week. As the cost of living rises, these dedicated staff members should not be left in financial difficulties as a result of doing their jobs.
Minister, Government must act. Unfinished business must be completed. We understand you’re the Minister for Health but decisions around review of Building Momentum will impact on your ability to provide a well-staffed health service. Nurses and midwives have made it very clear that they expect review of pay clause of Building Momentum to be actioned quickly. 
We note your colleague the Minister for Public Expenditure and Reform yesterday invited the Public Services Committee of ICTU to exploratory talks and nurses and midwives will expect unfinished business to be completed as agreed. As Minister for Health, you must emphasise to your colleagues in Government that retention is now as big an issues as recruitment. Any agreement must reflect and address that. 
Productivity of nurses and midwives does not have to be re-examined or used as an auction ploy again.
6. Risk of being a nurse and risks to patients
Minister, we cannot become desensitised to out of control overcrowding in our hospitals. It is not normal or safe for there to be 8,717 patients on trolleys in April. It is not normal or safe for there to be 29,506 patients on trolleys in the first quarter of the year while also dealing with a highly transmissible virus. It is not normal that there has been 2591 patients on trolleys less than 5km from here in Sligo University Hospital since January.  If it is this bad now, without meaningful action, what hope do we have come November, December and January? 
Hospital occupancy is constantly over the recommended safety level of 83-84% is unsafe for the workforce as well as the patients.
It has been repeatedly and robustly proven over recent decades that ED crowding results in an excess 30-day mortality for all patients and the recently published UK research confirms that delay to admission is, of itself, a cause of avoidable mortality to the patient subjected to this long wait, irrespective of overall levels of crowding. Our members find it completely unacceptable that patients are being put in harm’s way because of a reluctance by government to tackle the overcrowding crisis. 
7. Burnout
Nurses and midwives have faced an unprecedented increase in workload demands resulting directly or indirectly from the pandemic. Coupled with caring for patients with the virus, witnessing the physical and emotional effects on patients, families and loved ones has taken a psychological toll. The vast majority of our members are now telling us they’re mentally and emotionally exhausted, and this is going to have an impact on their safety and the safety of their patients and their long term ability to stay working in this profession. 
Nurses and midwives have been at work in a hazardous environment without reprieve for over twenty six months. They must gain relief from the constant overcrowded work situations faced daily, be provided with healthier and safer working environments, and have available and fast tracked clinical supportive measures in place to support their physical and mental health issues when they arise. Occupational health services are simply not available nationwide and many members report long waiting times for an appointment.
8. Expert Review
One major piece of work that was agreed as part of the Strike Settlement in 2019 was the establishment of an Expert Review Body on Nursing and Midwifery. This group was set up following a recommendation from the Labour Court with the purpose of carrying out an extensive examination of the nursing and midwifery professions. The review group was also tasked with addressing a number of the long-standing claims relating to nurse and midwife managers which the INMO had been pursuing during the 2019 strike.
The Review Body have been carrying out their work for almost two years and finally published their report on March 29th. On behalf of our members, I would like to thank the members of the Review Body.
The Expert Review Report offers some very important recommendations in relation to the future of nursing and midwifery in Ireland dealing with a range of issues such as – undergraduate and postgraduate education and development, digital health, nursing and midwifery workforce planning and management, and leadership and governance.
Minister you must act on this Report. It cannot be allowed to gather dust on desks within the Department of Health and the HSE or subjected to financial ransom that doesn’t appear to apply to other aspects of the health system. This report is paramount to the future of Irish healthcare and ensuring that nurses and midwives
remain in the system and central to its development and organisation.
9. Women’s Health and National Maternity Strategy
Maternity care in Ireland remains heavily reliant on hospital delivered care to women. Our amazing midwives have been both midwife and birthing partner to many throughout this whole pandemic as we have gone in and out of lockdown and maternity restrictions. 
Despite the many recommendations to expand choice for women in the maternity strategy, the pace of implementation has been extraordinarily slow. All political parties pledge commitments to the implementation of the strategy, but progress is not evident, and funding for the additional midwifery staff and midwifery led units remains insufficient. Furthermore, the implementation of a community midwifery service, including home birth options, remains unacceptably elusive. The number of staff midwives employed in the HSE in December 2017 was 1,446 WTEs. The March 2022 WTE for staff midwives stands at 1,421 WTE, a decrease of 25 WTE posts in four years. Investment in increased undergraduate training, postgraduate training and employment is a clear requirement. This service has increased activity, and we cannot continue to under-resource midwifery staffing. This is unsafe for women and their babies.
This issue of menopause is very serious. It is a woman’s issue and it must become a central plank of health policy. The potential for women’s careers to be negatively impacted by menopause needs to be eliminated, and education and awareness training are key to reducing stigma and facilitating the vital conversations women need to have at work.
With an overwhelmingly female workforce, the health service should be a leader in promoting workplace wellbeing for people experiencing menopause. Development of workplace policies is an employer responsibility for fostering equality and is vital for retaining skilled staff in their professions.
10. Disability Care
Adequate funding must be allocated to provide a rights- based approach for people with disabilities under the UNCRPD. The INMO supports the Oireachtas Committee in calling for “an operationally and financially sustainable model of service and governance”. This model must “feature multi annual investment planning to respond to demography and changing population health needs and should be based on community-centred services. Nursing led services for children and adults with disabilities. 
11. Community Nursing
The INMO has consistently identified the lack of staffing within the primary care setting, a situation that has been worsened due to the pandemic. According to the HSE (2021), the pandemic has presented unprecedented challenges within the primary care setting. Staffing capacity, disrupted by COVID-19 related absences, redeployment, and enhanced IPC for service delivery remain crucial challenges within the setting.
Provision must be made in Budget 2023 to commence the process of incrementally increasing the overall number of Public Health Nurses and CRGNs. 
12. Care of the Older Person
In Ireland, the two-tier public/private system has long impeded the delivery of safe care of older people. The privatisation of the older person’s care must be reversed; it is gravely concerning that this area of care is now views as ripe investment area for -profit making large multi-national companies. Already in Ireland 82% of such services are provided via the private sector.
We saw Minister, firsthand what this meant when the pressure of the pandemic hit many of the poorly staffed poorly paid and poorly protected workplaces. This year the HSE service plan, despite the Slaintecare strong recommendations does not provide for any insourcing of this service. The Oireachtas Committee’s strong recommendation on pay and conditions in this sector are easily corrected if the service is public service delivered. The failure to remunerate nursing staff in private settings comparable to colleagues in the public sector is a cost- saving measure that has exacerbated the difficulties complained of by providers.
Minister, if this is the model for care for the future.
• it’s not as Slaintecare set out; 
• it will not serve our aging population well;
Most older people I know have simple enough requests care availability when needed- without having to spend hours on a hospital trolley; They want care in their local community that is available and appropriate for each stage of their aging process and when they need long term care they do not want to be forced to move from their community.
Minister I’m from an offshore Island, it’s also a Gaeltacht area, there are several such areas throughout this country with aging populations, we are forcing many of these elderly people to spend their last days in environments alien to them from a language and environmental perspective.
I feel we can do better I feel we should strive to do better, and I know that with the right cross departmental supports we can ensure they receive services in their native language and in their local area. Minister, we have sought cross departmental work on this and we repeat that request here and ask that you lead on it with your colleagues in Department of Rural Affairs and Gaeltacht. 
13. Students
Minister, our students are the future of our profession and indeed the Irish health service. They have borne witness to the chaotic conditions that their colleagues are working in day in and day out. It is no surprise that many of them are now looking towards their future and thinking that working in the NHS or in Australia is a more attractive option – the problem is not just the conditions they are working in Minister, it is that it is impossible to afford to live near any hospital in any Irish city and maintain a decent quality of life between spiralling rents and the cost of living. 
Borders are open again and our graduates are in demand. Minister, you need to work with us to create a meaningful Bring Them Home campaign. You need to work with us to consolidate and implement what we have already agreed. You need to build on that and create in order to attract Irish nursing and midwifery graduates back to Ireland and show them that working in the Irish health service can provide a quality of life that they deserve. 
Closing Remarks
The role and influence of our trade union cannot be denied. We have been at the vanguard of winning change for nurses and midwives across Ireland. 
Minister, if you take one thing away from this conference, it is that we need a meaningful Bring Them Home campaign. I can see the ad now. If you deliver on this Minister, you will truly revolutionise staffing within the health service. Work with us to make it a reality. 
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