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Current issues: Update Number 2
Members Update 16.10.15
Friday, 16th October 2015
Dear Member
As part of our ongoing communications efforts I want to bring the following information to you in relation to important current issues.
As you will know the government brought forward its budget, for 2016, earlier this week.
In relation to health the INMO’s initial response, can be found on our website (www.inmo.ie).  As you can see we remain very concerned that the allocation will not allow the health service to grow sufficiently, in terms of capacity, to meet demand.  
Also, arising from the budget, we are seeking two early meetings, with the Department, to discuss the following:
  • the implementation of the Midwifery Strategy and, specifically, the number of additional midwives, to be employed in 2016, and the need to expand midwifery led services across the country; and
  • arising from the funding allocated how does the department intend to meet demand in terms of additional beds and staff.
Full details of the main provisions of the budget, including its impact on take home pay, can also be found here.....
2. Recruitment
The INMO has, in recent months, maintained sustained pressure, upon the HSE, to offer all our 2015 graduate nurses/midwives permanent posts.
We are, therefore, pleased to note that, last week, the HSE confirmed that it was directing all agencies to offer permanent posts to our new graduates (1,500 approx.) in all disciplines.
While welcoming this positive initiative the INMO will also be insisting, as per regulations, that all existing panels, for permanent posts, be fully exhausted in tandem with the offer to new graduates.
If any member, on an existing panel, has any concerns, with regard to accessing a permanent post, they should contact their local IRO immediately.
3.1. Nurse Staffing
You will recall that, last year, the INMO commenced a Safe Staffing Campaign for the purpose of ensuring consistent safe staffing, with an acceptable skill mix, is introduced across all services.  As a direct result of this campaign the then Minister for Health, Dr. James Reilly TD, established a special Taskforce, on Nurse Staffing and Skill Mix, which would, in its first phase, examine adult medical and surgical wards/units.
The INMO is represented, on this Taskforce, by myself as General Secretary of the Organisation.
I now wish to advise you that the Interim report, from this Taskforce, has been received by the Minister and is currently being considered by him.
The interim report recommends that a new approach to staffing, which will be applied in a uniform basis in all wards/units, would be introduced involving:
  • the use of an agreed dependency tool;
  • the allocation of hours on a nursing hours per patient day basis (as per New South Wales in Australia);
  • a 100% supervisory role for all CNM2s; and
  • much greater autonomy for senior nurse management to establish, and maintain, the required level of nurse staffing in each ward. 
The interim report has sought some earmarked funding, in 2016, to allow a pilot programme be commenced.
We expect early engagement, with the department, in the coming days, on this critically important issue, and will keep you advised.
3.2 Midwifery Manpower Report
The INMO, including the Officers of our Midwives Section, is scheduled to meet with the joint chairs, of the Midwifery Manpower Review Group, on next Monday, 19th October 2015.
This meeting is necessary as this Organisation continues to be concerned with regard to the work of this Review Group and any possible draft recommendations it might make.
The INMO continues to seek, and this is supported by senior obstetricians and international evidence, that the midwife to birth ratio, in Ireland, should be around 1 to 29.
Our concerns are further heightened as our midwife members, in a number of maternity hospitals/units across the country i.e. Limerick, increasingly express their fears with regard to standards of care due to low staffing.
Linked to the discussions referred to in point one above, regarding implementing the midwifery strategy in 2016, the INMO will continue to seek a significant increase in midwifery staffing, across the country, in the coming months.
The INMO recognises that our midwife membership, in light of recent reports and their own experience, are under intolerable pressure which can only be alleviated by improved staffing levels.  This will be a priority for us in the coming weeks.
4.1 As you may have seen, through media coverage, the INMO continues to be very active in demanding sustained measures to reduce the level of overcrowding in our Emergency Departments.
Last week we held a meeting, of ED representatives across the country, and, on the same day, these members also had a two and a half hour meeting, in INMO head office, with the Minister for Health Mr. Leo Varadkar TD.
Arising from these meetings, and informed by the representatives’ feedback, the INMO has, in recent days, held further discussions, with the HSE, on four critical areas:
(i) The immediate introduction of specific recruitment and retention initiatives to address the unsafe staffing levels that currently exist.
(ii) The need for greater, consistent, support from hospital managements, for ED staff, including:
  • an immediate health and safety review, in each Emergency Department, to  be carried out by an independent expert, and to report within four weeks; and
  • an immediate review of all Hospital Escalation Policies to ensure that they are consistently applied and utilised.
(iii) As per the Emergency Taskforce Report the immediate need for increased senior clinical presence, to ensure acute assessment by senior clinical decision makers, and enhanced collaborative working, throughout the extended day, on a 7/7 basis, in all Emergency Departments.
(iv) Increased access, when required by nursing staff, to diagnostics on an extended 7/7 day basis.
In particular we are actively engaged in seeking to agree measures which will lead to significant improvements in the ability of hospitals to recruit and retain nursing staff in Emergency Departments.
The INMO also raised these issues at the most recent meeting of the Emergency Department Taskforce Implementation Group, of which the General Secretary, Liam Doran, is joint chair, when it met last week.
In tandem with all of these efforts the Executive Council also decided that, if sufficient progress was not made in the four areas identified, then a ballot, of all members in Emergency Departments, would commence after 1st November.
With regard to this part of our campaign please note the following:
our members in St. Vincent’s Hospital, Dublin, have already commenced a work to rule, in protest at staffing levels and overcrowding, following a lunch hour protest last Monday, 12th October 2015;
? meetings are being arranged, with members in all emergency departments, to appraise them of all developments, in detail, and to prepare for any next steps, in our campaign, if they are required.
4.3 Hospital Overcrowding
In all of our activity, aimed at reducing overcrowding, the INMO is acutely aware, from our own experience and through our daily Trolley/Ward Watch, that a number of wards, in some hospitals, now carry extra patients, every day.
That is why we are demanding, as part of these renewed actions, a major focus on escalation policies, in each hospital, which must involve, as a minimum, the following:
  • additional ward rounds by senior medical staff (consultant/registrar) to assist early discharge and free up beds;
  • cancellation, where required, of any planned elective admissions, to again free up beds for admissions through ED; 
  • extended attendance patterns, of senior clinicians, to assist in patient flow and early diagnostics; and
  • enhanced role for nursing, following due recognition, in such areas as delegated discharge which would again free up beds and minimise overcrowding.
As you can see this whole issue is of major concern, as we enter the autumn/winter period, and we will keep members advised of all developments.
Following the successful Dail protest the Organisation’s RNID Section continues its Campaign of Excellence across the country.
In that regard a number of initiatives are ongoing including:
  • a meeting with the Minister for Disability Ms. Kathleen Lynch TD;
  • meetings in some ID Services across the country to raise issues arising from poor staffing and cutbacks; and
  • a recent meeting with the National Federation of Voluntary Bodies (in conjunction with the ICTU) at which a number of issues were discussed including the Person in Charge (PIC) issue and the membership of HIQA Inspection Teams within ID Services.  A further meeting with the Federation is being sought.
Our RNID Section remains absolutely committed to highlighting the expertise, of the RNID, and this work will continue in the coming months.
As you can see the Organisation is very active, at this time, in all areas of concern to members.    We will issue further updates, in the coming weeks, as we progress our demands/requirements on all of the foregoing.
As always thank you, most sincerely, for your attention to this note as I am always anxious to ensure you are fully informed on important issues.
Yours sincerely
General Secretary 
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Irish Nurses & Midwives Organisation (Cumann Altrai agus Ban Cabhrach na hEireann). The Whitworth Building, North Brunswick Street, Dublin 7. T:+353 1 664 0600 E:inmo@inmo.ie