Brendan Smith: Nursing placements, community care and research jobs

Thank you very much Cathaoirleach, like you I welcome our witnesses today and providing very, very interesting material, what is obviously a very important subject. I welcome the comments by Dr Healy in regard to the increased number of students applying through the CAO to go into nursing. You also mentioned from 2027 undergraduate programmes will include significantly more community and integrated care placements, embrace simulated care scenarios to provide more learning opportunities. I presume there is a significant element already community based and does simulated in that context mean from the classroom rather than in a ward or out in the community? Yes, so at the moment there is a portion of the undergraduate programme is community based and looking at public health nurses and community midwifery but we're moving to a 50% of the programme will now be community based to show the role of nursing midwives in integrated care and community care and proactive care. So it's a big shift, it also gives education providers much more capacity to deliver placements and take on more students. So it's a big shift that we're driving from next year. And then simulated care will be not to replace placements but to support preparing students for the placements. So it won't be delivered as an adjunct to a placement but in a supportive capacity. And at the moment are we using adequately the capacity of our hospitals that are not tier 3 in training? In the past it was an issue that people didn't often get internships in some of the smaller hospitals, internships across medicine and nursing in general. From my own knowledge in my own area, Cavern General Hospital, there would be placements for students from Dundalk Institute and elsewhere as well. At the capacity of those type of general hospitals, is that being maximised as much as it could be in the context of training of our students? Yes, very much so. So we're kind of at a junction now where we're maxing out the acute capacity within the system in terms of what we're doing. So we have students and we've pushed the limit of where we can put students safely within the infrastructure from a model 2, model 3 and model 4 hospitals. But we're realising now that patients aren't all in the acute system, they are actually more in the community now. So we're changing the model in which we deliver the undergraduate education to reflect that and utilising the community placements a lot more. And it goes without saying that all of us appreciate that there has to be safety and standards across at all times, that they are foremost in the training. You mentioned that you have significantly improved the time involved in processing applications for registration. In the past you would have seen a lot of us making representations. Thankfully in more recent times that's not the issue that it had been in the past and that's very, very welcome so it is. With regard to what Miss Veronica spoke about, you mentioned that Ireland has made significant investments in research infrastructure, including clinical research facilities and centres. Now you highlighted, as did Mr MacDonald as well and IBEC representative, the difficulties in retaining staff through the different inadequate funding mechanisms or the lack of stability, the lack of permanency to some of the posts. You mentioned, is there adequate cooperation across the universities, hospitals on an all-Ireland basis, on an Irish-British basis and an Irish-European Union basis? Is there the level of collaboration, cooperation achieved at the present time that would maximise the potential of the investment that's been made in other countries as well as our own to bring about the best results for patients, which is obviously the desired objective of everybody? Yes, thank you for that question. From a national perspective, the support is there and it has been highlighted, there has been many reports written and all recommending the same thing, that there should be greater long-term investment in funding, staff funding for clinical researchers. So I think the time to act is now and we seem to be moving forward in that direction and there seems to be collaboration, there is collaboration and there is positive movement in that direction. In terms of the European funding, certainly there is quite a lot of grants, there is quite a lot of European grant funding available, obviously it's a competitive process, so there is support there to continue on the research, but in terms of, maybe Angela, would you be able to contribute to that? Yeah, I think certainly there is a very high level of support, particularly across the universities in relation to supporting research, particularly around oncology research, and the reality is that even though there has been a lot of investment in the centres, the ability to take on more cancer trials in particular is capped because of the limited resources within the clinical trials research unit. So we could definitely open a lot more trials, not only if the staff that are in those units could be converted onto permanent posts, which would give them better retention and more job security, but also it would enable them to take on more research staff, which in turn would enable the country to open more cancer clinical trials in all the sites. I mean, Veronica spoke to the limiting factor, particularly in the North West, we're looking at trials that are called decentralised trials, whereby patients may need to go to say Galway for their new drug, the new drug that is being investigated as part of the trial, but they could, if the support staff were in place, in Letterkenny, Sligo, and so on, they could receive their standard of care element of the trial in those centres, which would cut down on the need for patients to travel and would really open up access to a lot more patients to participate in trials. So clearly is basically the message from everybody here, we have substantial investment in the infrastructure, but we don't have it in the personnel or ongoing stability and permanency for key researchers and other people working in that particular area. And that is exactly it, and genuinely, you know, people say if you had a magic wand, if we could convert those research staff to permanent posts, and in order to do that we really do need to provide ring-fenced whole-time equivalent numbers for the HSE for research posts, because the voluntary hospitals have more autonomy, they do have a little bit more leeway with how they allocate their funding, and they do support more research staff. The HSE hospitals are capped because of their overall headcount, and there are no ring-fenced posts within that for research. Thank you very much. Thank you, Cahiri.