Jennifer Carroll MacNeill: Nurses, Staffing and Reform

Ciarán MacNeill. Sorry, Taoiseach, we're out of time. Thank you, László Ciann Comhairle, and first of all, I'd like to, on today, which marks International Nurses' Day, recognise the presence in the gallery of the President of the INMO, Caroline Gourley, the General Secretary of the INMO, Phil Ní Ghaigh, who's now the President of ICTU as well, since last July. Congratulations to her on that. Also, I understand that we have in attendance the CEO of the Nurses and Midwifery Board of Ireland, Caroline Donoghue, and the President of the NMBI, Eoine Lynch. They're very, very welcome today to join me and the House in marking International Nurses' Day, an occasion recognised around the world to honour the professionalism, commitment, and vital contribution of nurses to our health services and to society as a whole. This year's theme is Our Nurses, Our Future, Empowered Nurses Save Lives. It's a powerful and timely message, and it's reflected in the government's clear objectives to deliver structural reform, supporting a sustainable supply of nurses to meet population health demands and support improved working conditions. We are also committed to supporting innovation, a range of career opportunities, as well as strong professional governance and leadership. Nurses have demonstrated that they can and that they want to work at the very, very top of their training, and we need that. It's essential for patient safety and a sustainable health system for the future. Ceann Comhairle, if we're to do this, I want to reflect honestly on the challenges that nurses face as we try to get to that. I am very aware of the recent IMO survey that indicates a high level of burnout, stress, and increasing violence and aggression in the workplace. While those issues are not specific to Ireland or nursing in Ireland, nurses and midwives as the largest workforce are disproportionately affected, in my opinion. This poses a greater risk to staff wellbeing, workforce retention, and the delivery of safe patient care. Nursing is the largest professional group within our health system. Simply put, the breadth and depth of health care working across every care setting at every stage of life, at moments of greatest vulnerability, nurses are often the very first point of contact and most enduring point of contact for patients. They provide highly skilled care. They lead with strong clinical judgment, and they deliver care with compassion that ensures patients, families, and service users remain at the centre of the work they do. I would like to take this opportunity to formally acknowledge and to formally extend my thanks to every nurse in every service right across the country. I have seen firsthand your leadership, professionalism, skill, and commitment to the health and wellbeing of our patients and all of our service users. I also think it's important to acknowledge the very significant progress that has been made in Irish nursing over recent years. I want to acknowledge that my department is the great beneficiary of the Chief Nursing Officer and her team in the department, who are leading on nursing policy solutions for the health service. Just so that people are aware of the integration of the nursing team into the department, it's a mixed team of professionals and civil servants. Our Chief Nurse Officer is Rachel Kenna. Deputy is Karen Green, who was the Director of Nursing in Beaumont. Deputy CNO, Kelly Mofflin, who was previously Director of Nursing and Mental Health Nursing. Deputy CNO, Gráinne Sinn, who was previously a Nurse Specialist in Cancer Care. She is also supported by a Project Officer of Oonamot Rogers from Midwifery, Clare Townsend and Tarmaline Rea, who were public health nurses, and also Harlan Corrigan, who were Renal Nursing, supported by a team of civil servants. I mention that so that deputies have a full sense of the integration of nursing into the Department of Health and the significance and importance that we place on that within the department, leading on nursing policy solutions for the whole healthcare system. So that has developed a well-developed national nursing workforce, but one that's also regarded internationally. And significant investment in nursing has enabled a more sustainable, highly skilled and motivated workforce in line with government commitments. And that's very much in partnership with nursing representative organisations and indeed every single nurse working in the Irish state. Nursing in Ireland is a progressive, well-regulated and forward-looking profession. Nurses are trained at undergraduate level in general, mental health, intellectual disability and children's nursing, enabling that system-wide contribution from the outset. That's very, very strong focus on education is clearly reflected in the recent review of undergraduate nursing education, which sets out not only the commitment to modernising practice, but the education reforms that reflect future healthcare environment graduates will be working in. It has considered digitally enabled care, universal healthcare and integrated services. From 2027 onwards, students will spend substantially more time training in community settings, supporting early career pathways in community care and acting as a key enabler of slaughter care delivery. I really do want to acknowledge how nurses and midwives work in an integrated way, providing person-centred care, combining their expertise in a seamless way to support individuals and families across the continuum of health. The State of the World's Nursing 2025 report, published by the World Health Organisation and the International Council of Nurses, highlights that the global nursing shortages remain a critical challenge. Nursing is the largest professional group within our health system. In Ireland, we're in the enviable position of having 14.3 practising nurses per 1,000 population. That is more than nearly all of the other European countries. I believe that it's just Finland and Norway that have higher numbers, but that also reflects the very different geographic spread of their population. Nevertheless, I'm very pleased that Ireland is so, so highly positioned among European countries in having so many practising nurses per 1,000 population. There are almost 93,000 nurses and midwives registered with the Nursing and Midwifery Board in Ireland, representing a 3% increase on last year and the highest number of registrants ever recorded. Overall, our growth in 2025 was an increase of 883 nurses. That's a hugely significant addition in a single calendar year, but it's bettered this calendar year so far. Already in 2026, in quarter one, we have an additional 843 nurses in the first three months of this year. So that is a real commitment to hiring, to recruiting nurses in permanent positions, and it is very, very clear that nurses want to work in Ireland. In addition to our Irish-trained nurses, whom the NMBI have told me are staying more and more in Ireland than had previously been the case, but in addition to our Irish-trained nurses, we benefit greatly from the contribution of a diverse international nursing workforce. It's important to place on record that our recruitment approach is firmly grounded in ethical recruitment. Ireland is signed up to and is aligned with the World Health Organization Global Code of Practice on the International Recruitment of Health Personnel. And indeed, when I was at the World Health Assembly last year, we sat at the front of the table alongside the Philippines in terms of leading that conversation about international, ethical international recruitment. We will continue to need international professionals, but given the global shortages of healthcare workers, a more sustainable health and social care workforce is the focus. Nursing has a significant and unsustainable reliance on international recruitment. Significant government investment is being provided to expand healthcare education capacity here. A €28.5 million investment over the next three years aims to deliver 1,100 additional healthcare training places each year across medicine, nursing, therapy professions, pharmacy and dentistry. 2020 to 2025 saw first-year nursing places in higher education institutions grow by 23%. While there are real, very real pressures in our system, increased demand and growing complexity, demographic changes, technological advances and financial challenges, but having a sustainable workforce is critical for the future of health in Ireland and that is what we are working towards. Despite our recruitment success, and I hope more to come and an awful lot more to do on that, but despite the success that I've outlined in 2025 and in the first part of 2026, nurses do continue to experience staffing gaps in acute and community settings and too much reliance on agency in certain areas. International as well as national evidence has shown the direct correlation between nursing staff levels and better patient outcomes, improved safety and reduced adverse events. It's also shown appropriate staffing enhances staff wellbeing and improves retention. Nursing in Ireland has shown national and global leadership by developing the Framework for Safe Nurse Staffing and Skill Mix, which we call the Framework. This is an evidence-based approach to determining appropriate nurse staffing levels across different care areas. The Framework is designed with patient need at the core. It's not about blunt staff ratios or minimum staffing levels. It's patient-focused. It's flexible. It's a flexible model that adapts to the Irish context. Phase 1 and Phase 2 is, as we describe of the Framework, our national policy. Phase 1 essentially applies to inpatient, adult, medical and surgical settings, while Phase 2 applies to adult emergency departments. Since 2020, a total of €56.2 million has been provided by government to implement this Framework, and that has delivered an additional 2,000 whole-time equivalent registered nurses and healthcare assistants. The Framework is now fully implemented in all our adult emergency departments nationally, and it is near full rollout in all applicable wards. The Framework, I believe, continues to demonstrate positive impacts for patient staff and hospitals. Some examples include reduced length of stay, shorter wait times and fewer nurse-sensitive adverse events. So it has improved working conditions, a reduction in signs of burnout, lower levels of absenteeism, improved staff retention, and from a cost and safety perspective, it helps to reduce reliance on agency staff and focuses on stabilisation through permanent, permanent whole-time equivalent staff. I know the INMO and nursing representatives are very supportive of the Framework and want us to drive hard, drive as hard as we can in its implementation. And in many respects, we are the envy of Europe in having this very professional structure, and we want to continue to drive that and retain the leadership position that we have in Europe in this way. Advanced practice is a hugely important part of what we're trying to do to support nursing generally and to support patient care. Advanced and specialist nursing practice has been the cornerstone of reform in recent years, delivering high-quality, autonomous care across acute, community and specialist settings. Care pathways are being transformed by providing quicker access to care, timely assessment, diagnosis and treatment and follow-up. It is reducing waiting times, it's improving continuity of care and supporting really good care closer to home. Advanced practice is not only a key lever for optimising the capacity of the existing health workforce, but it really is important in supporting and advancing meaningful and significant clinical career pathways for nurses and strengthens retention. I want nurses to work at the very top of their expertise, at the very top of their licence, at the very top of their profession, and advanced practice is the way towards that. As a result of some sustained investment, the number of nurses and midwives practising at an advanced level in March of this year was 1,354. We now have 2.7% of the nursing and midwifery workforce at advanced level and we're on track to reach the 3% policy target. That positions Ireland as a global leader for advanced practice. I might share my time with Minister Butler if that's okay, I'll take another four minutes. We have begun an evaluation of the impact of that and that will be central to shaping the next phase of advanced practice. May I mention virtual care and the pace of digital and technological reform that has opened so many opportunities to innovate, change and improve care for patients? Let me particularly mention this today because nurses are playing a pivotal role in the innovation and safe expansion of virtual and digitally enabled care. Through nurse-led virtual clinics, remote monitoring and community-based models of care, nurses are actively improving access for patients, supporting chronic disease management and reducing unnecessary hospital attendances and exacerbations of people's long-term illnesses. Our nurses are at the forefront of embedding digitally enabled services, ensuring the new models of care are well-coordinated, safe and focused on the needs of patients. That leadership is clearly demonstrated in the virtual wards now in every region. Those initiatives have been extremely successful at improving patient comfort. I spoke with a man in Kilkey yesterday in Clare who had been on a virtual ward from Limerick for five weeks after experiencing a neurological event and spoke of it very positively. It has supported individuals and patients like him, 2,800 patients, and it has delivered over 27,000 bed days for us, freeing up beds and other hospital resources for patients who do require more traditional care because virtual wards are not for everybody. But for those whom they are, they're being supported and delivered and led by nursing and taken together, safe staffing, advanced practice and virtual care clearly demonstrate how nurses are actively shaping service reform. They're not simply responding to it, they are shaping it. I attended the INMO conference last week and had the good fortune of meeting with many, many nurses and midwives from all over the country. I know and indeed heard again firsthand about how passionate nurses are about what they do, about the challenges that they experience and their commitment to their profession and commitment to their patients. I really want to refer to the expert review body on nursing and midwifery, which provides 47 recommendations of real significance and the positive impact of the expert review body's work continues to be realised year on year in so many different ways, but there have been delays in implementing some recommendations and that has caused frustration. Work is ongoing to finalise processes underway for those recommendations and I do want to reaffirm the government's clear recognition of the importance of actively supporting the continued development of the nursing workforce. I also want to acknowledge the practical improvements that will be delivered from local bargaining under the 2024-26 public pay agreement and I am informed that the proposals being finalised will deliver a broad range of measures to strengthen pay and progression across nursing and midwifery career pathways and are an important part of supporting retention and ensuring a sustainable nursing workforce. Last Ciancórla, International Nurses' Day provides an important opportunity for me and for indeed all of members of this House to formally recognise the professionalism, the skill and the unwavering commitment of our nursing workforce. I want to acknowledge not only the extraordinary contribution that nurses and midwives make every single day, but their leadership, their innovation, their compassion and the support that they bring to every person in our health service in the face of very significantly growing demand and ongoing pressures. On this day I reaffirm my strong personal and indeed the commitment of my department and the commitment of the government to the nursing profession and I really do welcome contributions of deputies and I hope that they will join me, I know that they will join me in once again placing on record our sincere gratitude for the continued dedication, professionalism of our nurses today and every day and acknowledge the many, many improvements and supports that we are trying to advance for the excellent nurses in our state.