MHK SPEECH FOR THE 98TH INMO ADC
Friday May 5th 2017
An t-aire sláinte, agus mo chairde atá cruinnithe anseo inniu, o fud
na tire, fáilte romhat agus go raibh mile maith agaibh go leir as mo
croi.
Minister, management, national executive and to you, the Nursing
and Midwifery members, from the many branches and sections the
length and breadth of the Country, I am honoured to address you, at
what is my first ADC as President. (So, no pressure)
The following quote has been attributed to both US Presidents Taft &
Truman and British Prime Minister Winston Churchill:
“If it is to be a minute speech I shall need four weeks in which to
prepare, if a half hour speech, then two weeks, but if I am to talk all
day I’m ready now.” Don’t worry I do not intend to talk all day
however, our employer has left plenty of scope for this over the last
year.
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On the day that gives recognition to Midwives Internationally as life
partners to Mothers and Families, partnership in healthcare, is the
true goal we all strive to achieve. In a year that the truth can only be
described as - stranger than fiction. I would like to start by
acknowledging you the members – who are real and tangible. Given
that you have all had lunch, and drowsiness may be beckoning, I am
going to get you all to stand, and give yourselves a massive and well
deserved round of applause as together, we are proactively shaping
healthcare.
1
Therefore, armed with a recent pearl of wisdom from my husband in
which he said, “no speech is ever too short, Martina” let me begin.
MHK SPEECH FOR THE 98TH INMO ADC
Friday May 5th 2017
(Now, please take a seat)
Over the course of this ADC, it is others that you have applauded, but
this ADC is about you, and for you the members.
This ADC serves many purposes however, the following are
instrumental as to how the organisations priorities are determined:
1)
In operating as a National Forum that enables you to highlight
issues, such as pay, work conditions, staffing, lack of study
support, that have been discussed and debated in many of the
motions presented over the last 2 days. Potentially, influencing
policy that spans the public, political, (and we have the Minister
in attendance) legislative, cultural and social media arenas.
2)
In listening, acknowledging, giving recognition to and dealing
with the many daily issues in your clinical areas, that have
taken on a relentless nature over the last nine years of
austerity. You, have unequally, shouldered the burden, in less
than desirable conditions, on a day to day basis, 24/7, 7 days a
week, 52 weeks of the year, with often and on more occasions
than not, more time, goodwill and thought for others than
yourselves.
PPT No 2
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Rohn is one of America’s Foremost Business Philosophers, who is
widely recognized as a personal development legend, and who
possesses the unique ability to bring extraordinary insights to
ordinary events.
2
I would like you all to just take a moment to read the overhead. This
is a quote from Jim Rohn.
MHK SPEECH FOR THE 98TH INMO ADC
Friday May 5th 2017
When you elected me as your President last year, and I now
personally thank you all for that honour, I reiterated that I was a
“safe pair of hands and will do my best to take care of you all” a
contention that I will live up to. Therefore, 2016 was a memorable
and proud year for me, and was coupled with the momentous
commemorations of the 100th Anniversary of the 1916 Rising. The
leaders of the rising were not to know the full outcome of their
endeavours, however those initial steps set in process the founding
of this great nation state. Today, I find myself addressing you in the
historical insurrection town, that is Wexford. The place of the
enlightened Rebellion of 1798, which saw the embedding of the
European ideals of Liberty, Fraternity and Freedom. Values and
beliefs that have permeated this country and its generations of
citizens.
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PPT No 3 – ask the Question regarding
LEADERSHIP &
WHAT CAN I BRING TO THE TABLE?
There have been many times over the history of this Union that
adept Leadership has been required to steer the Nursing and
Midwifery professions through inhospitable landscapes. Possessing
that ability of knowing when to hold them, and when to fold them,
has never been more acutely required.
3
This Union is founded on the belief of fraternity, which is rooted in
collectivity and is a safe forum that enables you to have the freedom
to articulate your workplace concerns. As your President, I will
endeavour over my two-year term to honour these concerns, in
tandem with the goals of my election speech to you all on May 6th
last in Killarney - which were to focus on PAY, HOURS of WORK,
STAFFING LEVELS & SAFETY and MANAGEMENT ACCOUNTABIITY.
Minister Harris, shares May 6th with me, as he was presented with
the health portfolio on that day, so perhaps it is no coincidence, that
he is as committed as I am to ensure that these goals underpin how
healthcare policy is framed and developed.
MHK SPEECH FOR THE 98TH INMO ADC
Friday May 5th 2017
Franklin D Roosevelt in his inauguration speech of 1933, stated the
following "The only thing we have to fear is fear itself – nameless,
unreasoning, unjustified terror, that paralyses needed efforts to
convert retreat into advance."
He willed and mobilised the American people to take that leap of
faith out of the abyss of the Great Recession of 1927. It is this
sentiment that nurses and midwives need to embrace and not fear
the economic mandarins who articulate the fragile growth of the
economy but on the other hand advise on pay restraint. We have
listened to the “green shoots theory”, however these shoots would
not be growing without our continuing to water them.
I am not fearless, I am tenacious in my commitment to ensuring that
Nurses and Midwives get a fair deal as to date this has not been the
case. I am driven by a sense of putting this wrong to right with an
innate dogged persistence that never gives up driving forward with
determination to achieve, the desired outcome for all nurses and
midwives – so Minister BEWARE!
I know that communication is the rock upon which all ideals either
succeed or perish. My daily mantra is the ISBAR Tool. As we can
only move forward in consensus, by listening to, including and
informing each other in the interest of fairness and consistency.
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I remain resolute in my stance that success will only come about in a
spirit of comradeship, strengthened by collectivity, and collegiality –
4
Any debates or discussions, must be based on trust, honesty and
frankness as without these basic tenets, progress is stifled and false.
The Minister has participated in discussions over the last year and I
know that communication lies at the heart of all that he does. As
these are vital components that ensure consensus and above all
understanding, as in this way the messages are clear and
unambiguous.
MHK SPEECH FOR THE 98TH INMO ADC
Friday May 5th 2017
which has been operationalised by the reflected positions adopted
and recommended by the National Executive and its Officers over
the last year.
PPT No 4 - My address will now focus on 3 areas
OUR HEALTHCARE ENVIRONMENT
Unfortunately, our healthcare environment is a frightening place
considering current conditions as a practitioner when faced with
ensuring safe quality care for our patients/service users. Yet despite
this, the values of care, compassion and commitment are the
ingrained principles that guide the actions of nurses and midwives, to
ensure our patients/service users obtain the best possible care
outcomes. Our CNO in the DOH, Position Paper on Values for Nurses
and Midwives, 2016 – is evidence to and articulates these values.
Unfortunately, these very values are beset by chaos, confusion and
complicity – where non-clinical management are consumed by
playing the numbers game, they hit the target but in so doing miss
the real point of care – a key failing point identified in the MidStaffordshire Report, (2013), that they have conveniently, set aside
in the interest of their own self-serving SILOS! Let me remind them
that the health of the citizens of Ireland is not an academic exercise,
consistent with ticking a box, as they cannot play around with real
lives.
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“once statutory responsibilities and accountabilities are devolved
from the centre to Hospital and Community Health Organisations,
dismantle the HSE and replace it with a much leaner national health
agency. In the interim, reform the existing legislation within which
the HSE operates to improve governance”.
5
Therefore, I welcome the Minister’s comment in his recent opening
statement to the Committee on the Future of Healthcare, where he
stated and I quote,
MHK SPEECH FOR THE 98TH INMO ADC
Friday May 5th 2017
This Union in its opening statement to this self-same committee has
strengthened this further by:
Forwarding that in Transforming Models of Care – that the overhaul
must result in nursing and midwifery staff being involved and
empowered, with accountability, to deliver clinical care at the most
effective level; and
That, in DEVOLVING FUNDING that frontline Nurse/Midwife
Managers have unfettered input at all stages of the annual budget
for their area/location.
I do not have to remind the Minister, of the stark reality of the
situations that you as the members work in. These are unstainable,
unacceptable and dangerous, and something will be done.
“Clear and present dangers” in the nursing and midwifery profession
exist the length and breadth of this country – it is not consigned to a
particular area as, ACUTE, MATERNITY, INTELLECTUAL DISABILITY
and our PUBLIC HEALTH nursing and Midwifery services have all
witnessed the consequences. The Missed Care Report in the
Community, serves as one evidenced based reminder of what is
currently happening in practice.
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Recently, I received an article from a good friend, the article was
entitled - Leaveism: the new public sector epidemic and
immediately I was struck by – 2 other recent isms namely –
Abseentism and Presentism and now we have Leaveism, so I was
intrigued with this article, which I felt was stating the obvious about
6
Nursing and Midwifery staffing is at an all-time low with activity at
and all time high, it is not sustainable, and the worrying factor is that,
not only can we not recruit nurses and midwives, but the retention
of those of us who remain and who have many years of experience
on the frontline is jeopardised.
MHK SPEECH FOR THE 98TH INMO ADC
Friday May 5th 2017
a system wide worrying phenomenon. The article co-authored by
Professor Sir Cary Cooper of Manchester Business School, who said
“We have now discovered that leaveism is endemic in the public
sector”, with as many as 76% of public service employees admitting
that they had taken annual leave instead of phoning in sick or leaving
work unfinished. I was not surprised at this UK finding, as
overworked staff too frightened to admit they can’t cope, access
work and continuing education anytime, anywhere via smartphones
and laptops (if they have them), or completing their relentless
paperwork as they have never had the clerical support person
appointed, and now see what might seem like an answer. However,
by working on mobile devices or completing paperwork, people can
easily conceal that they are enduring long hours and furthermore, as
cuts bite, the sheer work saturation prompts increased sickness
absence – with obvious costs - disruption of services. Professor
Cooper’s message was clear “People who don’t take their full holiday
entitlement to get away from work, is a real problem. It’s not
healthy.”
Anecdotally, I have identified this phenomenon in our Nursing and
Midwifery workforce, and it leaves in its aftermath, - burnt-out,
stressed, exhausted, demoralised, undervalued and disrespected
professionals – where for those who practise leaveism, the
accusation of poor time management is often levied at the
employee.
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The detrimental and catastrophic consequences of all this, has been
the utter annihilation of the nursing and midwifery profession
physically, psychologically, financially and socially with despite the
best intentions – of the Health Services People Strategy (2015-2018)
which supports the implementation of the organisation’s corporate
7
Nursing and Midwifery have carried the burden of economic failures
and political meandering from a professional and financial
perspective – this will stop.
MHK SPEECH FOR THE 98TH INMO ADC
Friday May 5th 2017
values of Care, Compassion, Trust and Learning. Yet, this Union had
to bring our employer to the brink with the threat of industrial action
to achieve a workforce plan. They do not engage, develop, value or
attempt to retain the nurses and midwives of this country. A
workforce plan is a fundamental spoke in the wheel of all
organisations, and should have been required to consider the 20%
increase in activity or the current and projected future surge in
demographics, chronic disease and lifestyle changes – challenges
that you Minister, have referred to on more than one occasion.
However, the MORATORIUM was the only show in town, the damage
of which is now coming home to roost – with theatres closed as
there are no theatre nurses.
Against this background I welcome the Minister’s letter, to this
Organisation, earlier this week, confirming the following:
That he has issued the written directive, under Section 10 of
the health Act 2004, requiring the Health Service Executive to
deliver upon the increase, of 1,208, the number of
nursing/midwifery posts, in the health service, by the end of
this year:
 this Organisation views this legislative underpinning of the
nursing/midwifery workforce as a critical first step in moving
towards staffing levels which are determined by
nurses/midwives, using evidenced based practice, which will
be respected, without question, by health employers, health
Ministers, and, indeed, the Houses of the Oireachtas; and
8
 we look forward to similar Directives underpinning further
increases, in nurse/midwife staffing levels, until they reach a
minimum of 40,000 over the next three years.
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1.
MHK SPEECH FOR THE 98TH INMO ADC
Friday May 5th 2017
2.
Confirmation that a circular has issued, at his direction,
delegating, to Directors of Nursing/Midwifery, the authority to
recruit under this workforce plan:
 this Organisation will no longer tolerate people in far
removed offices preventing Directors of Nursing/Midwifery
filling nursing/midwifery posts essential for safe staffing
levels.
3.
The establishment of the High Level Implementation Group,
involving senior nominees from the INMO, to monitor the
ongoing implementation of every strand of the recently
accepted proposals to begin addressing our
staffing/recruitment/retention crisis.
 This Organisation will also not accept any further examples
of management overtly breaching agreements and,
effectively, demonstrating no commitment to honour their
obligations when agreements are made in good faith.
 All we have experienced, in recent months, is endemic
management inertia or convenient amnesia, when it comes
to honouring their side of all agreements while they require
the INMO to comply with every line of national agreements.
This cannot continue.
 While fully respecting your commitment, on this critical
issue, I have to tell you that, at this conference, we have had
many examples given which continues to show a huge divide
between your commitment and the actions of local
employers.
9
Your repeated commitment, again explicitly provided for in the
agreement, to have permanent contracts of employment
issued to all members on panels and all 2016/2017 graduates:
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4.
MHK SPEECH FOR THE 98TH INMO ADC
Friday May 5th 2017
 This further inertia, and dare I say it complacency, only
guarantees another flight of our world class young
professionals to other countries – we need to hold on to all
we have and bring back thousands of those who left in
recent years.
Minister, from where I stand we have a very obvious example here of
an effective divorce between you and your undoubted commitment
to address these difficulties, as compared to the HSE who, by their
actions, repeatedly fail, or at the very least prevaricate, on
implementing what has been agreed or even what the Department
has told them to do. No coherent health service, serving its patients
and looking after its staff, can be managed in such a vacuum.
Nurses and Midwives, Market forces are with us, as I remind those
listening that our dual professions are not available “under the tree
at Spar” yellow packed for convenience, therefore, the proposals
must be committed to and honoured.
Otherwise the message is stark if this is not actioned,
NO NURSES & MIDWIVES = NO HOSPITALS OR SERVICES.
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“It is common sense to take a method and try it. If it fails, admit it
frankly and try another. But above all, try something.” Franklin, D.
Roosevelt, US President.
10
THE UNION RESPONSE
This Union at every opportunity has repeatedly applied, tried and
trusted Industrial Relations mechanisms and from the outset of my
presidency set about the task of supporting the realisation of my
presidential goals, of PAY, HOURS of WORK, STAFFING LEVELS &
SAFETY and non-clinical MANAGEMENT ACCOUNTABIITY at every
opportunity and in all fora, that we are representative on.
MHK SPEECH FOR THE 98TH INMO ADC
Friday May 5th 2017
Over the past year, since I have taken office, we have complied with
due process, engaged in all relevant forum and shown integrity with
regard to all of our obligations to implement agreements.
This approach to IR is lauded by this government who say we must
work within agreements. In that context I am now declaring, on
behalf of the INMO, that if due process, and mature engagement,
fails to address our key issues of restoration of pay, and parity with
colleague professionals, this union, strengthened by the resolve and
unity of our 40,000 members, will do whatever we have to do, to
secure the long overdue pay and conditions warranted to nurses and
midwives.
MY NAME IS … PARITY
Let me set out the context, Nurses and Midwives over the last 9
years have listened to the continuous mantra of what I refer to as
the “4 M’s - Moratorium, management constraint, more with less,
and must do better”. With the Nurse and Midwife within the
Healthcare system squeezed and being made to feel that they were
in some way responsible for the “ills” of the system. This seemingly
justified and legitimised, non-clinical management’s continued,
“contraction and cash harvesting policies”.
As Public Servants, Nurses and Midwives, the Bastions of care, were
well and truly vilified and seen as fair game. In levying this charge,
scant regard was given to the fact, that the very nurses and
midwives, “the firefighters”, supporting and carrying the broken
healthcare system were “being blamed for the fire”.
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 Nurses and Midwives, have endured between 16% - 39% cuts in
salary.
11
Let me set the record straight:
MHK SPEECH FOR THE 98TH INMO ADC
Friday May 5th 2017
 All new entrants to the Nursing and Midwifery profession since
Jan 2011 are on 10% less – therefore, equal pay is not applied for
doing the same job in Nursing and Midwifery, either.
 Our working week was increased with the addition of 1.5hrs, an
additional 78 hrs yearly under HRA, bringing our working week to
39hrs. This increase was despite, the fact that, Nurses and
Midwives work more hours per week than, all other professional
grades.
Minister, you have on numerous occasions referred to – our well
educated, highly skilled and experienced nurses and midwives as a
valued resource to our health service, yet the story thus far beguiles
that.
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Therefore, given that the supply of Nurses and Midwives is not
keeping pace with demand, I contend that we must be recognised as
a Giffen Good – A rare type of good, where an increase in price
causes an increase in demand – put simply if you pay Nurses and
12
This National Executive tabled an emergency Motion at conference
yesterday giving evidence to the realities of the disparities about Pay
and hours of work. PARITY, is now “the only show in town” for
Nurses and Midwives, and is what I consider as the STARTING POINT
in bridging the gap – when you consider that Nursing and Midwifery
are graduate professions, it is difficult to conceptualise why we are,
paid less and work more than our allied graduate Healthcare
professionals and public service counterparts – is this disparity
maintained because we are viewed as a Vocation as opposed to a
profession? And perhaps conveniently deemed to have taken a vow
of poverty as we don’t require purchasing power parity? or is it a
much more insidious Gender Inequality? A status, that when the
financial crisis hit, especially nurses and midwives, who are on the
whole women, it surfaces more challenges to their daily survival (De
Raeve, 2017).
MHK SPEECH FOR THE 98TH INMO ADC
Friday May 5th 2017
Midwives appropriately you will attract them – the UK, other
overseas employers and the Private Healthcare sector have
operationalised this classification. (the INMOs Graduate Student
Survey, April 2017).
This is not hearsay, we are rare and it is a worldwide phenomenon.
Indeed, a Global jobs’ search website in April 2017, revealed the
ratio of nursing jobs in Ireland to nurses looking for them is four to
one and that working in a hospital’s emergency department is the
least attractive option for nurses with almost two-thirds (63%) of
jobs still vacant after 60 days an indication of the reality of the
challenges faced in trying to fill these crucial roles.
So, Minister I ask you to appreciate my warning, that whilst the
expanded proposals, have stemmed the floods gates, it is a very
temporary plug. The real tipping point will be the forthcoming
engagement with government on a possible successor to the LRA –
as nothing short of PARITY of PAY & HOURS, with our Allied
Healthcare Professionals will appease. Pedalling uncertainty around
BREXIT or other Global economies, will not cut it. We have taken the
pain now we need to feel the gain! “because we are worth it” and we
have more than demonstrated our value.
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I agree our Nurses and Midwives are highly educated and practice in
charged and changing healthcare environments – we are responsive
and we have managed to maintain educational standards of
excellence despite continued inadequate support by our employer
(Motion 1 Professional Group 2) – with leaveism the only option as
13
That infamous phrase “SHOW ME THE MONEY” from the Movie
Gerry Maguire, comes to mind, as nothing short will be required to
defer an inevitable Armageddon of industrial unrest, if the
Government does not recognise the true value of nurses / midwives
ad agree that parity of pay and hours is fair, reasonable and long
overdue.
MHK SPEECH FOR THE 98TH INMO ADC
Friday May 5th 2017
our employers do not sanction or indeed support the release to
attend essential Continuing Professional Development (CPD)
Programmes. During the recent negotiation of the expanded
proposals we sought 1 hr per week (yes, a mere 1 hr) of Reflective
Practice for each Nurse and Midwife, to ensure safety and excellence
in practice. Incredulously, this was rejected, and this a potential
support framework to nurture the dual professions through the
transition of competency, as enshrined in the Nurses and Midwives
Act 2011.
This, the self-same employer who had just agreed to review the
NCHD Contract, that includes in section 9, Leave and Holidays – 18
working days of Study leave per 6-month period, and we’re told
we’re worth it!
Our Chief Nursing Office, has been visionary, two recent draft policy
documents released in March 2017, focus on developing graduate
specialist and advanced nursing & midwifery practice and developing
a community nursing & midwifery response to an integrated model
of care. These documents, whilst they comply with the governments
hospital avoidance policy, I caution that quality of the inputs to the
service must be given the time to develop and not sacrificed for
political expediency, as the problems will come back to roost, akin to
the Staffing Moratorium and graduate programme.
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And this Union like the GAA will, “BE THERE, ALL THE WAY” – shaping
healthcare with you.
14
PPT No 5
Finally, in my Role as the President, I want to give you hope and
reassure you all, that the future of our dual professions will change
for the better, I do care and I will do all within my power to level the
playing pitch for nurses and midwives, as there has never been a
more favourable time economically.