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The SDLP is sympathetic to the spirit of the amendment, but it believes that no Department can be totally exempt from efficiency savings. However, there should be no cuts to front line services. I have sympathy with the Minister in trying to balance a budget for such a demand-driven service, but I believe that the proposers of the motion are engaged in a bit of a cynical exercise. Rather than point-scoring, I would like to have heard some proposals for savings from the Chairperson of the Health Committee that would ensure that there will be no reduction in nursing posts, which is what the motion is about. Have the proposers of the motion asked their colleague the Minister of Finance and Personnel whether he has reviewed his comprehensive spending review policy with regard to the impact on employment and services? Indeed, do they have any suggestions for saving resources?
There is a fundamental contradiction between the loss of nursing jobs and the stated aim of the comprehensive spending review to free up resources to reinforce front line services. Speaking as someone who was a nurse for all too many years, there is nothing more front line than a nurse at the bedside of a desperately ill patient, or a nurse in the community who is an essential member of a primary care team.
I recognise that the reform and modernisation of health and social services is a never-ending and ongoing challenge. We support the Minister’s intent and his commitment towards an ever-greater focus on positive public-health promotion. It is not just about treating the consequences of ill health, it is about appropriate care in the community.
We recognise that the comprehensive spending review efficiency targets have been imposed on the Health Minister in an arbitrary fashion. The SDLP also recognises that given that the health budget accounts for almost half of Executive spending, there must be greater efficiency and enhanced productivity in the Health Service.
The trusts must put in place robust workforce development plans to ensure that registered nurses are adequately trained for the new service delivery that is expected of them. The planned cuts and redeployment of staff will have significant training and professional regulatory implications.
Nurses cannot be treated like pieces on a chessboard: a nurse cannot be taken out of an acute ward and shifted into community nursing without appropriate training, induction and support, or into mental-health nursing without statutory post-registration induction, education and support. Adjustments will certainly be required in the clinical mix among doctors, registered nurses, allied health professionals and care assistants. However, the casualization of nursing skills, which occurred so disastrously in the Thatcher era, cannot be repeated. So much was lost, and we are still trying to regain that ground.
The Royal College of Nursing has produced credible evidence to show that the critical role of the ward sister and other nurse managers is being undermined by the proposals. In some hospitals, ward managers are being asked to work across too many wards and too many locations. When that happens, the role of nursing ward managers as clinical leaders and patient advocates is undermined.
There is a continuing reduction of specialist nursing posts and a tendency to place inappropriate and unpaid leadership responsibilities on band 5 and 6 registered nurses, particularly on night duty staff. Senior nursing posts should be created in every acute hospital, which might convince nurses that their concerns are being listened to.
All changes must, of course, keep section 75 in mind. Any changes must be implemented with equality, integrity and probity, and, at all times, they must put patients’ interests first. The bottom line is that there should be absolutely no reduction in front line services and in nursing posts, as has been stated in the motion.