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Mr Peter Hughes - 12th April 2018

Minister, Chairperson, Delegates,

I am pleased to bring you this report as General Secretary on the occasion of our 47th conference here in the Slieve Russell Hotel, Cavan. I would like to especially welcome Minister Daly and look forward to his address. I want to thank the Cavan/Monaghan Mental Health and Intellectual Disability branches for hosting conference.

As you know we have focussed a lot of attention on the recruitment and retention crisis in nursing, and I will return to this topic later. But for now I am pleased to be able to report to Conference that despite this crisis our PNA membership remains stable and has even increased in the past year.

The National Ambulance Representative Association (NASRA) membership continues to grow with a significant increase in the past six months. This is a reflection of the leadership, hard work and representation provided by Tony Gregg and Mick Dixon over the past seven years. Mick has recently retired from the position of Chairman of NASRA and Sinead McGrath has been elected as the new chairperson. I want to take this opportunity to thank Mick for all his work over the years and wish Sinead every success in the role.

For over seven years NASRA subscriptions have been deducted at source by HSE payroll, However, since last November the HSE are refusing to deduct subscriptions at source for new applicants. This is a total affront to the fundamental rights of employees to organise and to freedom of association. When we consider that the HSE deduct at source for the credit union, Banks, insurance companies, GAA draws, their behaviour in relation to NASRA members is absolutely shameful.

NASRA mounted a very strong protest outside the National Ambulance Services Central Payroll Department in Tullamore in February as the first step of resistance to this discriminatory action by the HSE. We will be intensifying our campaign to resolve this basic fundamental right to freedom of association in the coming weeks and will not desist until this matter is satisfactorily resolved.

I will be insisting that the HSE respect the wishes of paramedics nationally to join the union of their choice and to recommence the deductions forthwith.

IFESA continues its work on behalf of its members despite a disappointing outcome in the Court of Appeal on the issue of union recognition.

Delegates, the inadequacies and underinvestment in the Child and Adolescent Mental Health Services have been highlighted at conferences for many years and in numerous other forums. I took the opportunity last June to outline the PNA's serious concerns regarding CAMHS to the Joint Oireachtas Committee on Child and Adolescent Mental Health Services on no less than two occasions.

This was an important opportunity to outline the inadequate service provision for the Children and Adolescents experiencing mental health problems in Ireland.

For a country that purports again and again to put the best interests of our children first, the Report from the Committee published in October 2017 highlighted some stark facts. According to the United Nations Children's Emergency Report “Building the Future” published last year, when compared to 37 nations in the developed world, Ireland has the fourth highest teenage suicide rate.

  • Current research would suggest that one in three young people in Ireland will have experienced some type of mental health problem by age 13 and this will have increased to one in two by the age of 24.
  • At the same time the child and adolescent population has increased by 21% since the publication of Vision for Change in 2006.
  • The increase in demand for services has resulted in long waiting lists. In August 2016, 2,080 children were waiting to be seen with over 170 of those waiting for over 12 months.
  • At the end of March 2017, 51% of referrals to CAMHS were waiting over three months for a first appointment.
  • Our recently conducted research in conjunction with the RCSI demonstrates that only 37% of multidisciplinary teams (MDT's) are resourced in line with Vision for Change recommendations
  • Only 53% of Liaison teams are in operation.
  • We also know there is a shortfall of at least 20 MDT's nationally as per Vision for Change. for example: Dublin North City and County should have 13 MTD's but have only 8
  • There are only 4 Day Hospitals nationally, a shortfall of 11.

Vision for Change recommended 100 beds nationally but considering the growth in the child and adolescent population and the demand for services this number needs to be increased by at least 25%. However, at present, there are only 67 beds in operation. To make matters worse this was reduced by 11 last year for four months with the closure of 11 beds in Linn Dara Dublin, due to nursing shortages. Can you believe it?

We all know too well that the lack of CAMHS beds ultimately leads to the totally unacceptable admission of children to adult admission units and there has been a great deal of media focus on this issue in the past year. In 2016, 68 out of 509 child admissions were admitted to adult psychiatric units. This represents 1 in 7 of all admissions and the indications are, despite all the rhetoric and lip service paid to addressing child and adolescent mental health that these numbers are not reducing.

The provision of services in CAMHS is in crisis due to an:

  • increase in population,
  • increase in demand,
  • lack of funding,
  • lack of nurses,
  • the inability of our services to retain nurses
  • shortage of child and adolescent psychiatrists.

This crisis, and by any standards this is indeed a crisis, needs to be addressed urgently with the provision of sufficient beds plus fully resourced MDT's and the provision of 11 more day hospitals, Home-Based treatment teams and out of hours services.

One of the recommendations of the Joint Oireachtas Committee Report to alleviate the waiting lists was for nurses to do first time assessments. We welcome this recommendation, however, the nurses would need to be practising at Advanced Nurse Practitioner (ANP) level and I believe this should be pursued without delay.

The Proclamation of the Irish Republic 1916 declared that “we must cherish all children equally”. This crisis in CAMHS is a total affront to that vision. Failure to address this crisis is not an option and we as a union, representing nurses who deal with the realities of Child and Adolescent Mental Health and the impact it has on parents and families, are determined to have this crisis resolved once and for all.

Eventually, two years after the Review of Roscommon Mental Health Services was commissioned and only after numerous demands by the PNA for its release, the Roscommon Report was finally published last September.

Delegates, this is among the most damning Report's ever to be published in Ireland in relation to mental health services. Among the many shocking findings, the Report revealed that despite a dearth of community services and where implementation of key changes set out in Vision for Change ranged from slow to non-existent, the Galway/Roscommon, astonishingly still returned €17.67 million to the National Division over a three-year period. This is unbelievable.

This was in the period 2011-2016 when there was a net reduction of 155 nursing posts. This Report is nothing less than a shocking indictment of the management of the service and highlighted the extent to which their failings had compromised the ability of nursing staff to deliver safe standards of care.

The fact that the Report draws parallels with the Mid Staffordshire Hospital scandal in the UK, regarded as among the worst scandals in NHS history, says it all and illustrates the scale of the failings and their impact on Roscommon. Not that any of this was a surprise to our members who have been highlighting the issues in Roscommon for years.

We continue to voice our unease and discontent that the implementation of the Report's recommendations are being left in the hands of a number of those so heavily criticised in the Report. The funds, so casually returned to the HSE, and the vital resources lost over the period of review, must be reinvested in the Roscommon/Galway services as a matter of urgency and the lethargy and foot dragging in the implementation of the 27 recommendations has to end.

The Roscommon Report recommendations have to be implemented urgently and all additional resources supplied to bring this service, neglected for so many years, in line with Vision for Change recommendations.

In relation to accountability for the litany of failings identified in the Report I am asking the Minister and the HSE to determine who is going to be held accountable for this ineffective leadership which has resulted in the undermining of the standard and safety of services for both staff and patients in their care.

I am calling for an Independent Investigation into the mismanagement of services on the scale revealed in the Roscommon Report so as to ensure that nothing remotely similar occurs in our mental health services.

As in many other areas of our services, it is abundantly clear that little has been learned from this Report. Incredibly only last week, in the same CHO area, the talks under the auspices of the WRC regarding the opening of the new 50 bed admission unit in University College Hospital, Galway, (UCHG) collapsed. The HSE are insistent on opening only 45 of the promised 50 beds. This is in direct violation to the agreement on the closure of 22 beds in Ballinasloe in 2014 when management gave a commitment that 50 beds would become operational In Galway.

Thankfully we have this commitment on the record of the Oireachtas. In his address to the Joint Oireachtas Committee on the Future of Mental Health Care on 18th January 2018, the Chief Officer, Mr Tony Canavan, told the committee with great confidence that “we are also in the process of completing the development of a new 50 bed inpatient unit on the grounds of Galway University Hospital”.

In the past week some members of the committee have expressed their dismay that this clear commitment to them has now proven to be hollow.

It is inexplicable that the HSE can simply renege on these commitments when there is a high level of bed occupancy within the existing 45 bed unit and minimal implementation of Vision for Change community services, with No Home-Based Treatment teams, No 24/7 crisis services and No regional ICRU's. We are determined to hold the HSE to its commitment to the provision of these 50 beds.

Inevitably, as has already been obvious in my address to you, once we begin any conversation on our mental health services we very quickly mention the hope and expectation that accompanied the launch of Vision for Change. The review of Vision for Change is currently underway but with the voice of the PNA being ignored, we would have to question the make-up of the oversight group.

It beggars belief that the voice of psychiatric nurses, the PNA, is not included in the oversight group. Despite being one of the most important stakeholders in the mental health sector, and the fact that we are the only representative organisation to conduct three substantial pieces of research on the implementation, or more accurately, the non-implementation of Vision for Change, we are left outside the door for this crucial review of Vision.

How can this be allowed, unless it directly relates to the fact that we continue to highlight the unpalatable facts about the record on what was to be the roadmap for the future of mental health services in Ireland.

These include:

  • A Reduction in beds of 92% from 1984 to 2016 – from 12,484 beds to 1002.
  • During the 11 years of Vision for Change 76% of beds were closed with only 30% of the promised community services provided.
  • The percentage of the health budget allocated for mental health has diminished from 14% in 1984 to 6% now.

The non-implementation of the community aspects of Vision for Change, the key pillar of the whole strategy, means No ICRU's, virtually No crisis houses, No crisis teams, inadequately resourced Home-Based and outreach teams.

The absence of Community Services has resulted in major issues of concern.

  • In the past 10 years there has been an increase from 3% to 8% of the prison population who have a severe and enduring mental illness.
  • Due to the failure in the provision of Assertive Outreach Teams and Intensive Care Rehabilitation Units (ICRU's), over 16% of the bed capacity nationally is occupied by service users whose admission has exceeded six months.
  • As a consequence of the 76% reduction in beds and the lack of community services there is a huge demand on beds resulting in 120% bed capacity. In practical terms this means that service users admitted for example to Waterford and Kilkenny must regularly resort to sleeping on chairs and couches due to the lack of beds.
  • Since December 2017 there has been 37 occasions where service users had to suffer the indignity of sleeping on chairs in the admission unit in Waterford.

From January to March this year there have been 43 occasions where service users in the admission unit in Kilkenny have slept on couches. We know, because we have kept meticulous records of this unacceptable practice.

Delegates, I ask where is the Mental Health Commission in relation to these scandalous circumstances where service managers do not appear to be perturbed by these practices?

Once again it is the PNA who must advocate for service users. Our members in Waterford and Kilkenny have decided that they will not tolerate this inhumane treatment of service users and are currently engaged in industrial action until they achieve a robust capacity protocol that could not be simpler: No bed- No admission.

Once again, nurses have to resort to industrial action to demand basic dignity, comfort and respect for those with a mental illness.

Our industrial action will be escalated in both services next week where we will be asking all members to withdraw all goodwill, to include not making themselves available for overtime. I want to commend both PNA branches on their action to date and once again our members have shown a commitment to advocating for those in our care.

I am calling on Government to ensure in the review of Vision for Change, that the recommendations of 11 years ago are finally delivered on. Part of our recruitment and retention agreement 2016 was the provision of a number of pilot sites for 24/7 crisis intervention services. Two years on and the HSE continue to ‘kick the can down the road' with the earliest introduction of even pilot sites unlikely to happen until 2020. 24/7 Community services are commonplace for over 20 years throughout the developed world but disgracefully our services offer more comfortable chairs to sleep on in overcrowded admission units rather than develop community services.

In February this year I was once again privileged to address the Oireachtas Committee, this time on the Future of Mental Health Care. This provided the PNA with an opportunity to address Oireachtas members from both houses and to outline the deficiencies as described above. We also set out our vision on the future of mental health care from the unique and insightful perspective of dedicated and professional nurses working on the frontline. We await the publication of the Committee's report in the near future.

Central to Vision for Change was the establishment of a National Mental Health Directorate to put in place the administrative and organisational structures to bring about the change required. Indeed the 1966 Commission of Inquiry recommended this very same requirement. The PNA consistently argued that the establishment of such a structure is essential to deliver on the implementation of the 160 recommendations of Vision for Change and would protect the mental health budget.

As a consequence, the Mental Health Division was established in the HSE in 2013. Part of its remit was to have operational and financial accountability for all Mental Health Services. Astonishingly five years later the Division has been disbanded. The consequence of this is that the budget allocation will be distributed to the CHO areas and as we have witnessed before funds are transferred between Primary Care, Social Care and Mental Health. Our experience is that Mental Health comes off as the loser in these exchanges.

We have to ask what does this inexplicable decision say about the attitude and regard for Mental Health Services and the priority they are given within policy planning?

By any standards this is this is clearly a retrograde step for the provision of Mental Health Health and I am calling on the Minister to re-establish a specific Division/Directorate for Mental Health as recommended 52 years ago and reinforced 11 years ago in Vision for Change.

You may recall at last year's Conference that I called for immediate engagement on the development of the new National Forensic Mental Health Service. This new development will comprise of a 170 bed campus incorporating a 120 bed forensic hospital, 10 bed child and adolescent mental health unit, 10 bed mental health intellectual disability unit and a 30 bed intensive care rehabilitation unit. The construction of these units is well advanced and are proposed to be operational by the end of 2019, early 2020.

Despite this being one of the largest public health investments in the history of the state, on a par with the development of the National Children's Hospital, our numerous requests for engagement to enable a smooth transition to this state of the art facility have been ignored.

Once again I am demanding that the HSE consult and engage with PNA to allow the perspective of frontline nursing staff to be at the forefront of this exciting, historical development for mental health services.

Last year St Patricks Hospital Management unilaterally decided to close the Defined Benefit Pension Scheme with effect from June 2017. This blatant undermining of our members and other union members rights and expectations was met with a great show of anger and solidarity. The PNA in St Patricks were to the forefront in leading the Inter Union Group to resist this move. A number of well attended lunch time protests ensued, which culminated in a ballot for industrial action up to and including strike. The turn out to ballot was phenomenal and the result was an overwhelming mandate for action.

Failure to resolve the matter locally led to a referral to the Workplace Relations Commission resulting in an acceptable outcome for those affected. Considering this dispute affected approximately 30% of members, all our members stood together and in solidarity with the other unions. The unity of staff demonstrated all the great qualities of trade unionism and I wish to commend the branch for all their commitment and hard work. We also owe a special thank you to Seamus Murphy who came out of retirement to bring his particular expertise to this complex issue and to the actuary advisor to the inter union group, Joe Byrne.

Intellectual Disability (ID) services continue to experience transition and change throughout the country. Continuing problems with the recruitment and retention of RNIDs has increased the burden on already overworked and undervalued nurses in this sector. The uncertainty of the future role of the RNID has only served to further exacerbate this problem. It has been over four years since the commencement of the Steering Group tasked with identifying the future needs and direction of the ID nurse. Over eighteen months since the completion of the draft report, the ‘Shaping the Future of Intellectual Disability Nursing in Ireland' has yet to be published by the HSE.

This delay in publication is a disservice to people with an intellectual disability and denies them nurse led person-centred quality care. I have written to the Minister and the HSE insisting on the publication of this report as a matter of urgency.

In my address to conference last year, I highlighted the dearth of Advanced Nurse Practitioners in Mental Health Services. Unfortunately this year I am to highlight the same problem which exists in Intellectual Disability Services. Despite many RNIDs pursuing education to Post Graduate Diploma and Masters level, there appears to be an unwillingness on the part of the Intellectual Disability Services hierarchy to utilise the leadership and professionalism of these highly educated nurses. Indeed, in a recent meeting, a senior manager of an intellectual disability service described one particular specialist RNID role as a ‘luxury' within the service. This is absurd.

The PNA believe that specialist RNID roles are an essential part of the delivery of a professional service for people with an intellectual disability, and will continue to demand more such roles for intellectual disability nurses.

A delegation from the PNA met with the Minister for Disabilities Mr. Finian McGrath last November to discuss issues specific to the ID sector. This was a worthwhile meeting which served to inform the Minister of some of the challenges faced by staff providing services for people with intellectual disabilities. Some of the issues discussed were:

  • The delay in the publication of the ‘Shaping the Future of Intellectual Disability Nursing in Ireland'
  • Issues pertaining to medication management within intellectual disability services
  • Recruitment and retention of nursing staff in intellectual disability services
  • Non-payment of increments within some Section 39 services

Since last year's conference, members working in ID services have held two meetings to discuss issues on a national level. These meetings have provided members with an opportunity to highlight local and national issues, compare services, and strategies for dealing with common problems. Further such meetings will continue throughout the coming year to inform and enable us to address the ongoing problems in this service.

I wish to congratulate Liam Hamill, St Ita's Services and Catherine Cocoman, Kildare MHS on their election onto the Nursing and Midwifery Board of Ireland (NMBI) in the categories of Intellectual Disability Representative and Mental Health Representative respectively. I also want to thank Noel Giblin for his work on the NMBI Board for the past 5 years.

However, I have major concerns over the financial operations of NMBI. As you are aware, we successfully resisted an increase in the retention fee of €100 annually. One would question how these fees are being spent?

Upon reviewing the most recent statements from NMBI I find the amount of money spent on legal fees in relation to Fitness to Practice to be highly questionable. That figure amounts to €3,145,964 in 2016, an increase of 31% from 2015.

Total expenditure for 2016 was a staggering €8,842,621 of which the Fitness to Practice legal fees equates to 36.7% of total expenditure.

Protecting patients and members of the public is at the heart of the role of the NMBI and in the CEO's words “NMBI is focused on strengthening our reputation, with our registrants, the public and our stakeholders”. I believe that spending 36.7% of total expenditure on legal fees does not strengthen any reputation with the registrants especially when it is the registrant's fees that are funding this exorbitant expenditure?

If a nurse is unfortunate enough to be referred to Fitness to Practice, they are likely to be represented by their Union Official and a Solicitor yet NMBI will have two Barristers and one/two Solicitors advising the CEO and the Fitness to Practice Committee. This disproportionate representation has got to stop. The key purpose of NMBI is to protect the public not to subject nurses to such high levels of legalities. I am demanding that the Nursing Board urgently review how the Fitness to Practice process is conducted and how it can minimise the use of legal personnel.

Colleagues NMBI will undertake an extensive consultation with all stakeholders including nurses and midwives on their proposals for a Scheme for Monitoring the Maintenance of Professional Competence as set out in the Nurses and Midwives Act 2011 from April to June 2018. The target date for the introduction of the scheme is early 2019. The PNA in collaboration with the Faculty of Nursing (RSCI) have developed training programmes to assist members to fulfil their CPD requirements. The programmes are accredited by the RCSI and NMBI and are available to PNA members at a subsidised cost.

You will have noticed in your packs an information sheet outlining the first series of PNA/RCSI programmes which will commence later this month. As the PNA/ RCSI College evolves we look forward to your support in building this initiative as a PNA member focused resource respecting the PNA's long tradition in relation to nurse education and practice on the ground to directly enhance service user experience and transform evidence into action.

As Horatio moves towards its thirteenth year the Officer Board are once again delighted to sponsor colleagues in participating in the forthcoming Horatio Congress Safe Settings in the beautiful Faroe Islands next month where mental health nurses from more than 15 countries worldwide will meet in Torshavn.

These events provide great opportunities for learning, networking, review and discussions about service delivery and quality initiatives across Europe. The Irish delegation is extremely popular amongst their European counterparts both in terms of the quality of their presentations, but also in their unique ability to lead the social itinerary.

As you know through the consistent leadership of Des as President and now Aisling as General Secretary Horatio continues to build as the representative leading voice for psychiatric / mental health nurses in Europe and beyond, influencing and advising the various organs of the EU on mental health matters and on nursing matters.

In the past year, new ground was broken when Horatio, represented by Aisling, was the first nursing organisation to present at the World Congress of Psychiatry in Berlin, which to date has mainly focussed on psychiatrists. This prestige event has in excess of 10,000 participants.

Horatio is also the only nursing representative voice at EU Forums, which develops principles and recommendations in relation to mental health care across Europe. Horatio's ever increasing networks ensure the presence of a respected psychiatric/mental health nursing voice to improve the quality of the services provided.

Now that we are emerging from probably the greatest recession to hit our country in which frontline workers' pay and terms and conditions were severely cut, it is now time to not only restore those cuts but also to ensure a decent and well-deserved salary for nurses. Last year saw the start of pay restoration, and I emphasise Start, with the Public Service Pay Agreement 2018 -2020 which was accepted by a ballot of our members in October 2017. This agreement is an extension of the Lansdowne Road Agreement and applies from January 2018 to December 2020.

The Key elements of the agreement are:

  • Pay restoration of 5.75% for the vast majority of nurses over the period of the agreement.
  • The conversion of the Pension Related Deductions, better known as Pension Levy, into an additional permanent pension contribution, will take effect from 1st January 2019. This has different ramifications for those covered under the 3 separate pension schemes.
  • Benefit of €575 for standard accrual members, i.e.;2004-2013 entrants
  • Benefit of €775 - €1776 for single pension scheme members, i.e.; post 2013 entrants on salaries of €35,000 - €50,000.
  • Combining the pay restoration and PRD changes for nurses on salaries between €30,000 to €50,000 the average increase is:
    - Pre 2004 entrants €1,909 - €2,790
    - 2004-2013 entrants €2,284 – €3,365
    - Post 2013 entrants €2,284 - €4,233

A key component of the Agreement and the PNA acceptance of the Agreement was the assurance that a process would commence to address the recruitment and retention crisis in nursing, to be chaired by the Public Service Pay Commission.

The process commenced in October 2017 and the PNA forwarded a detailed submission. Some of the key elements of our submission I will now address.

A comparison using Purchasing Power Parity (PPP) for the main destination countries for Irish nurses shows Irish nurses have the lowest purchasing power using (PPP) as recognised by the International Council of Nursing (ICN). For example:

Canada 27.13 per hour, Australia 21.10 per hour and Ireland 16.66 per hour.

According to the Department of Health the top five destinations for Irish nurses emigrating are Australia, UK, US, Canada and New Zealand. The Nursing and Midwifery Board of Ireland (NMBI) showed a total of 1,059 nurses and midwives sought “certificates of current professional status” in 2016, documents which verify their qualifications and are sought by nurses when they intend to work overseas. This is a strong indication of the nurse's intention to work abroad.

The UK has 24,000 nursing vacancies and this is expected to increase after Brexit. Mr Jim Campbell, Director of the World Health Organisation Workforce Department, speaking at the Global Forum on Human Resources for Health held in Dublin in November 2017, raised his concerns that post Brexit, the UK may try to fill gaps left by EU migrant health workers by attracting nurses from Ireland under the traditional UK-Ireland bilateral agreement.

The UK are offering packages such as:

  • €8,000 relocation costs (over five times the HSE “bring them home package” of €1,500 which only generated 6 psychiatric nurses)
  • Educational Opportunities
  • Low Cost accommodation
  • 37.5-hour week

Another key factor in the lack of service development is the crisis in recruitment and retention of psychiatric nurses.

In December 2016, HSE figures show that there are 885 psychiatric nurses over 55 and 867 nurses between the age of 50-54. Under fast accrual, potentially 885 psychiatric nurses may retire immediately, whilst a further 867 may retire within the next 5 years, this is a total of 1,752 which equates to 34.2% of the mental health nursing workforce. The headcount, as of September 2017 was 4748. These figures would suggest that there are 374 vacancies, however a recent survey of PNA branches suggest vacancies are closer to 500. Services with high levels of vacancies are:

  • Tallaght/St Loman's Dublin 52 vacancies (over 20%)
  • St. Joseph's Portrane 64 vacancies (over 20%)
  • Waterford 26 vacancies (over 19%
  • Louth/Meath 38 vacancies (over 16%)

When we factor in the service developments as outlined in Vision for Change, (which have not yet been implemented), there is a requirement for the provision of an additional 700 plus nurses. In addition when we factor in 10-15 nurses per assertive outreach team as recommended by Vision for Change, that is 1 team per 100,000 this equates to 675 nurses at 15 nurses per team x 45 teams.

In August 2017, the HSE figures reveal that only 93 new staff were recruited that year despite soaring demand in all areas of the mental health services, and the HSE's own admission that 1,963 new posts have to be filled if the level of staffing required in Vision for Change is to be achieved.

Upon recruitment to the Health Services, nurses are required to supervise, delegate to Health Care Assistants (HCA's) and provide clinical leadership.

Those same young graduate nurses are highly offended when they discover the HCAs they are supervising are being paid more than them.

  • In Ireland the nurse must reach the 5th point of the salary scale before s/he exceeds the pay of a HCA on the max of the scale (9th point)
  • In the UK the professional qualifications of the Nurse are recognised with the 1st point of the nurse's scale above the maximum of the HCA scale.
  • In the UK the nurse is recruited at the same level as the Therapy Grades (Physiotherapist, Occupational Therapist, Podiatrist, Play Therapists etc).
  • In Ireland the nurse is treated as a lesser professional than the Therapy Grades.
  • It is the PNA's view that the Staff Nurse Scale must start at a point higher than that of the HCA, e.g. €35,319 the first point of the Therapy Grade Scale.
  • Having regard to the comparable minimum qualifications (Honours Degree) and the role and responsibilities the Therapy Grades salary scale should be applied in its entirety to Nursing.
  • The development of the Staff Nurse scale in this way would enhance recruitment and retention.

The mental health service is in dire need of psychiatric nurses who will join and stay in the public system after qualifying. One of the most significant consequences of the recession - the decisions of Government to cut public sector pay, the graduate scheme and the enforcement of a recruitment embargo - was the creation of a culture of nurse graduate emigration. For those who were unable to emigrate or choose to remain at home, the private sector continues to offer exciting and financially rewarding opportunities. There can be only one outcome for our mental health services - the current crisis in nursing will get significantly worse in the next few years.

Should the Public Service Pay Commission fail to recommend remedial pay measures then the chance for this country to resolve this crisis will be lost for a generation with horrendous implications for the delivery and development of mental health services and patient care. The PNA cannot and will not accept anything less than a significant meaningful recommendation by the Public Service Pay Commission to address nurses pay.

The last year has been a particularly challenging year for the union, with three weeks of intensive pay negotiations, submissions to the Public Service Pay Commission, Joint Oireachtas Committees on Child and Adolescent services and the Future of Mental Health Care. Throughout this year we have had disputes in St Patricks hospital and the present disputes in Kilkenny and Waterford. We also had a dispute in St. Loman's -Tallaght service which successfully resisted the proposed closure of the high observation unit there.

We are currently in dispute in the Laois/Offaly MHS in relation to staffing levels, non- payment of temporary higher post appointments and the ongoing delays in the filling of permanent vacancies. All of this work requires the commitment of the local branch officials and members and I would like to thank and commend all the branches for their hard work throughout the year.

I also want to thank the Officer Board for all their dedication throughout the year. This year Kevin O Connor and Gerd Murphy are resigning from the Board and I want to thank them for their work and valued input over the years and look forward to their continued involvement.

I want to thank all the staff for their tremendous work and commitment to the PNA with no challenge too big and with numerous examples of finishing a meeting at 10.30 p.m. and attending a meeting at 9a.m. the next morning without a word of complaint. This dedication is immeasurable. I also want to thank all the wives, husbands and partners of all PNA activists and officials and of course I also want to thank Leish for all her patience and support.

Delegates, we face many challenges in the next year, particularly in relation to pay, staff shortages and inadequate service provision. However, I have no doubt that with the support and commitment of you the delegates, the officer board, and full time officials, we will face these challenges with the well renowned PNA persistence and resilience.

Thank you




1st January 2018, annualised salaries to increase by 1%

1st October 2018, annualised salaries to increase by 1%


1st January 2019, annualised salaries up to €30,000 to increase by 1%

1st September 2019, annualised salaries to increase by 1.75%


1st January 2020 annualised salaries up to €32,000 to increase by 0.5%

1st October 2020 annualised salaries to increase by 2%

Nurses on the Fast Accrual Pension Scheme, i.e.; Pre 2004 will continue to pay PRD as a Pension Contribution at 10% from €28,750 to €60,000 and 10.5% on €60,000 plus.

For Nurses on the standard accrual pension scheme i.e.; Pre 2013

10% - €32,000 to €60,000 and 10.5% on €60,0,00 plus.

January 2020 exemption will increase to €34,500

For Nurses on the Single Pension Scheme i.e.;2013 onwards

6.66% - €32,000 to €60,000 and 7% on €60,000 plus.

January 2020 exemption will increase to €34,500 and the rate will reduce to 3.33% - €34,500 to €60,000 and 3.5% on €60,000 plus.

To summarise there is no PRD benefit for those on the Fast Accrual Scheme ,i.e.; Pre 2004