PSYCHIATRIC NURSES ASSOCIATION of Ireland

PSYCHIATRIC NURSES ASSOCIATION of Ireland
Tel: 045 852300 Email: info@pna.ie

THURSDAY April 14th 2016 - Slieve Russell hotel, Ballyconnell, Co Cavan

PNA General Secretary , Des Kavanagh delivers his Annual Report to ADC in Cavan
PNA General Secretary , Des Kavanagh delivers his Annual Report to ADC in Cavan

Chairman, Delegates,

I am pleased to bring you this my 26 th Annual Report on the occasion of our 45 th Annual Conference here in the Slieve Russell Hotel, in Cavan. This is our 3 rd Conference in this wonderful hotel and I am sure it will be as successful as on previous occasions.

Despite the many retirements and limited recruitment, substantially due to the shortage of nurses and the ‘flight of the graduates', I am pleased to note that our nursing membership has remained remarkably stable. When the membership numbers are examined Branch by Branch there is in many cases a clear correlation between those branches where membership numbers are down and services where there are large numbers of vacancies. Indeed if every vacant post was filled we would now be looking at a significant increase in membership.

Our IFESA membership remains constant as we await the hearing of our case before the Court of Appeal this summer while our NASRA Membership of Ambulance Paramedics continues to grow steadily. In this regard I want to congratulate Tony Gregg and Mick Dixon on their work in representing Paramedics. We are currently in dispute with the HSE National Ambulance Service re their attempt to force through a policy of so-called Core Rostering in the Midland Area which is hugely threatening to the working and personal lives of our members. This is a policy which seems to be virtually unanimously opposed by Paramedics yet is being forced through by managers with complete disregard for the views of their staff. The impact of Core Rostering is that staff will be informed by Text and/or E-mail when and where they are working next week, but can then find their roster changed @24hrs notice depending on the needs of the service so that if the Paramedic was planning to attend a Parent-Teacher meeting, or to bring the kids to a sports event or attend a family event this can be changed without consultation. For the Community the new system will mean longer response times as staff may be assigned to areas they are not familiar with and without the local support they have at present. Our members in the Midlands voted 94% in favour of Strike Action.

The closure of A&Es and indeed of Acute services in different counties, e.g. Wexford, Tipperary, Carlow, Monaghan is having a huge impact on patients and families trying to access services. We have seen cases of patients from Tipperary being admitted to A&E in Kilkenny and following treatment/assessment being told they need to be admitted to the Acute Unit which for them, now, is in Ennis. This is just one of many examples arising from how our health services are so badly organised with CHOs operating within one set of geographic catchment areas and the Hospital Groups organised on the basis of different Catchment Areas.

Ambulance personnel are extremely frustrated when brought into the mental health arena where they are called upon to transfer patients from home to A&E and later from A&E to an Acute Units. The Ambulance Service have staff trained to deal with physical health issues which might arise as a consequence of Psychoses or Depressions, attempted suicide, poisoning etc but do not have staff trained to deal with mental health crises. Acute Units are sometimes asked to strip their units of staff to assist in the transfer of patients to the Acute Unit, thus enhancing risks to the patients and staff remaining in the understaffed Unit.

Worse still we have come across taxi drivers used to transfer patients having great difficulty getting the patient to co-operate with the completion of the journey, patients wanting to leave the taxi, to get out at the nearest river etc.

We urgently need HSE Managers to agree operational protocols which allow patients to negotiate their way through our health services in a manner which is facilitative, supportive and accommodating and avoids the types of scenario painted above.

If our ambulance services are going to be involved in supporting the transfer of mentally ill persons to and from and between mental health services we need the provision of dedicated training for such ambulance staff and the provision of Liaison personnel skilled in the management of distressed mentally ill people who need care.

We also need sufficient ambulances and ambulance personnel. The rationalisation of A&Es is substantially based on the efficacy of the Ambulance Service and emergency air services. Right now we don't have sufficient of either.

Our dysfunctional mental health services, shorn of adequate staff, denied adequate resources and depending on the goodwill and ingenuity of families, staff and others stumble from crisis to crisis with no sign that their Minister or Managers have any clue of how bad the service is; and worse still with no indication of any real commitment to dealing with the problems being experienced.

Over the last number of years the government has done a great job in building a culture in which every student nurse saw their future post-qualification in the UK, Australia, Canada etc. We now need serious commitment to replacing that culture with a commitment to making Ireland a country in which nurses are not just welcome and appreciated but appropriately rewarded; a country in which young nurses can see potential for a meaningful, safe and satisfying career.

The recent agreement on Pay for Students on 36 week placements (Internship) in year 4 and the restoration of incremental credit for Graduates for this 36 weeks is very welcome. Every Student Psychiatric Nurse in this country today knows that following 16 weeks service after their Registration they will be paid on the second point of the scale i.e. €30,067 p.a.

We now require the restoration of that increment for all Graduates from whom it was withdrawn since 2011 and the investment in career development consistent with the needs of patient care and service development. Graduates and junior nurses need to see their salary Scale reflect the responsibilities attaching to the role.

It is nonsensical to think that this year's Graduates will be on the same point of the scale as those who graduated a year ago and that those from whom that incremental credit was taken since 2011 continue to be denied their rightful place on the scale unlike those before them and those coming after them. This unfairness will continue to fester and must be addressed asap.

The shortage of Nurses is at critical level in many of our services. I will further elaborate on this in a special section on Recruitment and Retention tomorrow.

For the last 14 years we have had Ministers for Mental Health though the last incumbent seemed to be the Minister for everything. We now need a Minister for Mental Illness, a Minister who commits to understanding Mental Illness, not someone who will ponder ‘I often ask myself if Mental Illness really exists', but a Minister who understands the pain of those in the depths of depression, the horrors of those living with serious psychosis, the challenges of living with bipolar disorder and the many other serious illnesses which effect the human across the life span.

We need a Minister who will honestly acknowledge that the annual announcements of ‘increased funding for mental health services of 35 million Euro' is misleading.

Indeed in many of those years when such announcements were made the monies withdrawn from the budget exceeded the 35 million allocated. To the ordinary citizen if the Mental Health Service had been allocated an ‘additional' 35 million Euro every year for the last 10 years then we should have a budget to which an additional 350 Million Euro has been added in that period. Instead you and I, colleagues, know that the Mental Health Budget has been decimated.

Last week I attended a meeting with HSE Managers who want to introduce Peer Support Workers to Mental Health so that those who have a lived experience of mental illness might be able to assist others in the journey to recovery. I must say I support this concept and look forward to its implementation in the future. Right now I feel like a person in the desert who needs water and meeting a HSE Manager who wants to talk to me about going for a drink when I reach civilisation.

Mental Health care is provided to people in crisis by psychiatrists and psychiatric nurses. All of the other grades enhance care and recovery. Peer Support Workers will add another dimension. Right now we are in crisis. We do not have enough psychiatrists and we are experiencing a nursing shortage of critical proportions.

You will understand that I invited the Managers to embrace reality, to address the basics and then we will talk to them about such worthy projects as the employment of a new grade to enhance the patient journey.

Minister Lynch often spoke of her commitment to Child and Adolescent Mental Health Services, (CAMHS). We can honestly acknowledge that the opening of new Units in Cork, Galway, and Dublin has improved the quality of the infrastructure supporting CAMHS but her target was to provide 100 inpatient beds for CAMHS. I pointed out in 2014 that the total number of beds then available was 66, though not all were operational. This week I can only find 66 operational beds, though there are 74 in the system:

Merlin Park, Galway, 20 beds

Eist Linn, Cork, 20 beds, only 12 operational due to lack of Consultant cover.

St Vincents, Fairview, 12 beds

Linn Dara, Cherry Orchard 22 beds

In the absence of dedicated CAMHS beds children end up in Acute Psychiatric Units or paediatric wards of General Hospitals. It is also the case that some families are reluctant to allow their child to be admitted to a dedicated CAMHS unit because the facility is 2/3 hours away from their home. An additional complication is the shortage of specialist Psychiatrists for CAMHS. In many cases CAMHS operations have to stop when the Consultant goes on Leave or is off sick.

On January 18 th this year Michael Hayes, IRO, wrote to Minister Lynch pointing out that in the absence of a CAMHS Consultant Psychiatrist in South Wexford on holidays that service had shuddered to a halt because of the absence of a clinical lead. One Child had been admitted to Wexford General Hospital, as a place of safety, and up to 26 children weekly were being left without services.

In recent weeks the Wexford People newspaper highlighted the position of another child in a front page story where a mother was complaining that her 13 year old suicidal daughter has spent 7 weeks on a medical ward of a general hospital because she cannot access a CAMHS facility or inpatient service in Wexford.

A local advocate, quoted by the paper, described the situation as horrific. The journalist, David Tucker, says this case highlights ‘the chaotic state of child and adolescent mental health services in County Wexford and the wider Ireland'. Brendan Howlin, then Minister allegedly told the woman that ‘money is not a problem'.

The Government's failure to provide adequate services to our Children and Adolescents is a disgrace. Those politicians who celebrated during the 1916 commemorations should remember the signatories pledge to treat all of our children equally. Tell that to our citizens who are today trying to access services for their children.

As we await the formation of a Government we need a Minister who will say to his/her colleagues that while the closure of mental hospitals was a great achievement for Irish society the incarceration of so many mentally ill in our prisons is shameful and intolerable in a civilised society.

We need a Minister who will ask why we do not have a Secure Unit on the western seaboard, who will ask how it could be that HSE West sent back millions of Euro to the central coffers while modern units were closed and others not provided.

We need a Minister who will deliver more and promise less, who will achieve nett improvements over his/her period in Office.

We need a Minister who does not expect nurses to lick his or her boots but who will engage with the profession, who will listen to the real life negative experiences of nurses trying to provide services, who will accept and respect criticism in the spirit in which it is offered, who will not surround him/herself with admirers, with those who are just pleased to be provided with an audience, but with those who will tell it like it is.

We need a Minister who will not see Vision for Change as an excuse for cutbacks, nor as an optional agenda from which to pick and choose nice PR opportunities but as a policy of interdependent strands all of which must be developed and delivered if mental health services are to be truly comprehensive providing adequate care from birth to death. Below we will see the results of a review we recently completed into the extent to which the Recommendations of Vision for Change have been implemented.

Having commenced nursing as a student in 1971 one of the greatest changes I and many of you have been privileged to be part of is the closure of the big, old institutions that were the mental Hospitals. However, the correlation between the closure of hospitals and the increase in the prison population of people with serious mental illnesses is inescapable.

In this regard we continue to see cases of people with serious mental illnesses who commit horrendous crimes against society. The usual newspaper coverage will invariably state that the offended has a history of mental illness, had been treated previously as an in-patient of one of our services, had stopped taking his medication before the assault and was clearly delusional. Time after time, year after year, these cases populate our news media and you can be sure will again in the months ahead. Cases like the man who killed his former girlfriend, the father who killed his family member(s), the person who randomly attacked a stranger because the voices told him to.

It is reasonable to pose the question: Has the Minister, her advisors or her Managers ever suggested the need for a review of these cases to establish the common threads and to identify the need for a preventative strategy.

It is not acceptable that it is glibly acknowledged after many of these tragedies that the person responsible had been a user of mental health services but had not been compliant with treatment, had stopped taking their medication, stopped attending outpatient services, i.e. had fallen through the cracks in the system. Innocent people pay the price! Families pay a huge price for these failures. Governments seem to accept these incidents as unfortunate by- products of contemporary psychiatry. Surely more is required.

Over the last 20 years we have recommended the implementation of Community Supervision Orders. Our views have been rejected. Now we must ask the obvious question. What is the alternative? Or are we merely accepting these incidents, these deaths, as the unfortunate collateral damage of Community Care? Is there a point at which we will say enough is enough? Or perhaps we have to wait for the death of someone of importance in this society or the death of someone related to someone of importance?

Section 26 of the 2001 Mental Treatment Act allows for the provision whereby a patient can be absent from an Approved Centre i.e. ‘Absent with Leave'. I am conscious of the fact that the Steering Group which reviewed the 2001 Mental Health Act noted that this provision can allow for some patients to be absent on a continuous basis from approved centres through the ongoing renewal of detention orders, thus facilitating a kind of de facto community detention. The Steering Group was silent on the introduction of Community Treatment Orders and the majority of the latest Expert Group which ‘looked at this again agreed that the evidence is not convincing that community treatment orders are effective'.

The position arising then is that the Steering Group has not recommended anything by way of Community Supervision or Community Treatment Orders. Yet it is clear some members of that Group were in favour of some such system. It is also clear that Consultants are, by the use of the ‘Absent with Leave' provision, in many cases ‘de facto' providing for a type of Community Supervision.

I am now calling on the incoming Government to appoint a Commission to review all such killings and assaults over the last 10 years and to come up with recommendations for a future preventative strategy.

Following my retirement from my role as President of Horatio I was delighted to see Aisling Culhane elected to the Board. Some of you attended the Nursing Congress in Lisbon last Autumn and I am sure many of you will travel to the next Festival in Malta. These events provide great opportunities for learning, for networking and for review and discussions about service delivery and quality initiatives across Europe. Many of our nurses have reported back that when they have presented internationally their colleagues in other countries have been very impressed. Regrettably however our problem is that Ireland lacks a cogent strategy for ensuring that the clinical specialisms of Counselling, Cognitive Behavioural Therapy, Family Therapy, Drama Therapy, Art Therapy etc are available across all of our services. Regrettably Ireland is a patchwork quilt in which such specialisms are embraced in some areas and ignored or minimised in others.

We must continue to campaign for greater investment in those therapeutic interventions which add value to our services and add quality to the care provided to our patients. It is regrettable that years after the publication of Vision for Change we continue to see our services denied the resources we require and our patients deserve. We also need Managers with vision rather than the cost-cutters who populate so many senior posts.

The PNA has demonstrated over many years our commitment to the enhancement of education and development opportunities for nurses. This year we are spearheading two more initiatives:

  1. On October 14 th and 15 th we will host a Symposium for Irish Nurses in partnership with HORATIO and RCSI. The presenters will include Lecturers from some of our European partners and RCSI and some PNA members who have demonstrated significant clinical and academic competence
  2. We are currently working with the Faculty of Nursing, RCSI, on the development of Continuous Professional Development for Nurses having completed a needs analysis of PNA Members through a series of surveys and focus groups which have identified the following priorities:

•  Risk Assessment

•  Psychosocial Interventions

•  CBT/DBT

•  Medication Management

•  Service User centred communication and interpersonal skills

•  Clinical Supervision

•  Management of Serious Adverse Events.

•  Advance Practice Skills.

•  Meeting Regulatory Requirements.

•  Legal and Ethical requirements.

•  Mindfulness for Health Professionals

•  Maintaining Professional Competence.

At last year's conference in Athlone (April 2015) I highlighted the concerns of the PNA re the Mental Health Services in Galway Roscommon. For a number of years previously I had referred to this as a ‘Service in Crisis'. Our concerns were rejected by the Minister and by HSE Managers. In a recent High Court case the judge in her judgement stated, inter alia:

‘The Mental Health Commission in its 17 page report published in the middle of September,2015 that arose from its earlier inspection of a particular facility in Roscommon providing mental health services, concluded, inter alia, that many corrective actions had not been implemented some 8 weeks after the MHC's first expression of concern in April 2015;

The interim report of the external Review Group's ‘review of the quality, safety and governance of services within the Roscommon area dated 22 nd October, 2015 and referred to the ‘'poor implementation of governance arrangements and major relationship difficulties at most levels within the organisation'', before expressing the review group's increasing concern ‘'that Mental Health Services for the people of Roscommon are dysfunctional and carry unnecessary risk''

Since then a number of Managers with Responsibility for Roscommon have been reassigned to other areas, without prejudice and without any finding of fault, pending the finalisation of the external Review Groups Report on the service. I understand large numbers of people have met the Review Group whose work has been ongoing for several months now. I further understand their Report is imminent.

The Judge in this case stated that ‘none of the evidence………persuaded the Court to conclude other than that the services are in a crisis situation''.

Had the HSE listened to us that crisis might have been dealt with much earlier in the best interests of patients, community and staff. Instead they sought to ‘shoot the messenger'. It is surely time that the closed minds of Managers were more open to the reasonable concerns as expressed by staff and by organisations like this Trade Union.

I look forward to the publication of the Report of the Roscommon Review Group which will hopefully point the way to a better service in which a respected workforce will coalesce in pursuit of high quality care for our service users and the community.

I want to thank local politicians for their support including Denis Naughton TD, Michael Fitzmaurice TD and the many councillors who came to our public meetings and raised questions in the Dail etc. I must also acknowledge the work of Local Radio and Press who have themselves sought to highlight the manner in which Mental Health Services in Roscommon and indeed Galway had been undermined by the culture of cuts and no investment, closure of units and services, non-replacement of nurses, diminution of the contribution of specialist nurses, non-replacement of specialist nursing posts.

The policy Trust in Care has been in place for many years having been put in place following lengthy discussions between representatives of the HSE, DOHC, IBEC and the Health Sector Unions. The advice of lawyers was sought when putting together the Policy. As might be expected of an Investigatory process of a disciplinary nature this has led to the disciplining and dismissal of staff since its introduction.

Any such process will, by its very nature, constitute a very serious threat for any health service worker who is subject to its procedures. One of the re-assuring aspects of the agreed process is that it provides the opportunity for the accused person and/or his representatives to agree the membership of the Investigation Panel and the Terms of Reference.

When RTE broadcast ‘Bungalow 3' which highlighted poor and in some cases criminal practices in that Unit in Aras Attracta the local Area Manager set about the establishment of an Investigation and sought to do so in a manner which was completely consistent with the policy, Trust in Care. Regrettably for reasons which remained unexplained in the High Court the HSE Executive decided to abandon all regard for Trust in Care. The decision was then made to put in place an Investigation Team without any agreement with the Unions and to hold parallel Trust in Care and Disciplinary Investigations.

The PNA was unambiguous in stating that all such allegations should be investigated. The PNA respects the paramount importance of recognising the rights of the vulnerable to services of high quality and further, to Investigation into claims of substandard and/or abusive care. This has continued to be our view and indeed that of our members in Aras Attracta.

However, the actions of the HSE left us with no alternative but to challenge their decision to ignore procedures and to prejudice the rights of our five members to fair procedures, whom I must add were not subject to any criminal proceedings.

We wrote a number of letters to various members of the HSE Senior Management team but failed to elicit any response. We then referred the matter to the LRC and made a formal complaint to the Haddington Road Oversight Body. Eventually a reply was received from a Senior HSE Manager which effectively rejected our concerns and sought to insist that the HSE was acting in accordance with the Policy. Despite our best efforts HSE Senior Management refused to listen. Our solicitors then engaged in legal correspondence to avoid litigation, but to no avail. We were left then with no alternative but to bring a case to the High Court seeking an injunction to stop the Investigation proceeding. While the HSE's lawyers fought the case to the end we were successful!

The Judgement of the High Court is comprehensively in our favour. The Judge stated, inter alia, that

‘The attitude displayed by the defendants' (HSE) ‘to the efforts of the plaintiffs' (PNA)'s Representative to resolve the matter internally, is in the Court's view, reprehensible.'

‘……….the Court is satisfied that the plaintiffs have demonstrated a strong case that the Trust in Care Policy and Disciplinary Procedure do form part of their contract of employment and that their contractual rights to have an input into the composition of the investigation panel have been unlawfully interfered with by the defendant'. (HSE).

The judge was also critical of the decision of the HSE to appoint one group to collate the evidence, make the complaints and ‘'thereafter to become judges in respect of those complaints' and concluded that this ‘could certainly give rise to injustice and contravene the principle of nemo iudex in causa sua'.

The judge granted the reliefs sought by the PNA on behalf of our members in Aras Attracta. Last week we finalised agreement with the HSE which should now allow the Trust in Care Investigation to proceed as it should have done 12 months ago.

A report in the Sunday Business Post on Sunday March 20 th , 2016 suggests that the HSE has canvassed the Dept. of Health to remove the arrangements providing staff and their Representatives with the opportunity to influence the selection of persons to carry out Trust in Care Investigations. I have sought clarification from Mr. Tony O Brien, CEO, HSE re same. I have noted in my correspondence the points made by the Judge when she stated ‘'The right of an individual , who is to be made subject of a disciplinary process, to have an input into the composition of the panel who are to conduct that investigation, is a right of real substance. In all such disciplinary investigations, there is a potential inequality of arms in that the power of the institution is ranged against the individual. The requirement that the investigation team be agreed between the parties redresses that potential imbalance and is a material safeguard for the right of the individual to have a fair, unbiased and impartial hearing.''

The Report in the Business Post is extremely worrying. I can only assume the persons driving this are the same arrogant, bullish managers who refused to listen when we told them they were wrong, who failed to answer correspondence for months on end, who wasted tax payers money in defending their stupidity and arrogance!

The PNA went to the High Court to protect the Trust in Care Policy, putting at risk legal costs of €250-300,000 plus. I want to thank the Officer Board for supporting this case.

The attitude of the Board was characterised by Andy Myler, Trustee, who stated ‘We have no choice, we have to defend the Policy, otherwise bad managers will run riot'! We did and we won, and I want to tell HSE Management that we will continue to defend our member's rights to a system which guarantees fair procedures. I call on those other Unions who represent staff in the Health Service to demonstrate zero tolerance for any attempt by the HSE to undermine the Trust in Care policy. Members can be assured the PNA ‘will not be found wanting'.

The HSE Operational Plan 2016 states in its Executive Summary that ‘The total population is increasing and the population 0-17 years will increase by 11,680 children from 2015 to 2016', the adult population will increase by 1290 ‘with the biggest increase in the over 65 age group which will grow by 19,400'. It also forecasts a growing demand for specialist services from those within the growing homeless population experiencing mental illness.

I welcome this assessment. Taken in the context of the overall Recommendations of Vision for Change it is essential that the staffing numbers recommended then are updated to match current and future population trends.

Among the risks to the operational plan as identified included ‘The budget and staffing assigned to Mental Health provides for an expected level of service demand. There is a risk that continued demographic pressures and increasing demand for services will be over and above the planned levels thus impacting on the ability to deliver services'.

I am pleased to again welcome the conclusion reached as an accurate and sober forecast that must be taken on board by the incoming Government. However it would be more accurate to say that the budget and staffing allocated provides for the expected level of service provision rather than service demand.

Another identified risk is ‘Any failure to develop fully functioning Area and community mental Health teams will impact adversely on overall delivery of this plan and the adequacy of the service response'.

This is exactly the point which this Union has been emphasising since the publication of Vision for Change. Managers have acted to use VfC as a means of cutting beds and services without putting in place the community teams needed to provide the alternative service recommended and essential in the absence of the culled beds and services.

The Plan also makes reference to the need to transfer patients currently in the Central Mental Hospital in Dundrum to ‘private services'. It is essential that any such private service is inspected annually by the Mental Health Inspectorate so that we can be assured that those services are safe and appropriate and not just vehicles of profit for investors.

In recent months our Research and Development Dept., led by Aisling Culhane and in co-operation with RCSI, from whom the Report was commissioned, has been engaged with our Branches to benchmark our mental Health Services against the Recommendations of Vision for Change, 2006. Effectively we have worked with our branches to establish what should be in place and what actually is in place. The results are far worse than we expected.

Aisling presented her Report earlier but the following are some of the main points:

  1. Broad Based Achievements

•  Mental Hospitals have nearly all been closed.

•  Most Acute Units are based in General Hospitals.

•  Services for Psychiatry of Later Life have been strengthened.

•  Liaison mental health services have been strengthened.

•  There has been strengthening of interdisciplinary Community teams and home based teams.

•  SCAN and Suicide Prevention programmes have been improved.

  1. Significant deficits

•  There is a lack of High Observation beds and ICRUs.

•  A lack of Crisis Houses and crises services.

•  Acute Units often working @120% occupancy.

•  Lack of consistency between Mental Health Catchment Areas and community healthcare structures leading to crises in provision of mental health services.

•  Insufficient and incomplete Assertive Outreach teams.

•  Incomplete (not fully staffed) Community Mental Health Teams.

•  There is a lack of Specialist services (Addictions, eating disorders, etc).

•  Lack of Home based treatment teams.

•  Predominance of 9-5 Monday to Friday Community Services.

•  No dual diagnosis services (psych/ID)

•  Access to Day Centres and Day Hospitals limited.

•  Inconsistent service development across the country.

•  Limited Early Intervention systems.

When we look at what has not been delivered or has only partly been delivered it is easy to conclude that Vision for Change has been used to deliver savings for the HSE at the expense of the Mentally Ill.

Nurses as part of the Public Service have made a significant contribution to the recovery of this country from the devastating effects of the financial crisis. It is great to be talking about the recovery and about Pay Restoration and not about the fight to stop Government aided by ICTU trying to strip away our premium earnings. We and our front line colleagues won that battle. While we luxuriate in fighting off those wolves we will never forget. A long memory is essential for the future safety of our premium earnings. We know who we can trust. More importantly we know who can't be trusted.

While the country is recovering we acknowledge the challenges remaining:

•  An underfunded health service.

•  An appalling homeless crisis.

•  Huge debt repayments arising from the bailing out of the banks to the tune of 65.3bn Euro.

•  A public service where workers remain in very difficult financial straits because of the impact of pay cuts, the pension levy and increased taxes.

Nurses continue to suffer the effects of losing up to 25% of their income in pay cuts, levies and taxes. Nurses have had to make serious changes to their lives including the cancelling of health insurance, restructuring of mortgage repayments, re-organising of loan repayments, etc.

The sacrifices of our members as well as other public and civil servants has helped significantly in the recovery. We are rapidly moving to a new and better environment.

It is clear that the Lansdowne Road Agreement is fast becoming a relic of history and needs to be scrapped. The road to pay restoration must be embraced with enthusiastic steps which will boost earnings, stimulate the domestic economy and further contribute to growth in employment, reductions in spending on social welfare and boost the tax take. I accept that this, like all stimuli packages, require careful management. This is a time for encouraging the boom while being alert for those forces which can lead to a bust. It is appropriate now that people with jobs are paid a proper wage and that confidence is restored so that the broader society can benefit from increased employment and the flourishing of business.

It is most certainly time for our frontline workers to have their earnings restored so that our nurses, paramedics and firefighters can return to becoming fully functioning members of society, borrowing for small developments, enhancing the opportunities for small enterprises, encourage employment and put our banks and credit unions back in business lending money and making profits. However, the new normal must be managed, controlled and properly regulated.

The recent comments of Kieran Mulvey, Workplace Relations and Robert Watt, DPERS, were interesting, the clash of reality versus public relations. Mr Mulvey was right. He often is. Mr. Watt ignored reality in his anxiety to stem the growing demands for re-negotiation of the Lansdowne Road Agreement. He sought to create the impression that there is no problem recruiting public servants, including by implication, nurses. The evidence is very different. This country is experiencing great difficulty in recruiting and retaining nurses.

After a very expensive recruitment campaign in the UK, which we supported on our website etc the results were very disappointing. Only nine Psychiatric Nurses expressed an interest and of that only six accepted Posts. This tells me and would tell most people that this country has a problem recruiting nurses. I am sure Mr. Watt will point to the numbers applying on the CAO. The question is why are we unable to retain them on qualification? We know already that at least 6 of the 13 students who will qualify in Athlone this year have already accepted posts abroad. Pay is only one part but it is a real part of the problem. Talking of problems DPERS itself is a major problem!

I am honoured to have had the privilege of being your General Secretary for more than 25 years. This is the last occasion on which I will bring the General Secretary's Report before Conference. Today, I am pleased to report that the 2017 Report will be provided by Peter Hughes who will take up the position as General Secretary on January 1 st , 2017. I will remain around for a short while after that to assist Peter and support whoever is appointed as our next Industrial Relations Officer.

I want to thank our excellent frontline staff, our wonderful office staff and our partners without whose support this work would be even more difficult. I want to thank my wife Marie for her great support.

I also want to thank all of our Branch Officers for your work on the ground. Yours is the work that makes this Union the success it is.

Thank you