Jennifer Carroll MacNeill
Dún Laoghaire · Fine Gael · Ireland
“It will be provided by a registered pharmacist in accordance with the relevant pharmacy legislation, including this Bill. Section 2 of the Bill makes various amendments to the Irish Medicines Board Act and the Pharmacy Act. Those amendments ensure that whole legislative framework is cross-referenced correctly.”
“We now have a common conditions service where you can go to a pharmacy instead of a GP to get a diagnosis and prescription for eight basic conditions like conjunctivitis or urinary tract infections - the kind of things that just come up in people's lives all the time. We would like to expand more and more what pharmacies can do.”
“In particular, the board will be focusing on aspects of menstrual health, on aspects of postpartum mental health, particularly in traumatic birth cases, on something we have overlooked for some time, which is endometriosis, on women who are finding it difficult to access services in different ways, as Senator Harmon suggested, and on more…”
“The extension to 41- to 45-year-olds could possibly be €5 million to €8 million because there are statistically fewer women in that bracket trying to conceive, so the numbers are higher. It really is a question of funding. I remind Senators that they have also asked me to fund various other programmes.”
“That followed confirmation from the Pharmaceutical Society of Ireland and the Health Products Regulatory Authority that the patch and ring are classified as medicinal products, not medical devices. That is just a correction there.”
“That is why we have put so much money into supporting them in different ways, including the conclusion of a €50 million increase to their fees and to provide for the opportunity to raise private funds in this way, for example, the common conditions service. I want to see pharmacists doing more.”
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“I want to highlight the success of the HSE's home STI testing service, which includes HIV. In the pilot phase of that initiative we are supported by Sláintecare innovation funding 2021. The service was so successful that wider roll-out was accelerated and a scheme was launched nationwide in October 2022. Home testing is hugely important. It has added approximately 30% additional capacity to our systems. The home STI testing service allows people to test in the comfort and privacy of their own homes. It reaches those who might be reluctant to visit an STI clinic in person. People experiencing reactive results are then referred onwards for further testing or treatment, as appropriate.”
“Our new national sexual health strategy, published last year, reaffirms Ireland's commitment to building the services and supports that we need. Work has commenced on a HIV action plan with, most importantly, the inclusion of advocacy groups and people with lived experience. I hope they will find the process to be one that is rewarding and delivers for the future. The plan will encompass prevention, access to testing, diagnosis and treatment, wider supports for people living with HIV and continued work to reduce stigma. HIV testing is now more accessible than ever. People should get tested. It is available through 23 public STI clinics, a home STI testing service, antenatal and emergency departments, student health services, GP surgeries, family planning clinics and community partners.”
“People diagnosed early and receiving treatment can expect to live long, healthy lives. Evolving antiretroviral treatments have revolutionised survivor rates and the quality of life for people living with HIV since the mid-1990s. Undetectable equals untransmittable, or U=U. It is an important catchphrase to remember. When someone living with HIV can keep their viral load at undetectable levels through treatment it will not be transmitted to their partners. Needless to say, it also maintains their own health. The importance of prevention, early detection and treatment of HIV cannot be overstated. Those measures reduce the numbers infected and the risk of lasting harm and increase the chances of living a full life with HIV.”
“Irish AIDS Day has always been about people: individuals, families, friends, healthcare workers, activists, researchers and community organisations who have shaped Ireland's response to HIV over the past four decades. It is also about recognising the courage of those who spoke out when fear and misinformation were widespread - what a brave and honourable thing to do – and whose honourable advocacy transformed public understanding and policy. I pay tribute to them. Today, we mark something important. Ireland and the world have made remarkable progress. We are now living at a time that would have seemed impossible during the darkest years of the AIDS epidemic. Mary Horgan, Chief Medical Officer, pointed out to me how effective modern treatment is. It is extraordinarily effective. It is an extraordinary transformation.”
“I hope that is a measure of respect for the debate and of the guests as well. I welcome the opportunity to address this House today with statements on HIV and AIDS in Ireland. I recognise the Chair's contribution to making this debate happen. Today, we gather in solidarity, remembrance and hope. It is really important to take a moment to remember our friends who have passed away either from HIV and related illnesses or with HIV and related illnesses, which has become very different over time. I have a friend in particular in mind, as we all might. We come together to honour those we have lost to HIV and AIDS and to stand with those living with HIV and to renew our collective commitment to ending HIV transmission and the stigma it continues to effect in too many lives.”
“I recognise and welcome our guests to the Seanad, even though it is not my place to welcome them to the Seanad. The Acting Chair will forgive me. Perhaps I should say they are welcome to the Oireachtas. They are so very welcome. It is wonderful to see them and to have the opportunity to have this debate and to recognise their very important work in relation to that. I also recognise my officials who are so deeply committed to this area. Mary Horgan, our Chief Medical Officer, is here in support of this debate today and to contribute to the debate. Fiona Mansergh is an assistant principal in the rare diseases and sexual health policy area. Behind them is Bearach Reynolds, a specialist registrar in the office of the Chief Medical Officer. We are trying to bring the highest levels of both medicine and policy to this debate.”
“No, resourcing is not an issue. First, I want to go and see Clare myself to understand that better, and ask for a plan for the region for the development of services in Clare and Tipperary - Ennis and Nenagh - and not just Limerick. Overwhelmingly the focus in the mid-west has been on Limerick, which I understand. However, proper community care and proper integrated care requires a focus on Nenagh and Ennis as well. I have agreed a chair, who I believe will be excellent. I will meet the patient council this week. I really want its perspectives before I finalise the board. Thereafter we will appoint a board to do that work. That will begin over the summer but it will begin structurally in a very detailed way thereafter. I have a little bit more work to do on that.”
“I challenged the Irish Dental Association on that and it robustly defended the ability of dentists to do Botox and other things as part of their choice of how they practise. I have to highlight all these different things. Yes, we need to have a new contract anyway. Yes, we need to continue to make sure that we have a structured programme particularly for children. However, it is also true that there is not just dentistry happening and that is reducing capacity particularly in the public system.”
“I have already intervened with the HSE on two fronts. We will be producing a dental-specific plan. It is important to reference what the Deputy said about long waits, particularly for children. A specific intervention programme will last about two years. The Irish Dental Association has been involved with that. Let us not give the speaking points of private representative bodies either. I was at its conference and raised the increase in fees. The fee paid to dentists for medical card patients has been increased by 40% and yet people still do not want to do it. I do have to acknowledge that as part of their conference dentists had two days, one on dentistry and one on aesthetics.”
“There is no question that the entire Dáil wants to see a reduction in agency use. If that is what the Deputy is referring to, I do not know why it is being referred to in those terms, but it is certainly necessary, and it was told to me in the health committee, that we make sure we reduce agency staff and recruit permanent staff instead. I do not know what else the Deputy referred to.”
“I compliment the management of Tullamore hospital, who have managed demand better than most hospitals in the country and consistently achieve very few people on trolleys. We do that through a number of different ways, including purchasing private beds where necessary. That is part of what every hospital and region does. We need to standardise the cost in relation to that but we do use off-site capacity. I do not know what the Deputy is referring to with regard to black escalation. If it is that we are trying to manage the budget overall because the HSE has hired essentially an additional 2,500 people at the beginning of this year, without a corresponding reduction in agency staff, it may be that. The Dublin and midlands areas are particularly egregious in their agency use instead of hiring for permanent positions.”
“I am working with other European health ministers to find a way to streamline the way the HTA process works, reduce some of the national country administrative burden, make Europe a more powerful block, and rebalance that balance of power, crucially so that patients get access and so the Irish State can spend as much money as possible in getting as many drugs as possible for the broadest range of people. That will not always result in positive decisions by the HSE. I need to say that loudly. We have had difficult days on that, too, but we are desperately trying to take the right approach in every way.”
“We are just not in the same space. We do not have the same visibility. We are trying to partner with other countries to create a bigger market so we can be more attractive and also so we can negotiate on more attractive terms. I feel that the only group with all of the information are the drug companies and that the member states are working somewhat against each other in terms of each of them making individual negotiations because of the way the European treaty is structured and health being a national competence. It is something we need to reflect on.”
“Due to the way in which it is given, we are trying to work out whether this is something we can do more quickly in acute settings and how we can most quickly get this drug to the boys who need it so badly. Our broad approach is one of trying to give maximum access to it but I will defer to clinicians on who the appropriate people are to get it. Yesterday, I was meeting with the European health ministers. We had a working lunch specifically on medicines and the challenge of most favoured nation, MFN, access to medicines. We have been trying to work in different ways on two things. As a small country Ireland, like the Benelux countries, Croatia and other small countries, have a difficulty with access to drugs. If we look at drug companies making applications, they are making it to the likes of France, Germany and other huge markets.”
“It was Úna Ennis who coined the phrase "time is muscle". I am grateful to her for her engagement and advocacy all the way through. The first thing is that we are trying to get the drug physically into the country. My officials have been working on that for some time in anticipation of what we hoped would be a positive response. Of course, it is not just a decision whether to give the drug or not. It is also a decision about whether the drug is effective and for whom it is effective. It is a complicated balance and we must always defer to the scientists on these decisions as well, recognising that Ireland remains a country that believes in science. We are trying to get the drug physically into the country. This is a high-tech drug and not one that is put on the back of a van and sent to a pharmacy.”
“The question of being ambulatory, being able to stand and all of those things are not decisions for the Deputy and I but are decisions for clinicians. We want to make that drug as broadly available as possible but, ultimately, it is a clinical decision as to who should get the drug and who should not. I am so thankful to the HSE and thankful to the families for their constant engagement with me in relation to this, not just in our constituency, but around the country.”
“A commercial offer was received from Italfarmaco on 8 May 2026. Again, we were waiting for these applications to be made. The HSE drugs group continued that application at a meeting one month later on 9 June. When we bring together all of the different experts, it is not something that is stood up quickly. We have to review the documentation and have the scientific experts there. The drugs group supported the reimbursement of givinostat. Yesterday, the senior leadership team in the HSE supported that application and the drug will now proceed through a managed access protocol. We have discussed in detail with the families how a managed access protocol works. It is a matter of clinical decision making as to who gets the drug. Of course, as the Deputy has referenced, not every boy is suitable for it.”
“That is unprecedentedly fast, and I am very grateful to the HSE for its speed, reflecting the seriousness of this. On 30 September the HSE met with Italco Pharma to assess the HTA process. The assessment of the pricing and reimbursement application could not proceed until the full HTA was received from the Italian company. That was eventually received on 15 January 2026. We were updating the families at every stage, discussing and giving them full information and transparency as to what was happening. I am grateful to the HSE for concluding the assessment on 3 March, which was a matter of 26 days or so. That was very fast. The HSE's corporate pharmaceutical element, which is the interface between the HSE and the pharmaceutical industry, held a meeting with Italfarmaco on 27 March 2026.”
“The Taoiseach has been involved in this, asking Prime Minister Meloni to get involved to ask the Italian pharmaceutical company to make the appropriate, complete application here in order that the HSE could respond. I was on my summer holidays in August of last year waiting to see every day with the HSE whether the application had been made. Eventually, on 6 August, the HTA application was first made. I thank Michael Barry and the people in the HSE for the speed with which they processed that part of the application, which was exceptionally quick. The National Centre for Pharmacoeconomics did a rapid review. The application was made on 6 August, the rapid review was completed on 14 August and a full HTA commissioned on 26 August.”
“It is not as though Ireland simply gets it as a matter of course. The HSE needs an application to be made. The drug company has to choose to want to sell it here. We have been trying to encourage Italco Pharma for some time to make the appropriate application. The drug was approved in June of last year. I immediately met families in relation to the next steps. We did not get an application from the maker of givinostat for some time, so we all engaged in a lobbying campaign in different ways. I met the Italian health minister, Mr. Schillaci, in Luxembourg to encourage him to ask the company to make an application in Ireland. I made the same ask of him again at a later stage, in November, in South Africa, at the G20 meeting.”
“I thank Deputy Ward for raising this issue. This is something I have been working on with families for over a year now, since this drug was approved by the European Medicines Agency. I have met many of those families. I met them when they were here last week, before they had their audiovisual room briefing, I have met them four, five or six times online and I met them past year in person - I have met them so many different times. Together, we have been working to try to get this drug approved within the Irish system. As the Deputy will be aware, when a drug is approved at a European Medicines Agency level, it does not necessarily mean that it will be available in Ireland. Why? It is because it is necessary for the drugs company to make an application to have the drug available in Ireland.”
“The reality is that if someone turns up to the medical assessment unit in Ennis in the morning and needs an urgent CT scan, it will be read by a radiographer in Limerick, but if someone turns up to the medical assessment unit in Ennis in the afternoon instead of the morning and needs an urgent CT scan, it will not be read by the radiographer in Limerick. Instead, the patient will be transferred by ambulance to the emergency department in Limerick to have the scan there. There are still things that do not make sense and need to be fixed. Processes need to change to take the pressure off Limerick and other hospitals. A big part of that is investing in the community and step-down beds, as the Deputy said.”
“I thank the Deputy. I have not said anything about a supplementary budget. That was reported based on last year's, so I have no idea where that is coming from. Taking the case of Limerick, there were 20 delayed transfers of care there yesterday. Over the past ten days, Limerick has ranged from having 15 people on trolleys to 70 people on trolleys, at an average of about 30 to 40 each day. I was in Clare on Monday. The community supports are just as important in Clare to take the pressure off Limerick as anything else and I noticed that, on the same day I was in Clare talking about the development of care there, the Limerick doctors were highlighting patient safety issues.”
“I am asking the Social Democrats to come and meet NWHIP with me to hear more of the reality. There are not 240 women travelling because of fatal foetal abnormalities. There are some, but there are many women travelling for other reasons because there are different thresholds in the UK and Ireland. Some who are travelling will never meet the threshold in Ireland because the UK threshold is about serous handicap and others. The group of women does not number 240. It is a much smaller number. They are very case specific. Some of them will not be fixed by legislation of this kind. I am asking the Deputies for that meeting and to really get into that detail. We will never be able to fix this for every single situation. That is what I am trying to say. That is practically impossible in this context.”
“We know, as Members of the Oireachtas, that for people who are living to seven, eight, nine, ten or 20, these are fatal conditions. There is no point in Deputy Cairns shaking her head at me. This is the reality. This is true, and I really regret it. I am asking Deputies to come with me, to take a different approach and to take up my offer of meeting NWHIP and debating this issue in a different chamber. I do not want to be in a space against this when I know what the Deputies are trying to do is to resolve the cases of many women who have had such difficulty, but it is complex-----”
“Members of the Social Democrats, People Before Profit and others have argued the period should be up to a year. However, if a baby can live for two, three or four months, I do not understand how we would pick a timeline for that. I would ask Deputies opposite to pick the number of days that are appropriate beyond 28 days. I personally find it impossible to do so. Instead, the Deputies have created the idea of a fatal condition the foetus might have. That is the most expansive position that anybody has ever taken, and not just in this House. It impacts any condition that an infant or child might have. It goes way beyond the neonatal period. A fatal condition in the foetus is also one that a child would have, and there are a whole range of conditions.”
“It is only that I have just one minute remaining that I am not spending more time on this. I ask colleagues to forgive me for that. If I had time, I could detail some of those stories, as they have done. I do not mean to cause any upset to anyone but the reason the limit is set at 28 days is that where there is a condition that results in the death of a live-born infant, that death nearly always occurs in the first 28 days. Those first four weeks are known as the neonatal period. Of the approximately 190 infant deaths that occurred last year, about 150 of them were within that period. It is not a figure chosen at random. It was chosen because it is related medically to the period in which an infant is most at risk. Beyond that, the issue is extremely complicated.”
“What is proposed is a blanket decriminalisation and it is not confined to the woman's treating doctor but to any doctor. That is a very significant change. It is not just a drafting issue that could be fixed. I have only one minute remaining in which to deal with the most important issue, namely, fatal foetal abnormality. It is an extremely complex issue that raises many different ethical issues. I totally empathise with what the Bill is trying to achieve in this regard. I have met with and spoken to women who have faced unimaginable and harrowing circumstances. I want to explain why the Oireachtas took the approach of having the 28-day provision. I know these decisions are not easy. In fact, it is desperately difficult for anybody who falls outside that timeframe.”
“First, I do not want to create a precedent whereby we interfere in the medical profession in any area of clinical practice, whether it is obstetrics or cardiology. Second, I do not want to give a different Minister the opportunity to do something that would be very different from my world view. I do not believe it is a concept we should embed in legislation. The fourth issue is the decriminalisation of medical practitioners. This would be a very substantial policy and legal change. At present, a doctor's decision does not have to be correct. Doctors do not have to be right; they just have to have made their decision in good faith. That is the defence. A question arises as to why a doctor who carries out a termination unreasonably or acting in bad faith should be exempt from criminal sanction.”
“If the Social Democrats Members are on the progressive left, then I am on the progressive right. However, there are other Members of this House who take a very different view and I do not want any of them being Minister for Health and having the capacity to make ministerial guidelines. I do not believe we should bring that concept into legislation. I do not think it adds to what we are trying to do, which is to make things easier for women. Additionally, for doctors, it introduces more uncertainty because it says to them there are statutory rules and then there also are these ministerial guidelines. Which will the courts test? How does that work? We in this House are presumed to intend the impact of the changes we make in law, and that is the view the courts will take. I cannot support that concept.”
“The good faith test is already well understood by the courts. Adding words to that introduces more complexity. The third issue is with the ministerial clinical guidelines proposed in sections 9, 10 and 11. In short, I do not believe it is appropriate for me as Minister, or any Minister, to make clinical guidelines in any context. It is an interference in the independence of the medical profession. There may be a sort of assumption by Deputies opposite that every Minister is going to make guidelines that align with their view of the world. We already know that is not the case in respect, for example, of the heartbeat law that was introduced in Hungary in 2022. If a Minister were to bring in something similar here in clinical guidelines, it would require a woman to listen to the heartbeat before having a termination.”
“I wish I had more time to go through this but, in practical terms, the dual professional signature is a fundamental principle of safety that is widely practised in healthcare. It is a critical safety mechanism for high-risk actions and serious decisions, and this is a serious decision. I am very aware of the unintended or tragic outcomes that have already occurred where core principles of safety have not been adhered to in that way. That is the difficulty with this proposal. In addition, legally, the Bill provides that both those sets of decisions would be based on reasonable opinion formed in good faith and based on knowledge available at the time. That language is taken from the O'Shea report. I accept it is correct and I understand the motivation behind it. However, with all respect, Ms O'Shea is not a drafter.”
“In section 11, it is proposed to change the number of doctors involved in the decision about a fatal foetal abnormality by not requiring both of them to do an examination. It is a subtle nuance and there is potential for dependence on notes. Again, the practical reality is that two doctors are necessary. There would be an obstetrician involved but there would also be a geneticist or neonatologist, who would be the other doctor identifying the fatal foetal abnormality and the trajectory of it. Changing the threshold from examination to potentially including notes brings in a measure of uncertainty for the courts later. Questions might arise as to how far back the notes go. There is an extra element of uncertainty. My understanding is that Deputies opposite are trying to reduce uncertainty, not create it.”
“First, the Bill proposes to amend the statutory language to remove the requirement for two clinicians to be involved in the decisions regarding a termination where the life or health of a mother is at risk. There are really practical and clinical reasons that the input of more than one clinician is relevant in this decision-making. Doctors work as a team. Where, for instance, a woman's life or health is at risk because of psychiatric illness, a cardiology issue or a neurology issue, that will, of necessity, see the involvement of both a cardiologist, say, and an obstetrician. That is just the practical medical reality. Removing or changing that requirement creates an uncertainty I do not believe is helpful. The courts will interpret this later and that is meaningful. I do not have time to go into exactly how meaningful it is.”
“I will not comment further on this matter, as I have already spent longer on it than I intended, other than to make the point that a woman is already entitled, as a matter of ordinary medical law and practice, to take any such time as she deems appropriate to consider her decision on whether to avail of a procedure. I do not believe that creating a specific statutory right of reflection is helpful. It is not a panacea. As I have indicated, the issue with this proposal is just a drafting one and can be fixed. The other issues are more difficult. The second is the proposal for a reduction in the number of doctors making decisions. That applies in two areas.”
“The arguments for and against the removal of that provision have been well aired in the public domain. I personally do not see any difficulty with the requirement. That is my personal position. It is a policy choice. The HSE has advised that the current model of care is safe and that it is reliant on it, but that could change were the Oireachtas to make changes in legislation. As I said, I consider this the least problematic issue. The only drafting issue with this proposal, which could be fixed, is that it makes reference to a statutory right to a reflection period, which does not exist. There is no reflection period that exists anywhere else. There is no such statutory right. However, that is policy and it is fixable.”
“This Bill raises both significant legal and operational concerns and I have to bring those concerns to the House. It proposes five major changes to the existing legislation. I see policy difficulties with four of those changes and legal difficulties in all cases. I do not believe in my heart that those difficulties are all necessarily intended, which is why I am so careful around the question of drafting. I have done what colleagues opposite are doing, namely, brought something forward to be debated, which is the purpose of this House in many ways. However, it is also its purpose to enact legislation and I must point out the difficulties in that regard. The first and least problematic of the five issues concerns the amendments relating to the three-day waiting period.”
“I am asking colleagues to consider a different approach with which we could potentially work. I ask them to consider whether we could, for example, facilitate an engagement with the national women and infants health programme, NWHIP, and with the doctors who are discussing the improvements made since the O'Shea report, which Deputies opposite correctly relied on in the intent and drafting of this Bill. I ask that they consider how we could create a more structured engagement with any Deputy who wishes to understand exactly what has changed and how it is working from their perspective. That offer remains open irrespective of what happens today or at any other time. The reality is that when it comes to legislation, words matter. We are here as legislators and the courts presume that we mean the impact of the words we say.”
“I am grateful to them for that very constructive discussion. It gave me a much better opportunity to understand exactly what was being put forward, as I had some concerns and questions about the way in which the Bill was drafted. I am always reluctant to criticise the drafting of Bills because I was a drafter in opposition for Fine Gael for three years. I know how difficult it is and I really respect that process. I agree that most legislation can be fixed if there is agreement on principles across the Houses and through the different Stages. In this case, however, I am afraid I cannot agree in that way because the issues are based on principles, which I will discuss presently, that are so fundamental they go beyond what I can agree here and fix later.”
“I begin by acknowledging the women who have had truly heartbreaking personal circumstances in pregnancy and whom I know are the motivation behind this Bill by the Social Democrats. Many Deputies in all parties, both in government and in opposition, know people who have struggled with the worst news in pregnancy. I think of all of those women who inspired the Bill, the Social Democrats' work on it and this debate. I truly respect all Deputies' commitment to raising these issues. I always vote to enable debate. I worked in government in 2017 and 2018 to support the repeal referendum. I thank the Social Democrats Members for meeting with me last Friday, along with the State's interim Chief Medical Officer, the deputy chief medical officer and officials from my Department, to discuss the Bill.”
“On this day, I reaffirm my strong personal commitment and, indeed, that of my Department and the Government to the nursing profession. I really do welcome contributions from Deputies and I hope - I know - that they will join me in once again placing on the record our sincere gratitude for the continued dedication and professionalism of our nurses today and every day and acknowledging the many improvements and supports we are trying to advance for the excellent nurses in our State.”
“I am informed that the proposals being finalised will deliver a broad range of measures to strengthen pay and progression across the nursing and midwifery career pathways and are an important part of supporting retention and ensuring a sustainable nursing workforce. International Nurses Day provides an important opportunity for me and, indeed, all Members of this House to formally recognise the professionalism, skill and unwavering commitment of our nursing workforce. I want to acknowledge not only the extraordinary contribution nurses and midwives make every single day, but the leadership, innovation, compassion and support they bring to every person in our health service in the face of significantly growing demands and ongoing pressures.”
“I want to refer to the Expert Review Body on Nursing and Midwifery, which provides 47 recommendations of real significance. The positive impact of the expert review body’s work continues to be realised year on year in many different ways, but there have been delays in implementing some recommendations and that has caused frustration. Work is ongoing to finalise processes under way for those recommendations. I want to reaffirm the Government’s clear recognition of the importance of actively supporting the continued development of the nursing workforce. I also want to acknowledge the practical improvements that will be delivered from local bargaining under the 2024 to 2026 public pay agreement.”
“We have supported 2,800 individuals and patients like him, and it has delivered over 27,000 bed days for us, freeing up beds and other hospital resources for patients who require more traditional care. Virtual wards are not for everybody but for those who they are, they are being supported, delivered and led by nursing. Taken together, safe staffing, advanced practice and virtual care clearly demonstrate how nurses are actively shaping service reform. They are not simply responding to it; they are shaping it. I attended the INMO conference last week and had the good fortune to meet many nurses and midwives from all over the country. I know and, indeed, heard again first hand about how passionate nurses were about what they did, about the challenges they experienced and about their commitment to their profession and their patients.”
“Through nurse-led virtual clinics, remote monitoring and community-based models of care, nurses are actively improving access for patients, supporting chronic disease management and reducing unnecessary hospital attendances and exacerbations of people's long-term illnesses. Our nurses are at the forefront of embedding digitally enabled services, ensuring the new models of care are well co-ordinated, safe and focused on the needs of patients. That leadership is clearly demonstrated in the virtual wards now in every region. Those initiatives have been extremely successful at improving patient comfort. I spoke yesterday with a man in Kilkee in County Clare who had been on a virtual ward from Limerick for five weeks after experiencing a neurological event, and he spoke of it very positively.”
“We now have 2.7% of the nursing and midwifery workforce at advanced level and we are on track to reach the 3% policy target. That positions Ireland as a global leader for advanced practice. We have begun a national evaluation of the impact of that, and this will be central to shaping the next phase of advanced practice. Virtual care and the pace of digital and technological reform has opened many opportunities to innovate, change and improve care for patients. Let me particularly mention this today because nurses are playing a pivotal role in the innovation and safe expansion of virtual and digitally enabled care.”
“Care pathways are being transformed by providing quicker access to care, timely assessment, diagnosis, treatment and follow-up. It is reducing waiting times, improving continuity of care and supporting care closer to home. Advanced practice is not only a key lever for optimising the capacity of the existing health workforce. It is important in supporting and advancing meaningful and significant clinical career pathways for nurses, and it strengthens retention. I want nurses to work at the very top of their expertise, the very top of their licences and the very top of their profession, and advanced practice is the way towards that. As a result of sustained investment, the number of nurses and midwives practising at an advanced level in March this year was 1,354.”
“From a cost and safety perspective, it helps to reduce reliance on agency staff and focuses on stabilisation through permanent whole-time equivalent staff. The Irish Nurses and Midwives Organisation, INMO, and nursing representatives are very supportive of the framework and want us to drive as hard as we can in its implementation. In many respects, we are the envy of Europe in having this very professional structure. We want to continue to drive that and retain the leadership position we have in Europe in this way. Advanced practice is a hugely important part of what we are trying to do to support nursing generally and support patient care. Advanced and specialist nursing practice has been the cornerstone of reform in recent years, delivering high-quality, autonomous care across acute, community and specialist settings.”
“Since 2020, a total of €56.2 million has been provided by the Government to implement this framework. That has delivered an additional 2,000 whole-time equivalent registered nurses and healthcare assistants. The framework is now fully implemented in all of our adult emergency departments nationally and it is nearing full roll-out in all applicable wards. I believe the framework continues to demonstrate positive impacts for patients, staff and hospitals. Some examples include reduced length of stay, shorter wait times and fewer nurse-sensitive adverse events. It has improved working conditions and demonstrated a reduction in signs of burnout, lower levels of absenteeism and improved staff retention.”
“It has also shown that appropriate staffing enhances staff well-being and improves retention. Nursing in Ireland has shown national and global leadership by developing the framework for safe nurse staffing and skill mix, which we call the framework. This is an evidence-based approach to determining appropriate nurse staffing levels across different care areas. The framework is designed with patient need at the core. It is not about blunt staff ratios or minimum staffing levels. It is patient focused. It is flexible. It is a flexible model that adapts to the Irish context. Phases 1 and 2 of the framework are national policy. Phase 1 essentially applies to inpatient adult medical and surgical settings, while Phase 2 applies to adult emergency departments.”