FULL RECOMMENDATION
INDUSTRIAL RELATIONS ACTS, 1946 TO 2001 SECTION 26(1), INDUSTRIAL RELATIONS ACT, 1990 PARTIES : NATIONAL MATERNITY HOSPITAL (REPRESENTED BY IRISH BUSINESS AND EMPLOYERS' CONFEDERATION) - AND - IRISH NURSES ORGANISATION DIVISION : Chairman: Ms Jenkinson Employer Member: Mr Keogh Worker Member: Ms Ni Mhurchu |
1. Nurse management structure.
BACKGROUND:
2. The National Maternity Hospital, Holles Street, Dublin is a band two maternity hospital with over 203 beds. A series of nursing industrial disputes occurred in the mid 1990's and as part of the resolution of conflict a Commission on Nursing was established to review the structures in place in all Irish hospitals. The Report of the Commission on Nursing (Blueprint for the Future) was published in 1998 which offered a series of recommendations in relation to the implementation of change to meet the needs of nursing staff. Its purpose was to suggest general improvements that it viewed as important for the future successful functioning of Ireland's hospital system.
In October 2001, 4½ years after the Report of the Commission on Nursing, the Minister for Health & Children announced that he had established a Forum to examine difficulties in relationto the recruitment and retention of Midwives and their implications, within the three Dublin Maternity Hospitals, including the National Maternity Hospital.
The Union contend that the Hospital is not complying with the recommendation of the 1998 Commission on Nursing Report in regard to management structures. In May 2002 the Union submitted a claim for the creation of an additional 18.5 posts at CMM1, CMM2, and CMM3 levels. The Union claim that these posts were necessary to comply with the Commission on Nursing recommendations. At conciliation the Union submitted a revised claim for a total of 45.5 management posts. Management did not accept the Union's claim.
As agreement was not reached during the conciliation conference the dispute was referred to the Labour Court on the 15th February, 2003 in accordance with Section 26(1) of the Industrial Relations Act 1990. A Labour Court hearing took place on the 2nd April, 2003
UNION'S ARGUMENTS:
3. 1 The Management in theNational Maternity Hospital have not been as proactive as management's in other hospitals in implementing the recommendations of the Report of the Commission on Nursing. This has resulted in the Midwife members being penalised over the past four and half years in terms of promotional opportunity, salary and lower staff morale.
2. Following on from the Commission on Nursing, each hospital proceeded to ensure that each Unit of care was managed by a CMM2 grade. Each CMM2 was then supported by at least one CMM1. Management ofthe National Maternity Hospital appear to be unaware of their obligations with regard to implementing a management structure which reflects recommendations in the Report.
3. The Report of the Forum on the Dublin Maternity Hospitals recommended that "105 of the more experienced Midwives in the hospitals be upgraded" to CMM1 levels. 35 of these posts were allocated to the National Maternity Hospital. It appears that theNational Maternity Hospital endeavoured to plug the initial gaps in their Midwife Management structure, which arose from their non-implementation of the recommendations in the Report of the Commission on Nursing, with the 35 posts arising from the Maternity Hospitals Forum Report.
4. The fact that theNational Maternity Hospital, a publicly funded hospital has chosen to ignore recommendations arising from an initiative commissioned by the Minister for Health & Children is unacceptable, and must be corrected with retrospective effect to discourage future non compliance with such reports.
HOSPITAL'S ARGUMENTS:
4. 1 The National Maternity Hospital acknowledges the Report of the Commission on Nursing and seven CMMI positions were implemented as a result of the recommendation in the report. However, it does not accept that its recommendations were necessarily in reference to all hospitals across the board, as its suggested nurse management structures are not feasible in respect of the National Maternity Hospital's individual structure. The purpose of the report was not to insist on one hospital structure to affect all hospitals similarly but to offer a set of recommendations to be implemented, where appropriate.
2. Since 1999, the Hospital has received sanctioning for 42 managerial posts. Seven of these were implemented as a result of the Report of the Commission on Nursing. The Minister for Health and Children sanctioned 35 more additional managerial posts as a result of the Dublin Midwifery Forum held in May 2002. Notwithstanding the hospital's argument that it currently has adequate nursing structures to support its service, the Hospital does not have the authority to create further managerial posts In fact if they were created, it would result in a structure whereby approximately 140 managers would manage 100 employees.
3. Recent developments in community midwifery projects have meant that the average length of stay in the Hospital has been reduced. Two separate community midwifery projects are currently under way and a third is being developed. This will lead to a further expansion of ante-natal and post-natal care in the community inevitably leading to a further reduction in post-natal beds.
4. The finances of the State agencies are currently well publicised and this Hospital is no exception. Taking this on board it could not unilaterally afford the creation of these posts.
5. The claim is cost-increasing and is therefore prohibited under the Programme for Prosperity & Fairness and under the new national agreement, "Sustaining Progress". The claim would also result in knock-on claims in the other maternity hospitals in Dublin.
RECOMMENDATION:
The Court has given careful consideration of the submissions of the parties. The Union is seeking the implementation of the Commission on Nursing Report stating that the hospital has not properly implemented the management structure as outlined in that report. Management is satisfied that the report has been implemented correctly and states that the Union's claim is unnecessary given current service delivery requirements. The non-implementation of the report has denied promotional opportunities and salary increases for midwifery staff and has resulted in low staff morale, according to the Union. The Union maintains that the additional management posts granted as a result of the Dublin Maternity Hospitals Forum has not addressed this problem; it was intended as a recruitment and retention initiative. The hospital indicated that the Commission on Nursing Report was implemented by the appointment of seven CMMI positions as a result of the recommendations in the report.
The Union in its original claim identified units within the hospital where an additional 18.5 management posts need to be filled in order to fulfil their obligations under the Commission on Nursing. This claim was subsequently increased to 45.5 additional management posts due to recommendations issuing from a report dealing with staffing levels in Accident and Emergencies departments. The Court is of the view that this is an entirely separate issue and only serves to confuse the claim.
The Court has been furnished with the current staffing structure in the hospital along with details of the staffing structure in the other two maternity hospitals in Dublin and notes that this hospital has the highest ratio of CMMI to CMM2 posts.
The Union served this claim to the hospital by letter dated 24th May, 2002. This letter referred to the fact that management intended to make application to the relevant authorities for funding and sanctioning of the claimed 18.5 posts. Management for the hospital indicated to the Court that this was not sought; instead attempts were made to gain recognition as a separate specialist category for midwifery staff, this attempt has not been successful.
To address the claim the Court recommends that both parties should jointly examine the management structures in the National Maternity Hospital and identify those areas where management structures are not complying with the Commission on Nursing recommendations.
Having considered the Commission on Nursing Report, the Court is of the view that to implement the recommendations of the report, the parties should examine its requirements by reference to the criteria specified in the report,viz;-
- the number of CMMI posts will depend on the activity and complexity of the midwifery service;
- all CMMI's must be able to report to a CMM2;
- it will be extremely rare for all three levels of managerial posts (CMMI/CMM2/CMM3) to be in the same unit and only one person would be designated as being in overall charge of a unit or ward, therefore, it will only be in exceptional situations that both a CMM2 and CMM3 will be required in a unit or ward.
Having carried out this exercise the Court recommends that the parties should agree on the number, if any, of additional posts required and management should proceed to seek sanction and funding for the appointment of such additional management posts. If the parties fail to reach agreement the issue may be referred back to the Court.
Signed on behalf of the Labour Court
Caroline Jenkinson
6th May, 2003______________________
JB/Deputy Chairman
NOTE
Enquiries concerning this Recommendation should be addressed to Jackie Byrne, Court Secretary.