HEART BEAT:On paper we seem to have lots of nurses and few admin staff – but that doesn't seem to add up in reality, writes MAURICE NELIGAN
FLORENCE NIGHTINGALE was born on May 12th, 1820. Her birthday is now celebrated as International Nurses Day. A little known fact about this dynamic woman is that, retrospectively, she has been diagnosed as one of the first described sufferers of that medical enigma variously described as Chronic Fatigue Syndrome or ME (myalgic encephalomyelitis).
She was also a most meticulous person and her well reasoned arguments backed with relevant facts marked her as one of the earliest noted statisticians.
Prof Joel Best of the University of Delaware has written a brief and incisive book called Damned lies and statistics. The title presumably derives from Disraeli’s famous aphorism. The subtitle ‘Untangling numbers from the media, politicians and activists’, tells us what it’s all about.
He points out that one reason why people tend to accept statistics uncritically is the assumption that they come from people who know the facts. Furthermore, repetition of a particular statistic brings it into the realm of “sure everybody knows that”, at which point reasoned refutation becomes very difficult. He also notes that various groups often have a vested interest in manipulation or misrepresentation of figures either to bolster their own position or weaken that of others.
This all came to my mind recently when I heard it stated that Ireland had more nurses per million of population than almost any other country in the OECD (Organisation for Economic Co-operations and Development), save Norway. We are supposed to have 15.2 nurses per 1,000 of population against the OECD average of 8.9/1,000. There’s the statistic. Our nursing complement is way above average. What are they bitching about? It’s about time they got off their communal tail and did some work. If they were in Germany or wherever, they would know what work was all about.
Somehow that ‘fact’ and those figures didn’t seem right to me. The hospitals where I worked were not oversupplied with nurses; indeed the converse was often true. Furthermore they were hard working, competent, loyal and caring.
Now here comes the hard bit and bear with my simple mathematics. If we assume the OECD figure to be correct and we have the numbers claimed and, giving us a population of 4.25 million, we would have a total figure of more than 64,000 nurses. I didn’t realise that we had so many and furthermore I didn’t believe it.
Further inquiries were needed and it transpired that the OECD figures, while endeavouring to be uniform, are not so in fact. For example, midwives should not be included but they are in some countries including Ireland. There are other differences too across the geographical spread, in training and designation. It is the statistical problem of comparing apples and oranges and to use the figure without these caveats is careless. It may even be dishonest.
Now, as you all know by now, the HSE has some difficulty with figures. It can’t figure out how much PPARS (personnel, payroll and related systems) cost, or maybe it doesn’t want us to know. The latest debacle with the insurers could cost us €50 million, according to Prof Drumm, or nothing at all according to Minister Harney. It’s the way you tell ’em.
Then there are the conflicting reports as to how many actually work in the service. There seem to be about 112,000, give or take a few thousand. I became bogged down in this particular morass when I quoted figures used by three stockbroking firms, Davy, NCB and Goodbody in a joint paper issued on April 2nd. They averred that in the HSE there were about 49,000 administrative staff and 61,000 frontline staff and that such a ratio was unsustainable.
Rebuttal was swift and the numerical waters were muddied. A Mr Paul Connors, speaking for the HSE, said the true figure was 16,000 administrators. Further modification came from the highest levels of the organisation: there were only 6,000 in admin proper and the other 10,000 were in secretarial support of the frontline.
Stay with the maths awhile. If there are indeed only 16,000 and there are 61,000 frontline troops, that leaves 40,000 souls in limbo if the overall total is correct. What do these people do? Surely it is not beyond the capacity of this expensive overstaffed monstrosity to provide a categorical breakdown of its alleged 112,000-strong workforce? Then we’d all know and these controversies could finish. That would be a small step toward transparency. Needless to say, there is not a commercial company in the land that do not know their personnel numbers and into which categories they fall. Furthermore they don’t need an army to find out.
Back now to our lazy swarms of nurses and the fact that this ‘statistic’ peddled by whoever, does the nursing profession no favours. That would clearly seem to be the intention.
Let’s look at the real figures. In 2007 there were about 39,000 nurses and midwives in the HSE. In 2008 there were 37,000 and there are fewer today. There was no attempt to analyse this discrepancy. In fact, the numbers seem to have come from the live register of An Bord Altranais and cover every registered nurse in the State. It does not distinguish between part-timers, those temporarily overseas, those working privately or outside the HSE and, most significantly, those working only occasionally or not at all.
This explains why there are eight nurses trying to cope with upwards of 100 patients in a trolleyed AE unit and worked off their feet. It explains why one tired nurse, maybe with a care assistant, tries to cope with 40 older folk in a ramshackle under-funded facility at night.
The inadequate people who control our health service cannot any longer count on what William Henley described as ‘a well bred silence always at command’. The nurses are awake. Good luck to them.
Maurice Neligan is a cardiac surgeon