Exclusive: Northern Ireland CNO resolves to transform sector despite challenges

The chief nursing officer (CNO) for Northern Ireland has said she is “committed” to ensuring that nurses in country get a fair pay deal, amid almost two years of political turmoil and as more strikes from nursing staff loom.

In her first interview with Nursing Times, Maria McIlgorm reflected on some of the key challenges nurses in the country are facing and spotlighted the work she is undertaking to make Northern Ireland a country where nurses want to practise.

Ms McIlgorm took up the CNO role in the Department of Health in Northern Ireland in March 2022, having previously worked as a professional adviser with the Scottish Government.

“We have a workforce that we should be extremely proud of here”

Maria McIlgorm

She joined at a pivotal time for politics in Northern Ireland – just one month after the devolved government broke down and as the country was emerging from the Covid-19 pandemic.

Ms McIlgorm described her time in post so far as “challenging but rewarding”.

She said: “I’ve enjoyed engaging with nurses across Northern Ireland and listening to their concerns, and I’m well aware of the challenges they face. We have a workforce that we should be extremely proud of here.”

The ongoing political and financial disorder in Northern Ireland has been “compounding challenges further” for nurses working in already-stretched Health and Social Care (HSC) services, explained Ms McIlgorm.

But she noted that nurses and midwives had continued to show “dedication and professionalism” in their roles.

At the time of writing, HSC staff in Northern Ireland were still without a pay deal for 2023-24 or an improved offer for 2022-23, meaning that nurses there are now the lowest paid of their public-sector counterparts in the UK.

Progress on a pay deal has been delayed by the collapse of power-sharing arrangements in Northern Ireland.

The Democratic Unionist Party has been boycotting Stormont since February 2022 in defiance of post-Brexit policies affecting Northern Ireland.

Due to the lack of a fully functioning government, the Northern Ireland secretary in Westminster, Chris Heaton-Harris, was responsible for setting the country’s 2023-24 budget.

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As a result of his budgetary decisions, the Department of Health in Northern Ireland declared that it would be unable to make a pay offer to HSC staff.

Ms McIlgorm echoed this, warning that the budget had provided “no scope for a pay offer to be tabled this year”.

She explained that if the department was to match the Agenda for Change offer in England – a lump sum of at least £1,655 and an average 5% pay rise – it would “require large-scale cuts with severe and lasting impacts on patients”.

However, Ms McIlgorm said she shared the “deep-seated frustration” at the absence of a pay offer and the impact that it was having on the morale of the HSC workforce.

“The department has consistently said that it was facing an impossible position, and [some of the] decisions required have not been in the best interests of our health and social care system,” she added.

This is the second time in recent years that nurses in Northern Ireland have fallen out of pay parity with their UK colleagues amid a collapse of Stormont.

Nurses successfully went on strike in 2019, demanding that they received a pay deal that matched their counterparts in England and Wales. The industrial action led to political parties reforming government and nurses being given pay parity.

Four years on, nurses have found themselves in the same position again. At the time of writing, nurses and midwives from the Royal College of Nursing, Unison and the Royal College of Midwives were preparing to join other public-sector workers in a day of mass industrial action in Northern Ireland on 18 January over pay.

The strike day coincides with the deadline for Northern Ireland parties to form a government, otherwise a new assembly election will be called.

Ms McIlgorm said she recognised the right of nurses to participate in industrial action but noted that the upcoming strike day would “inevitably impact on patient care services”.

However, she explained that she had a “good relationship” with health unions in the country and that she continued to meet with them regularly to discuss their concerns.

“They’re well aware of the position the Department of Health is in currently,” said Ms McIlgorm. “I think it’s really important that we do have that good partnership working with our unions.”

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Before Christmas, Mr Heaton-Harris offered Northern Ireland a financial package worth more than £3bn, which included money to cover public-sector pay, on the condition that the political parties restore Stormont.

While talks had been held between the UK Government and the political parties, at the time of writing, the deal had not yet been accepted.

Ms McIlgorm explained that the department continued “to do all it can to be able to make a pay offer” to HSC staff.

“The pay environment is challenging, but I’m hugely committed to ensuring that staff [in Northern Ireland] do get the fair pay deal,” she added.

Despite the political upheaval, there is much work being done to transform nursing and midwifery in Northern Ireland, said the CNO: “There’s tangible work still taking place – even within the constraints [and the] political and financial context in which we find ourselves – to drive forward much-needed health transformation here, and I’m really focused on that work.”

One piece of work that was recently undertaken in the department was a report around the advanced nurse practitioner (ANP) role.

The report, commissioned by the previous CNO and published in November last year, put forward recommendations about how to expand the ANP role in the country.

Ms McIlgorm explained that the report would help to “enhance and strengthen the role that advanced practice can play in transforming our services”, adding: “I’m committed to growing this workforce and embedding advanced practice across a range of clinical settings, both in hospitals and the community.”

Also unveiled last year by Ms McIlgorm was her five-year vision for nursing and midwifery in Northern Ireland, which hoped to address some of the current challenges facing the professions.

The plan outlined four key priority areas: workforce and workload planning, education and training, career pathways and developing a quality assurance framework.

Ms McIlgorm said she wanted to “maximise the potential of the nursing and midwifery workforce”.

“I’m confident that, collectively, we can work together to address the challenges and make health and social care here, in Northern Ireland, a great place to work for nurses and midwives,” she added.

Part of the vision promised to “stabilise” the country’s nursing workforce, putting a laser focus on recruitment and retention.

Ms McIlgorm praised the efforts that had already been made in this area in recent years. She noted that, over the last decade, the number of commissioned pre-registration nursing and midwifery university places in the country had almost doubled – from 680 in 2012-13 to 1,335 in 2022-23.

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In addition, she highlighted that 1,000 nursing and midwifery students were set to graduate over the next six months.

This includes the first cohort of 300 graduates that were funded as part of the New Decade, New Approach agreement in 2020, which committed to an additional 900 nursing and midwifery undergraduate places over a three-year period.

Unfortunately, the Department of Health announced last year that the recent budget constraints meant it could not continue to fund the 300 additional places per year now that the agreement had expired.

In response, and for 2023-24 only, the Republic of Ireland agreed to fund some of the additional places to redress the cuts.

However, the future of these places beyond this financial year remains uncertain. Ms McIlgorm said: “The department will continue to look to expand places further when funding permits and those discussions are ongoing.”

Meanwhile, across other UK countries, there have been moves to introduce a band 4 nursing role to support the registered nursing workforce.

England rolled out the nursing associate role in 2019, with Wales and Scotland currently looking at introducing something similar.

Despite this, Ms McIlgorm explained that there were currently no plans in Northern Ireland to introduce nursing associates.

She said: “We certainly have been involved in some discussions with Wales but, at this point in time, our priority is to grow our [registered] nursing graduates in Northern Ireland.”

With winter underway, Ms McIlgorm thanked all the members of staff who were working “relentlessly to prioritise care” for patients during the busy period.

She urged patients and families attending services to be “patient with staff ”. “They are doing their very best in difficult circumstances – it is important that we really recognise that,” she added.

Looking ahead at 2024, Ms McIlgorm said her new year’s resolution for nursing was to widen engagement with nurses on her five-year vision and to explore how those on the front line might be able to take the work forward in the coming months.

She said: “It’s really important that nurses who are actually delivering services are fully engaged in that vision going forward.”

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