Consultation on the Development of a New National Skills Strategy

Consultation on the Development of a New National Skills Strategy 1. Introduction The Royal College of Surgeons in Ireland, since its foundation in 1784, has remained dedicated to its core mission of educating and training doctors and healthcare professionals to the highest standard. Enabling health care professionals, through high quality teaching and research, to support people to live long, healthy and productive lives is central to our mission. Today, that mission extends across the globe, exemplified by RCSI s undergraduate and postgraduate campuses in Dublin, Bahrain and Malaysia, which produce high quality medical graduates and surgeons, equipped with the knowledge and skills required to deliver the highest quality healthcare to patients in Ireland and worldwide. We are an independent, not-for-profit, international health sciences institution one of nine independent degree awarding institutions in Ireland. We are the only specialist health sciences educational institute in Ireland and one of the most global in the world. We strongly support the development of a new National Skills Strategy to cover the period to 2025, and are delighted to make an input. Naturally, our inputs are focused on health sciences, but we believe that they have broader relevance to the development of the Skills Strategy. 2. Key Issues The consultation paper provides an excellent overview of Ireland s education and training system, the labour market and business in Ireland. It highlights the challenges of developing relevant skills, activating skills and the effective use of skills. It provides a very useful foundation to the development of the strategy. Building on the consultation paper, RCSI would like to make the following points, which largely fall under the Developing Relevant Skills and the Effective Use of Skills themes of the paper. 2.1 Enterprise Focus A core stated goal of the draft strategy is to explore, with a range of stakeholders, the future skills needs of enterprise and to support wider economic and social development. The paper notes that Ireland has a well developed national infrastructure to support the identification of potential and emerging skills needs and future skills needs. The paper particularly focuses on international trading companies and businesses trading domestically. As a small open economy, we concur that it is essential that enterprise skills needs are catered for. 1

However, we would encourage a shift in focus from the future skills needs of enterprise to employers and the self-employed in the final strategy. A primary focus on enterprise skills risks, if narrowly defined, ignoring the skills needs of large sectors of the Irish economy. For example, 20% of the workforce (400,000 people) is employed in education and health and social work activities. An additional 100,000 people work in public administration 1. While these sectors do not compete internationally, these sectors are nonetheless highly dynamic. As people and skills intensive sectors with a range of public and private sector employers, they face major challenges in driving Irish living standards and broader quality of life. For example, as healthcare delivery models evolve, the future roles of healthcare professionals will change, as will the characteristics / attributes / competencies that determine success. Targeting the skills needs of all employers (private and public) and the self-employed will ensure that the quantum of generic cross-sector skills is not underestimated and that the specific skills needs of large domestic sectors such as health are understood, planned for and delivered. 2.2 Innovation in Work and Occupations As an increasing share of the population achieves third level degrees, we face a challenge to ensure that graduates have the skills and attributes that employers seek and that job matching services are effective. However, it is also essential that professional roles change to enable highly qualified graduates to utilise fully the skills that they have acquired. Investment in skills development must be matched by innovation in the workplace if we are to deliver world-class services, manage resources effectively, and encourage skills development and its full exploitation for personal and societal gain. We illustrate this point from our perspective, based on our history in shaping healthcare delivery. Ireland has invested significantly in health, education and research in recent decades. Re-imagining professional roles for nurses, pharmacists, physician associates and others, while challenging, should allow everyone to move one step up. It is essential that employers and other stakeholders, particularly in the public sector where roles can be more restrictive, work to promote the more effective use of skills. For example: The nursing workforce is the largest in the health sector hence advancing their skills and scope of practice is a key enabler of better health service delivery. In 2007, RCSI launched the first Nurse Midwife Prescribing Programme in Ireland, which broadened the scope of the nursing and midwifery professions significantly, and created space for doctors to focus on what they do best. Through our Faculty of Nursing and Midwifery, we enable continued professional development for experienced staff. We believe that further potential exists to increase the number of Advanced Nurse / Midwife Practitioners and to broaden their roles from very specific areas of practice to embracing a more systems approach/ chronic disease model, with primary care being a key focus. 1 CSO, Quarterly National Household Survey, Quarter 3 2015 2

The role of pharmacy is evolving rapidly. RCSI has provided the National Pharmacy Intern Programme for all Irish graduates since 2011, and hosts the new continuing professional development body for pharmacists - the Irish Institute of Pharmacy (IIOP), which was established by the Pharmaceutical Society of Ireland. The IIOP is responsible for overseeing the establishment of a new system of CPD and for driving the development of pharmacy practice to ensure that it meets the emerging needs of patients and the wider healthcare system. The model ensures that professional development is tailored to individual needs of pharmacists with a focus on retaining capacity to practise safely, effectively and legally within a pharmacist s evolving career and scope of practice. New skills development, provided through the IIOP, will enable pharmacists to support the evolving needs of patients and the health system and to provide important face-to-face health professional engagement with the public. In 2015, RCSI introduced the first Physician Associate course in Ireland. This full-time level 9 masters will introduce a new healthcare professional (to Ireland) who works to the medical model, with the attitudes, skills and knowledge base to deliver holistic care and treatment within the general medical and/or general practice team under defined levels of supervision. Supporting the development of these roles in the healthcare system is essential if we are to achieve a step up in skills capacity for all. 2.3 Work Permits for Non-EU Graduates Educated in Ireland Mirroring other countries, Ireland s approach is correctly to promote the sourcing of labour and skills needs from within the EU and EEA. Where specific skills prove difficult to source, an employment permit can be sought by an employer to hire a non-eea national. The ageing of the Irish population will increase the demand for health workers. The ESRI notes that even if there is a continuous supply of Irish born health and social care workers, Ireland will undoubtedly rely on the support of foreign-born health and social care workers in the future 2. As other EU countries are already experiencing this challenge, it is likely that the importance of non- EU/EEA supply will grow. At present, the consultation paper notes that of the 5,175 employment permits issued to end Q3 2015, over a third is driven by healthcare (36%). Professionals accounted for 73% of all permits issued and within healthcare key occupations include doctors and nurses. Demand for non-eu health professionals will continue to grow. The draft International Education Strategy (2016-2020) notes that the Government is open to looking at ways in which the immigration system can further incentivise high performing students to come to Ireland and to remain on after their studies with a view to them seeing Ireland as their potential future home in which they can contribute economically and socially and bring the benefits of their education to bear. It also notes that a number of countries have gone further for example, Finland and Norway 2 Working Paper No. 275, January 2009, Projecting the Future Numbers of Migrant Workers in the Health and Social Care Sectors in Ireland, Alan Barrett (ESRI) and Anna Rust (NUIG). 3

count periods of study towards eligibility for citizenship and Canada permits permanent residence for international graduates 3. Enabling and supporting non-eu graduates who are educated in Ireland to work in Ireland postgraduation, where specific skills prove difficult to source within the EEA, would support Ireland s international education strategy and provide the Irish healthcare system with highly qualified and ready to practice healthcare professionals with the necessary technical, language and cultural skills. 2.4 Preparedness for Practice/ Real World Experience for Learners As an increasing share of the population achieves third level degrees, we need to ensure that we retain skills-focused (behavioural and technical) qualifications. With respect to course composition, the ESRI note that there is a strong inverse relationship between the number of vocational course components in a degree programme and the probability of mismatch in first jobs 4. Reflecting this, the consultation paper highlights that skills development is more effective if the world of learning and work is linked. Medical education is built on this model. For decades, hospitals and increasingly other healthcare centres have played a key role in the provision of work place training for doctors, surgeons and other healthcare professions. In 2013, the Government announced the realignment of Irish hospitals with their medical school partners to create six Academic Health Centres in Ireland in order to bring practice, teaching and research together. It is important that the implementation of these hospital groups continue. The traditional apprentice system in Ireland has struggled to adapt and to expand into new sectors in recent years. It has also suffered from a perceived lower status than third level education. While the construction sector is seen as the traditional apprenticeship model, variants of this model have been successfully used in medical education for decades. Being able to offer key hands on skills and decision-making training in disciplines such as Medicine is increasingly the hallmark of excellent and sought-after programmes as numbers grow in the third level sector. Engaged senior teachers in a part-apprentice model remains critical to attracting excellent local and international students, producing practice ready healthcare professionals and meeting the needs of the health sector. In a world of MOOCs and online programmes, there may be lessons for all sectors about cherishing and highlighting the common value of skills training and apprenticeship across occupations. 2.5 Healthcare Policy The consultation paper outlines that net outward migration for Irish nationals continues and notes that a failure to attract emigrants back to Ireland will have serious social and economic policy implications. 3 OECD (2012) International Migration Outlook. 4 Recruitment methods and educational provision effects on graduate over-education and over-skilling, Seamus McGuinness, Adele Whelan and Adele Bergin Economic and Social Research Institute (ESRI), 29 May 2015. 4

While potentially outside the remit of a national skills strategy, is it notable that aspects of the Irish healthcare system are not conducive to attracting and retaining talent in Ireland. Numerous studies have reported that Irish health professionals are demoralised and dissatisfied with working conditions in Ireland and are leaving in increasing numbers 5. We must provide stronger career paths and better conditions to attract and retain talented people in Ireland. 2.6 Internationalisation of Education As a national skills strategy, the primary focus of the paper is rightly on domestic skills needs. However, it would be helpful if the strategy elaborated on the role of international education. Attracting international students to Ireland introduces students to a wider multi-cultural educational experience and helps them build global networks while allowing institutions to build greater critical mass and deeper expertise. As outlined in the draft International Education Strategy (2016-2020), it also makes a significant contribution to Ireland s broader economic development. We encourage the two strategies to complement each other in this regard. 27/11/2015 5 NCHD Emigration Crisis and the Need for Consultant-Delivered Care, Eoin Kelleher, Ruairi Brugha, The Irish Medical Journal, February 2014 Volume 107 Number 2. 5