Speech at the opening of the Institute of Community Health Nursing’s National Conference
21st May 2014
A Dhaoine Córa,
Ar an gcéad dul síos tá fíorchaoin áthais orm a bheith libh, agus tá brón orm go raibh mé beagán déanach ach thug sin deis daoibh a bheith ag éisteacht le mo chara Eleanor Shanley.
[Ladies and Gentlemen,
First of all I am delighted to be here with you today, and I apologise that I was a little late but this gave you the opportunity to listen to my friend Eleanor Shanley.]
I want to say what a great pleasure it is to be here and to have had the opportunity President of looking at projects on my way in, very very valuable projects. I was going a bit slow because I was gathering information for Sabina who was particularly interested in some of the projects including the different projects on early life and reading including the care of infants. Unfortunately we have one unavoidable family engagement that Sabina is involved in, so one of us have to go to it so I’m here on my own, but Sabina is more than here in spirit with you because she was very very interested from the very earliest days when our own four children were born, at every stage from the pre-natal stage right through to breast-feeding through early reading. These are very very good projects. I’ve been so pleased that some of them are being rolled out, some of them are already underway, some of them have a huge international reach. I expect to be in Africa before the end of the year and I really am very very impressed and I do congratulate you on all of them. I think as well that it shows something that is very important, the importance of taking the highly professionalised work that you do, both professionalised work in the sense of achieving excellence in your own knowledge and care that you are able to deliver it to the best possible standard, with empathy and compassion, and that that would come into the public knowledge and I think that that is the importance of your meeting.
I mentioned when I was looking at, I think the project that has the headline of ‘Dignity’, which is an all-island project, I mentioned Professor Martha Nussbaum, whom I am hoping to have the opportunity of bringing to Ireland later on in the year, and she has defined caring as ‘a basic human capability serving a fundamental human need’. And I think sometimes the importance of and the complexity of the relationship between a person who is doing the caring and the person who is being cared for can get lost in the arrangement of things. The right to care and the right to be cared for is, I think, where the discourse is going anyway in relation to human rights. I think as well that people speak about the moral obligation to provide basic health care for all of its people, more than the quantity of that, the quality and the form of that is very important. There are ethical issues that arise. They are not idealistic or abstract. They are very practical if we are to create a fully human landscape where the rights of the patient become secondary to any economic or bureaucratic efficiency.
I have been concerned about that for some time. I think I am patron of the Irish Psychiatric Association, for the training of Irish Psychiatrists and it’s a word that’s in my speech as well, if you use the word inter-disciplinary team. You have to do a lot of work on that because it is not a sharing of functions but if it is to be a real team it’s very important the quality of the relationships between the different people within it should be a sharing of concern, rather than a sharing of status. There’s a lot of work to be done there across all of the professions, in my view. I think sometimes within the system inflexibility, demands for repetition, hostility to change, don’t allow or get in the way of personal judgment and discretion. Personal judgment and discretion are incredibly important. It is of the nature of your work and all of you know all of this so much better than I. It occurs in these projects outside about the stressful conditions in which you will encounter people. Very often the confused condition in which people will be, the great uncertainty. I am very very impressed by it, and I thank you for all the people that you enable to stay in their familiar settings and to stay with what is close to them.
I remember when I was writing as a poet some time ago, a couple of years ago, talking to some people, to people who were getting ready to go into institutional care and choices had to be made between what you brought with you and really in the small and intimate objects that people were surrounded with. Once a whole life had been poured into these objects so making a selection, and yet at the same time sometimes it is inevitable.
I think that you integrate the home and community care service in a way it makes it so important for people to pass through the later stages of life as well and on to, and out of life, which is very very important. I so pay tribute to all of that but I’m not here to just pay tribute because I realise as well there is a particular project which is giving recognition to the importance of the professional delivery that is there. But the word professional should not ever exclude in the area of health and care. The word professional should never exclude empathy which is even more important and the relationship between human beings. When you are 73 and you look back across life and I think of all the times that the word professional has a connotation of coldness, distance, doing it ‘according to the book’; people who think of protocols and everything. Now I must ask the question, as someone who is working a campaign on ethics, I said to a group of people once – an ethicist – well you know there is a huge difference in not being caught and doing it with full human sympathy. I think that you are in the flux of things and it is of the nature that none of us are living perfect lives either and it is better in fact to sink with an imperfection that is human than to know nothing and to have achieved some kind of false perfection.
As you are, as I said, in the flux of things, that the interface between those who need care and between those who are delivering care, I think that it is very important that that be brought to the centre of things because we know with technological and scientific progress we are able to make real gains and we can reduce the necessity to attend hospitals for certain remedial or therapeutic treatments.
I think as well that those living with disabilities participating in the life of the community we should move on from the phrase ‘disability’ itself and start speaking about removing the barriers to full participation in the society through the entire life cycle and with life expectancy rising some people are now speaking about this as if – I hear some people talking about this as if – it was a great challenge. It is, of course, but there is nothing necessarily wrong with it. I am writing to ever more people on their 100th birthday. We send them the basis of at least one good night at least with their family and friends. The fact of the matter is – I keep telling people as well that Bertrand Russell didn’t begin writing the last volume of the history of modern philosophy until he was 75 which is kind of encouraging to myself!
In the changes that are taking place we have – I know many grandparents are back and are now looking after very very young children – but the structure of our economy and the connection between our economy and society meant that a great many of our young parents are spending a great deal of time in travelling. People have been moved away from multi-generational settings. They are often a very long distance from their work and this is creating its own new problems and you are dealing with it. I wish you very very well with all of that.
I also think as well that there is a need for multifaceted care options and to a healthcare professions. I do make an appeal myself as well with what I was hinting at earlier and which I want to state quite explicitly is that it is very important that those who are involved – I see very good improvements in it – but we have quite a distance to go in recognising the importance of people being able to work together and being able to recognise the particular skills at the different levels of intervention and response. We are not there yet. We are not there yet either in relation to the kind of equality that should exist in interdisciplinary exchanges nor indeed even in relation to language and we are paying a high price, far too high a price for status assertions I would call it and bureaucratic form.
I think the Institute of Community Health Nursing has, for almost thirty years, you have played a very good role in a gradual re-focussing within the health service on patient care within the community. It is a focus which centres on the need, and indeed right, of every person to live with dignity and independence, and to receive every assistance to continue to live autonomously and to actively participate in the life of their community, for as long as possible.
When I was 26 I was in America and one of the people I worked with was Professor John T. Lyle who was running a project in Chicago called ‘Links to Life’ and it really had the assumption ‘rule as you come into the world and rule as you end’ but in the great arc of – the longer you stayed and got engaged the healthier it all was. We need to rediscover this public world so that the concept of the public being able to stay in the public space for as long as possible is very very important. I think we don’t have the right to just exist or the right, slightly better, not to be forgotten. We have the right to participate for as long as possible and those who facilitate that are providing the best possible contribution in relation to, not just positive health, but also citizenship.
The work of the Institute, and of the many nurses that you represent, provides an essential service which allows so many of those affected by illness or any form of barrier that is between them and participation, or simply the ageing process to remain in their familiar settings, close to neighbours and friends, and part of a community setting whilst receiving essential medical care.
I remember a concept of the old days, of the Public Health Nurse, one of my aunts who was involved in the War and was a Lady Dudley Nurse, came back and worked in Limerick for a number of years. She died very young really due to her work in Palestine and elsewhere.
Your stated mission to “provide a professional forum for the public health nursing service, and to identify and respond to the evolving health care needs in the community, working with our members, partners and decision makers” every word in that is important and particularly the word ‘public’ because illness, care and so on are not matters of private, something private, to be purchased on the market only. When any members of our society are suffering or excluded we all suffer as a society but going back to your mission statement “provide a professional forum for the public health nursing service, and to identify and respond to the evolving health care needs in the community, working with our members, partners and decision makers”. Now working with our members, partners and decision makers in that is you are invaluable in relation to the access you have to the true experience of people scattered in the community and that should be able to flow into the decision making easily and quickly and remember the sea itself knows that the tide comes in and the tide goes out. Well information should come up from below as much as it comes down from above (applause). I think that there is an impressive range and breath to your work and the proposals outlined are very important to your work.
Today’s conference that you are having ‘Community and Public Health Nursing Matters’, is a very timely one, I think it reflects the growing role played by you in the delivery of the health services of which I have been speaking. I think in many cases it is not what you are described as that is important, I’ve said enough about it, but it’s also what you are.
It’s one thing to be described as participants in a multidisciplinary primary care team. It’s another thing to be experiencing a multidisciplinary primary care team. I wish you well in the transition from the description to the reality (applause). The form of the response you are called to do is not a reactive one but as I have seen in the projects and as you know better than me, it is the instrumental role in promoting the health promotion of the health of the well-being of the communities and facilitating people, as I have said, to remain at home. This requires flexibility, you can see things in the setting of the physical setting and you also know, need to know, about whom in fact the people that you are dealing with in turn. An assessment, and I emphasise again, an assessment that is your best shot at doing your best in the situation. But I think that by caring for people in their own home and setting, you create a relationship that has I what would call a character of mutuality. It is two human beings exchanging humanity in a particular way. That encourages in time, all my training as a sociologist tells me that, it enables when you have taken the tension out of it and removed the degree of fear as much as you can. For the people who are involved, for those to be cared for to discuss and articulate their needs. To describe what they are afraid of and everyone is afraid of something at some time, and you are giving your voice to them in that case.
I think in the history of our society, yes we needed institutional care and we provided it, and we improved it but we need more now. I think there was a time when medical treatment, I think there still is a time, when medical treatment and shelter is seen as the fulfilment of our duty but we have been challenged to focus on the needs that must be met if any society is to claim to be a truly just and inclusive one. One which is not just relegating fundamental rights such as respect, dignity and autonomy and the right to participate in society as some kind of secondary to the priorities of the economic market. We are judged by this and we will be judged by it historically. It is not a case of providing all of this when we can afford to, we have to start with it, and as I said, all of the famous phrases that I remember ‘as far as resources allow’ and so forth. Well you begin by deciding what it is that you want to do.
I think you are of enormous value to us, when I say ‘us’ I mean the people of Ireland, in implementing and giving real meaning to such things as the Charter of Fundamental Rights within the European Union, the Convention on the Rights of the Child and the Convention on the Rights of Persons with Disabilities and I think that that is very important. As well as this I want to say that historically we have had in the last couple of decades people have said “Oh, isn’t this great we’ll be able now to close down some institutions and we’ll be able to move all of the people we were caring for institutionally and with intense medical care, back into the community”. This raises challenges for the community in terms of its receptivity, it raises challenges in relation to its resources, and it raises challenges in relation to the recognition of the skills of those who will now be providing the service. It is something that has to be thought through will care. It is not something that can be done on paper and it is not something that can be done evenly in all circumstances and in all places. A long time ago in my previous life I was a member of a health board and I know what I am talking about there, I assure you. (applause)
I think that in the future of getting all of this right, and look in Ireland we are well capable of getting it all right and we will get it right but I think that the institutional community health nursing will have an important role to play.
I think in the end of the day too it is what is in one’s heart as what in one’s head is important and to have a generous instinct to reach out to others. We are all in the end, migrants in time. I think to be able to reach out and respond, to celebrate and also to get energy from the fact of sharing and recognising the dignity of other people is incredibly important.
You have had a long and distinguished history of support in community and public health and also in professional development and I think that the conference you are having today is a very valuable way of accessing current information and I think that that is very very important. I think you have a very busy programme and I mustn’t take up much more of your time. I think that as well that as that something that’s very important – I think that we could be conferenced to death in our lives and I think that it is important equally to have the informal exchange of information. The wisdom, and there is a difference between information, knowledge and wisdom and I think that in relation to that I have been able to change experiences to be able to offer encouragement, to think of new strategies. I think that that is very very important. That is part of your own professional development as well because true professional people do a great deal more listening than they do in fact on their electronic systems.
I want to wish you well, mar Uachtaráin na hEireann, as President of Ireland. I want to thank you for all the work you have been doing and for all the work you will do in the future.
Gabhaim buíochas ó chroí libh as ucht an chaoi a bhfuil sibh ag teacht i gcúnamh ar mhuintir na hÉireann agus guím gach rath agus beannacht oraibh don todhchaí agus don uile rud a bheidh ar siúl agaibh, go háirithe dóibh siúd atá lag in aon chaoi ar fud oileáin seo.
[I sincerely thank you for the manner in which you come to the aid of the people of Ireland and I wish you every success and blessing for the future and for all of your undertakings, especially for those people who are weak or vulnerable throughout this island.]
So I will you well in everything you do in the future and thank you for asking me to be here at your conference today.
Go raibh maith agaibh.