Speech by Mr. Micheál Martin TD – Meeting The Challenges Of Cultural Diversity In The Irish Healthcare Sector

It gives me great pleasure to accept the invitation to address this conference on “Meeting the Challenges of Cultural Diversity in the Irish Healthcare Sector” which is being organised by the Irish Health Services Management Institute in partnership with the National Consultative Committee on Racism and Interculturalism. The conference provides an important opportunity to develop our knowledge and understanding of the issues surrounding cultural diversity in the health sector from the twin perspectives of patients and staff. Cultural diversity has over recent years become an increasingly visible aspect of Irish society bringing with it both opportunities and challenges. It holds out great possibilities for the enrichment of all who live in Ireland but it also challenges us to adapt creatively to the changes required to realise this potential and to ensure that the experience is a positive one for all concerned but particularly for those in the minority ethnic groups. In the last number of years in particular, the focus has tended to be on people coming to this country either as refugees, asylum seekers or economic migrants. Government figures estimate that as many as 340,000 immigrants are expected in the next six years. However ethnic and cultural diversity are not new phenomena in Ireland. Travellers have a long history as an indigenous minority group in Ireland with a strong culture and identity of their own. The changing experience and dynamics of their relationship with the wider society and its institutions over time can, I think, provide some valuable lessons for us as we seek to address the more numerous and complex issues of cultural diversity which have arisen for us in the last decade. Turning more specifically to the health sector which is the focus of this conference, culture and identity have particular relevance to health service policy and provision in that The first requirement is that we in the health service acknowledge cultural diversity and the differences in behaviours and in the less obvious areas of values and beliefs that this often implies. Only by acknowledging these differences in a respectful way and informing ourselves of them can we address them. Our equality legislation – The Employment Equality Act, 1998 and the Equal Status Act, 2000 – prohibits discrimination on nine grounds including race and membership of the Traveller community. The Equal Status Act prohibits discrimination on an individual basis in relation to the nine grounds while for groups it provides for the promotion of equality of opportunity. The Act applies to the provision of services including health services. I will speak first about cultural diversity in relation to the patient. In this respect it is worth mentioning that the recognition of cultural diversity and appropriate responses to it were issues which were strongly emphasised in the public consultation process which we held earlier this year in the context of developing National Anti-Poverty targets for the health sector and also our new national health strategy. Awareness and sensitivity training for staff is a key requirement for adapting to a culturally diverse patient population. The focus of this training should be the development of the knowledge and skills to provide services sensitive to cultural diversity. Such training can often be most effectively delivered in partnership with members of the minority groups themselves. I am aware that the Traveller community, for example, is involved in in-service training for health care workers. I am also aware that the National Consultative Committee on Racism and Interculturalism has been involved in training with the Eastern Regional Health Authority. We need to have more such initiatives. A step beyond the sensitivity training for existing staff is the training of members of the minority communities themselves as workers in our health services. Again the Traveller community has set an example in this area with its Primary Health Care Project for Travellers. The Primary Health Care for Travellers Project was established in 1994 as a joint partnership initiative with the Eastern Health Board and Pavee Point, with ongoing technical assistance being provided from the Department of Community Health and General Practice, Trinity College, Dublin. This project was the first of its kind in the country and has facilitated The project included a training course which concentrated on skills development, capacity building and the empowerment of Travellers. This confidence and skill allowed the Community Health Workers to go out and conduct a baseline survey to identify and articulate Travellers’ health needs. This was the first time that Travellers were involved in this process; in the past their needs were assumed. The results of the survey were fed back to the community and they prioritised their needs and suggested changes to the health services which would facilitate their access and utilisation. Ongoing monitoring and data collection demonstrates a big improvement in levels of satisfaction and uptake and ulitisation of health services by Travellers in the pilot area. This Primary Health Care for Travellers initiative is being replicated in three other areas around the country and funding has been approved for a further 9 new projects. This pilot project was the recipient of a WHO 50th anniversary commemorative award in 1998. The project is developing as a model of good practice which could inspire further initiatives of this type for other minority groups. Access to information has been identified in numerous consultative processes as a key factor in enabling people to take a proactive approach to managing their own health and that of their families and in facilitating their access to health services. Honouring our commitment to equity in these areas requires that information is provided in culturally appropriate formats. The National Health Promotion Strategy 2000-2005, for example, recognises that there exists within our society many groups with different requirements which need to be identified and accommodated when planning and implementing health promotion interventions. These groups include Travellers, refugees and asylum seekers, people with intellectual, physical or sensory disability and the gay and lesbian community. The Strategy acknowledges the challenge involved in being sensitive to the potential differences in patterns of poor health among these different groups. The Strategic aim is to promote the physical, mental and social well-being of individuals from these groups. The objective of the Strategy on these issues are: While our long term aim may be to mainstream responses so that our health services is truly multicultural, we must recognise the need at this point in time for very specific focused responses particularly for groups with poor health status such as Travellers and also for refugees and asylum seekers. In the case of refugees and asylum seekers examples of targeted services are screening for communicable diseases – offered on a voluntary basis – and psychological support services for those who have suffered trauma before coming here. The two approaches of targeting and mainstreaming are not mutually exclusive. A combination of both is required at this point in time but the balance between them must be kept under constant review in the light of changing needs. A major requirement if we are to meet the challenge of cultural diversity is an appropriate data and research base. I think it is important that we build up our information and research data base in partnership with the minority groups themselves. We must establish what the health needs of diverse groups are; we must monitor uptake of services and how well we are responding to needs and we must monitor outcomes and health status. We must also examine the impact of the policies in other sectors on the health of minority groups. The National Health Information Strategy, currently being developed, and the recently published National Strategy for Health Research – Making Knowledge Work for Health provide important frameworks within which we can improve our data and research base. A culturally diverse health sector workforce – challenges and opportunities The Irish health service can benefit greatly from successful international recruitment. There has been a strong non-national representation amongst the medical profession for more than 30 years. More recently there have been significant increases in other categories of health service workers from overseas. The Department recognises the enormous value that overseas recruitment brings over a wide range of services and supports the development of effective and appropriate recruitment strategies in partnership with health service employers. These changes have made cultural diversity an important issue for all health service organisations. Diversity in the workplace is primarily about creating a culture that seeks, respects, values and harnesses difference. This includes all the differences that when added together make each person unique. So instead of the focus being on particular groups, diversity is about all of us. Change is not about helping “them” to join “us” but about critically looking at “us” and rooting out all aspects of our culture that inappropriately exclude people and prevent us from being inclusive in the way we relate to employees, potential employees and clients of the health service. International recruitment benefits consumers, Irish employees and the overseas personnel alike. Regardless of whether they are employed by the health service, members of minority groups will be clients of our service and consequently we need to be flexible in order to accommodate different cultural needs. For staff, we recognise that coming from other cultures can be a difficult transition. Consequently health service employers have made strong efforts to assist them during this period. Many organisations provide induction courses, religious facilities (such as prayer rooms) and help in finding suitable accommodation. The Health Service Employers Agency (HSEA) is developing an equal opportunities/diversity strategy and action plans as well as training programmes to support their implementation, to ensure that all health service employment policies and practices promote the equality/diversity agenda to continue the development of a culturally diverse health service. The management of this new environment is extremely important for the health service as it offers an opportunity to go beyond set legal requirements and to strive for an acceptance and nurturing of cultural differences. Workforce cultural diversity affords us the opportunity to learn from the working practices and perspectives of others by allowing personnel to present their ideas and experience through teamwork, partnership structures and other appropriate fora, leading to further improvement in the services we provide. It is important to ensure that both personnel units and line managers communicate directly with their staff and demonstrate by their actions that they intend to create an inclusive work place which doesn´t demand that minority staff fit. Contented, valued employees who feel that there is a place for them in the organisation will deliver a high quality health service. Your conference here today has two laudable aims – to heighten awareness and assist health care staff to work effectively with their colleagues from different cultural backgrounds and to gain a greater understanding of the diverse needs of patients from minority ethnic backgrounds. There is a synergy in these aims and in the tasks to which they give rise in the management of our health service. The creative adaptations required for one have the potential to feed into the other. I would like to commend both organisations which are hosting this conference for their initiative in making this event happen, particularly at this time – Racism in the Workplace Week. I look forward very much to hearing the outcome of your deliberations. Thank you.

An empirical study of the effectiveness of Irish banks’ lending regulations

The objective of this thesis will be to examine the effectiveness of lending regulations for Irish banks both prior to and after the collapse of the banking sector. The research developed a profile of the banking sector in Ireland, then evaluate the levels of stability in the Irish banking sector. In the course of this research, the author tried to establish an understanding of who is responsible for lending regulations for banks in Ireland, Investigate in particular: AIB, Ulster Bank & Anglo Irish Bank’s level of compliance with lending regulations between the Celtic Tiger and the present.

A crise bancária irlandesa de 2008-2011

A Irlanda é um país que décadas anteriores chegou a ser chamado de “O Tigre Celta”, devido a seu crescimento econômico expressivo. Após a crise financeira mundial e a ruptura de uma bolha imobiliária, entrou em grande recessão, com um sistema bancário insolvente, a ponto da necessidade de intervenção de organizações financeiras mundiais. Este trabalho tem como objetivo analisar a crise do setor bancário irlandês de 2008 a 2011. A dissertação analisa a origem da crise, os métodos de solução e seu custo social.

SCM key to competitiveness

Any meaningful attempt to eliminate waste and improve cost competitiveness in the Irish packaging sector must have a strong focus on how the supply chain is designed and managed.

Outsourcing in Ireland:a literature review, survey and case study perspective

Outsourcing, or offshoring as it is now known, has been around for many decades. In the beginning it was only the very peripheral activities that were blue-collar (lower skilled) work outsourced, but this is now all changing with the outsourcing of white-collar jobs. Historically outsourcing was used when organisation could not perform to world-class excellence in all sectors of the organisation due to incompetence of staff and/or management, lack of capacity, financial pressures, and/or technological pressures. The research currently underway is initially focusing on a literature review of current outsourcing applications in the market place and what impact outsourcing has on business performance. This paper will present the findings of the initial literature review. It will also discuss the methodology being followed to explore the Irish Industrial Sector.

Within-role, extra-role and anti-role behaviours in retail banking

Purpose: This paper aims to explore front line employee performance in retail banking and presents distinct components of employee performance, including extra-role and sabotage behaviours. Design/methodology/approach: Data was collected from Irish bank employees. Usable responses were received from 404 respondents and subjected to exploratory factor analysis. Structural Equation Modeling (SEM) was used to undertake a confirmatory factor analysis of the emergent five-factor model. Findings: Results indicate front line employee performance is multi-faceted and comprised of civility, assurance and reliability, customer orientation, as well as extra-role behaviour and anti-role behaviour, or sabotage. Research limitations/implications: This exploratory study focuses on the Irish banking sector. To explore the generalisabilty of results, replication studies among other samples of branch banking employees in other countries are in order. Moreover, our survey is limited to the views of branch employees. We advocate research among bank managers and customers to triangulate potentially divergent views about performance. Practical implications: Findings have implications for recruitment, training and rewards. To ensure new hires are service minded, managers must consider their potential for extra-role or sabotage behaviour. Employees who demonstrate extra-role behaviours must be rewarded to encourage the adoption of such behaviours. Managers must also seek to minimise job stress in order to curtail anti-role behaviours. Originality/value: This paper offers insights into employees' views about their own performance at the front line. It extends the conceptualisation of service quality, by considering extra-role behaviour and sabotage as components of employee performance. © Emerald Group Publishing Limited.

Economic impacts of seafood production growth targets in Ireland

This paper examines the potential economic impact of the Irish government strategy for the development of the seafood sector in Ireland, Food Harvest 2020 (FH2020). The seafood industry accounts for a large proportion of income and employment in peripheral coastal areas. Many of these regions are predominantly rural and they are largely dependent on the primary fisheries sector. Moreover, the services and retail businesses in these areas are heavily dependent on direct spending from the fisheries, aquaculture and seafood processing sectors. A social accounting matrix (SAM) approach with (1) set to zero purchase coefficients for all directly impacted industries and (2) changes in output converted to final demand shocks is used to calculate the economic and employment impact on the rest of the economy from an increase in the output in the fisheries, aquaculture and seafood processing sectors in Ireland. The results suggest fisheries sectors have strong links with the rest of the economy hence an important economic impact from a policy perspective.

Samuel Beckett, the Gate Theatre Dublin, and the contemporary Irish independent theater sector: fragments of performance history

From 1991, when the Dublin Gate Theatre launched their Samuel Beckett Festival featuring nineteen of Beckett’s stage plays, to more recent years, the Gate dominated Irish productions of Beckett’s theater. The Gate Beckett Festival was remounted in 1996 at the Lincoln Center, New York, and at the Barbican Centre, London, in 1999, and individual or grouped productions have toured regularly since then in Ireland and internationally. However, since the Irish premiere of Waiting of Godot at the Pike Theatre in 1955, in addition to several Beckett plays mounted by the National Theatre, many independent Irish theater companies, such as Focus Theatre, Druid Theatre, and more recently Pan Pan Theatre, Blue Raincoat Theatre, The Corn Exchange, and Company SJ (under director Sarah Jane Scaife), have produced Beckett’s drama. While acknowledging earlier Irish productions, this essay will consider the role of the Dublin Gate Beckett Festival and the Beckett Centenary celebrations in Dublin in 2006 in greatly enhancing the marketability of Beckett’s work, and will discuss the proliferation of productions of Beckett’s stage plays (as opposed to stage adaptations of the prose work, which is a topic for another essay) in the independent theater sector in the Republic of Ireland since 2006. In addition to giving an overview of these recent productions, the essay will consider some issues at stake in creating or constructing performance histories

Evaluating the additionality of public sector assistance to Irish firms: a question of ownership?

This article presents an innovative approach to estimating the additionality of financial assistance awarded to firms by an Irish regional development agency. The 'self assessment approach' is used to derive estimates of deadweight and displacement for firms in the Shannon region of Ireland. Irish studies have derived high estimates of deadweight by international standards. In light of this, and the fact that successive Irish governments have placed emphasis on Foreign Direct Investment as an engine for growth, the primary objective here is to address the question of whether the type of firm ownership matters with respect to resulting deadweight and/or displacement estimates. The latter question is addressed using logistic regression analysis to test whether, ceteris paribus, firm ownership is a key-determining factor for estimates of deadweight and/or displacement. The results show that ownership does not matter in the case of deadweight, but regarding displacement there are differences between indigenous and foreign-owned firms albeit at very low levels. More precisely, as expected, indigenously owned firms are more likely to lead to higher estimates of displacement.

Training and development in Irish technology companies

The sustained economic growth that has been experienced in the Irish economy in recent years has relied, to a large extent, on the contribution and performance of those industry sectors that possess the ability to provide high-value-added products and services to domestic and international markets. One such contributor has been the Technology sector. However, the performance of this sector relies upon the availability of the necessary capabilities and competencies for Technology companies to remain competitive. The Expert Group on Future Skills Needs have forecasted future skills shortages in this sector. The purpose of this research has been to examine the extent to which Irish Technology companies are taking measures to meet changing skills requirements, through training and development interventions. Survey research methods (in the form of a mail questionnaire, supported by a Web-based questionnaire) have been used to collect information on the expenditure on, and approach to, training and development in these companies, in addition to the methods, techniques and tools/aids that are used to support the delivery of these activities. The contribution of Government intervention has also been examined. The conclusions have been varied. When the activities of the responding companies are considered in isolation, the picture to emerge is primarily positive. Although the expenditure on training and development is slightly lower than that indicated in previous studies, the results vary by company size. Technical employees are clearly the key focus of training provision, while Senior Managers and Directors, Clerical and Administrative staff and Manual workers are a great deal more neglected in training provision. Expenditure on, and use of, computer-based training methods is high, as is the use of most of the specified techniques for facilitating learning. However, when one considers the extent to which external support (in the form of Government interventions and cooperation with other companies and with education and training providers) is integrated into the overall training practices of these companies, significant gaps in practice are identified. The thesis concludes by providing a framework to guide future training and development practices in the Technology sector.

Age, growth and reproductive biology of Plaice, (Pleuronectes platessa L.) in Irish waters, 2003-2005

The current study presents data on age and growth for plaice (Pleuronectes platessa L.) sampled between November 2003 and February 2005 in ICES areas Via (northwest coast of Ireland), Vila (Irish Sea), Vllg (Celtic Sea), VDj (southwest coast of Ireland) and VHb (west coast of Ireland), and data on the reproductive biology and maturity of plaice in ICES area Vllb (west coast of Ireland). This is the first detailed account of the biology of plaice for some of these areas. It is intended that this study will improve understanding of the life cycle of plaice and help fisheries scientists to better predict the effect of fishing effort on Irish plaice stocks. The overall length range found for plaice was 9-51.99cm TL, with a length range of 9-5 lcm TL for females and 9-40cm for males. In all ICES areas the length range for female fish was larger than for male fish. The age range of plaice sampled during this study was 1 to 16 years. In all ICES areas females had a greater range in ages and fish in the larger age groups. From analysis of length and age data it was concluded that there was a significant difference (P=0.000) in growth rate of males and females between ICES areas sampled in March 2004. The highest rate of fishing mortality was determined for ICES area Via (F=1.06) and the lowest for ICES area Vila (F=0.56). In each ICES area male and female plaice have fully recruited to the population by age 4, with the exception of females in ICES area Via, for which a tr value of 5 years was determined. Length at first maturity (L50%) was determined to be 23cm and 21cm for males and females respectively. Age at first maturity (A50%) was determined to be 3 years for both males and females. It was found that males and females in ICES areas Vllb, Vila and Via are well above the length and age at first maturity when they are recruited to the fishery. In ICES area Vllb female plaice spawn from November to March, with peak spawning occurring in February, and male plaice spawn from November to April, with peak spawning occurring in November. Spawning females had an age range of 2 to 10 years and spawning males had an age range of 2 to 7 years. From the oocyte length frequency distributions, it was determined that the plaice is a determinate batch spawner. During this investigation a total of 177 ovaries and 127 testes were staged using both macroscopic and histological criteria. The overall percentage of maturity stages which compared favorably between the two assessment methods was 22.03% for female plaice and 37.80% for male plaice. In general, the findings of this study indicate that there was a very poor match between the macroscopic and histological assessment methods. Given that the histological determination of these stages is based on the observation of a distinct set of developmental features, it is expected that it would be more accurate to use histologically assessed gonads to calculate the annual percentage maturity assessment. The biology of plaice in the areas studied is compared with previous studies of plaice in Irish and European waters.

“Policy Scepticism” and the Impact of Northern Irish Higher Education Institutions (HEIs) on their Host Region: Accounting for Regional Budget Constraints

This paper replicates the analysis of Scottish HEIs in Hermannsson et al (2010b) for the case of Northern Ireland. The motivation is to provide a self-contained analysis that is readily accessible by those whose primary concern is with the regional impacts of Northern Irish HEIs. A comparative analysis will follow in due course. A “policy scepticism” has emerged that challenges the results of conventional regional HEI impact analyses. This denial of the importance of the expenditure impacts of HEIs appears to be based on a belief in either a binding regional resource constraint or a regional public sector budget constraint. In this paper we provide a systematic critique of this policy scepticism. However, while rejecting the extreme form of policy scepticism, we argue that it is crucial to recognise the importance of the public sector expenditure constraints that are binding under devolution. We show how conventional impact analyses can be augmented to accommodate regional public sector budget constraints. While our results suggest that conventional impact studies overestimate the expenditure impacts of HEIs, they also demonstrate that the policy scepticism that treats these expenditure effects as irrelevant neglects some key aspects of HEIs, in particular their export intensity.

Regulatory Reform of the International Education Sector and the Student Immigration Regime

Ireland has a strong reputation for delivery of high-quality education services both to our own citizens and those who come here from abroad. A degree from an Irish university, Institute of Technology or high-quality private sector provider is an indicator of significant educational achievement, highly valued by our students and employers alike. Ireland is also a specialist in high-quality English Language tuition. Many thousands of students from the EU and around the world come to Ireland for full-time or short-term programmes.