I move that the Bill be now read a Second Time.
The Nurses Act, 1950, replaced earlier legislation dealing with the training and registration of nurses and midwives and established a new body, An Bord Altranais, to take over the functions of the former General Nursing Council and the Central Midwives Board. The object of the present Bill is merely to make some changes in the 1950 Act which time has shown to be necessary or desirable.
The Bill, made up as it is of a number of miscellaneous provisions, is essentially one to receive greater attention at the Committee Stages than at this stage. I think it will be adequate at present if I refer briefly to the provisions of the Bill and indicate the reasons why each of them has been included.
As stated in the explanatory memorandum circulated with the text, Section 2 is designed merely to clear up a doubt. When An Bord Altranais, in exercise of its powers under the 1950 Act, proceeded to draw up rules for the election of nurses to the Board, it did so on the basis of separate electorates for the different types of nurses. Thus, the draft rules provided that the midwives would elect the midwife members of the Board, the mental nurses would elect the mental nurse members and the general nurses the general nurse members, an arrangement which, I think the House will agree, was a perfectly reasonable one. The draft rules incorporating this system of separate electorates were approved by the Minister in 1953 and have operated since. However, doubts have been expressed as to whether a division of the electorate in the manner provided for in the Nurses Rules was covered by the 1950 Act. What we are doing now is to put the matter beyond doubt and so make it clear that the Nurses Rules of 1953 are in order.
Section 3 of the Bill will extend the Board's power to pay travelling expenses to its members so as to cover instances where they travel, on the Board's business, otherwise than to meetings of the Board and its Committees. Members of the Board, for instance, may have to visit hospitals which have applied for recognition as training institutions. It is, of course, proper that travelling and subsistence expenses should be payable on such occasions. The Section will remedy the oversight in the 1950 Act.
Sections 4 and 5 of the Bill are complementary.
On receipt of the audited accounts of the Board for any year, the Minister is required by Section 59 of the Act to pay over to the Board the ascertained revenue deficit for that year. Having paid over this sum, he collects back from health authorities under Section 60 half the amount. In practice, what happens is that the deficit in respect of a particular year is not recouped to the Board until twelve months after the end of that year, the Board working on overdraft in the meantime. The health authorities' share of that amount is not apportioned, collected and brought to account until the next financial year. There is, thus, a three-year cycle in respect of each year's accounts of the Board.
These arrangements, I think, are unsatisfactory in two respects—the Board has to wait for its money for over a year after the deficit has occurred and the final completion of the transaction is unnecessarily long drawn out. The existing provisions, however, are unsatisfactory in a much more important respect. They impose on the Exchequer and on health authorities an obligation to meet the deficits without giving the Minister an adequate say in the management of the Board's financial affairs.
The existing Act gives the Minister a certain measure of control in this respect. Section 61 requires the Board to submit to the Minister estimates of expenditure which may not be exceeded without his consent. Other sections require his approval to the number and remuneration of staff, the fees to be paid to examiners for their services, the travelling expenses to be paid to members and so on. All these controls, such as they are, are on the expenditure side of the account; there are no controls on the revenue side of the account.
The new procedure will provide for an annual grant to be fixed each year in consultation between the Board, the Minister and the Minister for Finance and when the grant has been fixed it will be a matter for the Board to keep its revenue accounts in balance in much the same way as the Voluntary Health Insurance Board, for instance, which gets no State grant, is required to keep its account in balance. So far as the cost to the Exchequer and to the health authorities is concerned, the new procedure will make no significant difference. This is not a device to save money for either. What will be achieved is that there will be an end to a procedure, highly objectionable in principle, under which a body created by the Oireachtas and not subject to the normal financial controls is in a position to decide for itself the size of the bill it will present, through the Minister, to the House and the local authorities for automatic payment.
Section 6 of the Bill, as explained in the explanatory memorandum, is introduced as a logical carollary of a provision in the 1950 Act. That Act made specific provision for the contingency that the Board might fail to perform any of its functions. In such an eventuality, Section 23 of the Act empowers the Minister, by order, to require the Board to perform that function. It goes further however and authorises the Minister, if the Board persisted in its failure, to remove the members from office and, further, to appoint a person or persons to discharge the functions of the Board. By a curious oversight, however, while the Act gave the Minister these rather drastic powers, it did not provide him with the means of satisfying himself whether, in fact, the Board is performing its functions. The obligation now being placed on the Board by Section 6 of the Bill to supply the Minister with information, on request, is a usual one in the case of bodies established by statute for special purposes. While I think it essential that the Board should be under a statutory obligation to furnish the Minister with such information as he requires, it is only right to say that at no time has the Board refused to give or been dilatory in giving information when required.
Section 7 of the Bill relates to the method of appointment and term of office of the President. Under the 1950 Act, the members of the Board each year elect one of themselves to act as President. The Oireachtas has by legislation created a considerable number of special bodies to which I have already referred for special purposes, industrial, commercial or, like An Bord Altranais, regulatory of a particular branch of the national life. In some cases the chairman or president is appointed by the Government or by the appropriate Minister. In other cases he is elected by the members of the body. I have been unable to trace any logical pattern in the whole procedure. I feel that, having regard to the purpose for which An Bord Altranais was established by the Oireachtas, its responsibility to the Minister for the performance of its functions and the manner in which it is financed, the appointment should be made by the Minister. I feel, too, that it is a bad principle to rotate the office of President during the five year lifetime of any particular Board and that, on the contrary, there is considerable advantage in appointing a particular person to be President each time a new Board takes office and in his continuing in office until the next Board takes over. In fact, this is what already happens under the 1950 Act in relation to the Chairmanship of the statutory Midwives Committee of the, Board. Section 33 provides that the Chairman during the entire lifetime of the Committee shall be the person appointed to the Board by the Minister under a particular head. In more recent times, the Opticians Act, 1956, and the Voluntary Health Insurance Act, 1957, provide that the President of Bord na Radharcmhastóirí and the Chairman of the Voluntary Health Insurance Board shall be appointed by the Minister for Health.
It is proposed, therefore, under Section 7 of the Bill, that future Presidents of the Board will be appointed by the Minister and that the President's term of office will normally coincide with that of the Board itself. The present President of the Board, whose term of office would normally end next January, will, by virtue of subsection (6) of the section, continue to hold the office for the term unexpired of the life of the present Board—the balance of the five-year term.
Section 8 merely removes an obligation on the part of An Bord Altranais to provide for the issue of special badges to all midwives. Most midwives are now general trained nurses who are already provided with a badge. As stated in the Explanatory Memorandum circulated with the Bill, under the new dispensation the Board, while relieved of the statutory obligation, will be in a position to provide such badges as they consider necessary for practising midwives in addition to the nurses' badge which they now issue.