Dáil Éireann debate -
Wednesday, 28 Nov 1984

Vol. 354 No. 5

Nurses Bill, 1984: Committee Stage (Resumed).

SECTION 9.

Debate resumed on amendment No. 2.

In page 8, subsection (1), to delete lines 34 and 41 and in page 9, to delete lines 1 to 5 and substitute the following:—

"(c) ten nurses resident in the State who are engaged in clinical nursing practice of whom—

(i) two shall represent nurses who are engaged in clinical nursing practice in general nursing,

(ii) two shall represent nurses who are engaged in clinical practice in psychiatric nursing,

(iii) two shall represent nurses who are engaged in clinical practice in midwifery,

(iv) two shall represent nurses who are engaged in clinical practice in public health nursing, and

(v) two shall represent nurses who are engaged in clinical practice in the nursing of mentally handicapped persons,".

—(Deputy Mac Giolla).

Minister for Health (Mr. B. Desmond)

I regret I cannot accept the amendment proposed by Deputies Mac Giolla or De Rossa or the amendment proposed by Deputy O'Hanlon and I should like to explain why. There are three points I should like to make in regard to the composition of the clinical panel. Bord Altranais is not a management body. There is a widespread impression that it manages on a service type of basis the nursing profession. It is a regulatory body and there is a profound difference. In simple terms, it will be responsible for the education and training of nurses and ensuring that that is suitable. It will also be responsible for maintaining discipline in the profession and it will decide on matters of great importance to the community and the profession. For example, it will decide the circumstances in which nurses should be removed from the nursing register and the circumstances in which removal would be warranted.

These matters involve working nurses in the clinical area. We cannot have on a body essentially charged with education, training and discipline a dilution of those involved on the tutorial side and a dilution of those involved on the administrative side. In effect representations I have received have proposed that arising from a fundamental misconception about the Bill. If, for example, it was a joint industrial council it would have an equal number of employer and worker representatives. The Labour Court would have that type of representation but this is not that type of body. It is a self-regulatory body on behalf of the profession. That is why I believe it would be taking a negative and narrow view if we were to exclude the three doctors out of 28 members on the board. It is my view that three is the minimum we should have on the board.

On the board at present there are six doctors. The working party recommended four doctors but I have reduced that to three. It is essential to have on the board a minimum of one general doctor for the training school, one doctor from the psychiatric training school and one doctor from the obstetric training side of the profession. It would be irresponsible of me to suggest that midwives or psychiatric or general nurses can be trained in the absence of any input from the medical side. I reject the amendment because it arises from a narrow professional reaction, particularly from some trade union reaction which is wholly inconsistent. The trade union officers on the working party contributed at great length to this working party report. That working party was set up by my predecessor Deputy Brendan Corish. I have incorporated about 40 per cent of the recommendations in their report into this Bill.

As regards membership, Mr. Edward Brown was appointed in January 1977, and this Bill has been gestating in the Department of Health for almost a decade. I regret to say my predecessor's report was in March 1980 and this is 1984. Ministers for Health were so busy issuing toothbrushes and visiting old folks parties, getting their photographs taken——

Mr. D. Gallagher

We did a far better job than the Coalition.

Mrs. O'Rourke

The Coalition have been in power for two years.

Mr. D. Gallagher

You are a disgrace.

Mr. B. Desmond

They were so busy doing the PR work for their party that they could not deal with fundamental legislation.

I accept that Deputy O'Hanlon is a serious colleague but some of his predecessors did not even try to do the work for which they were appointed, namely, to improve the legislative framework of the various professions, nursing, paramedical and so on. As I said among the membership were Mr. Edward Brown, National Group Secretary ITGWU, Mr. Fergus Finlay, Secretary, National Hospitals Branch, Workers' Union of Ireland, Mr. Phil Flynn, Deputy General Secretary, Local Government and Public Services Union, and they all signed this report. They wanted four doctors and I put in three, half the number on the present board.

There was a very distinguished panel of nurses and matrons, for example, Sister John Berchmans Matron, Mater Hospital, Sister Francis Joseph, Secretary/Manager, St. Vincent's Hospital, Miss E. O'Dwyer, Matron, Meath Hospital and so on. All their recommendations regarding ethical practices are in the Bill. Some people are so preoccupied with B. Desmond that they want these points out. This is the kind of nonsense one gets in this country because people cannot disentangle legislation from personalities. This has been the curse of this country.

I suggest that section 9 is reasonably well framed. I have met all the trade unions — ITGWU, FWUI, the Local Government and Public Services Union, the Irish Nurses' Organisation, the Matron's Association and I had a number of meetings with Government Deputies and Senators.

The only possible change I could contemplate is as follows and it may allay fears and improve the position. In this Bill it is provided that on the board there will be five nurses engaged in training, five engaged in nursing administration and five engaged in clinical nursing practice — admittedly the majority of nurses are engaged in the general and psychiatric nursing. We have one representative engaged in general nursing administration, one on the psychiatric side, one engaged in midwifery, and one engaged in public health nursing and one engaged in the administration of nursing of mentally handicapped persons. I would be prepared to increase the representation on the general nursing side from one to two, and on the psychiatric nursing side from one to two but I would not be prepared to go beyond that because it would unduly enlarge An Bord Altranais which is big enough already, having 27 members compared with 23 on the existing board. On that basis I can bring in an amendment.

I am aware of the points made by Deputies. I may drop the proposal that one of my nominees should be a nurse. I am dealing now with section 9(1)(d) where I may appoint 12 persons. After the elections are over it may be that on a geographical basis one part of the country does not have a nurse elected to the board. For example, it may be that of the 15 nurses elected all may come from the general nursing and psychiatric nursing areas. It could happen that nurses of outstanding competence in particular specialities, for example geriatrics, may not be represented on the board and it would be difficult for the board to cater for the education and training of particular nursing specialities. I want as broad a representation on the board as possible.

There is provision in the Bill for the appointment of two members from the Department of Health. Some people regard that as a creeping encroachment of the State on this wonderful independent profession, which is paid for by the State. That is absolute nonsense. As I said I hope one of my nominees will have a nursing background — there is nothing unusual about that because it is very essential if the Department are to have an input into the development of the profession — and the second person to be appointed will probably be on the general side.

It has been suggested that I should delete one of the third level educational establishments. I am a member of a trade union and I find it incomprehensible that such a suggestion should be made. If nurses are to have graduate training, if they are to be trained in colleges and come out with third level academic qualifications, there should be at least one person representing the nurse training colleges, the Royal College of Surgeons and UCD, in other words, the third level educational establishments involved in the education of nurses. I have no intention of changing that.

Under paragraph (d) one person will represent the management of health boards — that is reasonable — and one person will represent the management of hospitals. When appointing these representatives I will be writing to the professional bodies asking them to send me the name of a person from that speciality. I will not do what Deputy Haughey did when making various appointments. He asked for three names and then on the examination of their credentials one would be appointed.

Mrs. O'Rourke

The Minister will make sure the first time.

Mr. B. Desmond

I do not propose to do that. For example, I will write to the medical profession catering for the psychiatric side and ask for a nomination——

Mr. N. Treacy

They will be selected at the Minister's direction.

Mr. B. Desmond

I will not indulge in that type of political chicanery. The president of An Bord Altranais will be elected by the board. I have changed all that. Under the current Act I appoint the president. I wish to divest myself of that responsibility although I do not apologise for appointing Sister Columba as president of the present board. That is the privilege of the Minister of the day. However, under the new Act, the president of the board will be elected directly by the profession at their first meeting. These are changes in the best interest of the profession.

I do not know what misgivings or fears people have in regard to the new board. Most fears have been stirred up by people who are unused to going through legislation. Lawyers have advised religious orders that I am up to something and that, if they do not keep an eye on me, I will be running voluntary hospitals. They say that as I am paying 98 per cent of the cost of running the hospital I am now going to decide on ethics regarding nurses, despite the fact that most of the hospitals do not have ethical guidelines. Many of them are so badly run they do not have those guidelines which is an interesting feature in terms of hospitals.

I, therefore, am quite confident that the changes I suggested will be acceptable and balanced and will advance the best interests of the profession. Deputy O'Hanlon asked me about clarification in terms of a definition of nursing administration. It would be reasonable to regard these as from ward sister upwards. In the public health field it will refer to senior public health nurses and superintendent public health nurses who will be regarded as being in the administrative structure. That is the board classification which will come under the rules of appointment.

I regret that I do not see a necessity to accept amendment No. 3 in the name of Deputy O'Hanlon. While I fully appreciate the point he is making, I have received legal advice to the effect that the definition of a nurse as contained in section 2 obviates the necessity to amend this reference. The definition is that "nurse" means a woman or a man whose name is entered in the register and includes a midwife and "nursing" includes "midwifery". I expect that the rules to be drawn up by the board will specify the qualifications required of candidates for election in this group and, therefore, for that person a midwifery qualification would be specified. I have been in consultation with the parliamentary draftsman and the legal adviser of my Department. I accept their advice in that regard and I do not see the necessity to accept the amendment.

I am sure that many points will be raised but I am satisfied that the composition of the board is the best and most representative which can be put together within the constraints of keeping their size to manageable proportions. I hope I have met the points raised so far and on Report Stage I propose to introduce amendments with the agreement of the House.

Mr. Tunney

We all admire the Minister because he is a courageous man who says what he thinks. I take him at his word but I take issue with him when he says that to date there have not been any ethical guidelines in our hospitals——

Mr. B. Desmond

I said that many of the hospitals had no guidelines.

Mr. Tunney

The Minister is refining what he said. As they say in Irish "Do lig tú an cat as an mála". Hospitals have excellent ethical standards. Does the Minister intend to impose his standards on them? Obviously he must because the surest way of justifying his action is to establish the need for it. In all fairness, he will have to probe the matter much further.

The Minister normally claims to be a democrat but he is very dismissive of the representatives of this House when he chastised me and other Members for not accepting the recommendations of a working party who are not answerable to the public as we are. I do not feel obliged at any time to accept the directions of anybody other than myself in my interpretation of the wishes of the people who send me here, qualified by what I think is appropriate for me to do on their behalf.

Tomás Mac Giolla

What about the Whips?

Mr. Tunney

The Whips do not enter into it. Maybe conscience makes a coward of Deputy Mac Giolla in respect of the Whips to whom he is answerable. On the surface it appears to refer to the establishment of another board, but when you relate it to the function of this board, section 52(2) says that it will be a function to give guidance to the nursing profession generally on all matters relating to ethical conduct and behaviour. The Minister says that in many cases there have been no standards to date. Unless he can demonstrate to me how the establishment of this board will improve the existing ethical standards, I cannot accept section 9.

All legislation should be about fulfilling a need or improving a service which already exists. The Minister has advised the House that in the opinion of his advisers there is a need to create something that does not exist. My fears are that the purpose of this legislation is to destroy what already exists and is acceptable. I am not dealing exclusively with the actual membership but with what will be a function of the board. I am never beholden to anybody but we must all express views arising from our own experience which we know to be true. It is fashionable nowadays in the area of education to criticise the terrible Christian Brothers and priests. We all know that most of us would not be here except for the Christian Brothers, nuns and priests. Because of human frailty they had in their midst individuals who are not representative of the general body of persons in it, but that also applies to politicians. We cannot condemn an entire profession because they had in their midst a person who did not satisfy the requirements of the profession. We know that many of us would not be here were it not for the fact that when we required medical attention we had the good fortune to go to hospitals where the religious had a dominant role. We were happy then that the ethical standards obtaining were appropriate for us. In the establishment of the board and in particular with reference to section 52(2) there is no recognition of that. Various categories of people have been mentioned and I am sorry to see that the physically handicapped have not been included. Unfortunately there are many physically handicapped people who depend totally on the nursing care they get. The Minister might indicate if he is aware of the omission of that category and let us know if he will make provision for the inclusion of a nurse, male or female, who could speak on behalf of the physically handicapped.

My real fear and criticism of this legislation is that it tends to disregard the vital input into our medical services of the religious. I make no apologies for saying that. Again, it is not the "in" thing. Rather is it fashionable to throw bricks at the religious and run. Apart from any other consideration one gets more publicity for doing that. I do not seek publicity for anything I say here. I speak the truth as I see it. It is a most retrograde step, especially in the matter of medical ethics, to remove the only guarantee we have. If this legislation is passed I will not be happy if the element we have at the moment in regard to this matter is discarded. My wife and children, my friends and the people I represent will be equally uncomfortable. I know that all of us may have had occasion at times to criticise a person whom we might describe as — I leave out the epithet —"a — of a nun" but that was only one person who was probably in bad form and was not representative of her group. One cannot generalise. We must accept the facts as we know them. Let the Minister ask people if they are happy with the situation up to now, and if they are very anxious to have new bureaucratic ethical standards in our hospitals. I do not think he will find too many people who are interested——

Minister of State at the Department of the Taoiseach (Mrs. Fennell)

On a point of order, are we discussing the amendment? This seems to be a Second Stage speech.

An Leas-Cheann Comhairle

We are discussing the composition of the board.

Tomás Mac Giolla

Is that section 9 or section 52?

Mr. Tunney

I am sorry if I touched the sensitivities of the Minister of State. I am speaking to the amendment which refers to section 9 and also to section 52 (2). The Minister of State will have an opportunity later to demonstrate her satisfaction with the ethical standards that exist.

Mr. B. Desmond

It does not refer to them.

Mr. Tunney

The Irish language helps me. When the Minister said there were no ethical standards lig sé an cat as an mála.

Mr. B. Desmond

I did not use that phrase. The Deputy is being stupid.

Mr. Calleary

The Minister should withdraw that.

An Leas-Cheann Comhairle

I ask the Minister to withdraw that remark.

Mr. B. Desmond

I withdraw that remark.

Mr. Tunney

The remark referred to me and I take it as a compliment. My stupidity is superior to the Minister's alleged intelligence. I do not mind at all what he said.

An Leas-Cheann Comhairle

Will the Deputy please stay with the amendment?

Mr. Tunney

I hope the Minister will not doctor the Official Report or have it doctored. I wrote down what he said. He said there were no ethical standards at the moment.

Mr. B. Desmond

On a point of order, I did not make that statement.

Mr. Tunney

Perhaps the Minister will tell the House what he said and then I will withdraw my statement.

Mr. B. Desmond

I did not make the statement. The Deputy is deliberately trying to misconstrue my observation regarding the existence of ethical standards known to my Department in a number of hospitals. I said, and I repeat, that in very many hospitals there are no formal written codes of ethical standards.

Mr. Tunney

The Minister did not use those words.

Mr. B. Desmond

Perhaps the Deputy will let me finish. On that basis, as in the case of the Medical Council under the 1978 Act I am devolving authority on An Bord Altranais to set up, as the Medical Council have done under the 1978 Act — which the Deputy has not even bothered to read——

Mr. Tunney

On a point of order, the Minister interrupted me on a point of order——

Mr. B. Desmond

I will finish my point of order.

Mr. Tunney

It is a long point of order.

Mr. B. Desmond

The Deputy is being totally irrelevant. He is misconstruing the points I have made.

Mr. Tunney

When looking at the Official Report if the Minister discovers that he used the words he has now used I will withdraw the charges against him and I will allow him to say I am stupid. However, I say he will not discover that he used those words unless he can have them manipulated. He is misleading the House now by using the words he has used because he did not use them initially and he will find that out when he reads the Official Report. If he is now accepting it was not his intention to exclude the ethical standards that exist, will he tell me how he proposes to maintain them in the establishment of the board?

Mr. B. Desmond

If the Deputy will sit down I will explain it to him gently.

Mr. Tunney

The Minister has not the capacity for brevity that would encourage me to sit down at the moment. I will finish and I will listen to the Minister afterwards. The Minister has acknowledged now the ethical standards existing especially in our voluntary hospitals. I am including all hospitals where the religious have an input. I am not confining it to Catholic hospitals.

Tómás Mac Giolla

On a point of order, both Deputy Tunney and the Minister should have been ruled out of order because we will deal with these matters on section 52.

An Leas-Cheann Comhairle

I appreciate that the Deputy is anxious to get in himself. If he will allow Deputy Tunney to conclude I will call on him afterwards. The Chair will rule, not the Deputy.

Mr. Tunney

Deputy Mac Giolla is a man of reason and sense. He will realise it is not improper or irrelevant to relate the functions of the board as indicated in section 52(2) to what the board will do and the type of people on the board. Surely the matter of what will be the function of the board is relative to the personnel who will be on it. While I know that one should not develop contributions on section 9 that would be appropriate to section 52, a passing reference to it can be made. I am happy that I have indicated my position. I have expressed my thoughts and I finish as I commenced, paying my tribute to the invaluable and indispensable contribution that has been made to nursing, hospitalisation and medical care in this and other countries by the religious. I am happy that, apart from other considerations, in the matter of the ethical standards they are as high as I would require them. Naturally I will be pleased to hear how the Minister proposes to my satisfaction to raise them. Finally I would ask him to indicate what provision he has made for the physically handicapped in the membership of the board.

Tomás Mac Giolla

It is unfortunate that such a long time has been spent on section 52 since we will reach it later. The Minister was the one who raised it and Deputy Tunney was replying to the Minister. It should not have been raised at this stage.

I am very glad that the Minister has appeared to agree to amend section 9(1) (c)(i) and (ii). He accepts that the figures in paragraphs (i) and (ii) shall be two rather than one. That is an advance and it is something which has been demanded by people in the nursing profession. I would refute the point, as Deputy Tunney did, that anyone here or anybody in the trade union must accept the decision of the working party and what was signed by them. The Minister has said he has implemented 80 per cent of that report. The trade union involved did not sign the working party agreement. They are quite entitled to their own amendments to this Bill without being abused by the Minister. Because certain people who are part of the trade union movement signed the working party document they are being harrassed, harangued and abused by the Minister because they want more representation by general nurses than the Minister has provided for in the Bill.

The Irish Nurses' Organisation want to have 18 nurses. They propose a different method of electing the 18. Under the Bill there are to be 15 and then the Minister would appoint one nurse. Now the Minister has agreed to include two more from general clinical practice but he is suggesting that he will no longer appoint one nurse. In other words, subsection (1)(d)(ix) would be altered. Nobody asked him to do that. Why not continue to appoint one nurse? That would be 18, as requested by the INO. The transport union, who generally deal with nurses in general practice, have asked for 20 nurses, while 18 is the minimum asked by others. I would hope that the Minister would at least continue to appoint one nurse.

The Minister made a long attack on the second amendment in regard to doctors being appointed. He is suggesting that in our amendment we are saying there should be a total absence of any input from the medical profession. He said this was outrageous. Of the people appointed by the Minister one shall be a person who is experienced in the field of education and one shall be a person representative of third level educational establishments which are involved in the education and training of nurses. These can be medical people. One should be a person representative of management of hospitals other than hospitals administered by health boards. There can be medical people involved in that area. In addition to those and the two representatives of the Department of Health, the Minister specifically wants to appoint three medical practitioners. In many cases medical practitioners treat nurses as their employees, although they are not their employees. They would be inclined to endeavour to dominate or domineer the nurses on their own council. They have no place on the nurses' council, any more than nurses have a place on the Medical Council. This is the point we are making. Is the Minister suggesting that the nurses themselves are unable to do this job? Is Deputy Tunney suggesting that the nurses if they were in control of An Bord Altranais would have lesser ethical standards than before? Why would the nurses aim at lesser ethical standards than they had, any more than doctors or other people on the board?

I understand the religious will be included under the administration section. Those who are in the nursing area will also be included. A total of 17 people will be elected by the nurses, so religious who are involved in the nursing area may be put forward for election.

I would ask the Minister at least to cut down the number of medical practitioners being appointed to the board. There is an improvement in the election area, although it would be far better if the Minister continued to put two from the general nursing area so that there would be five from the training area, five from administration and ten from general nursing. That would give them their appropriate place. I am glad that the Minister has agreed to put two from general nursing practice and two from psychiatric practice on the board.

Mr. B. Desmond

I am not quite sure if I heard Deputy Mac Giolla correctly. My hearing is not the best. Did he say that the religious will by and large be appointed under the administration section? If so, he is under a misapprehension. Any nun or brother or priest, if he or she should hold a nursing qualification, will be eligible to be elected. There is nothing in the Bill which debars any member of a religious order.

Tomás Mac Giolla

That is the point I was making.

Mr. B. Desmond

I understood the Deputy to complain that religious would be coming from the administrative side.

Tomás Mac Giolla

Administration and training.

Mr. B. Desmond

That does not necessarily apply. I know some magnificent sisters and brothers who are ordinary nurses. The Deputy should go out to St. John of Gods or the Brothers of Charity. He will find that they are participants in the health services. Because we have a Nurses Bill many of us are rushing in here with all sorts of mad misconceptions. I delete the word "mad" and apologise to Deputies, but if my style appears like confrontation it is because I am impatient at people who come in here screaming about the Nurses Bill which many of them have not half read.

Mr. O.J. Flanagan

Will the Chair sit there patiently and listen to the Minister for Health hurling insults at Members who had read the Bill and who know more about it than the Minister? We also know more about the motives behind the Bill. It is a disgrace. The Chair should protect Deputies.

An Ceann Comhairle

Beyond the word which the Minister withdrew the Minister has not used any unparliamentary expression.

Mr. B. Desmond

In the past two or three months I have suffered such a torrent of abuse in representations I have received and comments at various political meetings in relation to this Bill that I am determined to put the record right. If I do so in the confrontation style I ask for the indulgence of the House, because it is the only style I know. Deputy Mac Giolla's amendment No. 4 has a reference to the appointment of a nurse. He was unhappy because I did not offer to appoint a nurse as one of my 12 nominees. The amendment, however, does not make provision for the appointment of a nurse. You cannot have both.

Tomás Mac Giolla

We propose to increase the number of nurses from another section.

Mr. B. Desmond

Some of the points made by Deputy Tunney require to be dealt with early on.

Mr. Tunney

I would ask the Minister not to vent his ire on me arising from attacks made by other Deputies. I am only responsible for myself.

An Ceann Comhairle

The Chair will protect Deputy Tunney when protection appears to be necessary.

Miss Flaherty

I understood that the Minister would reply to all of us later. I indicated that I wished to be called after Deputy Mac Giolla.

An Ceann Comhairle

I know of no such ruling. In accordance with practice, when a Minister and an ordinary Deputy from the same side offer simultaneously the Chair will call the Minister.

Mr. B. Desmond

Deputy Tunney referred to nurses for the physically handicapped. There is no division of the register for nurses for the physically handicapped. The Bill relates to a number of divisions of the register, namely, general nursing, psychiatric nursing, mentally handicapped nursing, public health nursing and midwifery. We must have regard to the professional body which, incidentally, were attacked by Deputy Woods in regard to work of extraordinary value. The working party did not recommend that there should be an entirely separate register for nurses for the mentally handicapped. The working party had given the matter every consideration. I do not know of any group of specialised nurses dealing with the physically handicapped who would seek a separate register. I took note of the points raised by Deputy Tunney but I am confident that I reflect the views of the outgoing board, of the working party and the experience of my Department.

A question was asked about the functions of the board in regard to unethical conduct. Under existing legislation it is not possible to deal with this matter unless we have particular complaints. Tomorrow morning, if the board get a complaint that a nurse behaved in an entirely unethical and unprofessional manner, either the nurse will be taken from the register or no action will be taken. That is the only power the board have. I am proposing a similar provision to that made for the medical profession in 1978 — there has not been nurses legislation since the fifties. I propose to insert a section which was unanimously accepted by the House in 1978 in regard to the medical profession. Section 69(2) of the 1978 Act states:

It shall be a function of the council to give guidance to the medical profession generally on all aspects relating to ethical conduct and behaviour.

I have here a copy of the current ethical conduct code for 1984 published by the Medical Council. It is a very interesting document. It was approved by the Medical Council of Ireland at their meeting on 11 April 1984. The second edition was published in October 1984. It is a very important document.

It recommends to the medical profession how they should conduct themselves in relation to fee splitting, advertising, attendance of doctors on their families, medical consent which is a major issue, confidentiality — another major issue — human research, reproductive medicine. It is stated in the code of conduct that abortion in any circumstances is professional misconduct and that it is illegal in the Republic of Ireland, that doctors must be prepared to resist requests by patients and their relatives to advise termination where pregnancy is unwanted. It deals with donor organ procurements, euthanasia, relationship to prisoners, alcohol and other health disorders. I could go on.

Tomás Mac Giolla

On a point of order——

An Ceann Comhairle

Is this a point of order?

Tomás Mac Giolla

It is a point of order. In dealing with section 9 the Minister is reading from a document dealing with the ethical code. Is he in order? There is nothing in section 9 about anybody's ethical code. Will you put the Minister in order please?

An Ceann Comhairle

I hope the Minister is either relating his remarks——

Tomás Mac Giolla

He is not.

An Ceann Comhairle

Wait. I hope he is either relating his remarks to the amendment before the House or that he is replying to points made during this debate by other speakers.

Mr. B. Desmond

I am replying specifically to the points raised by Deputy Tunney. A number of Deputies including Deputy Mac Giolla do not want to see the medical profession involved in the board.

Mr. Tunney

The Minister in my hearing was the first to refer to ethical standards. It was not I who raised the matter.

An Ceann Comhairle

The Deputy was replying to the Minister and now the Minister is replying to the Deputy.

Mr. B. Desmond

For the first time in the history of the profession — and when I explained this to the INO and to the Local Government and Public Services Union at a meeting last week they welcomed the prospect — a guide to ethical conduct will be determined by the profession. You cannot determine professional misconduct and fitness to practise unless you have a guide for ethical conduct and what it constitutes. It has absolutely nothing to do with the selective fear raised by Deputy Tunney that I intend to intrude on the current ethical codes within the hospitals. It has nothing to do with that. The promulgation by An Bord Altranais of a code of ethical conduct for the profession as a whole has absolutely nothing to do with the existing, where they exist, printed codes of conduct operating in particular hospitals, be they set out by a health board, or a private hospital, or a public voluntary hospital. Some of them have varying documents and a large number of them may have none at all.

Mr. Prendergast

May I ask the Minister a question?

Mr. B. Desmond

The fitness to practise provisions are being brought into being. We are dealing with the composition of An Bord Altranais. In so far as it will reflect the general ethos of the board it is important that we should have a balanced and sensitive approach to the matter. As now constituted the board overwhelmingly represents the nursing profession. To suggest that the nurses of Ireland cannot be trusted and should not be given the statutory power to meet as a board and set out for themselves basic fundamental ethical codes of conduct, as were given to the medical profession, is an affront to the professional integrity and the outstanding competence of the nursing profession.

It has nothing to do with the role of voluntary hospitals, health board hospitals, or private hospitals. These are all glorious red herrings produced by people who are highly suspicious about the outstanding merits of this legislation which was carefully drafted by me and the Department arising out of the working party report. It was drafted with great care. There is nothing implicit in this legislation which cuts across existing codes of conduct of voluntary hospitals, health board hospitals, or private hospitals. That is the reality. I earnestly hope this House will stick to the reality and not produce selective red herrings. It is very easy to do that in health matters as I discovered to my cost in the past two years. I responded in kind when these charges were made.

Dr. O'Hanlon

We want to produce a Bill which will be in the best interest of the nurses and the general public and will not interfere with the character and ethos of our Irish hospitals. There is nothing of a very contentious nature in section 9. It is fair to say that none of us will ever be fully happy with the composition of the board, but we recognise that the Minister has a very difficult task.

An Ceann Comhairle

We are on the amendment.

Dr. O'Hanlon

The Minister said Members of the House and people who made representations to him outside the House were paranoid. He also said hospitals were badly run. Lest it be taken that this is accepted by the House, on behalf of my party I want to say we are absolutely satisfied with the way Irish hospitals are run in terms of nursing, medical administration and ethical standards. I do not want to respond to what the Minister said about ethicle conduct. We made it clear this morning that we are opposing section 52(2). We will deal with that when we come to it. It is important that we do not lose sight of section 9.

An Ceann Comhairle

The Chair shares that hope.

Dr. O'Hanlon

I should like to move amendment No. 5 in my name. I know we are discussing amendments Nos. 2, 3 and 4.

An Ceann Comhairle

Amendment No. 5 may be discussed with amendments Nos. 2, 3 and 4 by agreement. The Deputy may not move amendment No. 5 but he can discuss it.

Dr. O'Hanlon

A number of Deputies referred to this amendment and the Minister responded. I welcome the decision by the Minister to allow for the election of two more nurses, one from general nursing and one from psychiatric nursing. He did not tell us whether he intended to remove two nominees from his own panel of 12. I presume he does not intend to enlarge the nursing board beyond 27 members. He might let us know how he intends to arrange for the election of two more nurses.

It is provided that two of the Minister's nominees shall be persons representative of the Department of Health. The Minister made an oblique reference to the fact that some Deputies thought that was an intrusion by his Department into the nursing board. I do not feel that and I did not feel it when I submitted this amendment. My amendment is intended to ensure that one of those two persons from the Department of Health shall be a nurse adviser. There are three established posts of nurse adviser in the Minister's Department. But because of the embargo implemented by the previous Coalition Government in 1981 and continued by the present Government, when two of those posts became vacant, they were not filled. There is now only one nurse adviser in the Department and it is not the intention of the Minister to have the other two posts filled. My amendment is that that nurse adviser should be a member of Bord Altranais. After all, if there is a nurse in the Department, one of whose functions is to advise the Minister, it is important that she be in attendance at and privy to the deliberations of that board. She could then go back to the Minister with the necessary advice, so that he could fulfil his statutory functions in relation to nursing. I cannot see any objection to that. I cannot envisage a situation where Bord Altranais would be in conflict with the Minister.

It is important throughout the whole health service that we recognise that everybody is on the same team — the Minister, the Department, the health boards, the nurses the doctors, anybody working in that field. If one of the two representatives from the Department were the nurse adviser, that would be in the best interests of the new nursing board. The Minister told us the category of nurses who would be eligible to participate in the election under section 9(b) — nurses resident in the State who are engaged in nursing administration. Would the Minister consider writing into the legislation what grades these nurses should be, in case it would be decided that only matrons of hospitals or nurse administrators should be involved and that the field might be very much narrowed down from the list of people read out by the Minister here this afternoon.

Miss Flaherty

I welcome the indication by the Minister that he is going to take on board the general thrust of the feeling of a large body in the House, that a valid case has been made by the Irish Nurses' Organisation and various other representative groups of nurses around the country for an increase in membership, in particular of general nurses, on this board.

On the move from 16 to 18, I would be interested in clarification on the appointees that the Minister is considering including here. Perhaps he might consider whether in some capacity the number of those appointed might be reduced and the number of nurses under paragraph (c) who were engaged in clinical nursing practice would be increased. That is the area of concern. I fully accept the Minister's explanation for the need for representatives of the training agencies of nursing administration on this board. The board has a two-sided function, over and beyond that of other similar professional boards. It has an important role in the management of training. However, an extremely valid argument is being put forward by nurses, for whom this would be the major regulatory body, for adequate representation on the board. I ask the Minister to look at the point raised regarding a possible expansion of paragraph (c) in one form or another. Is he willing to make changes in paragraph (d), perhaps by an alteration of the balance between those two sections?

Would the Minister have a look at other amendments suggested by the Nurses' Organisation relating to the specific use of the word "midwife" in relation to those involved in midwifery. It is desirable to have a specific improvement, because midwives of the nursing body are a group with whom 51 per cent of the population come into regular contact. Their contribution deserves specific recognition.

Like Deputy Tunney, I also refer to the absence of some specific mention of nurses involved with the mentally and physically handicapped, although the Minister did make some reply on this matter. There is in the submission from the Nurses' Organisation a reference to this, specifically in one of the sections in relation to appointees from those who are trained in psychiatric nursing and dealing with the mentally handicapped.

I again welcome, even though they are not strictly relevant here, the reassurances of the Minister in relation to the point raised by Deputy Tunney. It is important to note and welcome the fact that the president of the board will be elected. That is desirable.

Mr. Prendergast

I wish to support the point made by the last speaker in relation to a greater recognition of the role of the midwife in the Irish nursing profession. I have — and I am sure most Deputies here must have had — representations from people from that background who feel that they are very under-represented in the whole presentation of the Bill. I welcome the Minister's intention to put the nursing profession on the highest possible professional level. There is great concern among those people with experience of a background in midwifery that they are being totally forgotten or excluded in this Bill. They feel that the proper title of the Bill should be the Nurses and Midwives Bill.

I welcome the assurances of the Minister on the question of ethics raised by Deputy Tunney. The Minister referred to the fact that provision had been made that this House would give guidance to the medical profession on the question of ethics. If I heard him correctly, he said that this would in no way interfere with the written code and practice where such obtained in hospitals, whether private or coming under the public sector. It could very well be that there is an ethos in certain hospitals which might not be written but which would have been very well established by custom and practice, in line with the religious principles of the ethics of the predominent majority of nurses in this country. Would the Minister like to comment? I am asking the question only for information because of the worries and reservations, which may not be well founded, on the part of people in representative groups. They have written to me — and I am sure all other Deputies — on this line.

Would the Minister give the greatest possible reassurance to the interests in the nursing and medical professions that it is not the intention of the State to lay down ethical guidelines which might be manifestly in conflict with the widely held sense of ethics and principles of the practising majority of the profession? I take the Minister's point. I know that there is nothing sinister, but we are in the business of public relations and it is incumbent on the Minister and the House that that point is made clear. I know that the Minister has had meetings with representatives of the biggest nursing organisation in the country from my union, the ITGWU, and certain points and objections were made then. Would the Minister be good enough to make a statement to the House about the outcome of his discussions with representatives of my colleagues in my union who are very much involved in the nursing profession?

Mrs. O'Rourke

When we spoke here this morning and asked the Minister for an increase in the representation of nurses on the board he saw fit to go some of the way towards that. I want to take issue with him on a matter which he brought up. He said that this Bill presented an occasion for Deputies to come in stupidly or crazily screaming — then he removed the adjective — into the House making their points. The Minister was elected by people in his constituency and I and all other Deputies in this House were elected by people going to the polls and putting us forward as their representatives. I intend on any matters of legislation on which representations have been made to me and in which I have an interest to come into the House — not screaming but talking — and put forward my point of view. It is to be regretted in regard to this Government that when, for instance, you take up matters of education the Minister says, "How dare you?" She is always right. Now the Minister says that we are sinister, stupid, screaming, crazy. We are the Opposition, therefore we have a legitimate right to come in here and represent our constitutents——

An Ceann Comhairle

Would the Deputy put the amendment?

Mrs. O'Rourke

The Minister was allowed a free rein to tell us what he thought of us. I would like to tell him that his tour de force did not go down well with me, neither will it stop me from expressing the legimate representations made to me from groups of nurses whom I met in my constituency from whom I have received letters which I have answered. If you are a public representative your duty is to listen to people. Maybe you do not always agree with them and therefore you do not put some matters forward, but if you agree with the point of view then you are right to stand up here in the Parliament and express that point of view.

We are being well served in this country in so many respects by the existing hospitals, and their staff and the people who run the hospitals. The Minister is correct, it is a long time since legislation in this regard was enacted here, I believe some time in the fifties. It is time now, 30 years later, to bring forward legislation which will serve the nurses well. Our job is to scrutinise every line of this legislation, and once it is passed we can do nothing more about it. I shall be here as will all members of the other parties. We shall not be screaming but we will be talking.

Mr. Tunney

I am happy to detect the Minister's appreciation of the special position of the physically handicapped. I ask him to move a little further in this regard and assure us that in the matter of representations, when certain categories have been satisfied he will be prepared to take a special interest in the physically handicapped. In the various elections we know that medical politics will operate in respect of specific categories and in that regard I do not see provision for the physically handicapped. I ask the Minister to assure us that he will be especially mindful of them and include them.

Mr. B. Desmond

One purpose of having a ministerial role in relation to appointments is that one could encompass in the 12 appointees, for example, a person specialising in the care of physically handicapped people. That is a possibility which I will consider carefully. The section provides that:

two shall be persons representative of the interest of the general public.

It may well be that the board in their final composition will be lacking in certain areas. I mentioned earlier today care of the elderly and nurses specialising in geriatric care. Equally nurses specialising in the care of the physically handicapped could be brought in. A large body of nurses are beginning to specialise in renal dialysis, cardiac work and so on who may not be elected at all either among the 17 nurses or in the other area. I will do my utmost to encompass them.

I make a point to Deputy O'Rourke as one reason why I have been particularly irate in my approach to this Bill. Far be it from me to indulge in any way in a tour de force with her, but I have received 300 or 400 representations from Deputies and Senators in relation to this Bill. I regret to say that, had the Deputies and Senators assured those whom they met that the intent and fears they had were in the Bill, were unfounded then the need for an enormous amount of correspondence and representation would not have arisen. Whether we are in Government or Opposition, a responsibility devolves upon us. I want to give another assurance here. The Conference of Major Religious Superiors said: “Section 52 infringes on the inalienable right of a hospital to determine its ethical code”.

Mr. Prendergast

We are not discussing that.

An Ceann Comhairle

We must try to avoid Second Stage speeches. I know that it is possible to relate section 9 to section 52, but we should deal with one section.

Mr. B. Desmond

It is important to put out of our minds that there is no such impingement. My colleague, Deputy Prendergast, asked me another question and I must take issue with him. He asked me if I could guarantee or copperfasten the code of practice in line with the majority of religious belief in terms of hospitals. I cannot give any such guarantee. No section in this Bill requires me as Minister for Health to give such a guarantee. An Bord Altranais have been set up and they will affect the ethos of professional practice here if they are an elected body, and I hope that many more nurses than voted on the last occasion will vote for the nine and now 17 representatives. I hope there will be a decent live register to enable them to do so. They will reflect in the ethical code that they laid down in the context——

Mr. Prendergast

On a point of order, I want to make the position clear——

An Ceann Comhairle

That is not a point of order. We are on Committee and I cannot stop Deputies from speaking but I can stop them from interrupting other Deputies.

Mr. N. Treacy

On a point of order, our spokesman, Deputy O'Hanlon, asked for clarification from the Minister——

An Ceann Comhairle

That is not a point of order.

Mr. N. Treacy

When is he going to reply?

Mr. B. Desmond

I will come to that I ask my colleagues that the many misconceptions in relation to section 9 and other sections of the Bill will not be propagated in the discussion on this Bill. Deputy O'Hanlon raised the question about the additional two nurses in the clinical and psychiatric training areas I propose to appoint following their election. I will give consideration as to how I will recast paragraph (d) on Report Stage. Under paragraph (d)(ix) I will appoint one nurse and under paragraph (d)(x) I will appoint two persons representative of the interest of the general public; and under paragraph (d)(iv) I will appoint two persons representative of the Department of Health. This means I will make five appointments. It may be desirable to reduce that number to four, but we can discuss that in detail later.

I am not anxious to have a board of 30 members. I will try to keep the figure as reasonable as possible, but I take the point made by Deputy O'Hanlon in that regard. Deputy Flaherty raised a question about the definition of "nurse". I want to reiterate that the term "midwife" is encompassed within the phrase "nurse". There is no need to elaborate on this because "nurse" encompasses midwife and the general branches of nursing. That adequately covers the point raised by the Deputy.

I want to assure Deputies, and Deputy O'Rourke in particular, that I have stressed particular aspects of this Bill to dispel some of the widespread misconceptions and fears which, unfortunately, have been doing the rounds and I hope the remaining stages of this Bill will be quieter.

An Ceann Comhairle

Deputy N. Treacy.

Mr. Prendergast

May I have an answer to my question about the outcome of the meeting with representatives of the ITGWU?

An Ceann Comhairle

I must go to the other side of the House now.

Mr. N. Treacy

The Minister acknowledged the contributions made before lunch, but I appeal to him to increase the number of nurses on this board which he has already increased by one to 17. Again I want to stress that at least two-thirds of those on the board should be representative of the nursing profession. In other subsections of the Bill it is stated that a chief executive officer, a management team, a secretary of the staff and so on will be appointed and under paragraph (d)(iv) two persons shall be representative of the Department of Health. This is totally unnecessary. One officer from the Department is sufficient to represent the interests of the Department and to advise the board about legislation and other financial matters. In view of the fact that there will be a chief executive officer and a management team who will be responsible not alone to the board but to the Department and the Minister for Health, there is no reason why the Minister could not reduce that number to one and include another nurse on the board bringing their representation up to 18, thereby giving them two-thirds of the membership. I do not think the Minister can argue against that, because we come in here and argue for the people we represent. I resent some of the remarks the Minister made. I come from a constituency with a number of hospitals, a public general hospital, a voluntary hospital, a public geriatric hospital and a public psychiatric hospital. I am satisfied with the code of conduct, the professional approach and the caring attitude of the management and staff in these hospitals.

An Ceann Comhairle

That would be more relevant——

Mr. N. Treacy

The Minister said we came here and tried to create a certain climate and that we acted irresponsibly. This House would be irrelevant if we, the elected representatives, did not articulate the views of our constituents. I make no apology to the Minister for anything I say because I represent the views of the people in my constituency.

An Ceann Comhairle

The Deputy must relate his remarks to the amendment.

Mr. N. Treacy

The Minister said this Bill was designed to improve the nursing sphere. If he wants his commitment to the nurses to be seen in a magnaminous way, he should ensure that at least 18 nurses are members of An Bord Altranais and he should reduce the number of his departmental officials from two to one.

Mr. Begley

While I welcome the move from the Minister to increase the nurses' representation on the board, will he give more information to the House? Who will the nurses represent? There were to be 15 members out of a total of 27 and now that number has been increased to 17 out of 27. Under this Bill five nurses would be engaged in clinical nursing practice — they represent 20,000 nurses — while the other ten members, five engaged in training nurses, and five engaged in nursing administration, represent a few hundred nurses. That does not seem fair. Perhaps the Minister would be more forthcoming and tell us how he arrived at that representation. The Minister will agree that as the majority of nurses are involved in the general and psychiatric nursing areas they should be given greater representation than is provided in this Bill. The Minister might look to Britain to see how the nursing council of England and Wales is made up. There, 22 nurses are elected by nurses and 20 other people are appointed by the different secretaries of State, and more than half of them are nurses. The Minister might restore the balance before this section passes.

Mr. R. Bruton

I would like to comment——

An Leas-Cheann Comhairle

I must go to the other side of the House. Deputy Ormonde.

Dr. Ormonde

I am glad the Minister has conceded to some of our requests about the increased representation for those engaged in clinical practices. As Deputy Begley said, there are in excess of 20,000 nurses in clinical practice at present and I note the Minister has increased their representation by two. Unfortunately I was not here for all the debate and I am not sure where these two members are coming from. I should like to reiterate what Deputy Treacy has said. I understand that the Minister has conceded that there should be an increase of one in the number of nurses. In other words, he has raised the number from 16 to 17. Is the Minister indicating that he has not conceded that?

Mr. B. Desmond

One on each of the clinical——

Dr. Ormonde

I accept that, but do I understand also that the Minister intends to increase nurse representation from 16 to 17?

Mr. B. Desmond

The total would be 17 elected members.

Dr. Ormonde

Nurses?

Mr. B. Desmond

Yes.

Dr. Ormonde

In effect, there will be an increase of one over and above the number of nurses suggested in the Bill?

Mr. B. Desmond

No, an increase of two; one on the general side and one on the psychiatric side.

Dr. Ormonde

Is the Minister conceding that two-thirds of the board will be comprised of nurses?

Dr. O'Hanlon

There will be an increase of two elected members, but will the Minister appoint a nurse also?

Mr. B. Desmond

I will consider that question.

Dr. Ormonde

The provision states that there shall be two representatives of the Department of Health and in our amendment we are requesting that one of those should be a nurse adviser. That would be a response to the view of many nurses who feel there should be a two-thirds representation of their profession. If the Minister concedes on this point we will then have 18 nurses on the board, something that many Members have requested.

It is important that we should have medical representation on the board. On the outgoing board there were six medical representatives, but it is intended to appoint only three to the new board. A major factor in the provisions of the Bill will be nurse education. There is no doubt in the hospital scene doctors have a major interest in relation to nurse education. I am glad to see we have held firm on that.

Mr. R. Bruton

A lot of the debate is not central to the issue before us. We are dealing with a Bill designed at the end of the day to protect the public and ensure that options are available to the public that are safe. We should be discussing the fact that there will be only two representative in the interests of the general public. If we are anxious to provide a medical service in the nursing area that will have the range of options the public need and will be sensitive to the public need we should not concentrate exclusively on medicals, be they nurses, doctors or officials of the Department of Health. There should be a strong emphasis on members of the public who at the end of the day are the people who will be affected by the provisions of the Bill.

There is a general trend in dealing with the health area to put into professional expertise areas issues that are problems for the general public. The general public must confront the public health issue just as much as the professionals. If we wanted to provide community care to which nursing will be central we should have a great deal more public representation, because the public are the consumers of the medical services.

Dr. Ormonde

Surely most of the nurses could be regarded as consumers also.

Mr. O.J. Flanagan

I presume the board is necessary, but for the record I should like to know if the three medical practitioners to be appointed will be selected by the Minister at random from the list of qualified doctors or will the names be submitted by the Irish Medical Association. If the recommendation is that the names should be submitted by the Irish Medical Association I applaud it. The appointment of the board is vital, but it is dangerous also unless the recommendations for appointment to the board come from the organisations and associations which are above reproach. We are all aware that from time to time there is a weakness on the part of Ministers to extend their considerations to various degrees in the appointment of members to boards. That is human. One occupying a ministerial position cannot avoid being overcome by a certain amount of importance when making appointments. Naturally, human nature being what it is the person best known to the Minister responsible is likely to receive what can be considered as favourable consideration, very favourable and most sympathetic consideration. I have in mind a number of doctors who are well known to the Minister and closely connected with him, and I would not like to see them associated with the board.

Mrs. O'Rourke

The Deputy should tell us more.

Mr. O.J. Flanagan

If the Deputy represents her constituency in the efficient manner she has indicated to us she should know as much as we in regard to the loud and determined medical voices that are close to the Minister's hearing.

Mr. B. Desmond

I did not know of any doctors who liked me. That is news to me.

Mr. O.J. Flanagan

The doctors I am referring to seem to be loud in their praise of the Minister's activities.

Mr. B. Desmond

The Deputy had better name them, because I am two years waiting to hear something like that.

Mr. O.J. Flanagan

The Minister may want me to do that but I will not do so.

Mr. B. Desmond

If I get their names I will send them Christmas cards.

Mr. O.J. Flanagan

I should like to issue a warning that the medical practitioners appointed to the board must be highly respected in their own organisations and professional associations. They must enjoy the full confidence of the public. It is impossible in relation to this to divorce the question of the nominations to this board from that view, because the purpose of the board is to advise. They have an onerous responsibility in that they will be advising young girls training in the medical profession. Guidelines will be laid down and codes of conduct outlined. The board will also set the standard of professional conduct to be achieved. The character of those appointed to the board must be above reproach, and their outlook must be in accordance with proper thinking to be expected when dealing with sick people.

I do not like the section or the Bill. It represents part of the overall socialist liberal policy of the Coalition and I am afraid of it. I am doubly afraid of it.

An Leas-Cheann Comhairle

I presume the Deputy is dealing with section 9.

Mr. N. Treacy

The Deputy is doing great.

Mr. O.J. Flanagan

I am dealing with section 9. I am afraid of powers of this type being given to the Minister who is in charge of the Department at present.

Mr. B. Desmond

This is the first time I have heard a Member on the Government side calling me a socialist. I am very flattered.

An Leas-Cheann Comhairle

The Deputy should continue on section 9.

Mr. O.J. Flanagan

I will not make any comment on that, I will leave it to others who are probably more highly qualified than I in the theory of socialism. I will also leave it to the better judgment of the Minister.

I am afraid of the powers given for the appointment of a board which will be responsible for the whole administration of health as it affects the public. This board is vitally important because they will have a say in relation to the training of nurses. A nurse cannot be trained in the same way as other workers. Nursing is a calling, a vocation. It is a gift given to some and not to others to look after the sick. It is vitally important that they get proper training and guidelines in their early years. When this Bill is passed they will only get this from the board now being appointed. At present nobody can point a finger at the nurses, who excel in the discharge of their professional duties, and everybody who has been in hospital knows that. The training which nurses have got from religious sisters in charge of hospitals has brought some of the best trained nurses to the four corners of the world. No matter where one goes Irish nurses are looked upon with respect because of their ethics and their high professional standards. This is due to their training undertaken by the nuns. The nuns have been responsible for the very high professional code of conduct of our nurses. They perform with great efficiency in hospitals all over the world, especially in the mission fields, where proper codes of professional conduct are unknown. Reference was made briefly to the appointment of the head of the present board. This was an excellent appointment——

Mr. B. Desmond

She is not a socialist.

Mr. O.J. Flanagan

No, she is not.

Mr. B. Desmond

That is terrible.

Mr. O.J. Flanagan

I do not know the motives behind the appointment but the right person was appointed whether by accident or otherwise.

Mr. B. Desmond

She is an outstanding woman.

Mr. O.J. Flanagan

She is one of the most outstanding nursing sisters in the country and I have known her for the greater part of my life.

Mr. B. Desmond

Does the Deputy agree that my motives were pure?

Mr. O.J. Flanagan

I cannot read the Minister's mind but, whatever the motive, the right person was appointed. She has discharged her duties in the highest manner possible. One would expect that from a lady in religion who has had the experience of dealing with nurses, hospitals, those in bad health and those who are dying. I do not think a better person could have been appointed.

In relation to the composition of the board, Deputy Begley raised a very important point. He suggested that the Minister should look at the composition of nursing and training boards in other countries. I hope that the Minister, when appointing the board, will appoint those of a very high standard of professional conduct who also have very high moral standards so that they may be passed on to the nursing profession who, in turn, will bring comfort to the sick by practising the proper training which was taught to them in our hospitals. I salute everyone associated with the present board. We can be very proud of the high standard of our nurses and, in speaking about the appointment of the board, it is very gratifying that no Deputy can say that there have been defaulters in the nursing profession.

When making appointments to the board the Minister should sympathetically consider the special position of the midwife. I am sure representations have been made in that regard by trade unions and professional organisations dealing with the special claim which that section of the nursing profession enjoy. I hope Deputies realise that one of the essentials in the Bill is the appointment of the board. That is why we cannot rush the Bill through the House. We must know where we are going and try to extract every bit of information from the Minister because it is so important for the health service and the running of the hospitals. We must ensure that nothing is concealed in the Bill which will lessen the admiration and respect which those in the nursing profession have for the religious who participate in their training. They consist of nuns, priests and brothers. We owe a deep debt of gratitude to the religious orders in the medical profession. I hope the board will not be biased against the religious orders. It is right that there should be a voice in this House to sound a warning well in advance because many have expressed the belief that some of the motives behind the Bill were to squeeze out the nursing brothers and religious orders. I should like the Minister to give the House a guarantee that that is not the position. I should like him to give a guarantee so far as appointments to the board are concerned that where possible those engaged in the nursing profession and who are associated with religious orders be favourably considered. In this way their expertise and, above all, their training will be passed on in the code of moral conduct that must be exercised particularly by the nursing profession who have a grave responsibility in this matter.

Those of us who have had experience of hospitals rejoice that we had the benefit of the noble advice of the religious. They have a high standard of professional conduct. We are living in a time when these people are coming under attack by the media and by those in high places. Public representatives must make sure that the religious are given due justice and the recognition they deserve and which the Irish people expect them to get. We are not legislating for a few. We are not legislating for those who might be described as the cranks of the health services. We are legislating for all the people. We are not just dealing with a few medical crackpots who are anxious to enunciate their own theories of medicine, of medical practices and their own self-manufactured code of morals in hospitals and on boards.

As Members of this House we should keep a close and watchful eye to make sure that legislation of this kind is viewed seriously. Above all it must be viewed with a sense of justice and consideration for the sick and the poor who do not enjoy influence or wealth. However, these people have the love and charity of the nurses and they get words of comfort. The members appointed to the board will be responsible for the training of such people and we must ensure they are worthy of trust and responsibility. I am sure when the Minister makes the appointments none will be suspect or will bring dishonour or disgrace to the medical profession. I hope he will scrutinise the curriculum vitae of every person who is appointed and that he will consult with the Irish Nurses Association.

In relation to general practitioners, I hope he will examine their past history and conduct because they will have posts of great responsibility where they will train the nurses of the future. Many of those people who will be trained by those about to be appointed may come from religious orders for professional nursing training because in many instances they first enter religious life and then qualify as nurses. It is necessary that the right and proper people should give advice.

The Bill states that advice and guidance must come from those appointed to the board. There will be dangerous results if dangerous people are appointed. There will be good results if people of fruitful record are appointed; but there will be bad results if people of doubtful record, either professionally or morally, are appointed. That is why I want in advance to give the Minister due notice. All of us in the House and outside it will be watching with keen interest. We will watch with an attentive ear and afterwards we will have a loud mouth in this House to ensure that the appointments are above suspicion and are not promoted for the sake of political affiliations. The appointment should not be made of those in the medical profession, both nurses and doctors, who today are loudly applauding a new theory and a new doctrine that is foreign to the traditions and the Christian values of the Irish nation. We must ensure that the board will be free of such people.

There is a place in this country for everyone. Those who deserve a high place should be given that reward, particularly in relation to medicine, nursing and those who will be in charge of our hospitals. Those who will be appointed and who will provide the training and guidance for our future nurses will have a grave responsibility. They must set out the proper code of medical and moral conduct that is expected in hospitals. That is why it is right that we issue a warning to the Minister for Health that what he is doing will be watched carefully. Where we see an appointment made of a person who does not possess the right moral standards in our opinion as well as the right professional standards, the House and the country must be made aware of it. This is where the Minister has a grave responsibility. This is where he will have to forget his own personal feelings in relation to appointments of this kind. The matter is very important for Irish hospitals, for the nursing profession and for the patients. Above all, we must not forget those who have to foot the bill. The people expect high standards in our hospitals and they expect high standards from doctors, nurses and the advisers who will be on the board.

I am suspicious of the entire Bill but I do not disagree that some aspects of it are necessary. This will be an important board and that is why Members of the House should express their opinions on it. The board will steer the future of Irish medicine and the training and education of nurses as well as the conduct of hospitals for 25 years or more. It will be vitally important, therefore, that we get the right people appointed to the board, and Deputies will be keeping a keen eye on the appointments.

At present there are between 2,000 and 2,500 trained nurses here looking for work. Every week nurses are emigrating at the rate of 700 a week. Will this new board simply be training nurses for work in Irish hospitals or for hospitals in Britain, Germany, Scandinavia and the Far and Middle East? We have been training our nurses in a highly professional way and it is about time we thought about finding work at home in Irish hospitals for those boys and girls.

The board must be seen to be above reproach. In that way it will have the full confidence of the people. If it is a good board it will be a success and its work will be reflected in the hospitals for years to come, if it is a bad board the work it will do will be bad.

Mr. B. Desmond

Deputy Flanagan has been a Deputy for more than 34 years and it is 34 years since we had the last Nurses Bill. That will indicate how difficult it is to bring the whole training and professional structure of the board into 1984. However, it has to be done. The last board was set up in 1950 and has operated for 34 years with a substantial number of ministerial appointments over the years. The president of the board was appointed by the Minister of the day. This Bill changes that dramatically. The president will be appointed by a majority of the board. Seventeen nurses from the training, administrative and clinical sides of the profession will be elected by the nurses and I have not the slightest involvement in that area, so Deputy Flanagan can go to bed happy tonight because he has done a good day's work in supporting me.

Even those whom I have the right to appoint I will not be appointing personally but through professional bodies. The Minister for Education will nominate a person experienced in the field of education and I will be in consultation with her. I will urge her to nominate somebody from the Department, preferably some senior official who will represent the Department. I will be consulting the management of the health boards in regard to an appointment to the managerial structure of the board. I will appoint a doctor to represent the training hospitals. I will consult with the Royal College of Surgeons and the Royal College of Physicians in regard to the appointment of three nominees submitted to me by them. I will appoint three. Therefore, concern about ministerial appointments should not exist because I will be working in co-operation with the professional bodies. I will not be appointing a person with political service from a political party. I have not done that since I came to the Department, though I have made at least 120 appointments, and I ask Members to put down any questions they wish about any appointments I have made and I am prepared to answer them fully.

Mr. O.J. Flanagan

What about the family planning clinic in Dún Laoghaire?

Mr. B. Desmond

When the debate descends to that level we have an indication of the problems facing the health services.

I can assure Deputy Prendergast that I met the transport union and I gave an undertaking to review the membership in section 9. I have done that. I also discussed other sections of the Bill with the union; the fitness to practise section and the retention fee section. I gave general undertakings to the union but, understandably, I said to them that I had come the House first. The House decides. Nobody else does. I received representations from all the professional bodies. I spent hours and hours with these deputations. It was a very lengthy process. Their views have been considered carefully.

Another point was made by two Government Deputies. This enables me to pinpoint a misconception about An Bord Altranais and the health services. Deputy Bruton correctly identified the real purpose of this Bill which is to deliver the health services to the Irish people. That is what it is all about, and that is what it should be all about. In Europe, notably in America and increasingly here there is an amazing all-consuming preoccupation with the professionalisation of health. It has become so professionalised now that we will have to have a special grade to decide whether a cup of water can be given to a patient. I have absolute admiration for the work done over the years by Irish nurses. We also have a major problem which was alluded to by Deputy Flanagan. We have too many training schools and they are too fragmented. The type of excellent training which Irish nurses should get is not being given to them in full measure.

An Ceann Comhairle

The Minister is widening the field.

Mr. B. Desmond

Every hospital, every county, every local community want a nurses training school and, as a consequence, the whole thing is fragmented. We are appointing nurses under section 9. We have young men and women with an excellent standard of education and an outstanding sense of personal dedication who become nurses, but that does not make them professional nurses. They have to have training and a regular updating of that training, and a capacity to deal with new medical technology. They have to be fully registered. In recent years An Bord Altranais have not been able to do that job. The register is quite wildly out of date. That point was made about the person who has an outstanding capacity to grapple with the fundamental health issues. I counterpose that point to Deputy Begley and other Deputies over here who keep talking about a numbers game. It is not a numbers game.

Mr. N. Treacy

This is ridiculous. The figures are there.

Dr. O'Hanlon

On a point of order, the Minister has covered practically every section of the Bill this afternoon. We tried to deal with section 9.

An Ceann Comhairle

If we go on having a Second Stage discussion with every intervention we will never make progress. My opinion is that section 9 has been discussed adequately and that I should now put the question.

Mr. B. Desmond

It is not a question of 18 nurses out of 28 or 30. It is not a question of five, five and seven. It is a question of a broadly representative board and regulated training and education. That is the issue. If Deputies were preoccupied with a numbers game this afternoon that is not my responsibility. The working party report should have been read by Deputies before they spoke in this debate.

Tomás Mac Giolla

It is a numbers game because the Minister has put down the numbers in his Bill section by section. It is nonsense for the Minister to say we have no conception of what the Bill is about. It is here in front of us and we know what it is about. The Minister showed a certain amount of flexibility earlier on by doubling the number of nurses under section 9 (1) (c) (i) and (ii). I hope that on the sections where he has the appointment of people, he will also consider what Deputies have been saying.

I do not see and the nurses' organisations do not see any need for three doctors to be appointed by the Minister. The association of nursing teachers said that section 9 (1) (d) (i), (ii) and (iii) should be omitted. They do not see the need for medical representation on the nurses board. That was the main point they made. It does not appear that the Minister will concede on that. Will he consider the points made by Deputies? There is no representation for nurses or doctors who care for the physically handicapped. The Minister has wide scope to appoint a person involved in the management of a health board or the management of a hospital, or people from the Department of Health or those in the education area.

He should see to it that the interests of the physically handicapped are represented on the board. One other area of nursing which is not represented is paediatric nursing. The Minister said that under paragraph (d) (vi) one of the two people from the Department of Health will be from the nursing area. I am not quite sure what he said. Deputy O'Hanlon has an amendment down dealing with the advisory nursing area. I hope the Minister will clarify the type of representatives he will appoint. He should appoint somebody to represent the physically handicapped.

Mrs. Glenn

I am pleased that we have spent the day debating this Bill. It was worth while because we now have 17 members of the nursing profession on the board. I am glad the Minister made that concession. Could he clarify his intention in line 30, page 9, to appoint a nurse. Will that nurse fill some of the categories which are not already represented? That would satisfy the nursing profession and everyone in this House. Then the nursing profession would represent two-thirds of the membership of the board. Could the Minister be specific as to his intention in this regard?

Deputy Flanagan raised an important point on the method of selection to be adopted in relation to the three medical members of the board. Would they be selected or elected by their own profession? This may not be terribly important at present, but there are rapid developments in experimental medicine, much of which even today would not be accepted by the Irish people. It must be remembered that the last Bill has lasted for 34 years. It is difficult to imagine what will be going on in the medical field 34 years hence. It is essential that we should know how these people will be appointed, and I would be grateful if the Minister would indicate this.

Mr. G. Mitchell

I know that there has been a long discussion on this section. The prospect of 17 nursing members is very welcome, but there is a strong feeling among nurses that they should have a two-thirds majority on the board and if the Minister does not see fit to concede at this stage, perhaps he might consider the matter on Report Stage? That is the feeling also within the House.

Dr. O'Hanlon

Hear, hear.

An Ceann Comhairle

Is the amendment being pressed? I think we should make some progress.

Mr. N. Treacy

I want to make two simple points. The Minister has made much play of the matter of the consumer and the public. He has talked of a numbers game, but it is he who is playing a numbers game. Despite the fact that he has shown such an interest in the consumer and the public, he has equated the public with two representatives as against two of the bureaucracy of the Department of Health. Surely there is an opportunity here for him to change this imbalance and instead of the two from his Department to have one from the Department and put in one extra nurse, thereby bringing their numbers up to 18.

An Ceann Comhairle

This is repetition. That point was made earlier.

Mr. B. Desmond

With due deference to my colleague, the Department represents the public interest.

Mr. N. Treacy

State interest.

Mr. B. Desmond

Let us be very careful about what we say. It represents the national interest.

An Ceann Comhairle

Is Deputy Mac Giolla pressing his amendment?

Tomás Mac Giolla

I do not want to press the amendment at this stage. We have obtained as many concessions as we can. However, I should like the Minister to clarify the point raised also by Deputy Glenn as to whether he is going to elect that one representative shall be a nurse under section 9. In that appointment, would he try to make representation for the areas that are not represented?

Mr. B. Desmond

I do not want to prolong the debate, but surely of the persons appointed by the Department of Health, as I have already indicated, one is most likely to be the nurse adviser. We have only one in the Department of Health. That gives 18. It also may well be, for example, that a person representative of third level educational establishments involved in the education and training of nurses will be a nurse, as most of those so involved are. I do not know as yet. I must consider the question of the impact of the change that I have made in paragraph (d) on Report Stage. I can only give that assurance. I remember well that at the outset it was said that there should be a nursing representation of half. Now it is two-thirds. I do not think that that is the issue.

Tomás Mac Giolla

The Minister will consider it on Report Stage.

An Ceann Comhairle

Is amendment No. 2 withdrawn?

Amendment No. 2, by leave, withdrawn.

An Ceann Comhairle

Amendment No. 3 is in the name of Deputy O'Hanlon. Is that being pressed?

Dr. O'Hanlon

I am not sure of the reason for the Minister not accepting this amendment.

An Ceann Comhairle

It has been discussed before. We cannot discuss it again. Is it being pressed?

Dr. O'Hanlon

No, it is not being moved.

Amendment No. 3 not moved.

An Ceann Comhairle

Amendment No. 4 is in the names of Deputies Mac Giolla and De Rossa. This has been discussed with amendment No. 2. Is it being pressed or withdrawn?

Tomás Mac Giolla

On the assurance that it will be considered again on Report Stage, I will not move it.

An Ceann Comhairle

The Deputy will be in control at that stage.

Amendment No. 4 not moved.

An Ceann Comhairle

Amendment No. 5 in the name of Deputy O'Hanlon has already been discussed. Is it withdrawn.

Dr. O'Hanlon

No.

An Ceann Comhairle

Is the amendment being pressed?

Dr. O'Hanlon

Yes. I move amendment No. 5:

In page 9, subsection (1) (d) (vi), line 25, after "Health," to insert "one of whom shall be a nurse advisor,".

Amendment put and declared lost.

Question put and agreed to.

An Ceann Comhairle

Amendment No. 6 is in the name of Deputy O'Hanlon.

Dr. O'Hanlon

I move amendment No. 6:

In page 9, subsection (2), line 35, to delete "or paragraph (d) (viii)".

That subsection deals with consultation by the Minister with the Minister for Education and the consent of the Minister for Education to the appointment of one person who has experience in the field of education. I have no objection to that. It also refers to one who shall be a person representative of the third level educational establishments which are involved in the education and training of nurses. I cannot see why it is necessary for the Minister for Health to have the consent of the Minister for Education to the appointment of such a person. The Minister for Health would be in very close touch with what is happening in third level educational establishments dealing with health care. He mentioned that he would be consulting with the College of Surgeons. He would have closer contact with that college than would the Minister for Education.

Mr. B. Desmond

The section as it stands strengthens the general role of the Bill. I have been very careful about the way in which the Minister of the day goes about making those appointments. I know that the Deputy does not particularly object to the consent of the Minister for Education to the appointment of the person in the field of education. I think I should consult and get agreement and consent of the Minister for Education for the person representative of third level educational establishments. Otherwise, as Minister for Health, I should have to consult with those bodies, be it the Royal College of Surgeons or UCD. It is a courtesy to the Minister for Education that in relation to both appointments I should discuss the matter with her. The Minister for Education is anxious to see a greater integration of the Departments of Education and of Health in relation to nursing education. This would strengthen it. I can see that it is unusual, but it ensures that the appointment to the board will be subject to a Government decision, as is the current practice in relation to all appointments made by the present Government. I must bring all before the Government including the names of the elected members and the Government will formally appoint. Naturally, they will not delay the process in any way, but I hope to have a name for the Minister for Education who will do the consultation. She will assess the situation, ask for the nominations, send them on to me and I will appoint.

Dr. O'Hanlon

I am not anticipating or disputing the personnel who might be appointed by the Minister on this board. If the Dean of the Faculty of Nursing in the College of Surgeons is the appropriate person to appoint, I cannot understand why it is necessary to have the consent of the Minister for Education to that appointment. I believe that the Minister for Health should keep that function to himself. I agree with the Minister for Health that the Minister for Education should have an input into who the person would be who is experienced in the field of education. I am talking about third level training for nurses. If you are selecting somebody from an educational establishment catering for third level education for nurses, then the Minister for Health is the person appropriate to make that appointment.

Mr. B. Desmond

One of the reasons given is that since one person only is being appointed, my Department would have much more professional competence than I would have in that field. I do not want to arbitrate in this matter. In the years ahead if effective third level graduate qualifications are given to nurse training — we may be talking about Cork or Galway — then we have one appointee and the Minister for Education should make that choice. The Minister of the day will have a far better awareness of the kind of person who should be appointed following nominations to her from the respective establishments.

Mr. O.J. Flanagan

I read in the section:

(d) (i) Appointment shall not be made by the Minister without the consent of the Minister for Education.

This is an unusual inclusion in a Health Bill. Is my suspicious mind overworking? What is the motive behind this? The Minister for Health would have the same social feelings as the Minister for Education. I do not applaud some of the appointments which the present Minister for Education has made. They may be good, sound and in accordance with her conscience and a great fulfilment of her ambitions; nevertheless we are entitled to disagree with them. I would be happier about this if the Minister were prepared to consider sympathetically the dropping of the consent of the Minister for Education and to agree on the next Stage of this Bill to a certificate of qualification from the educational authorities or from the Civil Service Commission that a person is qualified. I would have more confidence in this Bill if such were written into it. Of all the Bills that I have examined and spoken on here over 40 years, I cannot recollect any other health legislation which includes a provision that before an appointment is made by the Minister for Health the consent of the Minister for Education must be obtained to such appointment. Is this handing over to the Minister for Education the function of appointing automatically the person possessing the qualifications recommended by the Minister for Education? If the Minister wanted to clear my doubts about this he would consider changing it. I do not like it. I would prefer that a certificate of educational qualification from the educational establishment at which the person concerned obtained the qualification would be the requirement. That would be on a nonpolitical basis, outside the relevance of political activity. It would be outside the control of the Minister for Education. I do not know if other Deputies approve of this provision. Am I reaching the stage of being suspicious of everybody around me? I do not like this to be included in the Bill.

I would prefer that the Minister would consult with the officers of his Department. It cannot be impossible with the very high standards of advisers in his Department to overcome the question of the establishing of educational status and qualifications with an input by the Minister for Education in submitting a report in support of the person concerned. We have the Civil Service Commission and the Local Appointments Commission. We have a little notice at the end of every public service appointment authorised by Deputy Boland, Minister for the Public Service, that political influence will disqualify. In this case when the Minister himself is considering an appointment we find that advice given for local authorities by the Minister for the Public Service is meant only for the public service. For all other appointments the application form indicates that all political influence of every kind and description will incur disqualification.

That is why I ask the Minister to consider this. If the boot was on the other foot and this was any other Minister for Education of any Government I would take the same stance because I think the provisions is wrong. The principle is to debar public representatives from making recommendations and to appoint on merit alone yet this appointment must bear the seal of the Minister for Education before it is considered by the Minister for Health. I do not like it, and I have the right to stand up in this House and say so. I appeal to the Minister to consult with the educational authorities who are absolutely impartial and who are not elected on a political basis and would have no political considerations one way or the other but would recommend on the marks, points and educational standards of the person concerned. I ask the Minister to reconsider this. The more one examines it the more difficult it is to understand.

Mr. B. Desmond

Again, Deputy Flanagan is suffering from a misconception. The LAC and the Civil Service Commission do not appoint members of boards, they never did, and thanks be to God they never will do so. Likewise there is nothing at all unusual in one Minister appointing members of a body having Ministers of another portfolio appointing on a cross basis. The Dentists Bill is a classical example with the Minister for Education appointing two members to the Dental Council. This kind of suspicion is ridiculous in this day and age.

Progress reported; Committee to sit again.