Skip to main content
Normal View

Dáil Éireann debate -
Wednesday, 5 Dec 1984

Vol. 354 No. 8

Nurses Bill, 1984: Committee Stage (Resumed).

Debate resumed on amendment No. 6:
In page 9, subsection (2), line 35, to delete "or paragraph (d) (viii)".
—(Deputy O'Hanlon.)

Do I understand that we have left section 9?

We are dealing with amendment No. 6 first. The debate on the section will come later.

I wish to indicate that I cannot find any reason for the Deputy's objections to the provision. The Deputy does not object to the provision for the consent of the Minister for Education to the appointment of a person who is experienced in the field of education. In effect we are talking about two people who are experienced in that field. In my view the inclusion of a provision for the consent of the Minister for Education to their respective appointments is a conventional matter. It is no more than one would give in terms of due regard to the role of the Minister for Education and because of that I cannot accept the amendment.

I should like to return to the specific point I made in relation to midwives. The Minister assured me that "nurses" is inclusive of midwives but the intention was to make sure that midwives were exclusive of all others.

The Minister pointed out that subsection (d) (vii) which concerns the appointment of the Minister's 12 nominees states that one person shall be a person who is experienced in the field of education but my amendment refers specifically to subsection (d) (viii). That subsection states that one person shall be a representative of third level education establishments which are involved in the education and training of nurses. The reason for the amendment is that I believe the Minister for Health is in as good a position as the Minister for Education to make a decision as to who the person appointed should be. For example, if it was to be somebody from the College of Surgeons the Minister for Health would be in a better position, due to his close links with the college, to make the appointment than the Minister for Education. I do not see why the amendment should not be accepted.

Amendment put and declared lost.

Amendments Nos. 7 and 8 are related and may be taken together.

I move amendment No. 7:

In page 9, lines 37 and 38, to delete subsection (3).

This amendment refers to the powers that the Minister has to change by regulation the composition of the board. We devoted almost all last Wednesday to discussing section 9 which deals with the composition of the board. Anybody who was here then will recognise that this is a very important section. There was great interest among Members in the composition of the Nursing Board. It is extraordinary that when this Bill becomes law this Minister or any future Minister for Health can change the composition of the board without coming before this House with amending legislation.

The Minister has put down an amendment which, in my view, aggravates the situation and makes it considerably worse because in the original Bill as circulated the Minister would have the powers to make these regulations with the consent of the board, but under his amendment, he can change the composition of the board after consultation with the board. There is a tremendous difference there. In other words — and I do not agree with it because in my view we need amending legislation to change the composition of the board — under the original section the Minister would have to have the consent of the board to change its composition, but now he can change the composition after consultation with the board. I fail to understand why the Minister would want to tighten his grip on the Nursing Board. Running right through this Bill the Minister has taken to himself phenomenal powers which do not appear in similar legislation. I cannot understand why he put down an amendment to take from the board consent for any change in its composition, and substituted consultation, because consultation gives the Minister a further power.

I am opposed to the whole idea of any Minister for Health changing the composition of the board without coming back to this House with amending legislation. This point was made very well last week when we spent almost the whole day discussing the composition of the board. This shows the fundamental importance of the composition of any board of this nature, not just the Nursing Board. I strongly hold the view that we should have amending legislation if we want to change the composition of this board, and we should have very good reasons for doing so.

Last Wednesday we had a very long discussion on the composition of the Nursing Board. It is clear that if subsection (3) is passed in its present form the Minister can change the provisions of subsection (1) without coming before the House. The Minister may have some explanation for this, but as the subsection stands he will have the power to make whatever changes he wishes. It appears that even after the very long discussion which took place last week on particular changes in subsection (1), some of which the Minister agreed to, it is not logical that after the Bill becomes law the Minister could change the terms of subsection (1) without any reference to this House.

The Minister said he was divesting himself of some of the powers he has under the present legislation, that is, appointing the president of the board, but he is taking far too many powers to himself under this Bill, so much so that one could get the impression that he does not have any confidence in the board he is setting up. As Deputy O'Hanlon pointed out, the Minister's amendment aggravates the situation. In the original subsection the Minister could only make changes with the consent of the board and that has been changed to "after consultation with the board", but he does not have to accept whatever advice the board give him.

Departments are always very anxious to retain as much control as possible. They find it very difficult to give away any powers but this is a matter for the Minister to decide. As I said, it appears that the Minister does not have very much confidence in the board he is setting up.

Another aspect the Minister referred to the last day and which may not directly relate to this subsection was the very large sums of money being paid by the State to the voluntary hospitals. From that one would get the impression that as the State was paying so much money to these hospitals the State could impose whatever it wished on them. I look at this from a different point of view. The money used is taxpayers' money and it should be used in the voluntary hospitals providing the services the people of the area want. I strongly urge the Minister to reconsider his position in respect of these subsections because under this Bill the Minister is taking too many powers to himself.

I will not delay the House very long. I endorse everything that has been said by our spokesman and by my colleague, Deputy Faulkner. Last week the Minister took the attitude that there should be no discussion in this House on the recommendations made to him by the study body. I do not know if this was a recommendation made by that body but even if it was I would not be happy giving any Minister the powers sought here, more especially having regard to his contribution last week. He said that as far as he was concerned most of our hospitals did not enjoy the ethical standards he would wish. That is what he said. He need not deny it or shake his head because this is in the Official Report. I regard this as something sinister. If the council were not doing what he wished, he would rejig it and put his own people on it.

There is much more in this legislation than meets the eye. We have heard the Minister expressing his unhappiness with the situation existing at present in the nursing service and hospitals generally. Since his appointment, the Minister for Health has demonstrated his lack of suitability in interpreting what is required in our hospitals. Last week he praised Deputy Richard Bruton's contribution when he said that we should only be concerned here with the taxpayer. I am also concerned about the taxpayer, not just about their monetary contribution but with the standards they would wish to see in our hospitals which should be preserved and not destroyed. I do not want to labour this point as I appreciate that we deal specifically with the function of the board in section 52 (2). It refers to giving the board permission to establish these standards and I hope the House will realise that the Minister and certain people in his Department are trying to dismantle the medical services.

In relation to the constitution of the board, I indicated last week that we can be quite sure that there will be very little representation for the religious. I am unhappy in that regard because hospitals which have a religious presence have benefited from it and I do not want to see it removed. The Minister indicated last week that he was getting vibes throughout the country that this anxiety was shared. He has an opportunity now of assuring the House that, apart from manipulating the whole service in respect of the establishment of this representation given to the nurses, he will accept the representation as prescribed under the section. It is not given to the Minister or his successor to change legislation passed in this House.

Our hospital services are vital. Their standards must represent the wishes of the taxpayer. I approve of the ethical standards which are there at present and I want them preserved. What is proposed here is a back door method of changing the spirit of this legislation and allowing a Minister to have the power to take away from this House what has been ordained by it.

Like my colleagues I find the Minister's amendment incredible and I support my party's request to delete subsection (3). Last Wednesday we discussed the composition of the board at length. We made a plea that the representatives of the nursing profession should be increased from 16 to 18. The Minister appeared to concede that point and he raised the level from 16 to 17. Why did he bother? There is no point in continuing with the discussion because, if he gets his way in relation to his amendment, he can decide what the total composition of the board will be. He does not have to refer to anyone; he can decide on the composition of a new board after making a simple telephone call of consultation with the board. This is an amazing decision. The Minister will probably refer to subsection (4) which says that a draft proposal of regulations shall be laid before each of the Houses of the Oireachtas but, in relation to that, there should be amending legislation before any decision is made in relation to the composition of the board. The Minister should concede that point.

I can allay Deputies' fears in regard to this question. The Dentists Bill is currently going through the House, it received the support of the Opposition parties in very full measure in Seanad Éireann and this arrangement was discussed at great length. This is a precise repetition of the provisions in the Dentists Bill and I have seen no reaction from the dental profession or the Dental Council in relation to it.

We are talking about legislation which will last for several decades and we must remember that those years are bound to bring developments in medical and nursing education and in practices and procedures which we cannot anticipate at this stage. We owe it to the profession and to the people for whom they care to make provision for these developments, in so far as we can foresee. I am merely making a provision that, following consultation with An Bord Altranais, the Minister of the day may bring in a variation of section 9. I fail to understand the tautology surrounding this when the Minister of the day must put the draft resolutions before the House. Any variation on section 9(1) must be put before both Houses of the Oireachtas and the regulations cannot be made until a resolution is tabled specifically approving each of these draft regulations. It cannot be more explicit than that.

Deputy Ormonde apparently wishes to see a new Bill brought in. One could have a new Bill but the parliamentary draftsman and the Attorney General, men not known for their excesses in terms of devolving powers on Ministers, recommend that it should and could be done by way of regulation. I do not want to bore the House but if I were sufficiently argumentative, I am certain that I could dredge up a list of 30 or 40 statutes where this prospect remains in terms of varying the membership of State agencies and boards. The words of a Minister in terms of this Act will be subsequently interpreted by the courts in terms of elaboration as to the intent behind the sections. It is inconceivable that any Minister would walk into this House and bang down regulations without first going to his Government where the matter would be discussed and approval given.

To vary the membership of a board requires a Government decision, the regulations would have to be submitted to Cabinet first of all and they would be subject to the scrutiny of the Minister for the Public Service, the Minister for Education and the Minister for Finance. Then the regulations would be tabled and there would be 21 days in which a nullifying resolution could be put down. The matter would be debated on the floor of this House as in the case of a new Bill. The fears of Deputies in this regard are unfounded. I realise I was especially trenchant in my views last week but those fears have been stirred up by the kind of contribution made by Deputy Tunney this morning. He referred to the fact that there is no provision in the Bill for representation of the religious. There is no provision in any legislation enacted by Houses of the Oireachtas for representation of the religious. There is no such representation in any statute dealing with education or health.

The Minister is being petty. I was not asking for that but I was indicating that the Minister was at pains to have them excluded. I was not asking for a provision.

I refuse to enter into an argument as to when I last beat my wife. That is precisely the kind of innuendo we have been hearing. I am sick and tired of listening to a number of Deputies in this House imputing motives to me as Minister for Health with regard to the role of religious in the health services, the role of voluntary hospitals and representation. I bitterly resent it and I know there are people stirring it up deliberately in relation to this Bill. It has nothing whatever to do with the role of the religious, non-religious, doctors or anyone else as a particular group. There will be elections and 17 nurses will be elected: there will be five on the training side, five on the administrative side and seven on the clinical practice side. I have no doubt that members of religious orders, as well as others who are not members of religious orders, will go forward for election on that panel. That is their democratic privilege as registered nurses on a Bord Altranais register. If they are elected I will not be examining if they are members of a religious order. They will be elected as nurses. The Deputy should disabuse himself of his prospects of gaining narrow political advantage over me as Minister for Health on an imputation of that nature.

On a point of order, on the amendment——

Is the Deputy speaking on a point of order?

On the amendment, with the Chair's permission. The Minister should not accuse me in the fashion he has accused me. I indicated to him last week that I was concerned for what I saw was the inevitable exclusion from this board of representatives of the religious.

The Deputy knows he is wrong.

That is a statement of fact. It was borne out by the Minister when he said in this House that as he saw it at the moment there were no ethical standards in most of our hospitals.

I did not make that statement and I said that on the last occasion.

It is in the Official Report.

No, it is not.

If I can get the Official Report I will show it to the Minister.

I must ask Deputies to deal with the amendment.

This is pertinent to the amendment. I will get the actual comment made by the Minister last week.

The Deputy would find is much more relevant on the section.

I appreciate it is much more relevant to section 52 (2).

Or even to section 9.

Bearing in mind what the Minister has said, he stands condemned out of his own mouth. As he looked for it we will give it to him. Last week the Minister, according to the Official Report, said, "I am now going"— I can see he probably meant "not"—"to decide on ethics regarding nurses——"

On a point of order, may I ask the Deputy to quote the sentence in full. He is imputing to me a statement I did not make. If the Deputy wishes to quote the Official Report he should do so in full, sentence by sentence.

I am quoting from column 1007 of the Official Report of 28 November 1984. I will continue with the quotation which reads:

...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.

That is the Minister's statement, not my statement. Subsequently when I challenged him on that he presumed to refine what he said and he repeated——

The Chair finds it impossible to relate that to the amendment before the House. It would be much more relevant to section 22 which we will come to later or even to this general section but not to the amendment.

This arose entirely out of the unfounded criticism the Minister made of me and I thought it appropriate that I should give him the words spoken by him last week. It is arising out of that and what is behind it that I have fears in giving to this Minister any powers to manipulate any board that is established.

If we have a general debate on every amendment we will not make any progress. I cannot allow that.

Is the Minister going to do as I suspected last week, is he going to doctor the Official Report? Would he like to comment?

On a point of order——

To put it mildly I am amazed that Deputy Tunney should make that statement and I must ask him to withdraw it.

It was not made to the Chair but to the Minister.

It is an accusation made against a Member of the House which is intolerable. I must ask the Deputy to withdraw it.

I ask the Minister——

I will be firm on this. The Deputy has accused the Minister of doctoring the Official Report last week and he is intimating the Minister proposes to do the same this week. I will not tolerate that.

I did no such thing. Initially I challenged the Minister on what he denied saying last week. I am now putting it——

The Chair is ruling that the Deputy made an unparliamentary accusation against the Minister when he was last on his feet. I want it withdrawn.

A Cheann Comhairle,——

The Deputy will either resume his seat or withdraw the remark.

I should like to withdraw it but I suggest to the Chair that he is at a loss in interpretating what I said.

I am saying that is what I heard and I must insist on the Deputy withdrawing it. It is the worst accusation I have heard in this House for many a day.

On a point of order, in fairness to Deputy Tunney he did not say that the Official Report was doctored.

Either Deputy Tunney withdraws the remark or he leaves the House. It is that serious.

Will the Chair tell me what precisely he wants me to withdraw?

The Deputy accused the Minister of doctoring the Official Report last week.

The Deputy did no such thing. I did not and I think your Clerk is advising you wrongly.

The Deputy imputed that.

I am ruling that he did. I heard it.

The Deputy quoted from the Official Report.

No, this was when he was on his feet.

On a point of order——

Deputy Tunney will either withdraw the remark or leave the House.

On a point of order, the Deputy quoted from the Official Report of last week and said he was satisfied that was what the Minister said. That is correct.

I am speaking about the last remark that Deputy Tunney made before the Chair intervened. Deputy Tunney said: "I suppose you will do as you did last week."

I did not. If the Chair says I said that I want to tell him that I did not say it. Your Clerk is advising you wrongly.

Deputy Tunney withdrew from the Chamber.

I regret that we have come to this impasse. I will repeat what I said on 28 November and confirm to the House that the first time I saw the Official Report in regard to what I said on the last occasion was this morning when I asked for a copy of it, knowing that Deputy Tunney was likely to raise the matter again. I did not go near anybody to doctor or in any way to interfere with the Official Report. I have not done so in my 15 years as a Member of the House. I will quote what I said on 28 November last:

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.

Those observations were made in defence of the need for clear national guidelines regarding ethical conduct to be applied on a national basis by the nurses themselves. In this legislation we cannot have disciplinary provisions unless we have a code of ethical conduct applying across the board in the profession. This does not exist on a national comprehensive basis as in the medical profession. It was against that background that I made the point. I hope that disposes of the issue. It is untrue that I indicated that the hospitals do not have the kind of ethical standards that I would wish to impose. I never said that.

I have indicated to Deputy O'Hanlon that I cannot accept amendment No. 7. It is essential that we should have a provision for the decades ahead so that, if the board come to the Department of Health and the Minister of the day indicating that they think the composition of the board should be revised, the Minister following consultations with the board can bring in appropriate regulations. There is nothing unusual at all about that provision. Accordingly, I commend the section to the House, assuring Deputies that if I thought I would be devolving excessive powers on a successor I would hesitate very much before doing so without coming back to the House to put the amended regulation through the House, after a vote if necessary.

The Ceann Comhairle is very anxious that we should confine ourselves to the specific sections of the Bill as we go through them. That is my desire. Last week and today it is the Minister who has been deviating from the section we are discussing. That is of particular concern to me in relation to this section because in the last 15 minutes we have been debating sections further on in the Bill.

The Chair is being put in an impossible position. One Deputy says something and another Deputy says another thing, but if I had tried to nip this in the bud I would be accused of being intolerant for not allowing reasonable debate.

I accept that, but the Minister responsible for piloting the legislation has been deviating each day from the sections we are debating. We were having a reasonable debate on these two amendments but we got away for 15 minutes to a section which is much further on. I do not intend to get involved in discussing matters in other sections because our function in Opposition is to ensure that we will play our part in seeing that this legislation will be good in the interests of the public and the nurses, legislation that will be a credit to the House. That cannot be if we allow the Minister to deviate from the section. I appeal to the Minister to stay with the section before us.

I appeal to everybody to do so.

On the amendments before us the Minister replied that the reason why he inserted this subsection is so that he can change the composition of the board by means of regulation. Originally the Bill provided that it should be with the consent of the board but now it is "after consultation with the board". His reason is that it had appeared in previous legislation, but he would not take up the time of the House to cite the legislation. He referred to the Dentists Bill.

This is a Bill relating to nurses and its aim is to regulate the nursing profession. Therefore, it is a sad thing to come into the House and find that the reason a subsection appears in the Bill is that it appeared in previous legislation. The Minister told us this was done on the advice of the Attorney General and the parliamentary draftsman. We as the people responsible must ensure that the legislation when passed will be good and I do not believe subsection (3) is good legislation.

Deputy Ormonde suggested that the Minister would bring in amending legislation rather than regulations. I do not see anything wrong with that. Last week we spent an entire day discussing the composition of the board, which is very important. Indeed it is most important when one looks at the functions of the board, like the power to regulate ethical conduct. There is nothing in this legislation to stop the Minister saying he will consult the board and then abolish all 27 members. Some Minister in the future might decide to do that. I do not suggest that this Minister will ever find it necessary to communicate with the board to tell them he intends to change the membership. As he said, perhaps in 20 years a Minister by regulation may change the composition of the board by abolishing all 27 members and replacing them with appointees he himself might feel would do the job as he might like it done rather than giving power to a board set up by statute. When we pass this legislation I hope to have confidence in the board and their composition. I would not want to see the board changed otherwise than by amending legislation. Regulations are a very simplistic way of making such a fundamental change in the Bill.

I cannot see why a Government could not bring in amending legislation to change the composition of the board if that were necessary. I am sure the Oireachtas will be the same in the years to come as it is now and will facilitate the Government of the day if amending legislation is necessary. Legislation has gone through this House in an hour. I cannot see why there is such objection to amending legislation. Why did the Minister submit his own amendment to tighten ministerial control over the Nursing Board and to provide that instead of with the consent of the board it will be after consultation with the board that the Minister by regulation can change the composition of the board?

Perhaps I misunderstood the Minister. I hope I did not. He appeared to suggest that the alteration in the composition of the board will be initiated by the Nursing Board and not by the Minister. We would probably find that acceptable. Like Deputy O'Hanlon I am worried about the Minister's amendment. It gives the impression that he is determined to strengthen his own hand. I am worried about an ulterior motive. The Minister appears to suggest that an alteration should be, or could be, or would be initiated by the board. If we could get a guarantee on that it would allay our fears to a great extent.

The Minister said that if approached by the board he would bring in regulations. Are these the only circumstances in which he would bring in regulations? The other point raised by Deputy O'Hanlon relates to amending legislation. Having discussed subsection (1) for such a long time, various views having been expressed on it and relative agreement reached on it, it seems to me that amending legislation is the only way in which any change should be made.

Whether the board initiate a proposed change in section 9 or whether the Minister initiates the change himself — and if the Minister initiates the change he is obliged to consult with the board — this would follow consultation with the board as proposed in the amendment. That is a formal statutory obligation on the Minister. In either case the Minister will have to explain himself to the House if there is the slightest contesting of the proposed change in the regulations. We brought in the amendment because we considered it inappropriate and undesirable that an exclusive veto should devolve on the board.

In the heel of the hunt, the Oireachtas should have the authority to determine the composition of the board as we are determining it today in this Bill. That is why we propose to change from "with the consent of" to "after consultation with". I have not met any hostility to this in the various representations we received. There is a strong view that this is the most appropriate way to deal with the matter. Many other sections in the Bill contain provisions for rules and regulations, for example, the rules relating to the conduct of the election. A question could arise about the method of election, whether it should be by proportional representation or by a direct vote. These rules and regulations will have to be drawn up subsequently.

The Minister has gone on to another section.

They will have to be laid before the House. I was asked a specific question by Deputy Faulkner, whether other sections of the Bill contained regulatory aspects. There are other sections under which regulations will have to be laid before the House. It would be inappropriate to have new legislation to make purely technical amendments to the constitution of the board, such as increasing the number of nurses on the clinical side of the board, or reducing the number of ministerial nominees.

Can the Minister clarify that? Why does he want to do it by way of regulation? Why not decide to do whatever he wants to do now rather than leaving this open in the Bill?

This is an enabling Bill. We are laying out what we are doing now and in the future any change can be made by regulation.

Can the Minister give us an example of what he has in mind?

I have nothing particular in mind. This is good legislative practice. There is nothing unusual about it.

Amendment, by leave, withdrawn.

I move amendment No. 8:

In page 9, subsection (3), line 37, to delete "with the consent of", and substitute "after consultation with".

Amendment put and declared carried.
Question proposed: "That section 9, as amended, stand part of the Bill."

Am I in order in making a few general comments on the overall section?

On section 9, as amended.

I respect your view, a Cheann Comhairle, that I should confine myself to the section. I welcome the undertaking given by the Minister to increase the nursing representation by a further two members. I am particularly pleased that one of the positions is to be given to the psychiatric nursing profession. For too long that section has not got the recognition it deserves. Unfortunately it will have to play a greater role in terms of health care in the future. There is an increase in the demands on the services provided by the psychiatric hospitals and the people who work in them.

Perhaps on Report Stage the Minister might consider the appointment of a doctor from the psychiatric services to the board as one of his own nominees. Psychiatric nurses need a strong voice in the formulation of board policy in relation to the future organisation of our health services. I would respectfully suggest that the Minister should not become too impatient with Members who wish to tease out and seek clarification on and amendment of sections which they feel are not in keeping with the expectations of the Irish people and, in particular, of the nursing profession whose members have made the service what it is today. The Minister is doing neither himself nor this Bill justice in reacting as he has been doing over the last couple of days. There is still a long way to go before this Bill will appear on the Statute Books.

We on this side of the House will try to assist the Minister — that is, if he is in a receptive mood — to bring in legislation which will do the nursing profession proud in the years ahead. That is what we are here for and that is why our approach to this Bill has been so responsible. I do not wish to be cynical, but the Minister would do well to take a lead from the example of our spokesman, Deputy O'Hanlon, who has confined himself to the various sections for the purpose of ensuring that every word and line in this controversial legislation — and whether the Minister likes it or not, it is controversial — will be teased out. I see the Ceann Comhairle smiling at me.

In relation to section 9, we are trying to get the foundation right. Everything that will happen from here on will be totally dependent on the board's effect on the formulation of policy. If we do not get the base right, nothing can go right after that. Section 9 is one of the most important sections of the Bill. The proposed new board will decide the future of our hospital services. The Minister has said that he hopes the legislation will stand for 20 years and we echo that hope. That is why we are going to the pains of tediously teasing out the various sections. The composition of the board and the values and attitudes of its members will be of paramount importance. I suggest that the Minister is likely to get a more balanced and more representative view from Members from all sides of the House than from some of the extremists who appear to have his ear and who would impose their minority view on our society, if given the opportunity. That is why it is vitally important that the backbenchers from all sides of the House, representing grass roots opinion — a happy phrase — be taken into consideration in the formulation of this legislation. The Minister should treat these views seriously and not cynically.

It is not good enough for the Minister to say that the Members who express views which are contrary to his own are paranoid, and it is a pity that he used that phrase. His welcome decision to increase board representation for the nurses is a direct result of the logical arguing of the so-called paranoid Members for this increase. Before we leave section 9, I appeal to the Minister to go all of the way, perhaps on Report Stage, to bring the level of nursing representation on the board up to the two-thirds majority which the nurses' organisations have requested and for which they have made such valid representations to Members on all sides of this House.

The Minister referred on a number of occasions to unease about this legislation. Whether he likes it or not, there is unease in that respect. That unease is reflected in this debate and I have no doubt that it will continue to be reflected as long as the debate lasts. I do not wish to attribute any allegations to the Minister, one way or the other. I am sure that he is a dedicated and committed man, anxious to do as he sees best to organise our hospital services for the future. His assurances here in relation to certain sections are welcome and I respect him for giving those assurances. However, I am sure that even he would agree that this is not legislation to cover his term of office. It will be the governing legislation for the future under which different Ministers and different Governments will operate in the years ahead. The Criminal Justice Bill, if I may take an example, was very tediously debated here. It has ended up as a vastly different document from that originally presented. It would be my hope that the Nurses Bill will leave this House incorporating many amendments representing the views of the people who speak here.

As I said, under section 9 the establishment of the board will be of vital importance. The composition of the board will have an important contribution to make with regard to hospital staffing levels. Our concern is more relevant than ever before, given the reduced level of hospital staff, now at an all-time low level. The personnel of the board would need to have a commitment to retaining, indeed increasing, that level and the opportunities for young student nurses for whom this country has a great tradition. We are not at present providing employment for these in our hospitals.

You are beginning to sound like a Second Stage speaker.

With respect, a Cheann Comhairle, I do not think that is the case. I am drawing an analogy between the proposed new board and its effect on the level of future services and staffing in our hospitals——

You are getting into its effect on the economy. You are getting away from section 9 of the Bill.

I shall bow to your guidance. I shall conclude by appealing to the Minister, to listen, as I hope he will, to the logical and constructive points raised by Members on all sides of the House. Last week I heard members of his own party and of Fine Gael make very reasoned and compelling arguments as to why the Minister should bring in certain amendments to this legislation. We are determined to ensure that the inevitable result of this debate, which will go on for many months, will be that we will have a Bill of which we, nurses and medical people generally can feel proud and free to operate under.

If any of the ground I mention has already been traversed I can only apologise. I did not take any part in the debate on the amendments. I would be grateful if the Minister would clarify some points which I need not tell the House did not occur to me spontaneously but were put to me by people representing the nursing profession in my constitutency. I am sure other Deputies have received representations to the same effect.

With regard to the election of members of the board by nurses, is it intended that nurses are to have a vote only in one of the divisions of the register, or if a nurse is registered in several divisions will she have a vote in each of them? I hope this ground has not been covered before and would be glad if the Minister would reply to this.

It was also put to me — it seems a reasonable point — that there should be a minimum experience qualification, it need not be a very exacting one, for any nurse before she is eligible for membership of the board. No one suggested what that minimum ought to be but the Minister might tell us if he intends that a nurse immediately after qualifying will be eligible for election to the board or if she has to have some minimum experience before that can happen.

In regard to section 9 (1) (b) it has been put to me that the clause (i) in (b) might be expanded in order to make it clear that nurses who are engaged in general nursing administration are nurses engaged in this administration at any level so as to include, for example, ward sisters.

I will now put before the Minister some matters which were represented to me as being omissions from this section. It appeared to those who advised me that it was an unfortunate omission that in subsection (1)(c) the Minister did not mention nurses in the occupational industrial field or nurses in the private hospital field. These points seem to be reasonable. I do not have enough experience to add much rhetoric to it but I should be grateful if the Minister would indicate his views on them.

Deputy Hyland was preoccupied about the need for two-thirds of the nursing profession to be represented on the board. If one takes the 17 elected members, and I have indicated that I intend to appoint a nurse adviser from the Department of Health to the board, that makes 18. Under (d) I have power to appoint a nurse, most likely from one of the specialist areas just mentioned by Deputy Kelly who would not have a separate division on their own. That makes a total of 19 and if there were no other changes 19 out of 29 gives two-thirds. As I indicated in reply to comments made about the section the last day, we should not play a numbers game in terms of the running of An Bord Altranais. They are an integrated profession working together. They are self-regulatory. I hope there will be real professional interaction between all 29 members of the board.

Deputy O'Hanlon was anxious that a psychiatric doctor should be appointed. There is provision for that. One of the medical practitioners will be employed in a hospital approved by the board for the training of psychiatric nurses. I will not be appointing a person as such in terms of selecting a person. I hope the nomination will come from the faculty of psychiatry and that the psychiatrists will nominate one of their eminent consultants for appointment by me. After consultation with such bodies I will make the appointment. If I have appeared to be impatient it is because I do not want repetition in terms of section 9.

Regarding the points raised by Deputy Kelly I appreciate that there are specific categories of the nursing profession who might feel they should have representation on the board. However, I have followed as closely as possible the report of the working party. They did not give separate designation, for example, to nurses employed in private hospitals on the occupational side, on the physical handicapped side or those specialising on the geriatric side. The divisions are broad ones and it was felt that in having a board one should not specially designate areas for division. I assure the Deputy I will take the points he made into account in any consultations I will have with the future board and hope the board take them into account also. At this stage I can only broadly make the point about the categories.

The provisions for election will be set out in the rules relating to the election. The rules must be drawn up. I take the Deputy's point in that regard. It is a valid one but it will be necessary to formally draw up the rules of the election. For example, we do not specify the method of election, whether it should be by way of proportional representation or whatever. That would have to be done. The Deputy has a valid point, but it is difficult to cope with and on Report Stage I will be more prepared to elaborate on it and endeavour to help as much as possible in that regard.

I assure Deputy Hyland that the board has no function whatever in regard to the levels of staffing in the hospitals or elsewhere in the health services. He will be happy to note that that will reside with him as a member of a health board.

That is not true. It does not reside with the health board. It resides with the Minister because he has consistently refused to fund health boards with regard to it.

I will resist the temptation. After experiencing 15 years of teaching on how to get a Bill through I will obey the Ceann Comhairle's instructions.

On a point of clarification, did the Minister say that the nurses would have a two-thirds majority on the new board of 29 members?

Effectively it would work out like that. Two-thirds of 29 is 19.4 or something like that, but anyway they would have 17 elected members, one additional nurse, as is provided in the section, and one nursing adviser. Whether nurses would regard nursing advisers from the Department of Health as being nurses I do not know but I presume they would agree that they would be classified as nurses. I hope to appoint a nursing adviser from the Department of Health. That will bring up the numbers and it would enhance the point at issue which, incidentally, I do not take to be a point. I see nothing meritorious in the concept of two-thirds any more than I see in the concept of 51 per cent. That is an erroneous professional criterion by which to judge a Bill.

I am merely commenting on the point that the Minister made that effectively the nurses would have a two-thirds majority. There would be 29 members on the board, and I compliment the Minister on giving an extra place to nurses in general nursing and in psychiatric nursing. At least that was one worthy change in the Bill, but did the Minister say that a nursing adviser from the Department of Health would be a member of the board? The Minister did not accept our amendment which asked that the nursing adviser from the health board be automatically a member of the board.

I can help the Deputy there. I was reluctant to write it into the legislation because we have only one nursing adviser in the Department of Health and if at any time that post was vacant because of embargo or otherwise the section of the Bill would be affected. I did not wish to write it in formally, but I have given an assurance to the House and to the representations I have received that where I will have power to appoint two persons representative of the Department of Health I hope that I will appoint the nursing adviser and that my successors will continue to do so. If I write it formally into the legislation, with the very limited staffing structure we have we might finish up with the post vacant for six months with nobody on the board for it as a consequence.

I am glad that the Minister has told us that he will appoint the nursing adviser from his Department. It is vital that the nursing adviser should be on the nursing board. After all, she will be advising the Minister and it is important that she will know the thinking of the statutory body representing the nurses and their function. I ask the Minister before Report Stage to look at the possibility of including in the Bill that the nursing adviser would be officially a member of the nursing board.

I take the Minister's point that there is only one nursing adviser in the Department at the moment. There were three nursing advisers but because of the embargo when two posts became vacant they were left unfilled in keeping with the Government's policy, but I cannot envisage any Government even a Coalition Government such as we have at the moment, doing away with all posts that would become vacant and that they would be left unfilled. I believe that in the foreseeable future, and certainly for the lifetime of this legislation, a nursing adviser post in the Department of Health will be filled.

On the question of the two-thirds majority, the nurses were anxious that they would have a two-thirds majority and I would see 20 out of the 29 as being the practical two-thirds majority. I take the Minister's point that if the board has 29 members he can get into percentages. As a practical application, to give the nurses a working majority on the board they would need 20. I compliment the Minister on increasing the number of nurse representatives on the board, but they will still not have the majority that they asked for.

The Minister was good enough to refer to points I made a few minutes ago with one exception. Does he intend that nurses to be eligible for election here, particularly under paragraph (c), should have some minimum experience? That does not arise under paragraphs (a) or (b) because it is clear that a nurse would not be training other nurses nor would she be engaged in nursing administration unless she had a great deal of experience. It arises under paragraph (c) and if the Minister has made up his mind about this I would like him to let the House know. The Minister may have intended that this point would be covered in regulations. Subsection (3) provides authority for the Minister to make regulations which would vary the provisions of subsection (1). Will such provisions cover the imposition of a minimum experience requirement? Perhaps it would, but I warn the Minister that clauses such as this which empower a Minister to make regulations to vary this and that can be quite tricky. Should litigation arise the courts are quite capable of holding that something which the Minister has done is not just a varying of a statutory provision but something which flies in the fact of it or which effectively annuls or negatives something which the Houses of the Oireachtas have resolved. I would not like to pronounce off the top of my head what is meant by the word "varying", but if I were in the Minister's boots and had an idea in the back of my mind that I would impose a minimum experience qualification which would, for example, exclude nurses with under two or three years experience from eligibility for membership of this board, I would feel that if I intended to do it by regulation this would be going rather further than simply varying the provisions of the subsection. If I had the idea of minimum experience in my mind I would prefer to state it here in the section. I do not want the Minister to reply in detail to this now if he would prefer to think about it and say something about it on Report Stage.

I do not want this board to become unwieldy, but in the interests of the demands of the nursing profession and their request that they have a two-thirds representation on this board, the logical step under these circumstances would be to increase their representation to 20 and following on that to increase the total on the board to 30.

One glaring omission in relation to this board is the absence of a student nurse. In this day of worker-director involvement an important aspect of the board would be that this major section of the nursing community, the student nurse, should have representation on it. This might get around the Minister's dilemma in relation to nursing representation. There are a number of significant problems concerning student nurses which should be voiced. I accept that the instructors, trainers etc. Of the student nurses are represented but there is no representation per se of the student nurses. The hospital in Ardkeen in Waterford has a nurse training school, and when the nurses finish their training they have no opportunity to get work experience before they go out into the world. They are barred from applying for jobs in other hospitals because they have not work experience following their qualifications. They are in a catch-22 situation. Because of such problems perhaps the Minister could get around his dilemma in relation to this by adding a student nurse on to the nursing representation and increasing the number on the board to 30.

Deputy Ormonde has made the point that I intended to raise. I said on Second Stage that there was a need to have a student nurse on the board. I am not going to go into the cases that have been brought to our notice of student nurses and the difficulties they have had which have been explained to us many times. Section 9 of the Bill needs attention and I support fully the case that Deputy Ormonde has made that a student nurse be appointed to the board. The Minister may well say that the board will be representative of student nurses but I submit that there should be a student nurse on the board.

The debate on this section has clarified a number of points that were causing concern. The discussion has been useful and worthwhile and I am confident that the board will now be a better board and a more useful one. I take this opportunity of appealing for more interest to be taken in the board. In the past there seems to have been very little interest in elections to the board. It is important that the nursing profession realise the importance of this new board and the importance also of having suitable people nominated for election to the board. It is in the best interest of the profession that the best possible people be elected and that interest in the board's operations be maintained.

I welcome the Minister's indication of his willingness to accept many of the points raised and to incorporate them in amendments on Report Stage.

I should like to return to a topic I have raised on a number of occasions. I refer to the need to have a specific reference to midwives as distinct from nurses. The trend in the Bill has been to use the term "nurse". There have been a number of areas in which we have encountered problems as a result of the use of generics because what is interpreted as being included in a generic heading can be quite different in respect of specifics. I am sure the Minister is aware that 2,000 of the country's 22,000 nurses are engaged directly in the practice of midwifery, mostly in our nursing hospitals but perhaps in the future in a mix both of these hospitals and of the community. Those 2,000 midwives have found that their identity and their separate specialisation has lost some of its impact since the Nurses Act of 1950 whereby they lost their separate registration but maintained a separate sub-committee within the board. However, that has not proved to be adequate protection in terms of their specific skills, interests and standards of practice. For the past ten years no recommendation forwarded by the sub-committee has been accepted by the board. These recommendations might be very wide ranging in terms of disciplinary measures and also of education matters in which they have a specific interest.

I appeal to the Minister, therefore, to consider this aspect carefully and to ensure that this Bill will not add to the problems I have outlined. There is a need to consider how the identity and special skills of midwives are recognised in the Bill. There is a tendency to assume that every nurse has a qualification in midwifery but is that training necessary when many of these people will move into such areas as theatre work, coronary care specialisation and so on? Therefore, I am asking the Minister to have regard to this lack of clear thinking in relation to the role of the midwife because this lack of clarity has led to waste not only in the Department but also perhaps in the training of nurses. Even more important, it has led to a failure to recognise the special contribution of the midwife to the health services.

I am not advocating that we follow Britain in any respect but I would remind the Minister that the corresponding British Act is entitled the Nurses, Midwives and Public Health Visitors Act — in other words, the different groups are clearly distinguished. While I can see the value in having the legislation as simple as possible, I am concerned that the term "nurse" is, to say the least, minimal in so far as midwives are concerned. Where the term, "midwife" is meant, it should be used. I trust that on Report Stage the Minister will be able to introduce amendments to cover these points.

Has the Minister any idea of who, or what sort of people, will represent the consumer interest?

I have an open mind on that issue. I have received representations from, for example, the ICTU indicating that that section are interested in putting forward names. With deference to Congress, I have acknowledged the interest of the ICTU in that regard but it would be improper for me to take further action pending the enactment of the legislation. I consider that there is a need for ordinary members of the public and for non-professionals to be represented in this area.

Regarding the point raised by Deputy Flaherty, I do not consider that there is any need for a statutory midwive's committee having regard to the inclusion of the fitness to practise provisions which apply to nurses whether with or without a midwife qualification.

However, there is nothing to preclude the board, should they so wish, from establishing a midwife committee under section 30 of the Bill. Compared with the UK legislation, I regard the inclusion of midwife within the general definition of "nurse" to be more appropriate. If one were to include in any title of a Bill references to every group who come within a general heading, one could have a very long title. I consider our procedure to represent a much more effective framework for statutory definition.

Deputies Ormonde and Daly raised the question of work experience. I assure them that, again through An Bord Altranais, we are considering this aspect. The board are completing a survey of the work experience of recently qualified nurses and when that is to hand we will be in a position to assess more accurately the extent of the problem and perhaps be able to make some proposals in that regard, proposals which might in some measure relieve the situation.

I assure Deputy Kelly who referred to the period of qualification prior to voting, that the existing provision is for only three months and there are pros and cons as to excluding newly qualified people. I will have a look at that issue between now and Report Stage. The 1953 provisions relating to nurses rules approved by the then Minister says that all persons registered at least three months prior to the last day for receiving nominations are eligible in terms of qualification of persons entitled to nominate or to take part in elections. On Report Stage we can tease out some of these issues in greater detail.

I was not here for the debate on this section so the Minister might have covered some of the points I am going to make. The main point is that this is a nurses board and that the nurses should be in control of the board. The general nursing staff, in the original draft of the Bill, had not got a fair representation in five. The Minister has accepted that to a certain extent and has increased the number to seven. However, when the Minister did that last week he also said in relation to ministerial appointments that paragraph (ix) would be eliminated and paragraph (ix) says: "one shall be a nurse". The Minister said he would have a look at the new representation and see if subsection (ix) could be left in. I do not know whether or not the Minister has made any decision on that. I hope that the Minister will leave that paragraph in and if the membership of the board is still too high he could drop off two of the doctors. I do not see why three doctors must be appointed to a nurses board. I doubt very much if the Minister would have three nurses appointed to a medical council or to a dental board. This is a nursing board. We seem to be under the impression that nurses are not capable of carrying on their own business in a professional way without interference. The purpose of this should be to establish nursing as a profession and let them decide on their own professional standards as others do. Rather than eliminating paragraph (ix) I would ask the Minister to eliminate two of the doctors. In his appointment of a nurse I would ask the Minister to consider two areas which have not been covered, paediatric nursing and those engaged in the care of the physically handicapped. That would strengthen the board and everyone would be represented. Nurses would be strengthened in regard to their profession. If the Minister must eliminate some people from the board in order to maintain the number at 27 he should eliminate the two doctors and keep the two nurses.

In relation to student nurse representation and the work experience situation I respectfully submit that should we await the setting up of the board to look into it it will be too late because at that stage the board will have been set up and there will not be an opportunity to ensure that student nurses get representation. The Minister appears to have some goodwill in relation to this section, so if he intends to do something about it, now is the time.

In relation to what Deputy Mac Giolla has said, I feel strongly about the doctor representation on the board. The doctors, as much as anybody else, are involved in the training of the student nurses. They have already been reduced from six to three on this board and it would be a pity to go any further. We can still ensure that there is a two-third representation for the nurses if we increase the composition of the board to 30 members and increase the nursing representation by giving one to the student nurses.

The report referred to earlier by Deputy Dr. Ormonde is an ongoing report which is almost finished. It refers to the working of the current board and I would be anxious to take it on board as quickly as possible.

Question put and agreed to.
Section 10 agreed to.
SECTION 11.
Question proposed: "That section 11 stand part of the Bill".

Section 11 gives the Minister power to set up the electoral process for the first election to the board and in it he can specify the class of nurses who may vote in any election. Last week I asked the Minister in relation to the three categories of elections for nurses, if he could say in relation to the administration section how the nurses entitled to vote would be classified and he told us that in relation to general nursing in hospitals, nurses from ward sister upwards, and in public health senior public health nurses who would be regarded as being in the administrative structure would be eligible. That is a broad classification. We should spell it out fairly clearly and take a liberal interpretation of that administrative section, section 9 (b):

five nurses resident in the state and who are engaged in nursing administration

because the bulk of the nurses in practice are general nurses. In order that there would be a fair and balanced representation, we should have a fairly broad and liberal interpretation of the type of nurse who would be allowed to vote under that section.

The other question pertinent to section 11, raised under section 9, is the system of voting, whether it would be a direct voting system or a proportional representation system.

There is one other point I should like to raise with the Minister in relation to replacements on the board. On the health boards, as at present constituted, the Minister has the power to appoint a replacements of anybody from the elected categories, the professional interests on the board. The Minister has the power to replace if a member were to leave the board for any reason, whether through death or any other circumstances. I hold the view that it should be the norm that the next person on the electoral list would be appointed automatically. I should like to see that sort of system apply — where there is election on to a statutory body — that the next person on the electoral list below those who had been elected to the board or body would automatically replace anybody who left the board rather than have a Minister appoint somebody himself, somebody who might not have stood for election originally. I am not saying that the present Minister would do so but, in the future, a Minister could appoint somebody who would not even be remotely connected with or have much interest in the category about which we are speaking.

I would ask the Minister to investigate that point in order to ascertain if something could be done to ensure that any replacement would be effected by way of somebody who had stood for election, somebody for whom the nurses themselves had voted, somebody just below those who had been elected to the board initially.

I might reiterate what Deputy O'Hanlon has said. I can think of one example in our health board where one of the elected members of the profession took up an appointment elsewhere and he was replaced by the Minister. In relation to the provisions of this Bill it is very important that the person who fills the position comes from the area from which that position was vacated, in other words, from one of the three sections laid down here. Let the Minister renominate somebody, but in relation to the other section — whether one goes along with what Deputy O'Hanlon has said, taking the next name on the list — I do not know how that can be done. However it is vital that any replacement be elected by one's peers. That was the situation that obtained in the first place and the one we must ensure continues, that rather than the Minister or anybody else filling such vacancy, the nurses themselves would decide who will replace such person.

I shall carefully consider the points raised by Deputies O'Hanlon and Ormonde on Report Stage. As Deputy O'Hanlon has pointed out, it has been the general practice in the case of health board vacancies. In the case of a recent vacancy in the North Eastern Health Board area, in exercise of the powers given the Minister under the Act, I selected the next person, with the next highest number of votes to fill that vacancy although, strictly speaking, there is no statutory obligation on one to do so. I have followed that practice in relation to a number of vacancies and, by and large, it works well. There is a difficulty in following that practice, that is that over a period of five years of a term of office a nurse may move from one category to another even though she may have been elected to an original category. Therefore, there is particular need to draft rather carefully. This issue will arise again under the Second Schedule of the Bill. Indeed, Deputy Mac Giolla has an amendment down in that regard, in relation to the filling of casual vacancies. I am not yet in a position to be entirely specific about who precisely can vote for whom, for the simple reason that there is need to examine this section, to investigate the existing rules, the quite elaborate rules of An Bord Altranais. The guidelines have already been laid down quite clearly in the existing rules. I shall bear in mind the points raised by Deputy O'Hanlon and others as soon as we reach Report Stage. That is as much as I am in a position to clarify at present.

Section 11 is quite clear in its intent, in providing for the first election to appoint the 17 members to represent the profession. For the first election I appoint the returning officer. For subsequent elections the board appoint their returning officer. That is the position regarding section 11 (1) and (2).

Question put and agreed to.
SECTION 12.

I move amendment No. 9:

In page 10, subsection (1), line 23, after "meeting" to insert ", which shall be held not more than six months after the passing of this Bill".

Section 12 (1) states that:

The first meeting of the Board shall be held on a day to be appointed by the Minister and the Minister shall notify the members of the Board of the time and place of such meeting.

My amendment would add the proviso that that meeting should take place not more than six months after the passage of this Bill. The reason for that is that this Bill can pass both Houses of the Oireachtas and then no action need be taken for some time. It is left entirely to the Minister as to when action might be taken. It could be a year, two, three or even five years. I believe it would be in the interests of the nurses generally, and indeed of the general public, that when this Bill passes both Houses its provisions come into effect as soon as possible thereafter. Because there must be elections to the board by the nurses I know it is not practicable to have the first meeting of the board held within weeks of its passage. For that reason I have inserted a period of six months in my amendment which I beleive to be a reasonable time within which to hold elections, giving the Minister time to organise the elections and hold the first meeting of the board.

I wish to associate myself with the amendment of Deputy O'Hanlon. There is so much interest being generated and commitment being shown by the nursing profession — as indeed by the legislators — to the provisions of this Bill, that it would be a pity if it were to be shelved for one reason or another, or perhaps put on the long finger. In other words, it would be a pity not to immediately harness the good will which will accrue out of its passage and the work that will have been put into it on all sides. I would agree with Deputy O'Hanlon that the first meeting of the board should take place within a period of six months.

There was a recommendation from the Irish Nurses Organisation and the National Council of Nurses in Ireland that the first meeting of the board be held within 30 days of the passage of this Bill. There are a lot of things to be attended to, a lot of organisation of elections etc. Therefore I would feel that 30 days is pushing things somewhat. At the same time, as Deputy O'Rourke has said, I would not advocate that it be put on the long finger, and six months would appear to be reasonable in this respect.

I accept fully the general intent of Deputy O'Hanlon's amendment but I am rather reluctant to insert a given period in the provisions within which the board must hold its first meeting. Equally, when I met the Irish Nurses Organisation they were anxious that there should be a 30-day period allowed. At a meeting with them on 3 September 1984 I assured them that I would mention for the record here, on Committee Stage, that I would ensure that the first meeting of the board would be held as soon as possible after the appointments had been made. For example, one of the difficulties about a 30-day period — if the elections finished in the month of say, June or the middle of July, it might not be possible for some of the Organisations, such as the medical organisations with whom I have to consult, to meet until the month of September. We would have to await their nominees to the board. To stipulate a period of 30 days would be too little while, at the same time, six months after the passage of this Bill would be too much. I intend to move immediately after its signature by the President. I would dearly wish to see a new Bord Altranais established and functioning, and I can assure Deputies there will be no delay whatsoever. Basically this relates to the election of the board. I do not think it will take six months to complete the necessary formalities. It may take perhaps a month or two but, to write it in and then not to adhere to that time limit, would mean that one could find oneself in the real difficulty of not having received all the nominations with a month having passed, when legally one would have to hold a new election.

It is not unreasonable then to say "within six months."

I shall consider it on Report Stage. Perhaps Deputy O'Hanlon and ourselves might consult on the matter. I do not want us to find ourselves in dire trouble in relation to the provisions of this section.

I might make the point that unless some period is specified — all right, we will accept the Minister's bona fides — it could well be another Minister who would be involved. I am not expecting the Minister to admit that. The first meeting of the board should be held on a day to be appointed by the Minister. A Minister could for one reason or another put off appointing a board for a year or even two years. If we pass this legislation the decision as to whether the board will ever meet will rest with the Minister. There should be some minimum time such as the amendment proposes within which the Minister must call a meeting of the board. Perhaps the Minister could suggest a period of three months or six months. He must be tied down to calling a meeting of the board because under the section a meeting might never be called.

I sympathise with the fears of Deputy Mac Giolla on this matter. I will examine a schedule for setting up the board. I am amenable to an amendment in that regard and we can examine it on Report Stage.

The INO also suggested the addition of a subsection whereby the outgoing board should cease to hold office on the establishment of the new board. I presume that is just a matter of form.

I take the Deputy's point.

Amendment, by leave, withdrawn.

I must ask to be excused. The Minister of State, Deputy Donnellan, will continue in my place until 1.30. I have a meeting with my UK counterpart which I am not able to defer and there is also a meeting of the Council of State. I will be back at 4 o'clock. The Minister of State has kindly agreed to take over.

We will look after him.

I hope this Bill does not finish up before the Council of State as well or I will be in real trouble.

We might have finished the Bill before the Minister comes back.

Section 12 agreed to.
SECTION 13.
Question proposed: "That section 13 stand part of the Bill."

I wish to ask a couple of questions. Section 13 (1) states:

The Board may, subject to the subsequent provisions of this section, from time to time establish committees to perform such, if any, functions of the Board as, in the opinion of the Board, may be better or more conveniently performed by a committee, and are assigned to a committee by the Board.

Will the sub-committee have full statutory functions devolved on them by the board?

It is also provided in the section that the chairman of every committee established under this section shall be a member of the board, excluding the president or the vice-president of the board. I do not understand why this should be. Every member of the board should have equal standing. There is a ludicrous situation in relation to the health boards where superannuated members cannot be chairman or vice-chairman. There is therefore a two-tier system on the health boards and I should not like to see any member excluded from the chairmanship of any sub-committee of the Nurses Board. Provisions of a similar kind are to be found in other legislation but I do not see any reason for its inclusion in this Bill.

The midwives section of the INO have requested the retention of a statutory midwives' committee as recommended in the report of the working party on general nursing in 1980. Perhaps the Minister would concede that point.

Subsection (1) provides that the board shall appoint such committees as they see fit to assist in carrying out their functions. Subsection (2) obliges the board to set up a fitness to practise committee. This is the only one which will be statutory. The rest may be statutory if the board see fit to give that amount of power. Subsection (3) enables the appointment of non-members of the board to committees other than the fitness to practise committee. The present board provides in its rules for the appointment of person other than members of the committees. Subsections (4), (5), (6) and (7) are self-explanatory.

The section proposes to set up sub-committees, some members of which will not be members of the board. This is at variance with the Medical Practitioners Act where all the sub-committees are made up of members of the Council. Could the Minister explain why people who will not be members of the board will be members of the sub-committees? Is it not of vital importance that there should be total unison as between the board and the sub-committees and that only board members should sit on the sub-committees?

It is up to the board to appoint people who can make a contribution to the sub-committees.

Would it not possible for the sub-committees, made up of members of the board and acting on behalf of the board, to call before them people whom they wanted to interview? Could they not appoint people to assist them and utilise their services without making them members of the committee?

It is up to the board to appoint members to the sub-committees as they see fit so that they can have some expression of opinion from them. Exactly the same position applies in relation to the medical practitioners. There is no great problem.

I asked why subsection (4) was included. Why should the president or vice-president be excluded from chairmanship? Surely it should be a matter for the board. The president might be too busy to be chairman of a sub-committee but why should he be excluded by statute?

I am informed that it is a normal provision.

This is the point I made when the Minister told us that certain sections were included in this Bill because they were also in other Acts. This is something we should get away from. This is the third time in six or seven years that we are legislating for professional bodies but a lot of the Bill is a copy of provisions in previous legislation. We have an opportunity now to update sections and subsections contained in previous legislation and produce a Bill that represents 1984 thinking on the subject. I do not think any Member will agree with that subsection, that the president or vice-president of the board should be excluded by statute from being chairman of the sub-committee. I am not referring to this legislation only but to any legislation.

I support Deputy O'Hanlon. Basically, the Minister said that mistakes may have been made in legislation in the past and certain sections or subsections could have been improved upon but he is not prepared to avail of the opportunity in this or other legislation to correct anomalies.

If the Deputies read the Bill they will see that quite a number of changes were made. The Bill differs substantially from the old legislation on nurses. I appreciate the point made by Deputy O'Hanlon in relation to the person to be chairman of the board. The Deputy is entitled to his opinion but he must appreciate that this is a standard type of provision. I will consult with the Minister about this matter and it is possible that on Report Stage he will consider making some change in the direction mentioned.

Will the Minister of State accept that we do not have to adopt a provision in the Bill because it is standard provision in other legislation?

I accept that.

I should like to get an undertaking from the Minister of State that he will take this matter up with the Minister and, perhaps, raise it again on Report Stage.

I give that undertaking.

The Minister did not reply to the point I raised about the request for the retention of the statutory midwives committee.

I did not get the point the Deputy made.

I made it clear but I will make the point again. Midwives have requested the retention of a statutory midwives committee, as recommended in the report of the working party on general nursing in 1980. That question is clear and is as I phrased it earlier.

There is no need for a statutory midwives committee in view of the inclusion of the fitness to practice provision which applies to nurses and those with or without midwifery qualifications.

Question put and agreed to.
SECTION 14.
Question proposed: "That section 14 stand part of the Bill".

It is appropriate during the debate on this section to pay tribute to the members of the various boards, including An Bord Altranais, for the work they do on behalf of the people they represent. I am not sure that the public or the professions appreciate the inconvenience these people go through. In return they are entitled by way of remuneration to travelling expenses and a subsistence allowance only. Those people who give so much of their time in the interests of nurses and the general public on a voluntary basis deserve our tributes.

Question put and agreed to.
SECTION 15.

I move amendment No. 10:

In page 11, subsection (1), line 15 after "by order," to insert "after consultation with the Board,".

This is an important section because it gives the Minister power to disband a board if the members refuse to perform any function assigned to them under the Act. While I accept the need for such a section I am concerned when it is taken in conjunction with sections such as section 54 which gives the Minister the right to assign new functions which may not have been debated by the House. The Minister by regulation will be in a position to assign new functions to the board. I am concerned about section 52 which deals with ethical conduct. In the context of the two sections mentioned we must give serious consideration to section 15.

I see the need for such a provision because if a nursing board went completely away from what was laid down by statute the Minister, or somebody else, would have to have the authority to disband the board. My amendment provides for consultation with the board before a Minister takes any such action. I want to ensure that the Minister does not take any such action without consulting the board and discussing with the members whatever misdemeanour they may have been guilty of.

I should like to point out to the Deputy that the Minister's power under this subsection is deliberately discretionary. The subsection, as drafted, leaves the way clear for consultation to take place. It goes without saying that if the board refuse, fail or neglect to perform any function assigned to them under the Act any Minister for Health before making an order would consult with the board to find out if there was any valid reason for their action. I submit, therefore, that the amendment the Deputy has proposed is unnecessary.

If the Minister can show me in the section where it states that it is necessary for him to consult with the board before taking such action I will withdraw my amendment.

That is not in the section. I am telling the Deputy that the Minister would consult with the board to find out why they did not carry out any direction given by him or fulfilled any function they should have fulfilled.

In other words, the Minister is accepting my amendment?

If that is the case the Minister should accept our amendment.

There is no need for this amendment. The subsection, as drafted, leaves the way clear for consultation to take place. It goes without saying that if the board refuse, fail or neglect to perform any function assigned to them under the Act any Minister for Health, before making an order, would consult with the board to find out if there was a valid reason for their action.

Will the Minister of State agree that the Minister for Health does not have to consult with the board?

In one breath the Minister of State was in total agreement with what we said; he recognised the need for consultation. If that is so why is it that he will not accept our amendment?

If it satisfies the Deputies opposite I will have a further look at the provision before Report Stage.

Why is it that the Minister cannot say "yes"?

One would need to be careful about saying "yes".

The Minister made an interesting statement. He said that where the board fail or neglect to perform functions the Minister would consult with the board to consider if there was a valid reason for their failure to perform a certain duty or function, but who decides a "valid reason"? I am interested in those words. We have an example in my constituency where a number of the members of a semi-State body were fired for precisely that reason. They thought they had a very serious valid reason for not performing a particular duty, but the Minister disagreed, although the board agreed with the members, and the members were fired. I would be concerned that where all the board members felt there was a valid reason for not performing a particular duty, or neglecting to perform it but the Minister thought there was valid reason, that the Minister's view would prevail.

It is the Minister's view that matters.

That is why it is extremely important to put in writing what Deputy O'Hanlon suggests.

We will have a look at it on Report Stage.

Will the Minister accept the amendment?

I can see no reason why this amendment cannot be accepted at this stage. This is a very reasonable amendment. The Minister of State accepted that a reasonable Minister would consult with the board, but we are legislating for decades ahead when a Minister might not be reasonable. In this case I can see no reason why this amendment cannot be accepted. It merely asks that the Minister consult with the board before removing members from office and that he would not take a high-handed approach and remove the members from office without consultation. I see no reason why this amendment should be left until Report Stage. I have every confidence that the Minister of State can make a decision on this.

In the discussions on subsections (2) and (3) the Minister was most anxious to consult with the board on various issues and I am astounded that he is not prepared to concede on this point. I am a little apprehensive about the Minister's reaction because it is a very simple matter.

We will have a further look at it on Report Stage.

The Minister will agree there is a wonderful cross-section of all the health services represented on this board. It is not incumbent on the Minister to consult with the board on any matter before he removes them from office, but surely it is not asking too much for him to accept this amendment which would make it incumbent on the Minister to consult prior to making any decision to remove members from office. The Minister should accept this amendment now rather than waiting until Report Stage.

I have already replied to that point.

Amendment put and declared lost.

I move amendment No. 11:

In page 11, between lines 28 and 29, to insert the following subsections:

"(4) The Minister may amend or revoke an order made under this section, including this subsection.

(5) Every order under this section shall be laid before each House of the Oireachtas as soon as may be after it is made, and, if a resolution annulling the order is passed by either House of the Oireachtas within the next twenty-one days on which that House has sat after the order is laid before it, the order shall be annulled accordingly and in case of an order made under subsection (2) of this section the members of the Board who had been removed from office by virtue of the order shall be restored to office but without prejudice to the validity of anything previously done by any person or persons appointed to discharge all or any of the functions of the Board under and by virtue of the order.".

The Minister is given two permissive powers under this section, first, the power to direct the board to carry out their functions and second, the power to remove the board from office. The exercise of either of these powers could have significant effects for the profession as a whole. It is therefore considered desirable to provide for the amendment or revocation by the Minister of an order under this section and for the Houses of the Oireachtas to be given an opportunity to annual such an order.

While obviously this is an improvement on the original Bill, nevertheless I do not understand why the Minister introduced two subsections which would oblige him to lay the regulations before the Houses of the Oireachtas and, if the Houses of the Oireachtas so desired over 21 days to revoke the regulations, they would have to make a decision on that. Earlier today we discussed section 9 under which the Minister, when making regulations, can change the composition of the board. He makes it mandatory on the Houses of the Oireachtas to debate those regulations. They must come before the Houses and the Houses must approve the regulations. I do not understand why in a section of such fundamental importance as section 15 a similar subsection is not brought in instead of the subsections which says that the regulations should merely be laid before the Houses and if someone is quick enough to spot them they can be raised here. It is not mandatory for the House to debate this but it is mandatory on the House to debate a change in the composition of the board.

This section is of more fundamental importance than section 9 because here we are giving the Minister power to remove from office every member of the board, those elected by their peers and those appointed by the Minister. Now a very vague watered down subsection is being introduced and Members will have to be very alert to see the regulations when they are laid before the Houses of the Oireachtas. They would probably be placed in the Library, but we might not be notified.

If we introduce a subsection to ensure that we do justice to the board and that we will not have a Minister removing the board from office without just cause, I ask the Minister to introduce a subsection similar to section 9(4) which would make it mandatory on the Houses of Oireachtas to debate these regulations and to pass a resolution approving them before a board is removed from office.

As the Deputy is aware an order is laid before the Houses and if within 21 days there is no disagreement, it becomes an order.

Deputies are not notified that such is the case.

Many orders have been laid before the Houses in the past and everybody is notified by post.

My understanding is that it appears on the Order Paper but I believe this case is of such fundamental importance that it should be brought into the House and debated.

Is the Deputy talking about a particular order or generally?

I am talking about this order particularly because section 15 is of fundamental importance. Here we have a board, the majority of whom will be elected by their peers and 12 appointed by the Minister, and we are now giving the Minister power to remove them from office if they are guilty of a misdemeanour. To date, we have not succeeded in having the Minister even consult with them. Hopefully on Report Stage that will be changed. I am asking that it be mandatory that the Minister come into this House with the regulations and have them approved by the Houses.

In the history of the State it is very seldom that a Minister used that power. Deputy Geoghegan-Quinn referred to the board of Údarás and I remember once the boards of RTE and Dublin Corporation were removed by the Minister. They are the only three cases which spring to mind. This power is used very rarely. For that reason, if there was a debate on the matter it would not take up much time in the House. Section 15 is of such fundamental importance that we should include a subsection which would make it mandatory on the Houses of the Oireachtas to approve regulations laid down by the Minister.

I support Deputy O'Hanlon on this issue and I should like the Minister to be specific in this regard. It is draconian to suggest that a Minister could remove the elected representatives of a profession from office. I have given a lot of thought to this and I should like the Minister to outline the circumstances which would lead to that measure, especially in regard to a profession such as nursing. Why were regulations of this nature not inserted in the Dentists Bill? What is different about this Bill?

If the board refused to register people who were entitled to be registered because of an EC Directive, the Minister would have power to remove members. I appreciate the points made by Deputy O'Hanlon and Deputy Glenn and perhaps they could be considered again on Report Stage.

It looks as if we will have more to do on Report Stage than on Committee Stage. The Minister should make some decisions.

I do not think that Report Stage is intended to be a repeat of Committee Stage but that is what will happen because it is convenient for the Minister of State to suggest that our amendments should be discussed on Report Stage. I am not blaming him for that but this amendment is fundamentally important. In the cases of the RTE Authority and the Údarás Authority mentioned by Deputy O'Hanlon, the people removed by the Minister were those who were appointed by a Minister to the board. However, this is a completely different matter. These people are elected by their own profession and they are now going to be removed from office by a Minister. If the elected members on the nursing board feel they have a valid reason for neglecting to perform a particular duty and if the Minister thinks they do not have a valid reason they will be removed from office without reference to this House. We should not have a repeat of Committee Stage on Report Stage.

The Deputy is entitled to express her opinion and she should be able to see that, while we could have a division on this amendment, we are trying to accommodate all shades of opinion in the House. She should not be trying to make a mountain out of a molehill.

Amendment put and agree to.

Section 15, as amended, agreed to.
SECTION 16.
Question proposed: "That section 16 stand part of the Bill".

I am glad to see that the board, not the Minister, will appoint the chief executive officer as it appears throughout the Bill that the Minister is assuming an inordinate amount of power. I see also that his terms, conditions and the duties he performs are with the consent of the Minister. While I do not want to fall into the trap which the Minister and the Minister of State fell into this morning of saying that certain provisions were in previous legislation and, therefore, would be included in this Bill, I should like to draw attention to the fact that the Registrar of the Medical Council is appointed by the Medical Council and there is nothing about the consent of the Minister. This is something that runs throughout the Nurses Bill and to which we objected on Second Stage. We do not understand why it is necessary to have the consent of the Minister in the appointment of the chief executive officer. I have every confidence in the Nursing Board to do that job. Subsection 4 says that the Minister may, whenever and so often as he thinks fit, declare that any power conferred on the board by this section shall be exercisable only with the consent of the Minister and whenever any such declaration is in force, the said power may be exercisable only with such consent. That gives an inordinate amount of power to the Minister and I should like the Minister of State to explain the thinking behind that subsection.

Subsection 3 says that there shall be paid by the board to its chief executive officer out of funds at its disposal such remuneration and allowances as the board, with the consent of the Minister, from time to time determines. The nurses will be funding the board and will be fully responsible for all funds. I do not understand why it is necessary to get the consent of the Minister when they are funding the board. Perhaps the Minister of State could deal with those points.

Most of this is standard procedure in legislation of this kind, even if it does not fully satisfy Deputies.

The Minister misunderstood me. I welcome the fact that the CEO is appointed by the board instead of by the Minister. However, I would welcome any subsection which is specifically designed to make this better legislation. I am concerned at the number of times we have been told today that the reason for the subsection is that it is standard procedure in legislation. We are legislating for the nursing profession to regulate their own members. Why is it inserted in subsection (1) that the Minister must give his consent to the conditions of service for the chief executive officer when this does not appear in previous legislation dealing with similar bodies.? It appears here because, throughout the Bill, the Minister is taking more and more powers to himself which do not appear in previous legislation. That is why I asked why it appeared in this section as there is no reference to it in Bills of a similar nature.

I also ask why it is necessary to have the consent of the Minister for payment of the remuneration of the chief executive officer because, as proposed in the Bill, the board will be funded exclusively from the nursing profession. The State will not be obliged in law to make any financial allocation to the board. We will deal with that on section 25 because that section states that board will be funded by the nursing profession. I wish the Minister to explain exactly what subsection (4) means. It appears to me it is giving an inordinate amount of power to the Minister. How will he use his power under that subsection?

The pay of chief executive officers is not determined by the Minister but is governed by the public pay agreements. We have nothing to do with it. In the normal course it might be expected that the giving of such consent would be a formality. However, in a situation where, for example, the board might have cause to dispense with the services of the CEO or otherwise radically adjust his conditions or functions, the consent clause would operate both as a saver for the board and/or as a protection of the interests of the chief executive officer.

Did I understand the Minister of State to say that the Minister does not have any say in the remuneration of the chief executive officer?

No. It is a matter of public pay. There is a scale laid down.

If the Minister does not have any say with regard to the amount paid to the chief executive officer I should like to quote for the Minister for State subsection (3) which states:

There shall be paid by the Board to its Chief Executive Officer out of funds at its disposal such remuneration and allowances as the board, with the consent of the Minister, from time to time determines.

Surely that gives the Minister all the power to decide how much the CEO will get? The board can decide on any figure they like but if they do not get the consent of the Minister the CEO will not receive that amount. I should like to know from the Minister of State how he can interpret that subsection to show that the Minister has no say in the amount the CEO will receive.

The Minister as a member of the Government has an obligation in relation to pay agreements. That is why there is that provision in subsection (4). It is not just in relation to this chief executive officer but in relation to all chief executive officers.

In other words, the Minister of State now accepts that the Minister will decide the level of remuneration of the chief executive officer of the board even though the board will be funded exclusively by the nurses themselves.

As I have pointed out, it is not just in relation to this chief executive officer but many others. Their pay is governed by public pay agreements.

It is very important to get this clear. Is the Minister of State now telling us that the Minister will decide the level of pay even though the chief executive officer will not be paid out of funds from the Exchequer? Is the Minister of State telling us the Minister will decide the level of remuneration for somebody who will be paid out of funds that do not come from the Exchequer?

Subsection (3) provides that the CEO will be paid by the board such remuneration and allowances as the board, with the consent of the Minister, determines. The question of consent comes in because the Minister, as a member of the Government, decides on the level of pay of chief executive officers by way of public pay agreements.

Will the Minister of State tell the House if two consents are involved, the consent of the Government of which the Minister is a member and also specifically the consent of the Minister for Health? Has consent to be given on two occasions?

I have already pointed out the responsibility of the Minister as a member of the Government with regard to public pay in the context of chief executive officers. The Minister will have a certain function in controlling the overall level of pay and remuneration. The board decides and the Minister either approves or disapproves.

I would be interested to know what would happen if the Minister disapproved. Will the Minister of State not accept that this board is different from the boards of semi-State bodies? This board is funded by the profession itself. The funds will not come from the Exchequer as they do in the case of many of the semi-State bodies. Will the Minister of State not accept that in this case the consent of the Minister should not be required with regard to the salary of the chief executive officer?

It is well established that public pay policies are controlled by the Government. There will be a substantial amount of funds in this new board and somebody must have responsibility in this matter. If the Minister did not have some responsibility here, I am sure the Deputy would be the first to criticise if the board did not operate in the way one would expect from the point of view of finances.

I am worried by that statement. The Minister of State is now saying that he and the Minister have suspicions that the funds collected so carefully by the profession——

That was not the suggestion.

The Minister of State suggested we would be very concerned if the funds were spent in a way that might not be professionally correct. The nursing profession have given tremendous service to the community for many years. They have a very worthwhile code of ethics and code of practice that may not be appreciated by the other side of the House but that is appreciated over here and I am sure that Minister State also appreciates it. I have made the point that this board is different from the other boards of semi-State bodies in that they are funded directly from the Exchequer. This board will be funded directly by the profession and I think the salary of the chief executive officer should be decided by the board. Perhaps the Minister of State might be able to give the House an example of a similar situation where funding for a board comes directly from the profession concerned and not from the Exchequer and where the consent of the Minister is required with regard to payment of the salary of the CEO.

I cannot give the Deputy a direct example and I do not see any reason for doing so. The point I have made is that the buck must stop somewhere and in this case it stops on the desk of the Minister for Health. As I said, the level of fees being charged to fund this new board are quite substantial.

Is the Minister of State talking about substantial fees?

I am talking about registration fees and so on. The board will deal with a lot of money and as the boss of the board the chief executive officer will have to deal with those finances. Pay across the board has to be held at a certain level. There is no point in my saying to the Deputies opposite that this board, apart from any other board, should be allowed to pay anything they like to their chief executive officer. It is only reasonable to expect that the Minister would have some input in the matter.

Progress reported; Committee to sit again.
Sitting suspended at 1.30 p.m. and resumed at 2.30 p.m.
Top
Share